Columbia ^BnttJer^ittj) College of Pftpsiitiansi anb g)urseon£! Hibrarp Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/reportfromselecOOgrea REPORT. OJ\TAGIOUS DI8EA8E8 ACTS. Ordered, by The House of Commons, to be Printed., ^IQ July 1881. \_Price 6*.] 3.51. Under 3 lbs. REPORT FROM THE SELECT COMMITTEE CONTAGIOUS DISEASES ACTS TOGETHER WITH THE PROCEEDINGS OF THE COMMITTEE, MINUTES OF EVIDENCE, AND APPENDIX. Ordered, ly The House of Commons, to be Printed, 28 July 1881. Z5^- [ ii ] Contagious Diseases Acts. Ordered,— \_Friday, 14iA January 1881] :— That a Select Committee be appointed to inquire into the Contagious Diseases Acts, 1866—1869, their Administration, Operation, and Effect Committee nominated of — Mr. Massey. Mr. Stansfeld. Mr. Cavendish Bentinck, Colonel Alexander. Viscount Cricliton. Mr. Burt. Mr. O'Shaughnessy. Mr. Osborne Morgan. Mr. Cobbold. General Burnaby. Sir Henry Wolff. Mr. Ernest Noel. Colonel Digby. Mr. William Fowler. Mr. Hopwood; That the Committee have power to send for Persons, Papers, and Records. That Five be the Quorum of the Committee. That all Reports and Eeturus relating thereto be referred to the Committee. That it be an Instruction to the Committee, that they have power to receive Evidence which may be tendered concerning similar systems in British Colonies, or in other Countries, and to report whether the said Contagious Diseases Acts should be maintained, amended, or repealed. Ordered, — \_Tuesday, \st March 1881] : — That Colonel Alexander be discharged from further attendance on the Committee. That Colonel Tottenham be added to the Committee. Ordered, — [^Thursday, lOi/j March 1881]: — That the Committee do consist of Seven- teen Members. That Dr. Cameron and Dr. Farquharson be added to the Committee. REPORT p. ill PROCEEDINGS OF THE COMMITTEE p. iv MINUTES OF EVIDENCE p. 1 APPENDIX p. 445 [ iii ] H E P R T. THE SELECT COMMITTEE appointed to inquire into tlie Contagious Diseases Acts, 1866 — 1869, their Administration, Operation, and Effect ; and who were instructed, That they have power to receive Evidence which may be tendered concerning similar systems in British Colonies, or in other Countries, and to Report whether the said Contagious Diseases Acts should be maintained, amended, or repealed ; -Have agreed to the following REPORT :— Your Committee have partly considered the subject refen-ed to them, but have not been able to complete the inquiry. They have resolved to Report the Evidence already taken, and to recommend the re-appointment of the Com- mittee in the next Session of Parliament. 28 Juli/ 1881. 33'- a2 328537 PROCEEDINGS OF THE SELECT COMMITTEE PROCEEDINGS OF THE COMMITTEE. Wednesday/, 23rd February 1881. MEMBERS present: Colonel Alexander. Mr. Cobbold. Sir Henry Drummond Wolff. Mr. William Fowler. Mr. Osborne iMors;an. Mr. Stansfeld. Mr. Massey. Viscount Crichton. Colonel Digby. Mr. Massey was called to the Cbalr. The Committee deliberated. [Adjourned till Wednesday next, at Twelve o'clock. Wednesday, 2nd March 1881. MEMBERS present : Mr. Massey in the Chair. Colonel Digby. ■ Mr. Cobbold. Viscount Crichton. Mr. Burt. Sir Henry Drummond Wolff. Mr. Osborne Morgan. Mr. Cavendish Bentinck. Mr. Stansfeld. Mr. Hopwood. Mr. O'Shaughnessy. Colonel Tottenham. Mr. William Fowler. Dr. Charles Henry F. Routh was examined. [Adjourned till Monday next, at Twelve o'clock. Monday/, 7th March 1881. MEMBERS PRESENT : Mr. Massey in the Chair. Colonel Digby. I Mr. Stansfeld Colonel Tottenham. Sir Henry Drummond Wolff. Mr. Osborne Morgan. Mr. Cavendish Bentinck. Mr. O'Shaughnessy. Mr. William Fowler. Mr. HojDWOod. Dr. Charles R. Drysdale was examined. [Adjourned till Wednesday next, at Twelve o'clock. ON CONTAGIOUS DISEASES ACTS. Wednesday, 9th March 1881. MEMBERS PRESENT ; Mr. Massey in the Chair. Mr. Cobbold. Colonel Digby. Mr. Ernest Noel. General Burnaby. Sir Henry Wolff. Ml-. Osborne Morgai The Committee deliberated. Mr, Cavendish Bentinck. Mr. Stansfeld. Viscount Crichton. Colonel Tottenham. Mr. William Fowler. Mr. Hopwood. Motion made, and Question proposed — " That, in the opinion of the Committee, it is desirable that Dr. Farquharson and Dr. Cameron be added to the Committee " — (Mr. Osborne Morgan): — Amendment proposed, to leave out from the word " is " to the end of the Question, in order to add the words " not desirable at the advanced stage of the inquiry into the Hygienic branch, that any further addition be made to the Committee " — (Mr, Stansfeld) : — instead thereof: — Question put. That the words proposed to be left out stand part of the Question. — The Committee divided : Ayes, 8. Mr. Cavendish Bentinck. Viscount Crichton. Mr. Osborne Morgan. Mr. Cobbold. General Burnaby. Sir Henry Wolff. Colonel Digby. Colonel Tottenham. Noes, 4. Mr. Stansfeld. Mr. Ernest Noel. Mr. William Fowler Mr. Hopwood. Main Question put, and agreed la. Question, That this Resolution be reported to the House, — put, and agreed to. [Adjourned till Wednesday next, at Twelve o'clock. Wednesday, \6th March 1881. members present ; Mr. Massey in the Chair. Dr. Farquharson. Mr. Cobbold. Colonel Digby. Colonel Tottenham. Mr. O'Shaughnessy. Mr. William Fowler. Mr. Osborne Morgan. Professor Henry Lee was examined. The Committee deliberated. Mr. Cavendish Bentinck. Mr. Stansfeld. General Burnaby. Mr. Ernest Noel. Dr. Cameron. Mr. Hopwood, Mr. Burt. [Adjourned till Monday next, at Twelve o'clock. 351. a3 PEOCEEDINGS OF THE SELECT COMMITTEE Monday, 2\st March 1881. MEMBERS PKESENT Mr. Massey in the Chair. Dr. Far quh arson. General Burnaby- Colonel Digby. Colonel Tottenham. Mr. Osborne Morgan. Mr. Cavendish Bentinck. Mr. William Fowler. Dr. Cameron. Mr. Burt. Mr. Hop wood. Mr. Stansfeld. The Committee deliberated. Inspector General Lawson was examined. [Adjourned till Monday next, at Twelve o'clock. Monday, 28th March 1881. MEMBERS PRESENT : Mr. Massey in the Chair. Dr. Farquharson. Mr. Cobbold. Viscount Crichton. Mr. O'Shaugbnessy. Colonel Tottenham. Mr. Cavendish Bentinck. Mr. Stansfeld. Mr. Osborne Morgan. Mr. Hopwood. Dr. Cameron. Mr. Burt. Mr. William Fowler. Colonel Digby. Inspector General Lawson was further examined. [Adjourned till Monday next, at Twelve o'clock. Monday, 4th April 1881. MEMBERS PRESENT : Mr. Massey in the Chair. Dr. Farquharson. Mr. Cobbold. . Mr. O'Shaugbnessy. Mr. Osborne Morgan. Mr. Cavendish Bentinck. Mr. Stansfeld. Mr. Hopwood. Mr. William Fowler. Colonel Tottenham, Dr. Cameron. Colonel Digby. Inspector General Lawson was further examined, [Adjourned till Monday, 2nd May, at Twelve o'clock. ON CONTAGIOUS DISEASES ACTS. Monday, 2nd May 1881. MEMBERS PKESENT Mr. Masset in the Chair. Dr. Farquharson. Colonel Digby. Mr. Cobbold. Sir Henry Drummond Wolff. Mr. Osborne Morgan. Mr. O'Shaughnessy. Mr. Staasfeld. Mr. William Fowler. Mr. Burt. Inspector General Lawson was further examined. [Adjourned till Monday next, at Twelve o'clock. Monday, 9th May 1881. membbes peesent : Mr. Massey in the Chair. Dr. Farquharson. Colonel Digby. Mr. Cobbold. Mr. Osborne Morgan. , Mr. Stansfeld. Mr. James Lane was examined. Dr. Cameron. Mr, Hop wood. Mr. William Fowler, Mr. Cavendish Bentinck. Mr. O'Shaughnessy. [Adjourned till Monday next, at Twelve o'clock. Monday, IQth May 1881. members peesent : Mr. Masset in the Chair. Mr. Stansfeld. Mr. Hopwood. Mr. Burt. Mr. William Fowler. Colonel Tottenham. Dr. Farquharson. Colonel Digby. Mr. Cobbold. Sir Heniy Drummond Wolff. Mr. Osborne Morgan. Mr. Cavendish Bentinck. Dr. John Birkbeck Nevins was examined. On the following Question being asked — " As I understand you, the general resuU of the answers which you received was, that no practical difficulty is found in inducing patients to remain until they are cured " The Committee deliberated. Motion made, and Question proposed — " That it is competent to the Comniittee to permit a witness who has collected independent evidence upon a certain point at issue, to state the general result of the information which he has so received "—(Mr. Stansfeld):— 351. a 4 PROCEEDINGS OF THE SELECT COMMITTEE Question put. — The Committee divided : Ayes, 3. Noes, 6. Mr. Hopwood. Colonel Tottenham. Mr. William Fowler. . Dr. Farquharson. Mr. Stansfeld. ' Mr. Osborne Morgan. Mr. Cavendish Bentinck. Mr. Cobbold. Colonel Digby. Dr. John Birkbeck Nevins was further examined. [Adjourned till Monday next, at One o'clock. Monday, 23rd May 1881. MEMBERS PRESENT : Mr. Hopwood. Dr. Cameron. Mr. Stansfeld. Mr. Cavendish Bentinck. Sir Henry Drummond Wolff. Colonel Digby. General Burnaby. Mr. Cobbold. Viscount Crichton. Mr. Ernest Noel. Dr. Farquharson. In the absence of the Chairman, Mr. Osborne Morgan took the Chair. The Committee deliberated. [Adjourned till Monday next, at Twelve o'clock. Monday, 30th May 1881. MEMBERS PRESENT ; Mr. Masset in the Chair. Colonel Digby. Mr. Osborne Morgan. Mr. Stansfeld. Dr. Cameron. Mr. Hopwood. Mr. Burt. Mr. William Fowler. Mr. Cavendish Bentinck. Dr. Farquharson. Inspector Silas Rendel Annis was examined. [Adjourned till Monday, IStli June, at Twelve o'clock. Monday, \3th June 1881. MEMBERS PRESENT : Mr. Massey in the Chair. Dr. Farquharson. Mr. Osborne Morgan. Mr. Cavendish Bentinck. Mr. Hopwood. Mr. Stansfeld. Mr. Cobbold. Inspector Silas Rendel Annis was further examined, [Adjourned till Friday next, at Twelve o'clock. ox CONTAGIOUS DISEASES ACTS. Fridai/, \7th June 1881. MEMBERS PRESENT : Mr. Masset in the Chair. General Burnaby. Dr. Farquharson. Colonel Digby- Mr. Cobbold. Mr. O'Shaughnessy. Mr. Osborne Morgan. Mr. Cavendish Bentinck, Dr. Cameron. Mr. William Fowler. Mr. Hopwood. Mr. Burt. Mr. Stansfeld. Kev. J. Tirffield and Dr. J. C. Barr were examined. [Adjourned till Monday next, at Twelve o'clock. Monday, 20th June 1881. members present ; Mr. Masset in the Chair. Dr. Farquharson. Mr. O'Shaughnessy. •Sir Henry Drunimond AYolfF. Mr. Osborne Morgan. Dr. Cameron. Mr. Hopwood. Mr. Stansfeld. Mr. William Fowler. Mr. Cavendish Bentinck. Colonel Tottenham. Mr. Cobbold. Eev. Prebendary C. Wilkinson and the llev. Edward Grant were examined. [Adjourned till Thursday next, at Twelve o'clock. Thursday, 23rd June 1881. MEMBERS present : Mr. Masset in the Chair. Dr. Farquharson. Mr. O'Shaughnessy. Mr. Osborne Morgan. Dr. Cameron. Mr. Hopwood. Mr. Mr. Mr. Mr. William Fowler. Stansfeld. Ernest Noel. Cobbold. Colonel Digby. Mr. Adam Stigant and Mr. William Piddock were examined. Adjourned till Monday next, at Twelve o'clock. 351. PROCEEDINGS OF THE SELECT COMMITTEE Monday, 27th June 1881. MEMBERS PRESENT : Mr. Massey in the Chair. Dr. Farquharson. Colonel Digby. Mr. O'Shaughnessy. Sir Henry Drummond Wolff. Mr. Osborne Morgan. Mr. Cavendish Bentinck. Ml-. Hopwood. Mr. Burt. Mr. Stansfeld. " Rev. Henry Reid and Mr. Rawdon Macnamara were examined. Adjourned till Monday next, at Twelve o'clock. Monday, Ath July 1881. MEMBERS PRESENT ; Mr. Massey in the Chair. Colonel Digby. Colonel Tottenham. Sir Henry Drummond Wolff. Mr. Osborne Morgan. Mr. Hopwood. The Committee deliberated. Adjourned till Wednesday next, at Twelve o'clock. Wednesday, 6th July 1881. MEMBERS PRESENT : Mr. Massey in the Chair. General Burnaby. Sir Henry Drummond Wolff. Mr. Osborne Morgan. Mr. Cavendish Bentinck. Mr. Stansfeld. Mr. Ernest Noel. Mr. William Shaen was examined. Viscount Crichton. Dr. Cameron. Colonel Tottenham. Mr. Burt. Mr. William Fowler. Motion made, and Question put — " That evidence of the circumstances attending the introduction and passiilg of the Contagious Diseases Acts be admitted as within the scope of the order of reference to this Committee" — (Mr. Stansfeld): — The Committee divided : Ayes 5. Mr. Stansfeld. Mr. Burt. Mr. Ernest Noel. Mr. Hopwood. Dr. Cameron. Mr. William Shaen was further examined. Noes 7. Mr. Cavendish Bentinck. Viscount Crichton. Mr. Osborne Morgan. General Burnaby. Sir Henry Drummond Wolff. Colonel Digby. Colonel Tottenham. [Adjourned till Monday next, at Twelve o'clock. OS COXTAGIOUS DISEASES ACTS. Monday, Utii July 1881. MEMBEES PRESENT : Mr. Masset in the Chair. Dr. Farquharson. Colonel Digby. General Burnaby. Mr. Cobbold. Sir Henry Drummond WolfF. Mr. Osborne Morgan. Mr. William Shaen was further examined. Mr. Cavendish Bentinck. Mr. William FoTvler. Mr. Hop-wood. Mr. Burt. Mr. Stansfeld. Dr. Cameron. [Adjourned till Monday next, at Twelve o'clock. Monday, ISth July 1881. MEMBERS PRESENT : Mr. Masset in the Chair. Dr. Farquharson. Colonel Digby. Sir Henry Drummond Wolff. Mr. Osborne Morgan. Mr. Cavendish Bentinck. Mr. William Skaen was further examined. Mr. Burt. Mr. Stansfeld. Mr. William Fowler. Mr. Cobbold. [Adjourned till Thursday next, at Twelve o'clock. Thursday, 2\st July 1881. members present : Mr. Masset in the Chair. Dr. Farquharson. Colonel Digby. Mr. Osborne Morgan. Mr. Stansfeld. Mr. O'Shaugbnessy. Mr. Cavendish Bentinck. Dr. Cameron. Mr. William Fowler. Sir Henry Drummond AVoltf. Mr. Alexander M'Coll and Mr. William Krause were examined. [Adjourned till Monday next, at Twelve o'clock. 351. PKOCEEDINGS: — CONTAGIOUS DISEASES ACTS. Monday, 25th July 1881. MEMBERS PKESENT : Mr. Massey in the Chair. Dr. Farquharson. ( Mr. Stansfeld. General Burnaby. | Mr. Osborne Morgan. Mr. O'Shaughnessy. | Mr. Cobbolcl. Sir Henry Drummond WolfF. Dr. Cameron. Mr. Cavendish Bentinck. | Mr. William Shaen was further examined. [Adjourned till Thursday next, at Twelve o'clock. Thursday, 28th July, 1881. MEMBERS PRESENT : Dr. Farquharson. Mr. Osborne Morgan. Mr. Cavendish Bentinck. Mr. Hopwood. Mr. Stansfeld. Dr. Cameron. Mr. William Fowler. Colonel Tottenham. In the absence of Mr. Massey, Mr. O'Shaughnessy took the Chair. Mr. William Krause was further examined. The Committee deliberated. Mr. Bull, Mr. Thomas Hinds, and Mr. IVilliam Krause, were further examined. The Committee deliberated. Motion made, and Question proposed, " Tiiat no further evidence be taken by the Committee this Session " — (Mr. Osborne Morgan) : — Question put. — The Committee divided : Ayes, 4. Dr. Farquharson. Mr. Osborne Morgan. Mr. Cavendish Bentinck. Colonel Tottenham. Noes, 3. Mr. Hopwood. Mr. Stansfeld. Mr. William Fowler. Motion made, and Question, " That your Committee having partly considered the subject referred to them, have been unable to complete the inquiry. They therefore resolve to report the Evidence already taken, and to recommend the re-ajipointment of the Committee in the next Session of Parliament " — (Mr. Osborne Morgan') — put, and agreed to. Report, in accordance with the foregoing Eesolution, read the first and second time, and agreed to. Ordered, To Report, together with the Minutes of the Evidence, and an Appendix. [ xiii ] EXPENSES OF WITNESSES. NAME OF WITNESS. PROFESSION OR CONDITION. From whence Sutnraoned, Number of Days Ahsent from Home, under Orders of Committee. Allowance during Absence from Home. Expenses of Journey to London and back. TOTAL Expenses allowed to Witness. £. *. d. £. s. d. £. .. d. Rev. Prebendary C. Wilkinson. Vicar, St. AnJrew, Plymouth. Plymouth Four 4 4- 4 - - 8 4- Rev. Edward Grant Vicar of Portsmouth - Portsmouth Two 2 2- 1 11 - 3 13 - Rev. John Tuffield Congregational Minister Woolwich Two 2 2- - 5 - (twice.) 2 7- Dr. J. C. Barr Physician, Lock Hos- pital. Aldershot One 1 1 - - 8 - 1 9 - Mr. B. C. Miller - Alderman . . - Portsmouth Two 2 2- 1 11 - 8 13 - Mr. A. Stigant - Chairman of Local Board. Chatham - One I I - - 10 6 1 11 6 Inspector Silas R, Annis Metropolitan Police - Devonport Seven - 2 16 - 6 16 6 (twice. ) 8 12 6 Mr. William Piddock - Outfitter, &c. Deal Two 1 10 - 1 - - 2 10 - Rev. Henry Reid - P.P., St. Finbars, Cork Cork Five 5 5- 6 10 - 11 15 - Dr. Birkbeck Nevins - Physician - - . Liverpool - Four 12 12 - 3 3- 15 15 - Captain Alexander M'CoU Chief Constable - Glasgow - Three - 3 3- 5 15 - 8 18 - Supeiintendent Wreford Superintendent, Borough Police. Plymouth Three - 2 5- 4 - - 6 5- Mr. William Krause City Missionary - Woolwich Two 2 2- TOTAL - - 5 - - - £. 2 7- 77 9 - 351. [ xiv ] LIST OF WITNESSES. Wednesday, 2nd March 1881. Dr. Charles Henry Felix Routh - - 1 Monday, 7th March 1881. Dr. Drysdale - - - - - -17 Wednesday, 1 Qth March 1 88 1 . Professor Henry Lee - - - - 37 Monday, 21 st March 1881. Inspector General Lawson - - - 58 Monday, 2Sth March 1881. Inspector General Lawson - - - 73 Monday, 4th April 1881. Inspector General Lawson - - - 78 Monday, 2nd May 1881. Inspector General Lawson - - - 98 Monday, 9th May 1881. Mr. James Robert Lane - - - - 113 Monday, I6th May 1881. Mr. John Birkbeck Nevins, M d. - 138. 153 Inspector General Lawson - - _ 152 Monday, 30th May 1881. Inspector Silas Rendel Anniss - - - 157 Monday, I3th June 1881. Inspector Silas Rendel Anniss - - - 181 Friday, 17 th June 1881. Rev. Thomas Tuffield Dr. Coleman Barr - 205 - 217 Monday, 20th June 1881. Rev. Prebendary Charles Thomas Wilkinson, D.D. - - 227 Rev. Edward P. Grant - - - - 240 Thursday, 23rd June 1881. Mr. Adam Stigant 251 Mr. William Pittock - - - - 269 Monday, 27th June 1881. Rev. Henry Reed - - - - - 276 Mr. Rawton Macnamara - - - - 290 Wednesday, 6th July 1881. Mr. William Shaen, m.a. - - - - 301 Monday, nth July 1881. Mr. William Shaen, m.a. - - - - 320 Motiday, I8th July 1881. Mr. William Shaen, m.a. - - - - 343 Thursday, 2\st July 1881. Mr. Alexander M'Call Mr. William Krause 370 388 Monday, 25th July 1881. Mr. William Shaen, m.a. - - - - 393 Thursday, 28th July 1881. Mr. William Krause - - - - 419. 427 Mr. John Bull 423 Mr. Thomas Edwin Hindes - - - 426 [ 1 ] MINUTES OE EYIDENCE. Wednesday, 2nd March 1881. MEMBERS PRESENT : Mr. Cavendish Bentinck. Mr. Burt. Mr. Cobbold. Viscount Crichton. Colonel Digby. Mr. William Fowler. Mr. Hopwood. Mr. Massey. Mr. Osborne Morgan. Mr. O'Shaughnessy. Mr. Stansfeid. Colonel Tottenham. Sir Henry Wolff. The Eight Hon. WILLIAM NATHANIEL MASSEY, in the Chair. Dr. Charles Henrt Felix Eouth, called in ; and Examined. Mr. Stansfeid. 1. You are Doctor of Medicine of the Uni- versity of London ? — Yes. 2. And you are a member of the College of Physicians and the College of Surgeons ? — Yes. 3. And a Fellow of the University College, London ? — Yes. 4. Do you hold the appointment of senior physician to the Samatarian Free Hospital for women and children ?— I do. 5. And you are consultative physician for the Hospital for Diseases of Women, for the North London Consumptive Hospital, and Vincent- square Hospital for Women and Children ? — Yes, 6. Have you at any time made venereal diseases your special study ? — When I was abroad I visited all the different hospitals at Vienna and Paris with regard to that particular subject ; and spe- cial advantages were given to me in allowing me to attend the Hcpital de L'Ourcine for Women, to which ordinary Englishmen are not admitted. I also visited the large institutions in Vienna, so that I had ample opportunities of becoming ac- quainted with the opinions held abroad. 7. At what time was this experience of yours gained? — About the years 1847 and 1848. 8. That was in the early part of your medical career '/ — In the early part of my medical career. 9. Have you more or less latterly studied the operation of the Contagious Diseases Acts in this country ? — I have. 10. I am speaking with reference to their hygienic effects ? — I am. H. In consequence of that study have you made public your views or taken any public 0.44. Mr. Stansfeid — continued, action in the matter? — I read an address upon the subject at the meeting of the Association at Birmingham, and I also read a paper at Geneva, at the International Congress held tliei'e to con- sider this very subject. 12. Have you joined any body of professional men in thio country who have interested them- selves especially in this subject? — I have joined the National Medical Association for the Aboli- tion of State Kegulation of Prostitution, and I happen to be a vice-president of the Association. IS. Now, without going into the minutiaj of statistics, have you made yourself, broadly speak- ing, familiar with the official returns on this subject in the Army Medical Reports for some years back? — Yes, in fact in that first paper I quoted largely from them. 14. In your opinion have those Acts been, hyglenically speaking, a failure or a success ? — A failure. 15. 1 hey have, in your opinion, failed to accomplish the purpose for which they were in- tended? — They have. 16. Is your opinion shared by the majority of the medical profession ? — No, I think not. 17. To what would you be disposed to attribute the strong differences of opinion upon this sub- ject that exists within the ranks of that profes- sion ? — To several causes. First of all the great majority of the medical men have possibly never examined these reports for themselves, and they have been influenced by the names of high and eminent persons to assent to their conclusions. That is a very general princij)le at work in our profession as well as in others. Again, I think that there is a naturally conservative feeling in our profession, in so far that they oppose un- A orthodox MINUTES OF EVIDENCE TAKEN BEFOEE THE 2 March 1881.] Dr. RouTH. [ Continued. Mr. Staiisfeld — continued, orthodox opinions, and we see evidence of that in a few examples that I may mention to you First of all vaccination was most staunchly opposed by the profession when it ■was first introduced. Then, again, the use of the speculum for the examination of females led to most violent altercations. Then the use of chloroform in labour cases led to great opposi- tion. When opinions are taken up generally by the profession they are held with some degree of tenacity. For instance, for many years the doc- trine "was held with regard to this very disease, that secondary symptoms were not contagious. I know perfectly well in olden tim-es men who were not very particular, used to think there was no harm in having connection with a woman who had secondary disease, provided she was cured of her primary sores ; now, of course, that opinion is entirely given up, and we believe that both secondary and tertiary sores are cortagious. Then, again, there is a certain bias of mind which iniluences a number of medical men to draw different conclusions from the same facts ; such facts, for instance, as the use of alcohol, or the subject of contagion generally. In fact, I might here make a remark which would, per- haps, fix that in the mind of some of the Members present. Sir Thomas Watson has laid down as an explanation of that peculiar bias the fact that generally persons who hold Conservative opinions are strong contagionists ; whereas, those who liold Liberal opinions are anti-contagionists. That seems to be the bias of the mind. I merely mention that to show why from the same facts different men may come to different conclusions. 18. I suppose there are other causes? — In- dubitably ; there is no doubt a very benevolent intention on the part of the profession; they feel it is a grand thing to mitigate disease of a pecu- liarly serious character so as not to affect our military or naval efficiency, and also to ameliorate the condition of those poor unfortunate women who are prostitutes, particularly those in camps and sea- port towns. 19. Those laudable objects of the promoters of this legislation have, in your opinion, not been fulfilled by the Acts themselves?— I quite believe that. 20. Will you direct your attention for a mo- ment to the Army ; have the Acts, in your opinion, had any important effect upon venereal diseases ; I mean specially upon syphilis in the Home Army ? — I should say not. 21. You have, I think, you told us, considered more or less the question of efficiency, and you have also read the evidence given before this Committee by Dr. Kevins and others ? — Yes, I have read the evidence given by Dr. Nevins, by Sir William Muir, and by Surgeon Major Law- son. 22. Do you find that during the operation of the Acts, and therefore, presumably in con- sequence of their operation, any reduction has been effected in true syphilis in the Army ? — I should say not. 23. You have in your hand the returns made by Surgeon-Major Lawson with regard to secondary syphilis in the Army ; do they show any reduction in consequence of the operation of the Act. I will take first the years, 1860, 1861, Mr. Staiisfeld — continued. 1862, and 1863, before any Contagious Diseases Act was passed. Will you tell us what was the ratio, per thousand strength, of admissions into the hospital, for secondary svphilis in those years? —In 1860 it was 32-73, in 1861 32-69, in 1862 34-66, in 1863 35-94. 24. Will you give us the ratio per thousand in 1864?— 35-06. 25. The first Act was brought into operation at the end of the year 1864 ; is that within your knowledge 1 — It is. 26. That Act which is now repealed did not jjrovide for the j)ei'iodical examination of women''' — It did not. 27. The earliest existing Act is the Act of 1866 ?— Yes. 28. And that Act was only slowly brought into operation, and was only fully in operation in the year 1870; are those facts true i* — Per- fectly true. 29. If we take the period of the partial opera- tion of the Acts, omitting 1864, when the Acts were not really in operation at all,- what do we find the figures to begin with in 1865? — 29*65 per thousand of admissions; in 1866 24-77, in 1867 28- J4, in 1868 31-89, in 1869 26-22, but we find in 1866, after the Act of 1864 had been in operation two years, and when the Act of 1866 was passed, a ratio of 2477. 30. Tlien when we go to the period from 1870 to 1878, during which the Acts are admitted on both sides to have been in complete oiDcration, what are the proportions there ? — In 1870 25-01, in 1871 20-30, in 1872 24-26, in 1873 23-19, in 1874 24-06, in 1875 28-7, in 1876 27-4, in 1877 23-78, and in 1878 26-64. 3 1 . That is to say, after the lapse of these nine years of complete operation of the Acts, the ratio in 1878 is higher than the ratio in 1869 ? — Yes. 32. And do you deduce from those figm-es that the Acta have not appreciably affected the amount of secondary syphilis in the Home Army of this country ? — Yes. 33. Now, with regard to gonorrhoea, what should you say as to the operation of the Acts upon the proportion of gonorrhoea cases? — It has been admitted on the part of the advocates of the Acts that they have had very little effect in improving them, until we come to the year 1873 ; that is the year in which the law was passed by which certain stoppages were placed upon the pay of soldiers if they were found diseased, and consequently the soldiers did not come to their medical officers, but they went to the chemists in the neighbourhood ; so that it did not appear as a return in the returns of the medical officers. 34. Have you referred to the Army Medical Report of the previous year, 1872; does it contain any statement upon this subject? — InthatReport, at page 12, there is the statement " The fact remains that the average ratio of admissions for the eight years, from 1865 to 1872, was higher at the protected than at the unprotected stations.'' 35. The ratio of admissions for gonorrhoea ? — That is so ; the article speaks of the relative pre- valence of gonorrhoea. 36. These statistics show a reduction, from whatever SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. March 1881.] Dr. RouTH. [ Continued. Mr. Stansfeld — continued, whatever cause, since these Acts were passed, in ■what has been called primary venereal sores ? — Yes. 37. In what class of sores, in your opinion, has that reduction been effected ? — I should say in very great measure, and by far the greater majority in what have been called dirt sores ; that is, those sores which are not contagious in the sense of producing secondary symptoms, and -which originate in want of cleanliness by either party. 38. And which are not therefore truly syphi- litic? — And which are not truly syphilitic. 39. They are sometimes called pseudo- syphilitic ? — Yes. 40. And you would draw that inference from the fact which you have shown to us, and the opinion which you have expressed, that there has been no reduction since the Acts of secon- dary syphilis in the Home Army ? — I could put it in this way, that if all these sores had been true syphilitic sores, we ought to have had a very much greater reduction in secondary syphilis ; whereas we have not, and that in itself is an a i>riori argument that many of these sores were not really true syphilitic sores. 41. Your opinion that these sores are only in part svphilitic, is not, I presume, based exclu- sively upon the fact of the non-reduction of secondary syphilis 1 — No, certainly not ; not ex- clusively. 42. In the Army Medical Statistics, I believe, venereal diseases are divided into two classes, primary venereal sores, and gonorrhcea? — Yes. 43. And under the head " Primary Venereal Sores," they include all sores affecting the gene- rative organs ? — Exactly. 44. As those sores, within your knowledge as a medical man, are only partially of a syphi- litic character, are you enabled to state with absolute confidence that under the head " Pri- mary Venereal Sores " in the Army Medical Reports, are contained a certain proportion of cases which are non-syphilitic in their nature ? — Most assuredly. 45. For the better understanding of the Com- mittee, I may take that nevertheless a venereal sore which is not syphilitic in its character is, in a certain sense contagious ? — Yes. 46. Those sores, like all sores, in fact, are con- tagious ?— Yes. 47. Contact with a sore is apt to produce a sore ; but what you would say is, that contact with those sores does not convey true syphilis, because they are not syphilitic in their nature ? — That it does not give rise subsequently to con- stitutional syphilis ; it does not give rise to secon- dary symptoms. 48. I infer that, in your opinion, the classifi- cation of venereal maladies in the Army Medical Reports is not the true scientific classification ? • — So I should say. 49. What would you regard as being a truer classification ? — ^I think they ought to put " True Syphilis," and " Dirt Sores," or some other name ; pseudo-syphilitic, if you like ; in order to dis- tinguish the sores. 50. Some witnesses have told us that it is im- possible to distinguish those cases ; that, I pre- sume, is not your opinion? — Excuse me, they 0.44. Mr. Stansfeld — continued, are very difiBcult to distinguish at certain stages, exactly in the same way that you may have a hard sore that you cannot positively state as syphilitic which may be syphilitic, and you may have a soft sore which may also be syiDhilitic and v;hich you cannot tell at the time is so. That is entering upon the question of diagnosis between sores. 51. I infer from your evidence that if a diffi- culty was found in classifying, at an early date, venereal sores, and they were still to remain for a certain period unclassified, they should be headed as " non-classified venereal sores"? — Certainly. 52. In putting before Parliament and the country the proposed hygienic beneficial conse- quence of this legislation the Ai'my Medical De- jjartmenfc has chosen to select a certain number of military stations, and to compare them with another selection of similar military stations ; do you approve of that comparison ?— I do not think the comparison is exactly philosophical, for it appears to me that, for instance, to compare a large town with a small camp, would not be the proper way of doing it. If you compare them at all, you ought to compare a small camp with a email camp, one under the Acts and one not under the Acts ; or a large camp with a large camp ; or a town with a town, and then you would come to something like a conclusion which would be logical. 53. Have you in your reading of the Army statistics, observed that the favourable com- parison of subjected stations with non-subjected stations, only applies to the comparison of sub- jected stations with large towns 1 — Yes. 54. -And I believe, in your opinion, that is not a fair or scientific comparison ? — Exactly. 55. In fact, in large towns there are greater temptations and opportunities for sexual indul- gence, and there is less possibility of keeping watch over the men ? — It stands to reason that in a small camp all the men are well overlooked, and the neighbourhood is well known, whereas in a large town this is frequently impossible, unless you have every soldier followed by a policeman to watch where he goes. Of course in a small town you have much less difficulty than you would have in a large one ; in fact, i do not see how it is possible that the two things can apply for one moment for comparison, and I am sur- prised the comparison ever was made. 56. Have you known or ever seen the Report of Lord Herbert's Commission ; the Report of 1857 ?— I have seen it. 57. I think there is a passage in the Report of that Commission which bears upon this qiiestion : will you kindly read it ? — The passage occurs at page 15 : " There is, doubtless, a greater amount of dissipation of other kinds among soldiers than among young men of the same class in civil life. Their residence in large towns ofiers great temptation and great facilities for sexual de- bauchery, and the diseases which are thereby generated, the existence of which the soldier, from some cause or another, frequently conceals, thereby greatly adding to the intensity of the malady, and the difficulty of cure, as well as to the necessary severity of the treatment, no doubt having a most injurious effect upon his con- stitution." A 2 58. That MINUTES OP EVIDENCE TAKEN BEFORE THE 2 March 1881.] Dr. RoTJTH. [ Continued. Mr. Stansfeld — continued. 58. That passage emphasizes the disadvantages in this resj^ect of large towns ? — Yes. 59. Now, in comparing generally a subjected with an unsubjected station, are there not certain elements of possible fallacy ; for instance, what about the removal of prostitutes from one station to another? — Some prostitutes who object to these examinations pass out of a protected dis- trict into an unprotected district. Mr. Osborne Morgan. 60. Are you personallv acquainted with these facts ? — Not from actual personal knowledge. Mr. Stansfeld. 61. Supposing it to be established in evidence that there is a certain natural tendency upon the part of seriously diseased women to escape from a subjected district to a contiguous district for the purpose of avoiding examination, that would operate unfavourably as regards the unsubjected district in any comparison between the two ? — Most assuredly ; that is the only conclusion. 62. This Committee have it already in evidence, and it is admitted, that troops entering a sub- jected district are examined for the purpose of ascertaining whether they are diseased, and, if necessary, they are sent into hospital and cured ; but when those troops ai"e sent into an unsub- jected station those precautions are not taken ; is that a fact which, in your opinion, aifects the reliability and soundness of these comparative returns ? — It must necessarily do so. I do not see how it could do otherwise. 63. Would not you say that such a practice as this operates not only unfavourably, but with gross injustice and unfairness to the unsubjected stations ? — -Most assuredly. 64. At this stage of the proceedings we are discussing simply the Army Medical Reports, and therefore I won't put to you any question as to the women, except so far as it may be essential in your view to explain certain opinions in the con- ditions of this subject ; but I will ask you first whether it is not the fact, as stated in the returns before Parliament, that the number of registei'ed prostitutes has diminished in the subjected dis- tricts ? — It is so stated. 65. Is it stated anywhere within your know- ledge, or is credible in your opinion, that during that same period there has been any diminution in the amount of sexual intercoui'se on the part of soldiers and sailors, or of the civil population hypothetically protected by these Acts ? — No, I think, on the contrary, there is every reason to believe that these Acts are regarded by a number of persona as so far protective that they are enabled to indulge their passions more freely and with less chance of catching the disease. 66. Have we not this fact on the departmental statements that there is a very considerable re- duction in the number of registered prostitutes ? —Yes. 67. In your opinion, against which no state- ment has been put forward, there is at least the same amount of sexual indulgence, and probably more ? — It must be so. If a number of men are accustomed by habit to have intercourse with a certain number of women, and the number of women diminishes, if the men are to have the Mr. Stansfeld — continued, same amount of sexual intercourse they must have more to do with these same women. 68. Or they must resort to clandestine prosti- tutes ? — They must. It is observed as an incon- testable fact that wherever severity is carried on upon women that are registered it leads to their number diminishing and to the inci'ease of clan- destine prostitution ; that is a fact attested by all the foreign authorities in countries where these Acts have existed for so long. Sir Hejiry Wolff. 69. Is there any authentic record of that as a fact, that it is established by foreign authorities that clandestine prostitutes increase as the number of registered ones diminishes ? — There are several statements on that subject in the French authors. I presume you will admit these facts, that if certain authorities that have the business of exa- mining these women make that statement, and if, for instance, they say for every 6,000 or 7,000 women that are registered there are 40,000 clan- destine women, and that statement is made upon a French authority whose business it is to exa- mine these women, I am bound to believe it. 70. We should like the authority ? — I am not prepared to give that authority now, but I could at some future time. Mr. Stansfeld. 71. I understand in your opinion as a medical man, if you reduce the number of registered prostitutes in a particular district, the demand of the men upon them remaining the same, you in- crease the danger and the probability of disease ? — Yes. 72. You would not say, I believe, that no im- provements in the condition of prostitutes have been effected since the Acts came into operation ? — No ; on the contrary, I think they have been improved in some respects. For instance, they have better clothing, food, and lodging; they are looked after, and they have more money to spend than they had before the Acts. 73. That is to say, they have a more extensive clientele ? — Yes. 74. That, in your opinion, is the hygienic danger ? — Yes. 75. I have not asked you any question with regard to the effect of these Acts upon the effi- ciency or non-efficiency of the army. We have the Departmental figures before us, but I should like to put another question to you upon that point. I understand in your opinion as a medical man the conditions created by these Acts are likely to stimulate an increase, and that you be- lieve they do stimulate an increase, in sexual in- dulgence on the part of the men ? — Yes, that is my opinion. 76. Now what would be the effect in your mind, as a medical man, of that stimulated and increased sexual indulgence upon the soldiers and sailors of our Army and Navy with regard to their efficiency ? — Perhaps I have strong ojoinions upon that subject, but I may be excused if I mention them, and I do so quite as much as an Englishman as I do as a medical man. My opinion is that it deteriorates the physique of our men, so that they are not possessed of the energy which they had before ; and this fact, I think, is proved, I won't say by our own soldiers, because SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 2 March 1881.] Dr. RouTH. [Continued, Mr. Stansfeld — continued, because that of course would be disagreeable, but by the history of nations. The more nations are allowed to indulge in sexual debauch the worse soldiers they become, and therefore I look upon it as an intense calamity to this country that we are encouraging soldiers to debauch themselves more and more. 77. You mean this quite irrespective of the creation of specific diseases ; you are speaking entirely of enervation? — Enervation and debility produced in the physique. We know in private practice that a man who is a rake has no physical power, and these Acts, I think, have the ten- dency to pervert our soldiers in that direction. It appears to me to be the rational conclusion if you give them encouragement. 78. A reduction is shown, atany rate, in those which you classify as dirt sores consequent in point of time upon the Acts ; but would you attribute even that reduction entirely to the operation of the Acts ? — No ; I should say it is the result of the increased cleanly habits of the soldiers, and particularly of the rules that have been adopted to that end. 79. You mean the rules adopted under the Report of Lord Herbert's Commission ? — Yes. 80. Will you give its the reference ? — This is the recommendation to which I refer, at page xviii of the Report of the Commissioners appointed to inquire into the regulations affecting the sanitary condition of the Army : " In the Repoi't of the Barrack Committee we find the following recom- mendations. Attached to the sleeping compart- ments of each company there should be an ablu- tion room fitted up with tin basins, and water laid on. In this room there should be a portion boarded off, divided within into two or three closed spaces, with foot-pans, where men could retire from the view of their comrades for the purpose of washing their entire persons. It has also been suggested that a washing establishment sufficiently large for the purpose of washing not merely the wearing apparel of the men, but also their bedding, should be built, and that it should be provided with washing and mechanical con- trivances for drying clothes. With both of these recommendations we cordially concur." 81. With regard to the increased danger, in your opinion, of contagion from the reduced number of registered prostitutes, I would ask is it not the danger of what is called mediate con- tagion especially ? — Yes. 82. Would you explain to the Committee what mediate contagion is ? — I take the example of a prostitute who has carried on her game for some time, and who is in a state of syphilisation in particular, Upon her the poisonous secretions from diseased men may not produce the same effect as they would upon another, because she is endued with a certain power of resistance. A soldier comes to her who is diseased, and has connection Avith her ; soon after another soldier comes who is not diseased, and he has connection with the same woman. His parts are in contact with the diseased secretion of the previous sol- dier, and he carries away the syphilitic disease. That is what I mean by mediate infection, and, of course, if a woman has had, as I heard stated by one witness, sometimes as much as 25 con- nections daily ; one man, you see, would be quite 0.44. Mr. Stansfeld — continued, sufficient to disease 24 persons, supposing they were all healthy, and had connection with that woman, though she herself might show no trace of the disease. 83. And that, in your opinion as a medical man, is not merely hypothetical, but practically possible? — It is incontestable. 84. Now, in your opinion, is there any system of periodical examination by which you could secure the Army against the danger of this disease in their intercourse with women ; will you take the classes of disease one by one ; take gonorrhoea : can you be certain by medical examination of the existence of gonorrhoea? — It is perfectly impossible to state definitely whether a woman is affected with gonorrhoea, or whether she is affected with one of those ordinary discharges which occasionally occur in females, such as vaginitis. 85. Therefore a woman might be considered and dealt with as suffering under gonorrhoea when she was only suffering under leucorrhoea? — Indubitably ; and that often occurs. There are no signs that I know of, either general or microscopical, by which, given the secretion of a woman, you can say it is gonorrhoeal and not vaginitis, or inflammation of the passage. 86. Would the latter condition bo a condition capable of conveying contagion ? — Oh, yes. 87. Contagion of what ? — Of gonorrhoea. 88. But the fact would remain. You could not say for certainty whether the woman was afflicted with gonorrhoea or was in a condition which did not imply venereal disease of that character ? — Y^es. Will you allow me to make a further statement upon that point. It is per- fectly possible for a woman to have a point of ulceration in the vagina; a pure healthy woman; and for that spot to secrete a pus, which will produce in a male distinct gonorrhoea. I have several instances of that kind on record amongst persons whose characters were above suspicion. 89. And would those persons have been passed as healthy ? — The thing must have been over- looked. 'i>0. Is it not possible for the woman to remove for hours the traces of gonorrhoea before ex- amination, so that it would be extremely difficult for a medical examiner to ascertain her con- dition ? — Of course ; and many women are thoroughly well acquainted with that fact. Washing out the vagina with merely plain water will do it in many instances. Of course if the disease is very acute that could not be so ; but in the ordinary course it would be quite easy, and it is constantly done. 91. The chief object of the Act, as admitted, I believe, on all sides, was to reduce, if possible, true syphilis ? — Yes. 92. Now, can you easily, readily, and surely detect the true infecting chancre in the woman ?- — In the first place, the real chancre in the woman is often very small. It is painless and hidden in the folds of the vagina, so that it cannot be detected, and therefore the most close examination of a woman would not lead you to believe that she was affected by the disease. I would exemplify that by one cii-cumstance, which will show you how often these things may oe overlooked. There is a disease which affects A 3 women MINUTES OF EVIDENCE TAKEN BEFOEE THE 2 Alarch 1881.] Dr. RouTH. [ Continued. Mr. Stansfeld — continued, women which we call vesico-vaginal fistula, where there is a pretei-natural communication between the bladder and the vagina, or between the rectum and the vagina ; and over and over again, with speculum in hand, and with an experience of over 37 years, 1 have failed to discover that opening, and have been obliged to find it out by throwing milk, as it were, into either passage. If I could not detect the hole, you see at once how difficult it would be to detect a mere excoriation ; _ and therefore it follo^vs that in many cases, not in all, I should be unable to detect that a woman was affected with the disease, whereas she might be seriously affected with the disease. 93. And that would be especially the case in true syphilis? — Yes; because true syphilis is much less painful in the woman than the pseudo- syphilis, and it is not so extensive. 94. It is not only less painful, but am I not correct in supposing that the non-infecting sore is also larger, and much more easily discover- able ? — Most assuredly. 95. Therefore, there is the least chance under this system of discovering the sore which it is the most necessary to discover? — Yes. 96. But syphilitic contagion may be produced by secreiion? — Yes. 97. Can it always be ascertained by examina- tion that the secretions of the women are of a syphilitic character ?— Not by an ordinary ex- amination, because, as I said before, you cannot possibly detect by the quality of the pus whether it is infecting or non-infecting. I would refer upon that point to the authority of Mr. Morgan, of the Lock Hospital in Dublin, who himself proved and has published a number of cases to show that the secretion of a woman perfectly cured, as far as he could make out, of a primary disease, would produce syphilis by inoculation upon herself and upon others, and in his work he has actually published and printed a number of cases to the effect that even as late as three months after the appearance of the disease has gone you can, by inoculation of the secretion, produce a sore. Mr. Osborne Morgan. 98. Are those cases frequent? — Yes; I do not hesitate to say it. Mr. Stansfeld. 99. And you would say that it is not at all uncommon that after all the discoverable symptoms of sji philis have passed away, a woman may remain in this condition for months? — Mr. Morgan makes it three months ; I should believe longer, but it is not the custom in London to inoculate. I look upon that as a sine qua non to enable us to state definitely whether a disease is syphilitic or not. 100. If we were in search of an absolute safeguard at any particular moment in this matter, our only course would be to inoculate the woman with her own secretions in order to establish her condition ? — Certainly ; that is my opinion. 101. I take it that no method of examination could protect men against that mediate contagion of which you have spokeu ? — None. Mr. Stansfeld — continued. 102. Have you any other authority of members of your own profession which you desire to quote in support of your evidence ? — Mr. Gant, in one of the last works published upon Surgery, makes this remark. He says : " As Eicord truly observes, ' gonorrhoea often arises from inter- course with women who themselves have not the disease ' ; and yet more explicitly Didas affirms that from the very fact of a woman having a discharge, no matter what its origin, she is liable to give that discharge to a man. It is therefore of the utmost social importance, affecting the moral character of any woman who is a wife, not to overlook the difficulty or the impossibility of a diagnosis as affecting the character of any woman who is a wife or mother, who would suffer the most wrongful and cruel imputation by a rash and erroneous professional judgment. Nor need I dilate upon the further responsibility of the practitioner respecting any such questions when made the subject of medical legal inquiry, or perhaps criminally affecting a chaste woman." He says again : " The distinction between gonon-hcea and simple urethritis in virtue of the specific nature nf gonorrhceal pus is now gene- rally acknowledged to be no longer tenable." Then he says, " The matter retains the power of infection for a definite period. In one case Titley found that a girl had communicated the disease immediately on leaving the Magdalene HosjDital, after a seclusion of one year ; and in another case, according to Hunter, after two years' seclusion. 103. Is that a work recognised as an authority ? — Oh, 3'es ; it is the most recent, I believe, that has been published. Then, in a work on " The Pathology and Treatment of Venereal Diseases," by Bumstead and Taylor, Professors at New York, and which is also a work of authority, we have this statement : " Of one thing I am absolutely certain, that gonorrhoea in the male may proceed from intercourse with a woman with whom coitus has for months, or even years, been practised with safety, and this, too, without any change in the condition of her genital organs, perceptible upon the most minute examination with the speculum." Then, again, he says, at page 188, " The initiatory symptoms of gonor- rhoea in women are often obscured in the rare instances afforded for examination by the previous existence of a leucorrhoeal dischaz-ge." Mr. Lane, a surgeon of St. Mary's Hospital, and of the London Lock Hospital, says, " I know of no proof whatever that a gonorrhoea is anything more than a urethritis." " To all intents and purposes a gonorrhoea may be caused in a male by mucous, or muco-purulent, or menstrual discharge in a female, the origin of which is altogether independent of contagion. It may be caused in young men especially by excessive sexual indulgence." Mr. Osborne Morgan. 104. I should like to ask whether these are exceptional cases such as a scientific man would recognise and take notice of as medical curiosities, or are they common enough to affect our practical conclusions in such cases? — In my opinion they are quite common enough to afifect your practical conclusion. 105. May SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 2 March 1881.] Dr. EouTH. [ Continued. Mr. Osborne Morgan — continued. 105. May I ask you how many cases you have met with of this kind in your own practice ? — I have met with them by hundreds, but the noint that makes it more marked in my view is, I have found it amongst those who are perfectly free from any implication on their characters. Chairman. 106. Does that lead you to the conclusion that the examination of the women by the speculum is generally delusive and useless ? — In very many cases, certainly. Mr. Osborne Morgan. 107. In what proportion of cases is it delusive ? — That is really a question f could not answer. In acute cases it would not be delusive, but in chronic cases how could I tell (as I have just read) that a woman might not communicate the disease. I have known secretions produce the disease when I could not detect a sore. Mr. Staiisfeld. 108. Have you any more authorities from which you desire to quote ? — A statement by Dr. Lancereaux in his Treatise on Syphilis is one that I should like to refer to. He is writing upon public hygiene, and is the head of the clinical department C'f the Faculty of Medicine at Paris. He says : " Let us .add that as exami- nation takes place shortly after the arrival of the women at the dispensaries, they do not fail always to remove by washing and astringent injections the product of secretion indicative of the con- tagious lesion. Under these circumstances only a comparatively slight security is ever obtained." Mr. Simon says : '' In women, primary venereal ulcers and other local states capable of infecting wdth syphilis, not only very often pass unnoticed by the patient herself, but have often been over- looked in examinations made expressly for their discovery." Mr. Berkeley Hill, in speaking of measures applicable to women with reference to syphilis and local contagion, says : " There is great difficulty in detecting disease if it is to the interest of the prostitute to conceal it." Then, again, as to the security which it is sometimes supposed to give, he says, at page 269 : " On the other hand, special precautions aiFord a false and mischievous security by removing the dread of contagion to those yielding to their passions when considerations of a restraining character are es- pecially necessary." Chairman. 109. You are aware that Mr. Berkeley Hill is a strenuous advocate in support of the Acts ? — I am aware, but I only quote to you what he says. Professor Aitken, in his work on the Science and Practice of Medicine, says, speaking of women, " A hard chancre or sore in them is exceptional, and when it does occur it remains small, is ill- developed, and is readily overlooked even when searched for with great care, aided by a vaginal examination with the speculum." Mr. Langston Parker says in his evidence before lie Venereal Commission at Question 3333 : " I am certain that these uterine discharges in a woman who had had secondary syphilis, but had had no sore, pro- duce frequently indurated chancres and constitu- 0.44. Chairman — continued, tional disease in a male." Mr. Holmes Coote made this remark before the same Commissionwith regard to women. He says, in answer to Question 4139, " I have known that it is so difficult to examine the mucous tract in a female, the vagina or the os uteri ; you cannot with certainty tell what dis- ease is going on there." Those are a few quota- tions confirmatory of what I have stated. Mr. Stansfeld. 110. You have told us to-day in your opinion the false sense of security engendered by the Acts has increased sexual indulgence ? — Yes. 111. Can you give us any evidence founded uppn your own practice and experience on that point? — Most assuredly ; with regard to certain foreign places the thing has often been told to me; they said, " When you go to Paris you need not be afraid because all the women are visited " ; and I have known instances from my intercourse with Paris in which (hat has occurred over and over again, in which men, relying upon the security which they supposed they had, gave way to indulgence. Sir Henry Wolff. This is again foreign evidence. I object to it? Mr. Stansfeld. 112. I am asking Dr. Routh whether, of his own experience as a medical man, he has known persons relying upon a sense of security, which he thinks a false sense, incurring disease? — I say decidedly, and I gave you my exam|)le. I cannot give you the Army, because I do not go and question the officers and soldiers ; but that is the fact. Colonel Tottenham. 1 13. There is only one question with regard to the inspection of troops. I understood you to state that troops, on going into a subjected dis- trict, were examined, but were not so in non- subjected disti'icts ; was that what vou stated "'' —Yes. 114. Are you aware that troops are medically inspected with a view of detecting venereal dis- eases on a certain day in every month, or per- haps oftener than that, in the course of the year ? — I only state what I read in the reports. 11.5. But you are not aware, of your own knowledge, that troops are subjected to those examinations on other occasions ? — No, I am not aware of that fact. I must qualify that. Many years ago I went down to Woolwich and saw Dr. M'Leod there when he was alive, and he told me that he was in the habit of doing it occa- sionally. It is the only circumstance I know of from my own personal knowledge, and that is many years ago. Colonel Pigby. 116. You mentioned the ratio of diseases xh. 1878 as higher than in 1869. I wish to know if you have taken into consideration that that may be so in consequence of the short service now in vogue in the army, and of the men being younger, and therefore more liable to disease physically ? — I cannot pretend to answer that question at all. A 4 117. Pc.haps MINUTES OF EVIDENCE TAKEN BEFOKE THE 2 Alarch 1881.1 Dr. EouTH. [ Continued. Mr. Osborne Morgan. 117. Perhaps you can answer whether young men are more liable to the disease than older ones ? — That is indubitably the case. Colonel Dighy. 118. You are not aware that there are fewer married men in the army now than there were ■when there were older soldiers, and that married men are less liable to catch the disease? — I should hope so; that is all I know about it. I do not know that I can be competent to give any opinion upon that subject. 119. You have mentioned that you are not aware that the soldiers in the Guards are examined in London ? — I am not aware of that fact. Mr. Cohhold. 120. Under the term "dirt sore" do you in- clude a soft chancre ? — I will answer that question Yes and No ; that is to say, occasionally a soft chancre may be contagious, so as to produce secondary symptoms, but I would not say a soft chancre was a dirt sore. 121. You have mentioned the sore that is im- possible to discover by means of the speculum ; might a woman have that sore for some time with- out being aware of it herself? — Oh, yes ; that explains the occurrence of those bad cases of secondaiy syphilis, because they have had it for a long while and did not know it. 122. The mediate connection, as, I think, you called it, which gave rise, or what might give rise, to such a very large amount of disease, and do harm which no Act or legislation could pre- vent, would that, in your opinion, prove that the present Act has not failed in its attempt to miti- gate the disease? — Partially. Sir Henry Wolff. 123. I wish to ask Dr. Routh one question ; you gave statistics, in the first instance, specially relating to secondary syphilis? — Yes. 124. You did not go at all into the question of jjrimary syphilis ? — No, I did not. 125. Now, though in 1869 the ratio of second- ary syphilis was very slightly smaller than in 1878, are you aware that the ratio for primary syphilis was 78'72, and that in 1878 it was 64"7 ? — That is not the return that I have; I am speaking of the entire Home Army. 126. This is the entire Home Army ; it was the same Paper I was referred to ; it is the table at page 48 of the Keport ? — The note I have in this statement is, that the table which I quoted from was computed from Table A. on page 55 of the same Report. 127. I took your statistics without questioning Table 3, and when you come to my statistics. Table 4, you will not admit them ? — You asked me how I got these numbers ; I will tell you ; I have not got the same numbers. 128. I say, in Table 3, you quoted tables of secondary syphilis; I take the same Return, Table 4, on the question of primary syphilis, and I ask you if you are aware that the same Parlia- mentary Paper returns the ratio of primary syphilis in year 1869 at 78*72, and in 1878 at 64"7 ? — No, I was not aware of that fact. 129. You said the doctors who were informed Sir Henry 7-FoZ^^-continued. of these Acts had not sufficiently studied the question, therefore I wish to see whether you have sufficiently studied it, because we must go on with some further statistics ; in this Paper there is a note to this 78, in which it says, " The ratios this year were so much affected by calling out the Reserves, that Sir William Muir advised the Select Committee to omit it in calculation ; " in 1869 he points out that, as I said before, the admissions for venereal sores were 78'72, but in 1877, when the Returns were not affected by the calling out of the Reserves, they had gone down to 45'9 ? — You really are cross-questioning me upon points which I have not gone into. 130. I had not looked at these tables before you called my attention to them just now ? — I gave you the evidence upon the tables I brought forward and that have been calculated for me, and, of course, if you want any further opinion upon that subject, I must ask you to give me a little time. 131. Then, as far as I understand, you are not prepared to give any evidence on the question of primary venereal sores ; you limit yonr evidence to-day to the secondary syphilis? — I have not given any evidence of primary venereal sores to-day. 132. You do not give evidence upon that point ; you limit it to secondary syjjhilis ? — Yes. 133. As vice-president of the society you mentioned, have you at all referred to page 55 of these Retui'ns ; the return reilating to the entire Home Army in venereal disease, showing the strength of the Army from 1860 to 1878, and also the average daily loss per thousand strength by venereal diseases combined? — I really have not gone into the whole of these points. I gave you the evidence upon what I had gone into as bearing upon the subject. Of course if you want me to do that, I must ask for a little time, because I cannot get over all these statistics in a moment. As I said before, I have read them broadly. 134. May I ask you to look at that page now, page 55. If you look to the year 1860, you will see the strength of the Army is 97,703, and if you look at the last column, you will see the average daily loss of service i)er thousand of strength from these diseases combined, is 23"35 ; and if jou look at the last column on the line of 1878, you will see the strength of the Army was 101,129, and the average daily loss of service 10-23, less than half what it was in 1860?— Yes. 135. Be good enough to turn over the page and go to page 56, i-eferring to Devenport and Plymouth. In 1860 the total of those sick from primary venereal sores, secondary syphilis, gon- orrhoea, &c., was 103"81. If you will turn over to the last column on page 61, you will see in 1878 that total was 28-15 ?— That is so. 136. At Portsmouth it is 189-74 in 1860, and in 1878 it is 42-52 ?— Yes. 137. Then we go on to Aldershot. The total in 1860 was 353-18, and in 1878 it was 138-44? — I quite see that, but I think if you will look at some of the intermediate years, you will find that there is no regular diminution. For instance, take the year 1860, it is 103-81, and in the next vear it is 113-24 in Devonport and Plymouth. 138. The SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 2 March 1881.] Dr. PouTH. \_Continued. Sir Henri/ J^^'olff — continued. 138. The Acts were not iii force then. In Devonport and Plymouth in I860 it is 103-81, and in 1870, the year the Acts came into force, it is only 21*89 ?— Then look at the next year, it goes on to 51, more than double ; there is no regular diminution. 139. You may give me every year afterwards : 1872,40-81: 1873,30-40; 1874, 24-29 ?— But bear in mind that in 1873 there was an alteration made as to the hospital stoppages, and there- fore there was a marked diminution. That is admitted. 140. Then we will come to 1878, and that, I think, you said only applies to gonorrhoea ? — I did not say only to gonorrhoea. 141. You said that was one of the reasons? — Yes, one of the reasons ; but now from that time it is again on the increase. 142. Is there not a perceptible difference between 1860, when it was 103-81, and 1878, when it is 28*15 ? — I am quite aware of that ; but still the fact was brought out very clearly by Dr. Nevins, that there was a gradual fall in the disease, in syphilitic sores aud gonorrhoea, irrespective of the unprotected districts. 143. There is no question about districts ? — And, in point of fact, from the table which I have calculated here, speaking of the entire Home Army, and speaking of primary venereal sores, which I did not read about, the ratio jjer thousand admissions : I find, for instance, taking the first years from i860 to 1863, the average annual fall in the ratio per thou- sand admissions was 5(>1 per cent. That was before any Acts were in existence. The 1864 Act was repealed; and in 1866 the exami- nations were made ; and going I'rom 1864 to 1869, tlie intermediate period when there was partly Acts and partly no Acts, the average annual fall per cent, was 5-15 ; that is to say, whereas the syphilitic diseases were diminishing when there were no Acts whatever, the annual fall per cent, being 5-6 1: after that, in the intermediate period between the changes of the administration and subsequent enactments, the fall was 5-15; that is to say, less than when there were no Acts ; but since the Acts have been established the annual fall is now 2-56 ; so that actually the fall in the admissions of primary sores is less consider- able than it was before there were any Acts whatever ; that is what my tables show. I am speaking of primary venei-eal sores. 144. You do not deny the fact that the daily average loss of service between 1860 and 1878 is a difference of 23-35 to 10-53 ? — Certainly; but I did not go into the question of loss of service at all. 145. Nor do you deny these statistics gene- rally ? — No. 146. Then you say within the years 1860 and 1865 the per-centage dropped so much ; are ycu aware that the Army decreased between 1860 and 1866 from 97,000 to 7u,000?-But I am calcu- lating tlie ratio per thousand. 147. I am coming to that? — I was not aware of the actual numbers, but I knew there had been some change at that time. 148. There were 97,000 in 1860, and in 1866 there were 70,000 ; you yourself said the fewer women there were in proportion to the numbers 0.4). Sir He itrt/ JVoIjjf — continued, of men the more likely was disease to be gene- rated by the larger clientele of the woman? — Certainly. 149. Therefore the diminution between 1860 and_1866 probably might have been owing to the diminution of men in proportion to the women on the different stations ? — 1 could not exactly say that, for my experience would be rather the othe'r way. A young man, or a young prostitute, is more likely to catch the disease than an old man or an old prostitute. Mr. Osborne 3Ior(jan. 150. Do I understand you to say you know nothing of these tables except what appears upon the face of them ? — 1 have read a good deal upon the subject. 151. I mean personally? — Personally. 152. You take them for what they are worth ? — Y'es. 153. JNIay I ask whether you have had any experience in Army medical practice ? — No ; I have never been in the Ai-mv. 154. Have you ever visited a military Lock hospital ? — No. 155. Then your knowledge of the subject is entirely derived from your private practice, and I suppose your hospital practice ?— And what I have seen abroad especially. 156. Have you ever practised in a Lock hos- pital of any kind ? — No. 157. May I ask what experience you have had in the examination of women with the speculum, or otherwise, for the pr.i'pose of detecting vene- real disease ?— Well, I can only tell you this : for the express purpose when I was abroad I have seen as many as 81 women examined of a morning. 158. How long ago is that? — In 1848. 159. Since that time?— What I have seen has been almost exclusively in hospital practice. 160. Have you examined many of these women for the express purpose of detecting whether they were suflTering from venereal disease ? — Every time I put up the speculum it was with that ob- ject. 161. Are you in the habit of using it often for that purpose ? — At the present time my practice is more amongst tlie better classes. I, of course, every now aud then get some cases in ho.spital practice, but I am retiring from that at the pre- sent moment. 162. I was speaking of your general practice, not in 1848, but since you ha%-e been in prac- tice? — I have examined a large number of jiros- titutes, if you mean that, who have come privately. 163. For the express purpose^ — For that express purpose. 164. You stated that it was very difficult, if not impossible, to discover the presence of con- tagious disease in a woman ; i should like to know to what extent you carry that theory ; would you say, for instance, that in one out of two examinations it would lead to no discovery whatever? — Really when you come to that ques- tion of statistics I should find it veiy difficult, because I have not got the records. 165. Of course general answers of that kind are very little use ? — Really I want to speak the B truth 10 MINUTES OF EVIDENCE TAKEN BEFORE THE 2 March 1881.1 Dr. E.OUTH. \_Continiied. Mr. Osborne Morgan —continued, truth. If you will allow me to make a guess at it, I should say that out of 10 women perhaps there might be six ot seven in whom I could not find any trace of the disease. 166. Do you mean to say that out of iO diseased women you would not find traces of disease upon six or seven : do you really mean to say that? — Yes, that I supposed to be diseased women, that came to me to be examined for the purpose of ascertaining whether they wei'e diseased. That is the point I put. They might not be diseased at all. 167. No; what I wanted to know is this, and I want to put it clearly in order that there may be no mistake about it: given 10 diseased women, women reaDy diseased, coming to you, or coming to any otlier competent medical man, in how many of these women should you say the exami- nation would be purely abortive, that is to say, that the medical man would not be able to ascer- tain the traces of disease, and would pass her as a healthy woman ; can you give me any idea ? — I should say about one-half. 168. I mean in the course of your personal practice ; do you mean to say in one out of every two cases a diseased woman who came to you, you would pass as sound? — -I mean to say this, it is perfectly impossible from the examination made as it now is, as you make it in the Army, to say definitely whether a woman is diseased or not, I wish to put that very strongly, unless you inoculate. I cannot by the nature of the dis- charge, by the appearance of the sore, in many cases say whether it is a syphilitic sore or not, and the only test I have of it in private practice is this, that of course I have the test that the husband may be diseased, or the wife, or the child may be diseased, but in speaking of an ordinary prostitute, when I do not know who she has been with, it would be morally impossible for me, unless the sore was very large, to say that woman was diseased unless I did so, and therefore in asking me the simple question I think I should be right in sayiug about one- half. 169. Are you speaking of true syphilis or pseudo-syphilis ?— I am speaking of true syphilis only. 170. Do I really understand you to say, speak- ing from your own experience, that in one case out of two, you pass as healthy a diseased woman ? — I should pass as healthy a diseased woman if I did not inoculate her. 171. Do you do it? — I do do it in this way, because women object to the inoculation, and I give a guarded opinion, and say, " So far as I believe, you are free from disease." Mr. Fowler. 172. You mean to say, taking the ordinary mode of examination used in the Army, you could not tell in one case out of two whether the woman was or was not diseased ? — I could not tell whether her secretions would communicate the disease. Mr. Osborne Morgan. 173. I understand you to carry your theory so high as this, that in one case out of every two, any examination which is not followed by inocu- Mr. Osborne Morgan — continued, lation is absolutely useless? — That is my impres- sion. 174. You spoke of pure women communicat- ing the disease ; surely that is a very exceptional case? — No. 175. Do you really mean to say that pure, virtuous women communicate the venereal disease to men? — Not venereal disease. 176. Are you not speaking of that disease? — No, I am speaking of gonorrhcea. 177. And you say that that is a common thing? — It is not at all an uncommon thing. 178. It is admitted, I believe, as regards primary syphilis, the amount of disease has diminished since the Acts came into operation; that is what I infer ? — Yes. 179. Now, jirimary syphilis is a very painful disease ? — You mean the true j)rimary sore ? 180. I mean both; I am only speaking from what I read in these reports ; does not it allude to buboes and other things which incapacitate men ? — Indisputably, but the true primary sore is much less painful than the pseudo-syphilitic. 181. Both would incapacitate, would i.hey not, a man from duty for some time ? — They might. 182. If neglected I suppose they might lead, if not to constitutional disturbance, to very serious results? — Possibly so. 183. In the way of buboes? — Breaking up the health of the man or woman. 184. You said the tendency of these Acts was to convert the soldiers into rakes, and you made that observation upon this ground, that the fewer the women with whom the soldiers had inter- course the more frequent would be the in- tercourse ? — No, not exactly. The inference I drew was from two or three circumstances con- nected with it. In the first place there is such a thing in the human mind and in the human body as habitude. If a man is in the habit of having much to do with women it becomes a need; he has learned the habit, and he likes to do it often and often, so that it becomes a sort of intoxication, just as a man who is accustomed to drink longs to di-ink again. In the first place by holding out to your soldiers that facility, and that sense of security which these Acts would tend to give, you encourage the habitude in the soldier of having connection with women. Next, if the number of the women is limited, and there- fore more diseased, not having cured that habitude in the soldier 185. You assume now that they are more diseased?-— They must necessarily be, thereby you run the risk, by the diminution of women, of increasing the amount of disease in your soldiers. And then I said that the efi^ect of that was in my opinion to deteriorate their physical qualities, by making them physically weaker. 186. On the other hand, should not you say the fewer women there were the less temptation there would be : take your own illustration, drink. It there are 10 public-houses in a parish or town, there is less temptation to men to drink than there would be if there were 30 ? — I do not know that. I tiiink it would lead to those 10 public-houses having a great deal more busi- ness to do than if there were 20. 187. Do I understand you to say the fewer temptations a soldier has the more likely he is to indulge SKLECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 11 2 March 1881.] Dr. EouTH. [ Continued. Mr. Osborne Morgan— CQTitva.ViQdL. indulge in such a practice ? — I do not sav that there are fewer temptations because there are fewer women ; it does not follow at all. The man has got tlie habitude. Take the case of drink. Supposing there were only two public- houses, the man has learned the habitude ; he will go to those two public-houses, and will fre- quent them more often than he would if there were more. It does not diminish his temptation. 188. I infer, from what you have said, you do not know much of the character of soldiers? — I have very little to do with soldiers. 189. Should j^ou say that, as a class, they were likely to be influenced by those prudential con- siderations which you have suggested in the case of the young men who went to Paris, and would be likely to indulge in sexual intercourse because they thought they would be safe ? — That is what I have been taught in early times. 190. As to soldiers, or young men generally ? — As to young men generally, and soldiers, I suppose, in particular, because they are not of the very best class. 191. I am speaking of the prudential considera- tions that you say affect men, and lead them from a sense of security to indulge in more fre- quent sexual intercourse ? — That is what I have been taught, and what I have observed. 192. You spoke of mediate contagion; I un- derstood you to mean the case of a woman who is not herself diseased, but who has had connec- tion with a man who is diseased, and afterwards communicates that disease to another man ? — Yes. 193. Have you come across any case of that kind in your own j^ractice ? — I have met a few in private practice, where I have been inclined to conclude that that has been the cause, and where I found no disease 194. Excuse my pressing these things, of course evidence is evidence ; do you know of your own personal knowledge of any case of what you call mediate contagion ? — I have known a certain number of cases in which I could find no other explanation, and I know j^erfectly well from the facts that if you take the secretion of some of these women who themselves are not diseased and inoculate with it, you produce the disease ; a fortiori, if a man has connection with them, he would take the disease; it follows as a matter of sequence. 195. Have you never seen, in your experience, secondary syphilis occur in women in whom there has been no previous hardness and sores ? — Yes, several cases. 196. Is not it a fact that indurated sores are very rare in women ? — Comparatively rare. 197. I understand you to say, I believe we all agi'ee, that gonorrhcea is much more difficult to detect in a woman than syphilis ? — Much. 198. What did you add to that, '•' by examina- tion " r — Yes. You must allow me to qualify that. True syphilis in a woman is much more difficult to detect than the pseudo-syphilis ; and in the same way gonorrhasa, if a woman cleans herself beforehand, is much more difficult to detect than would be what is called a pseudo- syphilitic sore. 199. That would probably account for the fact that, as regards gonorrhoea, the Acts and ex- 0.44. Mr. Osborne Morgan — continued, aminations instituted under the Acts have been less effective than as regards syphilis ? — Pre- cisely. 200. Is not it the fact that, independently of the Acts, there have been considerable fluctua- tions in these diseases in different years ?— Yes. 201. Is there a steady ratio of increase or decrease ? — In the address I read at Birmingham I had a table to show the increase of syphilis in these early years, showing that it was a disease which was very severe ; for instance, taking the Dragoon Guards and the Dragoons in 1859, the number of cases per 1,000 was 402, whereas, in 1837 to 1S46, it was only 206-1 . I wanted to show the variation of the disease, that, just as small pox or any other disease, it may become violent at times 202. That may be said of all zymotic diseases? — Of all enthetic diseases. Mr. Cavendish Bentinck. 203. You have told the Committee you are Vice-President of the National Medical Associa- tion for the repeal of these Acts ? — Yes. 204. Is that an association composed entirely of medical men ? — No, I think not exclusively. i would not answer that question positively ; it is purely medical men at Liverpool, but I thouglit there were one or two laymen in it. 205. One would wish to know whether it was an association for medical piu-poses ? — Entirely ; they publish a medical journal, I believe. 206. Wholly for the purposes of this Act ? — Opposing this Act. 207. Will you sav that the opinions enter- tained by that association and by yourself are not shared by the majority of the medical pro- fession ? — No, I said 1 believed that to be the case. 208. You know that it is the case ? — Yes, I think I might say 1 know it. 209. With regard to medical jiractitioners, who make these diseases their special study, what is their opinion on the subject of the Act ? — The majority ai'e in favour of the Act, but there are some, I believe, opposed to it. 210. Have you practised in the cure of these diseases at all yourself? — Oh, yes; how is it possible in the course of 37 years not to treat these cases. 211. Constantly? — I suppose I have had a pretty good sprinkling of them. 212. But the medical practitioners who are most eminent in their profession in the largest practice ; have you any means of knowing what their opinions are with regard to the operations of these Acts ? — Of course when we meet together sometimes we have conversations, and the opinions are not altogether the same on all sides. 213. Do you know any man who is a leader in the medical profession who is opposed to the Acts ? — I know Mr. Henry Lee is. You are asking important questions, and I do not think it is quite right that they should be put, because whatever 1 say is reported ; you bring me into direct contact with other men. From such con- versation as I have had, for instance, with Mr. Jonathan Hutchinson, I do not think he is in B 2 favour 12 MINUTES OF EVIDENCE TAKEN BEFORE THE 2 March 1881.] Dr. RoUTH. [ Continued. Mr. Cavendish Bentinck — continued, favour of the extension of the Acts to civil popu- lations. 214. This is a question of authority ; one of the most important things for a layman, if I may use that term, with regard to myself, is to know what are the opinions of the authorities ; 1 want to know from you what is the opinion of the best and highest medical authorities upon this point ; we know what the opinion of Sir James Paget is, and of some others, but with regard to spe- cialists, we wish to know whether you can point out the name of any specialist in first-rate practice in this speciality who is opposed to the Act? — I mention the name of Henry Lee ; he is a specialist in that particular branch, and has written a great deal upon it ; I know that he is dead against the Acts. 215. Now, with regard to the operation of these Acts after a long series of years ; it is a fact, is it not, that there has been a very large reduction in primary syphilis ? — A large reduc- tion in primary sores ; I do not call them all syphilis. 216. And to that extent the Act, therefore, has done a great deal of good ? — Yes. 217. I understood you to say that many of these sores were not purely syphilitic ? — Yes. 218. And you drew the inference that if all the sores had been truly syphilitic there would have been also a great reduction of secondaries ? — Yes. 219. Are you not awai-e it has been stated over and over again in evidence before this Com- mittee that the number of secondary cases cannot be gained from the numbers of primary cases, because it does not follow that primary cases have been contracted by the patient when he was in the Army ? — I am aware of that, but at the same time it is a source of fallacy. 220. Is it not a fact that secondary symptoms constantly appear at long periods after primary sores ? — It may occur 20 years after the pri- mary sores. 221. It is a case of oi'dinary occurrence? — Not so ordinary, but not unfrequent. 222. And consequently it does not at all follow that the primary sore should have been con- tracted while the man was in the Army ? — Very true. 22.3. Then, agaui, have you considered the effect of Loi-d Cardwell's Order ? — Yes. Would you allow me to make this remark : how do you know that many of the soldiers that contracted primary sores while they were soldiers, after they had left you had not had secondary syphilis ? 224. You must not ask me questions ? — It cuts both ways. I have met diseased persons in my dispensary practice, long after they have left the Army. 225. Are you not aware that there are at the present moment a far larger number of recruits and young soldiers than there ever have been before ? — Yes. 226. As to these men, many of whom, are affected with secondary symptoms, it does not follow but what they contracted the seeds of the disease when they were out of the Army ? — Of course I cannot estimate that quantity. 227. Therefore it is far more likely that the secondary symptoms should be increased by cases Mr. Cavendish Bentinck — continued, where the primary syphilis was contracted out of the Army ? — I do not think it is far more likely ; that is a matter of opinion. 228. With regard to sores that you say are non-syphilitic, is it not admitted that the nature of the sore cannot be distinguished until some time after the patient has been under treatment ? —Yes. 229. Therefore, in the first instance, wliere a man is discovered to be diseased, he must be placed in hospital, whether his sore is syphilitic or non-syphilitic ? — Yes. 230. He must be placed in hospital before the disease shows its decisive symptoms ? — Certainly, if he declares himself. 231. If he declares himself, then he has to go to hospital ? — Yes. 232. And you cannot tell for a long time to which category his sore belongs ? — Well, gene- rally speaking, the dirt sores, the pseudo-syphi- litic sores, are more easily cured. 233. But you cannot always tell a dirt sore ? — Of course you cannot always ; I think that was stated in one of the reports from the Army. 234. Did you say dirt sores are not con- tagious? — No, I did not say they were not contagious, because a dirt sore may be communi- cated to another person, but it does not produce constitutional syphilis. 235. It is a contagious disease '•' — If it goes from one person to another, of course. 236. At all events, you admit the Act has been of great service in reducing the disease ? — Probably in reducing this sort of disease, but it has not succeeded in reducing constitutional syphilis or gonorrhoea to an appreciable extent. 237. How do you know it has not succeeded in reducing primary syphilis ; how do you know in one of those cases of the 42 per cent, the greater per-centage of any number you see here is not primary syphilis? — I know it from the state- ments made in other authors. 238. This is a most important matter, and I want to have a clear answer; I want to know n]ion what possible evidence you come to the conclu- sion that out of any one of these primary vene- real sores, taking any one column you like, the majority are not syphilitic ? — I arrive at that conclusion from the statement I think also made by Sir William Muir. One said it was three to one, and another medical man of the Army said it was four to one ; but there are some state- ments here which you will allow me to read. It is an opinion given by Mr. Berkeley Hill in his book upon syphilis. 239. Mr. Berkeley Hill's opinion has nothing to do with an Army Keturn : the Army lieturn says, in any one year, there are so many cases of primary venereal sores. That shows that there has been a gradual fall in these, and therefore a great diminution of disease has followed ; 1 un- derstand your argument is, that these primary venereal sores are in great measure the pseudo- syphilis, and not real syphilis. I want you to give me the reasons which have led you to that opinion, and Mr. Berkeley Hill has nothing to do with it; he is not before the Committee? — Of course, in a point like that, the statistical explanation given by an autliority would have some weight. 240. You SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 13 2 March 1881.] Dr. RouTH. [ Continued. Mr. Cavendish Bentinck — continued. 240. You and your friends have undertaken to show that these primary sores are not real syphilis, but pseudo-syphilis ; I want to know whether you can furnish us with any evidence to prove that assertion ; I do not want opinion, hut I Avant something tangible that I can take hold of? — The proof I gave you is one that ap- pears to me satisfactory, that if they were all primary sores we ought to have a great deal more constitutional syphilis, and I quote from ipen who have made that a special study, and they show that the real infecting sore is posi- tively less numerous than other sores, and I wanted to read you this so as to show you one of the reasons why I believe that to be the fact. It says, at Plymouth, in the !Naval Hospital, in the years 1861, 1862, lS63,and 1864, there were 2,515 cases of venereal disease; of those 1,634 were cases of ulcer, and 1,140 were independent of constitutional syphilis ; only 494 were suc- ceeded by constitutional disease, and nearly 70 per cent, were non-infecting chancres ; he says, " This proportion may be taken to repre- sent the average proportion of non-infecting sores among venereal ulcers." Ricord makci; them three to one. Mr. Osborne Morcjan. 241. May I ask whether what you call true syphilis is always followed by what you call secondary symptoms? — If not cured at the time, invariably, but 5'ou may have any number of infecting sores which are not followed by secondary symptoms. Mr. Cavendish Bentinck. 242. Then I understand you have no reasons to give in support of the position you advance except by citing some extracts from a work by Mr. Berkeley Hill?— I do not tell you that. 243. Then tell me upon what grounds ; it is no use your beating about the bush ; if you have no reasons, I will pass to another branch of the subject ; if you have any reasons, do tell us wliat they are ?— I gave you my opinion, founded upon my own experience and the experience of others. I cannot do more. 244. What experience? — 1 have had patients with infecting sores, patients with non-infecting sores, and I have had some that have been in- fected and not followed by constitutional syphilis. I infer, from the style of those cases, that some were true syphilis, and some were pseudo- sy philis. 245. Then you really have no tangible grounds for enabling us to arrive at the conclusion that the great number of tliese eases in any one year arose from a true syphilis ? — I cannot say that. Mr. Oshoriie Morgan. 246. If these primary cases were properly treated there would be no secondary syphilis ? — Not if they were taken in time. Mr. Cavendish Bentinck. 247. I understand you really have no positive ground to go upon for arriving at an opinion that a majority, or any material proportion, of these venereal primary sores arise from pseudo-syphilis? — I really cannot say that I draw that conclusion at all. 0.44. Mr. Cavendish Bentinck — continued. 248. What conclusion do you draw ? — I will try to put it to you in another way. Suppose I am reading the history of a disease, and in that history I find there are a certain proportion of cases which are f illowed by certain symptoms, and there are other eases in which those symp- toms do not follow ; they resemble one another and they require to be diagnosed, and you can only diagnose them by tlie subsequent results that follow in another case. That is the ground- work of my opinion ; upon this I practice. I find this to be verified by many instances ; and I come to the conclusion that what I have already read upon the subject is true ; and I quote authorities whicli are of the same view as my own, and therefore I come to a conclusion. I did not see those particular cases that are on record; and is it reasonable that you should ask me to tell you that so many were true syphilis and so many were not ? If I had seen them, it would have been a different thing altogether. 249. Then you have no reason for saying that the Acts have not resulted in considerably re- ducing the primary syphilitic sores? Mr. Osborne Morr/an. 250. If they have reduced the primary syphilis by leading to the cure of primary sores, does it not follow that they would to that extent prevent and so reduce secondary syphilis ? — Indubitably, if you could cure every case. 251. And, pro tanto, to the extent to which they enable medical men to cure primary syphilis they could do away with secondaries ? — Certainly. INIr. Cavendish Bentinck. 252. Therefore, if the primary syphilis was effectually cured, no secondary syphilis would come ? — Certainly. 253. If the doctor is worth his fee, you never would have secondaries from a primary sore ? — You would not. 254. Now 1 must ask you once more whether you have any ground for supj^osing, beyond the authorities you have cited, that ihe majority of those primary venereal sores are not pseudo- syphilitic ? — I have not seen the cases. I an- swered the question before, that I had no other ground but what the knowledge of medicine shows me, 255. Therefore tliey might all be really syphi- litic sores ? — I cannot say that. It is contrary to the common sense of my learning and pi-actice. 256. That might be ?— I say they could not be according to the evidence. 257. But the majority of them might be? — No, certainly ; the majority would not, as fur as I can make out the case. 258. .Judging from the authorities you have cited '— J udging from the authorities I have cited, the majority would not be syphilitic. 359. You say you have not seen the practical working of any one of the Military Lock Hos- pitals ?— No. 260. Do you think that the medical officers who have charge of those hospitals are of opinion that in the majority of cases they aie able to detect when a woman is diseased'.' — No, I know nothing at all about their opinions. B 3 261, You 14 MINUTES OF EVIDENCE TAKEN BEFORE THE 2 March 1881.] Dr. KouTH. [ Continued. Mr. William Fowler. 261. You made a remark with regard to the probable benefit resulting from the act in the reduction of primary venereal sores. There was some question put to you to that effect, to which you gave a quasi affirmative answer. I want to ask you this question. I find by the Return laid before the House in 1879 (Appendix No. 1), a Paper handed in by Sir William Muir, that taking the 14 subjected districts only, and taking the ratio per thousand of admissions in the years 1860 to 1863, you began with 146 and you ended with 107. It is page 157. The Paper is 323 of the 30th of July 1879. I make out the average annual fall before the Acts was 9-63 in those years. I am dealing with the subjected districts as a better illustration ; the average annual fall was therefore 9*63 per cent. Now, if you take theyearfe 1864 to 1869, there is a fall from 102 to 66. That was when there was only a partial application of the Acts, and that makes an average fall of 7*44 ; and if you take the years 1870 to 1878, there is a fall from 55 to 40, or an average fall of 4-83. Does it not, therefore, follow, whatever the causes were that led to the fall before the Acts came into operatiou, that the fall was much more distinct and rapid before thev came into operation, than it has been since ? — That is precisely what has been said. I stated before ever the Acts were established, the fall in those sores, both for subjected stations as well as in the entire Home Army, was greater than it had been since. Mr. Hopwood. 262. t ou were asked by Sir Henry Wolff a question about the statistics ; you have taken, I believe, in that table which you began with, the statistics furnished before this Committee by the Army authorities .: I mean the statistics as to secondary symptoms ; they are not your own ; but they are those that have been furnished to this Committee ; and you take them as you find them ? — As I find them. 263. It IS conceded by the authorities that there is a very trifling reduction, if any, in the ratio of secondary symptoms ? — Yes. 264. You have pointed out that all the cases of secondary or primary are included under the one head " primary sores " ? — No, no ; the secondary syphilis is not included under the head of " primary sores ; " it is a different column altogether. 265. To begin with, you pointed out a defect of the classification of the whole class of venereal sores ; I am not speaking of that table ; but I want the whole return, as I understand it ; the return kept of venereal sores ; there is no dis- tinction made between pseudo-syphilitic and true syphilitic ? — That is so. 266. They are all lumped together ? — Yes. 267. Then this return deals with the cases of secondary symptoms which have been afterwards detailed or recorded in the records of the Medical Department r — Yes. 268. Does that give you, comparing that with the whole list of sores, any test as to the number of_ primary cases which were syphilitic ? — It might be got at by calculation, but I could not state that positively 269. Supposing you had a case submitted to Mr. Hopwood — continued, you of what you call pi-imary sore, at first you would be in doubt whether it was true syphilis or not ? — Yes. 270. If you were allowed to follow the history of that case for six weeks or two months, in a large proportion of cases you would ascertain whether it was, or not, true syphilis ?— 'Certainly. 271. I apprehend that is open to the Army surgeons to do with these cases ? — Yes. 272. Well, now, if jou find that there is that power given, and yet no record made representing the primary sores to true syjahilis, do you draw the inference that in the judgment of those capable of judging, the jjrimary sores were not syphilitic? — That is the natural conclusion I would come to. 273. As to the primary sores, as we under- stand, you think a categorical name for a large class of them would be "dirt sores"? — Yes. 274. And therefore would be affected by arrangements made for the greater cleanliness of the troops ? — Yes. 275. And you have quoted from Mr. Sidney Herbert's Commission the suggestions made for that purpose ? — Yes. 276. And we have learned from other sources that these were carried out ; do you largely attribute the cure of primary sores to those means of ablution and greater cleanliness being afforded to the troojjs ? — Yes, certainly. 277. I mean, as apart from the regulations prescribed by this Act? — Certainly, because soldiers have cleaner habits. 278. And therefore, if a large diminution of primary sores has taken place since the Acts have been in operation, it may be not propter hoc but post hoc, and not attributable to the Acts them- selves? — That is quite my conclusion. Mr. Stansfeld. 279. You were asked by Colonel Tottenham on what authority you had felt able to state that soldiers coming into a protected district were examined to prevent them spreading the contagion of venereal disease ; but that if they were sent into an unprotected district they were not so examined. Have you before you the Report of this Committee of 1879?— Yes. 280. Would j'ou turn to question and answer 284 to 287 ; those are questions addressed by myself to Sir William Muir; will you kindly read them ? — " It is the rule of the service that regiments coming in from an unprotected district, as they come into unprotected districts, are ex- amined ; and all men found diseased are sent into the hospital, and the same applies to soldiers coming from furlough ; they are examined, and, if found diseased, they go into the hospital. ( Q. 285). Does that rule only apply to protected districts? A. Only to protected districts. (Q. 286). Therefore, w'hen you have a regiment coming into a protected district, or men coming back from furlough you take care to pick out and send to hospital those who are unhealthy ? A. Yes. (Q. 287). Do not they take those precautions in an unprotected district? A. No." 281. You were asked some questions by Sir Henry Wolff upon the decrease of primary venereal sores in Devonport and other places between 1860 and SELECT COMMITTEE ON CONTAGIOITg DISEASES ACTS. 15 2 March 1881.] Dr. RoUTH. \_Conti'nued. Mr. Stansfeld — continued. anl 1878. As I understand you, you are aware of those reductions, and you attribute tliem partly to the opei'ation of the Acts; but not entirely as far as primary venereal sores are concerned ? — Yes. 282. But in your view there is no evidence of a reduction in secondary syphilis ? — Certainly, as I make it out. 283. You were asked by Mr. Cavendish Bentinck whether you had any knowledge en- titling you to express the opinion that infection could be or was at all conveyed by what is called mediate contagion ? — Yes. 284. Is there any difference of opinion upon that subject amongst medical men, or is it not universally admitted that such a thing as mediate contagion is a pi'actical danger ? — I never heard it doubted. 285. You were asked also if you could state any authority, any specialist, who might be held to be an authority who disapproved of these Acts, and you cited Professor Henry Lee. Is he not a very high authority ? — A very high authority. 286. Would you sa3r there is a higher authority on the subject in England than Professor Lee? — I would only say the^proof of my belief is that when- ever I have had a case of that kind I send to him. 287. Would you be prepared to say that there is no higher English authority upon this class of diseases than Professor Henry Lee ? — That is my opinion. 288. My right honourable friend said, " Do not trouble me with opinions, but prove to me that these primary sores in the Army Medical Statistics are not everyone of them syphilitic ? " He challenged you to the proof; is this a ques- tion upon which there is any difference of medical opinion within your knowledge ? — Not within my knowledge. 289. Will you turn to Question 310, a ques- tion addressed by myself to Sir William Muir ? — " If we compare the figures with the figures of secondary syphilis, I presume 1 should not be far \vrong in saying that not above one-third or one-fourth of these [cases are really syphilitic ? A. I think not; about one-third, I should say." 290. Will you turn to 919, a question ad- dressed by Mr. Shaw Lefevre to Mr. Lawson ? — " Should you state that about one-third of the cases lead to secondary syphilis ? A. " That seems to be about the proportion." 291. Now Question 3115, a question of my own to Mr. Bond ? — " What proportion of cases would those be ? A. \ have no statistics ; I can only give my own experience. About one- third of the sores that I see at Westminster Hos- pital are syphilitic ; that is my experience." 292. And these are the medical gentlemen who are called by the lJe2:)artment, not by myself?- — Yes. 293. You have been asked whether if really primary syphilis could be cured, there would be any consequent secondary symptoms, and your reply was, " No, if cured ;" but now, however early real primary syphilis is discovered, am I not right in saying that in the vast majority of cases secondary symj)toms set in ? — I should not say the vast majority ; 1 should say in a very large number. 294. Within what period oi' time? — It varies 0.4t. Mr. Stansfeld — continued. within from five to six weeks, pei'haps up to a year.^ 295. In a very large proportion of cases primary syphilis is followed by secondary dis- ease ? — Yes 296. As to the proportion, that I suppose is a subject ujaon which there might be difference of medical opinion ? — Yes. 297. We find, as you have shown us, there has been no reduction of secondary syphilis in the Home Army ? — Yes. 298. And I take it, you abide by your infer- ence from that fact that there has been no reduc- tion of primary syphilis ? — It follows. 299- And that whatever the cause, whether it be a difficulty of ascertaining primary syphilis, or whether it be the want of proper treatment, the Acts have failed to reduce secondary syphilis ?^ Yes. Sir Henry Wolff. 300. The honourable Member for Cambridge asked you a question as to the fall of the diseases between 1860 and 1863 ; are you aware that within that time the strength of the Army fell from 97,000 to 75,000 ?— I was told so here. 301. You will see it in the book ? — Admitting that fact, there is no question for a moment 302. I also ask you to look at page 47, in which there is a Paper handed in by Dr. Nevins, show- ing that the ratio in 1860 of primary venereal sores was 146, and that fell in 1863 to 107, and that in 1869, when the Act was more stringent, it fell to 65-14; that in 1872 it fell to 54; in 1873, owing to Lord Cardwell's Order, it fell to 35, and rose again in 1878 when the Reserves were called out to 40. Now do you think that that gradual fall was in any way attributable to the Acts or not? — It may have been, partly ; because the more severe and stringent your regulations the more cleanly your soldiers would be; but judging from the greater fall that took place at other periods 1 have mentioned, I do not think it necessarily follows as a positive conclusion. 303. You do not attribute the greater fall in the earlier time to the diminution in numbers of the Army ? — Not necessarily. 304. Some time ago you said you did ; I asked you whether the fact of the number of women being larger in proportion to the number of men would not diminish the chances of infection, es- f)ecially looking to the evidence that you have given about immediate infection, that the larger number of women ia comparison with the number of men, the less chance there was of infection? — I stated that, certainly. 305. Therefore, are you not of opinion that the fall in the number of men between 1860 and 1863 lessened the chances of infection ? — It might have done so. 306. Then I have to ask you another question with regard to your evidence about the secondary symptoms. If you look to the Paper on page 48, you will see it was 31*89. Dr. Nevins makes it a little less, 30-39. You did not quote 1868, you merely quoted 1869, in which you stated that it was 26-22, and then going to 1878, yoit stated it was 26-64, and therefore that there was an increase on 1869 ? — Yes. B 4 307. Are 16 MINUTES OF EVIDEKCE TAKEN BEFORE THE 2 Blarch 1881.] Dr. KouTH. [ Continued. Sir Henry Wolff — contlmiecl. 307. Are you aware that in that interval the short service came in by which the men coming into the Army were much younger ? — No, I was not aware of that. 308. Assuming it as a fact that a younger class of men came into the Army, would not that account for the small increase between 26"22 and 22-64, inasmuch as you say the young men are more liable to infection than older men ? — You see we are speaking of secondary syphilis ; and while it is indubitable that the younger men ■would be more likely to catch primary syjihilis, I am not sure that I could say that they would not be more easily cured of the secondary. 309. But then I have already shown you that there has been a large diminution in the primary sores between some years by Table No. 4? — But you would infer that the diminution had something to do with Lord Cardwell's Order that you have been speaking of. 310. When was the Order?— In 1873. 311. But between 1869 and 1873 there was already a diminution before the Order came in from 78-72 to 68-94 ; it is already a diminution of 10. Do you think that diminution is attri- butable to the Acts ?— it might be, but I do not see that so small a diminution can be necessarily put down to one thing more than another. Suppose, for instance, the disease was better treated. 312. I am merely asking the question? — I said it mio-ht be that, but it might be from some other cause. I find so often in comparing different districts that in one there is a great deal of syphilis, and in another very little, and the Acts exist in both ; why is it so ? 313. Are you aware that between the years 1869 and 1873 the strength of the Army was con- iderably increased, from 73,000 to 88,000?— f am aware of the fact. 314. Therefore I wish to j)oint out that in the year 1869 when tlie ratio for primary disease was 78-72, the strengtli of the Army was only 73,000, whereas in 1872 when the ratio had decreased to 94, the strength of the Army was9i;,218 ? — It • Sir Henry ?^f'oZ^— continued. is really very difficult for me to answer that ques- tion. 1 do not know the contingent circumstances imder which this increase of the Army took place ; supposing it had taken in a large quantity of bad characters there must necessarily have been an increase; but, if on the contrary, there was not an increase of bad characters, there would be neces- sarily a decrease. 315. Then you think the decrease of the ad- missions for primary venereal sores, between 1869 and 1S72, notwifhstanding the increase of the Army, depended on the character of the 12,000 additional men brought in, and not upon the Acts? — Yes, and I do not know that the Act could produce that change. 316. May I ask if you have studied the sta- tistics very carefully ? — I have stated before that I was broadly familiar with them, but of course latterly I have not looked at tlie subject so verj^ closely. 317. You have read papers on the subject? — Yes. 318. And you have read these i:)apers at Bii-- mingham and elsewhere without studying the statistics? — Oh, no, I have looked at these perhaps not as closely as I would if I had been aware that you were going to cross-examine me in this way. When I read papers on the subject I always took a general view ; a general view of the tout ensemble. 319. I think you said at the beginning of your evidence, that the medical gentlemen who were in favour of the Acts were in favour of them because they were of a conservative tendency, and had not studied the question sutBciently ? — I never stated that ; I said a great number of medical men who were in favour of the Acts had not studied the ciuestion. 320. May I ask if you have studied the statis- tics? — I have studied them as well as I could in the time I had. 321. You studied them sufficiently to enable you to instruct the public by reading a paper at Birmingham on the subject? — I thought so. ExPLANATOUY NoTE to Reply to Question 314. There is absolutely no correspondence between tlie increase of the army and the increase of venereal disease, and vice versa. (^Ve Table by Director General iVluir, p. 68, Report, 1880.) The only exception to this statement is in the first year, 1860. The following years especially illustrate this conclusion: — 1864, increase of army was 4,579, with a fall in cases of disease of 1,527 ; 1870, increase of army 12,574, decrease in disease 1,250; 1871, decrease of army 1,026, increase of disease 3,430; and 1874, increase of army 3,446, and decrease of disease 3,023. SELECT COMMITTEE ON CONTAGIOVS DISEASES ACTS. 17 Monday, 7th March 1881. MEMBERS PRESENT : Mr. Cavendish Bentinck. Mr. Burt. Mr. Cobbold. Colonel Digby. Mr. William Fowler. Mr. Hop wood. Mr. Massey. Mr. Osborne Morgan. Mr. O'Shaughnessy. Mr. Stansfeld. Colonel Tottenham. Sii- Henry Wolff. The Right Honourable W. N. MASSEY, in the Chair. Dr. Drysdale, called in ; and Examined. Mr. Stansfeld. 322. You are a Doctor of Medicine ? — Yes. 323. A member of the Royal College of Physicians ? — Yes. 324. And a Fellow of the Royal College of Surgeons ? — Yes. 325. Do you hold the appointment of Senior Physician to the Metropolitan i'ree Hospital ? — Yes. 326. Are you physician to the Lock Hospital of the Rescue Society ? — Yes. 327. Where is that?— At Hampstead. 328. Have you made venereal diseases a some- what special study ? — I have. 329. And yo'i are, I believe, the author of various works upon the subject? — I am. 330. Have you acted as honorary secretary to the Harveian Society Venereal Diseases Committee ?— I did in 1867. 331. Were you a delegate from that society to the International Medical Congress held in Paris in 1867? — I was. 332. I believe you had been examined as a witness previous to that date upon this subject ? — I have been examined two or three times before Parliamentary Committees. The first occasion was in 1866. 333. I forget whether you were examined before the Royal Commission ? — I do not remem- ber. I have been examined twice before. 334. I presume that I am right in assuming that you have given a careful consideration to the operation of the Contagious Diseases Acts in this country ? — I have. 335. From what point of view ? — A strictly professional point of view. 336. From a hygienic point of view ? — Entirely, with regard both to venereal diseases and syphilis. 337. In so doing you have, I presume, more or less examined the Army Medical Statistics and Reports ? — Yes, I have read them very regularly and very carefully year by year. 338. With the view of considering and ascer- taining what effect the Contagious Diseases Acts have had upon the health of the Britieh Army ? — Yes. 0.44. Mr. Stansfeld — continued. 339. Now let us go to that subject, the effect upon the health and efficiency of the British Army of the Contagious Diseases Acts. Some differ- ence of opinion has made itself evident as to the classification of diseases in the Army Medical Reports : will you give the Committee the bene- fit of your view as to the proper classification of the various venereal diseases ? — I think that the diseases that we meet with may be divided into gonorrhoea, true primary syphilis, soft sore, and then, lastly, occasionally a mixed sore, one that migli t give syphilis and might present also a so ft sore. 340. Would you kindly give us a sufficient description of these various kinds of venereal disease to enable the Committee to distinguish the one from the other, as far as your professional information enables you to do so ? — I suppose I need not go into a description of gonorrhoea. True primary syphilis appears always in the form of some small lesion at the point that was infected. It appears about a month after the person has had intercourse with the other sex, very rarely much less than a month. It is usually painless, fre- quently a little indurated ; so that when you take it between your fingers you feel a little in- duration, sometimes like cartilage, sometimes like a hard lump. In the male sex you invariably find the glands of the groin enlarged about the size of an almond, for instance, and you find in addition to that that the character of the sore is usually of a brownish ham colour. It is very apt to bleed. It is slightly ulcerated and does not eat away the tissues at all. Sometimes it is exceedingly insignificant, so slight that you can hardly know whether there is a sore or not, a mere gate for the poison to enter the body. That is the case especially and ver}- frequently in the female ; it is so very slight as often to escape detection. Secondary syphilis invariably fol- lows the first sore : the first sore is, as it were, the prelude to the constitutional, when- ever you have one you must have the other ; they usually precede each other by a few- weeks. There is no such thing as a pri- mary syphilis without a secondary syphilis. The first sore appears at the end of a month, the C second 18 MINUTES OF EVIDENCE TAKEN BEFORE THE 7 March 1881.] Dr. Drtsdale. [ Continued. Mr. Stansfeld — continued, second appearance will make itself manifest in about six weeks afterwards, either in the form of a slight measly eruption on the chest or abdomen or in falling of the hair, slight sore throat, inflam- mation of the eyes, iritis, and then eruption of different kinds on the body, pustules or scales. The glands of the body get enlarged, behind the ears, in the back of the neck, in the groin, and elsewhere. Then, of course, you have tertiary syphilis, which may occur in 8 or 9 per cent, of all cases of syphilis. That again affects the throat, and will eat away the soft palate or destroy the nostril or produce ulceration all over the body or cause paralysis or many other lesions. 341. You have described secondary or constitu- tional syphilis, and you have stated that that is aninvariableconsequenceof true primary syphilis? — It is invariable ; the one cannot occur without the other. 342. Primaiy sy[)hilis cannot occur without being followed by some secondary symptoms? — Secondary symptoms cannot occur, except in the case of an infant, without the primary syphilis. 343. You mean every person who has primary has secondary syphilis ? — In fact, that he has syphilis; everybody who has primary syphilis has syphilis. Sir Henry Wolff. 344. Does that mean that primary syphilis is inevitably followed by secondary syphilis? — Yes. Mr. Stansfeld. 345. I want to draw attention to this fact, that an opinion was expressed on the last occasion that we met, by a witness before us. Dr. Rouih, to this effect. He was asked by the Judi;e Advocate if they had reduced primary syphilis by leading to the cure of primary sores, and whether it would not follow that that would prevent secondary sypihilis; the answer is, "Indubitably, if you could cure every case. (Q.) Pro tanto to the extent which they enable medical men to cure primary syphilis they prevent secondaries? (^.) Certainly. {Q.) Therefore, if the primary syphilis is effect- ually cured, no secondary syphilis would follow. (^.) Certainly." That is the difficulty; I under- stand you, from your study of this question, and your special experience, to say that i^rimary syphilis is syphilis ? — Primary syphilis is syphilis already. 346. And that there is no such thing as syphilis without constitutional derangement, and those constitutional affections which go by the name of secondary syphilis ? — No such thing ; it is impossible. 347. I suppose it is natural to presume that the earlier you take in hand a case of true syphilis the more likely you are to deal benefi- cially with it by medical care and treatment ? — Precisely. 348. That, I presume, is true, but your opinion amounts to this, that though you may modify and diminish the subsequent consequential secondary symptoms, they will inevitably occur ? — That is precisely my conviction. I now come to the pseudo-primary syphilis, or what has been called chancroid, or what I think is better called Eoft sores. The soft sore has nothing whatever to do with syphilis. It is as different from true syphilis as a leopard is from a dog ; they have nothing to Mr. Stansfeld —continued, do with each other; they are utterly distinct. The soft sore iu its appearance is entirely dif- ferent from the hard ; it is an ulcer which eats away the tissue superficially. It has no period of incubation. If I take a little pus on a lancet from a soft sore and inoculate myself on the chest with it, if I take a magnifying glass and examine it 24 hours afterwards, I find that the ulcer has already commenced ; it will go on and will be apj)arent in the course of three days. There is a small eating away of the tissues ; hence you see it is entirely different from the hard sore. Then the characters of the soft sore are entirely different from those of the hard sore. If you look at it you will find that it has got a red margin the same as if you dipped your brush in carmine and painted round the margin of the ulcer ; the floor of the ulcer is greyish in appearance, not as it was in the hard, reddish or ham-coloured. Then it is not as the other was, raised above the surface, but always cuts into it, as if you punched it out with a punch. A person may have a thousand soft sores during lifetime, but they never have more than one hard sore ; that is to say, I have seen patients who have had several hundred soft sores on their body, because they have been treated for syphilis by the so-called syphilisation; but I have never seen in any person a second attack of a hard sore. A person may have two or three hard sores at the same moment on the body, but he might have any number of soft sores during his life, that is to say thousands. A friend of mine in Paris, M. Auzias Turenne, inoculated himself from head to foot with soft sores, in order to make experiments upon himself. He never mentioned it to anyone during life, but when he died he was found to be a mass of scars fi-om head to foot. During the whole of that time he had never once inoculated syphilis upon himself. Again, a c^ise occurred in Norway, where a man had leprosy, and this man having leprosy, my friend. Professor Boeck, thought that he would, perhaps, do him good by inoculating him with soft sores, and so this jooor leprous patient was inoculated with soft sores, perhaps five or six hundred times ; but he never got syphilis during the whole time. They then inoculated him with the product of a hard sore, and it was immediately followed by syj)hilis. You will see, therefore, that the hard sore has no more to do with a soft sore than a cat is like a dog. They are a different species, and have nothing to do with each other. 349. Then you hold very distinctly what we have called the dual theory, with regard to venereal poison ? — I hold that it is now jjerfectly made out ; there is no doubt of it whatever. Mr. Osborne Morgan. 350. Do I understand you to say that a hard sore must, in all cases, be followed by secondary symptoms ? — Decidedly, and without any doubt. 351. Is a hard sore incurable to this extent, that it must be followed by secondary disturb- ance ? — Precisely ; it is syphilis already. Mr. Fowler. 352. You merely mean to say that is the commencing symptom of the disease ? — The hard sore should be called the first symptom of syphilis. SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 19 7 March 1881.] Dr. Drtsdale. [ Contin ucd. Mr. Fowler —coniinxxzA. syphilis, and the other should be called a soft sore ; it should have something to distinguish it, for they have nothing to do with each other. Mr. Stansfeld. 353. Then you are a dualist, as far as the unity or dualism of the venereal poison is con- cerned ? — Yes. 354. You will see in the Report of this Com- mittee, in 1879, at pao-e 137, and Question 2864, Surgeon Myers, of the Coldstream Guards, has this question put to him, — " There is only one question I wish to put to you upon the character of the disease. You have stated in a most positive way that there is only one syphilitic poison ; and in a subsequent answer you made the admission that medical opinion was, to say the least, divided upon that subject ; do you adhere to this positive statement upon that which is simply a matter of opinion ? A. 1 think it is accepted by many of the leading men of the profession who have studied the disease ; I could mention several, but I will mention one, as he has taken a very prominent part in relation to this disease of late j'eai-s. He has actually asserted that the doctrine or idea of the duality of syphilis is dead ; I refer to Mr. Jonathan Hut- chinson. Q. (2865) Have you got any quota- tions from him with you ? A. 1 have not it here, but I think you will find it in the Report of the Pathological Society's Transactions in 1876, when he broui;ht forward a discussion on syphilis before that society, at which I think all the Englishmen who had studied this disease specially gave their opinions ; it was a very remarkable discussion upon the subject of syphilis. He brought for- ward, and either then or subsequently he has asserted that the doctrine of duality of syphilis is dead. I could mention several names, if you wished it, of leading men ; and I think it would be advisable to do so." He mentions the name of Sir William Fergusson. I said, " Would you kindly refer me to what those persons stated ? He says, " I think you will find it all stated in the discussion to which I have referred," and then he mentions certain names. I want to draw attention to those names. Mr. Myers mentions the names of certain medical men as uuicists, to use a phrase which I think he used, and those names were brought before us in a way which led me to suppose for a moment that all these gentlemen took part in the discussion, but that is not the case, is it ? — I do not think any of these gentlemen, except Mr. Hutchinson, took part in the discussion. 355. I take it you do not agree with Surgeon Myers in his statement that belief in dualism is practically dead? — I think the other opinion is entirely dead. 356. In your opinion the unicist theory has very nearly died out, and the general opinion, with the exception of Mr. Jonathan Hutchinson, is the dualistic? — I think all men of note, with the exception of Mr. Jonathan Hutchinson, entertain that view. 357. Let me take the list of eminent men men- tioned by Surgeon Myers. He begins with Sir William Fergusson. He is no longer living ? — No. 358. Mr. Syme ? — He had been dead a long time. 0.44. Mr. Stansfeld — continued. _ 359. Dr. Acton?— He had been dead a short time. 360. Mr. Holmes Coote ?— He has been dead five or six yeai-s. 361. Was Mr. Holmes Coote a member of the Royal Commission ? — Yes. 362. Is it within your knowledge that the result of the evidence taken before the Royal Commission on his mind was such that he subse- quently became a member of the Committee for Promoting the Abolition of the Contagious Dis- eases Acts ? — Yes, I remember it. He was surgeon to St. Bartholomew's Hospital. 363. And he became a member of the com- mittee of the National Association for the Repeal of the Contagious Diseases Acts ? — He did. 364. Then there was Mr. Busk ; is he still living ? — I really do not know. 365. Mr. Samuel Lane? — I think he is dead. 366. Mr. Grascoyne ? — He is dead. 367. Mr. >olly ? — He has been dead for a long time. 368. Then I find in that list the names of Mr. Longmore and Mr. Spencer Wells. Is it clear that those gentlemen were unicists ? —I think they were dualists, as far as their expressions go. 369. Can you refer to any statement of their views upon that subject ? — Mr. Spencer Wells, in the Report of the Committee appointed in 1864, in reply to Question 1326, says this, " I am not aware of any syphilitic sore that does not affect the constitution. I have been in the habit of observing three classes, the soft, the decidedly hard sore, which I would class among sores with thickening, scarcely amounting to induration ; and the simple sore, which does not produce any constitutional disturbance at all." Mr. Osborne Morgan. 370. Would you adopt that classification your- self?— No; I only adopt the soft sore and the hard sore. Mr. Stansfeld. 371. The point of my question is this, — Mr. Spencer Wells was cited by Surgeon J\lyers as being a unicist, and you cite those answers to prove him a dualist ; now we come to .Mr. Long- more ? — I have here a quotation from Mr. Long- more, Professor of Military Surgery at the Army Medical School at Netley. He says, be- fore the Venereal Commission, " My opinion very strongly is, that the term ' syphilis ' should be restricted entirely to those sores which are followed by secondary symjjtoms." 372. And you infer from that statement that he believes in the existence of sores which are not followed by secondary symptoms, and which are, therefore, not syphylitic? — Yes. 373. Therefore, in the list of names quoted by Surgeon Myers, I understand you find the large proportion of the names of eminent men are names of persons who are dead, and the two names, Mr. Longmore and Mr. Spencer Wells, as you think, are inaccurately quoted ? — I do. 374. At the time that these eminent men lived and expressed these opinions, was there any man considered to be the most eminent au- C 2 thority 20 7 March 1881.] MINUTES OP EVIDENCE TAKEN BEFORE THE Dr. Drysdale. [ Continued, Mr. Stansfeld — continued, thority upon that subject? — There was one you all know, I have no doubt, by name, and that is, the great physician, Ricord. of Paris. 375. He was originally a unicist ? — M. Ricord was, until 25 ^^ears ago, a unicist, when he was converted by a pupil of his of the name of Bas- sereau, who first discovered that syphilis always came from syphilitic patients ; that a person who had syphilis had always caught it fi'om another person who had syphilis. When he found a patient had got a liard sore he went to the person who had given it him, and found that they had either a hard sore or secondary syphilis ; and when a person had a soft sore he went to the person who had given it to him and found that they had always had a soft sore ; consequently he showed M. Ricord the fact that one disease never gave the other, and M. Ricord, after having been all his life a unicist, then be- came, and has been since, a dualist. 376. Will you explain what you mean by distinguishing between a person who has a hard sore and a person who has syphilis ? — ^What I mean is this, that Dr. Bassereau found a person with a hard sore in the Hopital de Midi ; he got that person to tell who it was gave it to him, and went and examined this person, and found always that she had either had secondary syphilis, that is, eruptions, and what are called mucous tubercles, or else that she had the same lesion that the patient was suffering from, that is, a hard sore. 377. The difference between the two cases is that the hard sore might have passed away and given place to what you call secondary symptoms? — Secondary symptoms, M. Ricord did not know at first to be contagious, but they are now known to be very contagious. 378. Is that change of (-pinion of M. Ricord mentioned in any English work ? — I do not know that it is, but it is universally known to all of us. 379. I think it is mentioned in Mr. Berkeley Hill's work?— It is Mr. Berkeley Hill, in a work written by him in 1868, who says : "Ricord, nearly 30 years ago, completed Benjamin Bell's proof that gonorrhoea had no connection with syphilis. In 1858 he acknowledged himself convinced by the arguments of his former pupil Bassereau, that there are two kinds of contagious venereal ulcer, one of necessity a part of general or constitutional syphilis, the other but a local disorder, without any general action on the system." Mr. Hill adds ; " The views of Bassereau have received attention in all countries, and are pretty generally adopted. 380. Mr. Hill is well known as a dualist ? — Mr. Hill is very well known ; a most eminent writer on the subject. 381. Will you furnish us with extracts from some leading authorities of the day in support of your proposition that the best medical opinion of the day is in favour of the dualistic theory ? — In the first place the Venereal Commission of 1865, page 14, section 2, lines 8 to 13, say, "In reference to this subject the first question arises, can the poison which produces the local sore be identical ^^ ith that which produces the syphilitic sore? The term 'syphilitic' cannot be applied to a sore which exhausts itself in its local actions Mr. IStaiisfeld — continued, and does not become the parent or precursor of syphilitic disease." In lines 23 to 27 they saj', " Presuming the local sore therefore to belong to a different class of disease, if it be placed in juxtaposition with any of the varieties of the syphilitic sore, the Committee have no alterna- tive but to express their belief in the non-identity of the two poisons." The next quotation is from Professor Bumstead, of New York, a very well known man. He says in his fourth edition, published in 1879, page 17, " We claim that the distinct nature of the chancroid and syphilis is a question already settled in the affirmative as recognised absolutely by the great majority of the profession, and as recognised practically by all, with a few exceptions." Professor Aitken says in his " Science and Practice of Medicine," vol. 1, p. 868, 6th edition, " The present period in the history of syphilis." " Its commencement is of very recent date, since 1856; and is characterised by a belief in the duality of the venereal verus exclusive of gonorrhoea. The surgeons of Lyons, Rollet, Diday, and Viennois, Mr. Henry Lee, of the Lock Hospital, and Mr. Henry Thompson, of University College Hospital in London, Hubbenet of the Syphilitic Clinique at Leipsic, Sigmund of Vienna, and Von Baarensprung wf Berlin, are those who, by experiment and careful observation, have thrown most light on this remarkable disease. In addi- tion to the specific virus of gonorrhoea (which may be eliminated as distinct from those about to be noticed), these observers recognise two forms of venereal disease, distinct in their oi'igin, pro- pagation, and development. They recognise specific differences in the mode of development, and in the sequence of phenomena which distin- guish an 'infecting ' and a ' non-infecting ' sore. They have shown that the sore which eventually contaminates the system commences differently from the sore which does not affect the system." At p. 867, he says " It has been a subject of discussion, whether these several affections are due to one and the same virus, whose action is modified by admixture with secretions, or by peculiarities of constitution on the part of the recipient; or, whether a separate specific poison exists for each form of venereal disease. This latter alternative is now proven to be true." Lanceraux, of Paris, who is well known as a great writer, in his Treatise on Syphilis, vol. I., pp. 107-8, says, " It is notpi-oved that a genuine soft chancre has been in any case the initial lesion of constitutional syphilis. It is not proved either that this same affection has ever transmitted an indurated chancre and syphilis. We shall continue to believe that the list of syphilitic dis- ease should comprise three orders of disease, three distinct species, if we may so speak, which are — gonorrhoea, chancre, and syphilis." On pp. 120-1, he gives the distinguishing characteristics. 382. By chancre he means soft chancre? — Yes. Mr. John Barton, of Dublin, of the Lock Hospital, says, in his work on The Pathology and Treatment of Syphilis, p. 24, " The conclusion to which we arrive is that there are three varieties or species of venereal disease, gonorrhoea, simple or chancroid sores, and syphilis, each of which, however complicated with other diseases or influenced by the health or habits of the patient. SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 21 7 March 1881.] Di-. Dktsdale. [ Continued. Mr. Stansfeld — continuefl. patient, remains distinct from the other ; each produced by a peculiar irritant or poison, repro- duces that poison, and is thereby capable of com- municating the same form of disease. That in no case can one of these species be produced by any other, although they may all exist in the same patient at the same or different times. Further proof than that already given of the truth of this distinction will be affdrded by the study of the special characters of each variety, the difference between them being more dis- tinctly marked as the symjjtoms, natural causes, complications, and suitable treatment of each is examined and contrasted." Mr. Berkeley Hill, in his work which I have just quoted, " SyjDhilis and Local Contagious Disorders," says, " liicord, Rollet, Cullerier, and others, all belong to this school. Ricord, nearly 30 years ago, com- pleted Benjamin Bell's proof that gonorrhosa had no connection with syjthilis. In 1858 he ac- knowledged himself convinced by the argument of his former pupil, Bassereau, that there are two kinds of contagious verereal ulcer : one, of necessity, .a part of general or constitutional syphilis ; the other but a local disorder without any general action on the system. The views of Bassereau have received attention in all countries, and are pretty generally adopted ; " and on page 20 he says, " Contemporary autho- rities, we find, hold syphilis to be a specific dis- ease, produced solely by contagion." On page 24 he says, " The view adopted in this book holds the principle pi'oducing the local contagious ulcer to be distinct from that producing true syphilis." Dr. Achille Vintras, physician to the Trench Dispensary, says, " I believe in duality." In answer to Question 5254, Venereal Commis- sion : ■' What are the grounds upon which M. Bassereau, and subsequently M. Fournier, came to the conclusion that there are two viruses " ? he replies, " Because both they and Messrs. Clerc, Diday, Rollet, and Guerin have established that if the two chancres were different in their species, they were also in their origin, since in all cases where a positive diagnosis had been made they always reproduced themselves in their own form, the one never becoming the origin of the other ; hence their belief in the existence of a double virus. Mr. Thomas Longmore, Professor of Military Surgery at the Army Medical School, Netley, says. Venereal Commission, 9245, " My opinion very strongly is, that the term 'syphilis' should be restricted entirely to those sores which are followed by secondary symptoms." Mr. Langston Parker, who is a well-known authority, who died a few years ago, in his Modern Treat- ment of Syphilitic Diseases, pp. 12,S-124, says, " Two great classes of primary syphilitic sore are met with in practice, differing widely from each other in their appearance, their symptoms, their complications, their effects on the economy, and the influence of remedial agents upon them. Both these classes of sores are due to the action of a specific poison." Mr. Foioler. 383. Is that Mr. Longmore the same gentle- man mentioned by Mr. Myers ? — Yes. Dr. Patrick Watson, a well - known surgeon of Edinburgh, says on the Venereal Commission, 0.44. Mr. Fowler — continued. Question 4643 : " I divide them into hard and soft, these two forms being synonymous with constitutional and local. Q. 4649. Have you seen secondary disease frequently, or occasionally follow a soft sore and a suppurating bubo"? A. I have seen it accompanying it in rare and exceiJtional instances, but in all" the instances where I have met with such a sequence, I have either so far doubted the accuracy of the diagnosis, or have believed from further investigation, that an indurated sore pre-existed or supervened on the date of the soft chancre. Q. That would be based on previously formed opinions ? A. A^o, upon personal observation. Q. You have a soft sore which is followed by a secondary disease ? A. Which is accompanied by secondary disease. Q. Would you not say followed; are they con- current? A. Followed, implying sequence of time, I admit, but not as cause and effect." Mr. Stansfeld. 384-5. Therefore I am right, I presume, in in- terpreting your opinion to be that the largest preponderance of medical opinion is in favour of the dualistic theory ? — All the men of any authority on the subject, with the exception of Mr. Hutchinson in this country, are of my opinion, and in Paris ; I know the Parisian men very well, and Paris is supposed to know more about syphilis than any other city ; they are Avithout exception dualists. Mr. Osborne Morijan. 386. Assuming this dual theory that you have pro- pounded, and given a case of an indisputably hard sore, treated under the most favourable circum- stances ; that is to say, discovered at once and immediately most skilfully treated ; would it be possible, in your opinion, to prevent that hard sore being followed by constitutional disturb- ance ? — Impossible. 387. The moment a man is once affected by hard sore, that man necessarily, notwithstanding the best possible treatment, becomes subject to constitutional symptoms ? — Whenever 1 see a patient who has a hard sore, I say, '' You will inevitably have other symptoms." 388. Is science powerless to prevent a hard sore developing into constitutional disease ? — • Perfectly. 389. You say that positively ? — I say that positively. Mr. Fowler. 390. You do not mean powerless to moderate it ? — I say it may modify it, but it cannot pre- vent it ; the wolf is already in the fold. Mr. Osborne Morgan. 391. The man has already constitutional dis- ease ? — The man has already syphilis. 392. And no treatment will prevent that man or woman from becoming afterwards the victim of constitutional disease ; is that so ? — I say that they have it already ; it will be followed by either grave or slight symptoms. 393. Though it would be followed by consti- tutional disease, still I assume you would say, if taken in time, the severity of the constitutional disease would be very much reduced? — Precisely C 3 394. Would 22 MINUTES OF EVIDENCE TAKEN BEFORE THE 7 March 1881.] Dr. Drtsdale. \_Continued. Mr. Hopwood. 394. Would you give us an example of the mildest form of constitutional derangement which you conceive would follow this hard sore ; I want to know about the most modified proof to your mind of the existence of constitutional disturb- ance ? — Among young people, such as I have in my hospital at Hampstead ; healthy young women of the ages of 17, 18 or 19, syphilis is often a vei-y slight affair; a little falling of the hair, a few eruptions on the body, a slight sore throat. Mr. O'Shaughnessy. 395. Do you mean all these together, or any one of them ? — Any one of them ; a very slight thing ; a few glands behind the neck enlarged ; a little falling off of the health ; a very few things worth mentioning. Mr. Osborne Morgan. 393. Those are cases where the patient gets proper treatment? — I am very much obliged to you for saying it. Mr. Hopwood. 397. In those cases where those slight consti- tutional symptoms appear, have you any reason to believe that by treatment they can be cured, so that there is no rational fear of a recurring attack later in life ? — I should not be in the least surprised to see any of those patients ten years afterwards with paralysis. ^Syphilis is so uncer- tain, that if you have the slightest attack of it, it may kill you in the long run. If a person has had syphilis at the age of 18, they may die of it when they are 60. Mr. Stansfeld. 398. In order to avoid confusion, I should like to go back to your classification. There is one heading of venereal disease upon which you have given us no explanation yet, the " mixed vene- real sore"? — That is a very important case. It will often happen that men are not very par- ticular as to the persons they consort with, and the consequence is that they will get at one time two poisons; they may get a soft sore and a hard sore together. They may get a soft sore and syphilis together. Hence, what will follow is this : supposing a man has connection with a woman who has syphilis, and at the same time has a local affection called a soft sore, in two or three days he will have a soft sore, and in a month afterwards he will have a hard one. 399. And they may be upon the same spot? — ■ They would often be upon the same spot, because that was the point that was scratched in some way ; that was the gate of the poison. The soft sore would appear in three days, and it might be cured, and in a month afterwards you would see a hard lump appearing, which is the syphilis be- ginning to show itself. Mr. Osborne Morgan. 400. The two diseases are compatible ? — Per- fectly so. The three are compatible : gonorrhoea, syphilis, and soft sore. They may all be in the same person, and often are. Mr. Stansfeld. 401. Therefore, in your opinion, the soft Mr. Stansfeld — continued, chancre does not develope into the hard chancre, but it may be accompanied by a hard chancre ? — Precisely ; a soft chancre never becomes a hard chancre. 402. And you would attribute the opinion, in some men's minds, that the soft chancre might become real syphilis, to the existence of a mixed , venereal sore ? — Precisely. 403. With reference to the question put by my right honourable friend, the Judge Advocate, to Dr. Pouth the other day, though your opinion is that true syphilis must be followed by secondary symptoms ; that is to say, true syphilis takes a certain time to develope symptoms of that disease, still, you have said that the gravity of those ulterior symptoms and conditions may be very much modified by early and successful medical treatment; that is your opinion? — Yes. 404. Now, applying that opinion to the con- dition of the Army, would you not naturally and logically infer that the early examination of men would be very desirable? — Precisely so. 405. If the object is to protect the men of our Army and Navy from the inroads of consti- tutional disease, the logic of that case is, that you should examine them at the earliest possible stage and treat them ; is it within your know- ledge whether that is or is not done in the Army ; if not, I can bring it within your knowledge, because we have it in evidence before this Com- mittee ; all the members of this Committee have not been on the Committee from the first, and therefore it might be as well that I should refer you to it ? — I know that they have given up ex- amining the soldiers in the Army. 406. It is perfectly clear that this veiy neces- sary precaution of an early examination of the men is not by any means universally adopted in the Army ; that is, within your knowledge ? — That is within my knowledge. 407. But now, as to the liability of the men to take constitutional disease from women, that must de|)end upon the condition of the women with whom they consort? — It must. 408. And therefore the pertinent question is the condition, in point of disease, of the women rather than of the men ; will you take in your hand this public document, the " Annual Police Report upon the Contagious Diseases Acts for the year 1879," and will you tell me the pro- portion of disease amongst the women from the year 1870, when the Acts came into full operation, down to the present day ; you will find it in column 31, page 5? — The heading is, "The Annual Ratio per Cent, of Cases of Disease Cal- culated on the Average Number of Women on the Register." In 1870 I find the proportion is 148'25 per cent. 409. That is as nearly as possible 150 per cent. ? — Yes. 410. And am I quite correct in saying the meanins; of those figures is that, upon the aver- age, every woman upon the register is returned as diseased one-and-a-half times a year ? — That is the meaning of it. 411. Now go to 1871 ?— In 1871, the propor- tion is 135; in 1872, 146; in 1873, 141; 1874, 137; 1875, 127; 1876, 129; 1877, 148; 1878, 153; 1879, 162-55. 412. Therefore, there is no evidence of diminu- tion SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 23 7 March 188 J.] Dr. Drtsdale. [^Continued. Mr. Stansfeld — continued, tion of disease amongst tlie registered women between 1870 ard 1879 ; but in the latter years there is a sliglit increase ? — Yes, there seems to be an increase. 4 13. Tiie statistics do not enable us to classify the diseases, to say what proportion were syphilis and what proportion were not? — No, there is no classification. 414. I presume from the evidence which you have given that you do not approve of the classi- fication of venereal diseases in the Army Medical Reports? — I hardly like to say how much I disapprove of it ; tliey almost seem to me to make the Army Medical Reports of no use what- ever. 415. What is the classification in the Army Medical Reports? — They put primary sores, which, as you see, mean tiiese two sores that I have mentioned, which have notliing to do with each other; tliey put them all together as if they were the same thing. 416. And that classification of two utterly un- connected and very diflPerent diseases under the same head of primai-y sores, you hold to be an unscientific classification? — I think it makes the Army Medical Reports of no use whatever ; the Frencli people would not understand them at all. 417. The Continental classification is between what is local and what is constitutional? — Yes; in all Parisian hospitals they are distinguished. I hold in my hand a number of tables connected with the Hopital du Midi, and they entirely separate them. 418. You know what have been stated by official witnesses to be the objects of the Conta- gious Diseases Acts /^ — ^Yes; to prevent conta- gion amongst the soldiers and sailors of this country. 419. First of all, to reduce those diseases ; and another object was to increase the efiiciency of the Army and Navy? — That was so. 420. With regard to these objects, how should you test the usefulness or inutility of the Acts with reference to such a disease ? — I should like to know whether they have done any good to syphilis. 421. With regard to gonorrhea, it is admitted that no effect worth discussing has been pro- duced by the Acts? — My impression, from all that I have studied upon the subject, is, that no one contends that gonorrhoea has been in any way affected. For instance, it is stated in the Minutes of Evidence of 1879 that " There was very little diminution, according to the return, up to 1868 " (priacipally before the Acts); Minutes of Evi- dence, Select Committee. Then it says, " The average ratio of admissions for the eight years from 1865 to 1872 was higher at the protected than at the unprotected stations." 422. You are quoting from the Army Medical Report, 1872 ?— Yes. And then, thirdly, " There is reason to believe that the fall in the rate of admissions for gonorrhoea in 1873 is connected with the issue of the Royal Warrant . . directing that the pay of soldiers admitted into hospital with venereal diseases should be for- feited during their stay there " (Army Report, 1873, p. 3, lines 18-21 ; see also Army Report, 0.44. Mr. Stansfeld — continued. 1874, p. 1, lines 23 and 24 ; and 1877, p. 16, foot- note, " Stoppage of pay in force "). From all that I have seen and heard, I believe it is generally admitted that gonorrhoea has not been affected in any way whatever. 423. As to the alleged reduction of syphilis in the Home Army, the Army Medical Heports give you the reduction in primary sore-s ; but you have told us, have you not, that there is no evi- dence of the reduction of syphilis ? — Nothing whatever to do with it, except in so far as it hap- pens to make that unparalleled mistake of con- founding the two, hard and soft. 1 do not know who is responsible for it ; but the person ought to be reprimanded. 424. Taking the reduction in primary sores, syphilitic or unsyphilitic, for whatever it may be worth, do you think it is fair in a scientific sense to make a comparison between the 14 sub- jected districts and the 14 selected unsubjected stations ? — No, I noticed that ; and I think that was vei-y well answered by my friend Dr. Nevins, in his Report, in which he says that you cannot possibly compare a large city like London with some small protected stations, such as Shorncliffe. They are not comparable, because in the one case you have a large population where women go about and can easily contract disease, and in the other you have a small country station. 425. Have you a list of those stations, sub- jected and unsubjected, with the proportion of admissions for primary sores ; they are in evi- dence before this Committee at p. 49 of the Re- port for 1880?— Table No. 6 says, "The 28 selected stations, arranged in the order of average ratios per thousand admissions for primary vene- real sores, from 1867 to 1877 inclusive." 426. Will you give me what are the two sta- tions in which there is the lowest annual average projDortion of admissions for primary venereal sores i^er 1,000 ? — ^Athlone seems to be very low, 30'4 ; and the next is Pembroke Dock, 30'9. 427. And those two lowest stations are non- subjected? — They are marked as not subjected. 428. Will you turn to the column to the right and compare Windsor, which is a subjected sta- tion, with II ounslow and the Isle of Wight, which are non-subjected? — Windsor is 76 per 1,000; Hounslow 66 ; and the Isle of Wiglit 72 per 1,000 ; so that Windsor is higher than the other two. 429. It is when you go to the large town and city populations that you come to the large figures and the large proportions ? — Yes, that is so. 430. And those proportions are so immensely larger as to very much disturb what would other- wise be the balance between one station and another ? — It is the very large towns like Man- chester, Dublin, London, and Sheffield that disturb the whole calculation. 431. And if you were to eliminate those large towns as not being a fair subject of comparison with camps or arsenals under strict military dis- cipline, you would entirely alter the comparison between those two classes of stations ? — That seems exactly as you say. 432. As the Army classification of primary sores does not distinguish between those which are C 4 syphilitic 24 MINUTES OF EVIDENCE TAKEN BEFORE THE 7 March 1881.] Dr. Detsdale. \_Continued. Mr. Slansfeld — continued, syphilitic and those which are not, you must have recourse to the statistics of secondary syphilis ? — That is the only way in whicli I. can see that you learn anything about it. 433. What do those figures tell us about the effect of the Acts upon secondary syphilis ? — In my table tiiey shew that from 1860 to 1865, the average rate per 1,000 for secondary syphilis was 31 "74 ; and between 1866 and 1871, the average rate per 1,000 of admissions for secondary syphilis was 2526. Mr. Osborne Morgan. 434. Where do you get that? —Calculated from Table No, 4, p. 48, Report of Select Com- mittee, dated 10th March 1880. Mr. Stansfdd. 435. Have you worked out the average ratio per 1,000 of so-called jirimary sores during the first period from 1860 to 1865 ? — There were then 104-75 in 1,000. 436. Therefore between 18G0 and 1865, before the Acts, you have a proportion of 104 for pri- mary sores, and 31'74 for secondary svphilis? — Yes. 437. Now, take the period of the gradual ap- plication of the Acts from 1866 to 1871 ?— In that case you had secondary syphilis producing 25'26 per thousand admissions and 75'38 for what are called primary venereal sores. 438. The relationship between the two being nearly the same ? — Y es. 439. Then you came to another period of six years, from 1872 to 1877, when the Acts were fully applied ? — The primary venereal sores are then 53"53 per thousand, and the admission for secondary syphilis is 25*22. 440. AVe get as the result of the complete working through six years of the Contagious Diseases Acts a diminution of one-half of the proportion per thousand of so-called primary venereal sores, but a largely increased proportion of secondary syphilis ; first of all, if you com- pare the period of six years before the Acts and the period of six years of the complete appli- cation of the Acts, you will have, in the first place, primary sores, 104, and in the last 53 ; therefore you reduce the primary sores one-half? —Yes. 441. But if you refer to the averages of secondary syphilis, though you find a reduction compared with the period before the Act, you find the secondary syphilis is stationary in the six years of the gradual application of the Acts, and in the six years of the full application of the Acts, you find the proportion of secondary syphilis to primary sores iias become largely increased ? — Yes. 442. In the first years your secondary syphilis is as 31 to 104, and in the last it is as 25 to 53 ? —Yes. Mr. Osborne Morgan. 443. As compared with primary sores ? — Yes. 444. Taking the six years before the Acts came into operation, the six years in which they were in operation partially and the six years in which they were in full operation, and dividing the whole period into three periods of six years each, what increase or decrease in cases of secondary syphilis Mr. Osborne Morgan — continued, do you find ? — When there were no Acts at all, they fell from 31'74, to 25; but when the Acts came in they did not fall at all. 445. The second six years? — From 1860 to 1865, before there were any Acts, there were just about 32 per thousand cases of secondary syphilis. In the next six years there were 25 per thousand. 446. They fell in the second six years? — Yes, and then in the last six years they remained the same ; just 25 again. Mr. Stamfeld. 447. Now look at these figures a little more in detail. Take Table 4 : The Act for the compul- sory examination of women was first introduced in 1866, and came gradually into operation in 1867; will you give us the figures, year by year, from 1860 to 1865, with regard to secondary syphilis? — In 1860, secondary syphilis was 31 "30 ; in 1861, 31-26; in 1862, 3291; in 1863, 34-19; in 1864, 32-99; and in 1865, 27-81; then in 1866, 23 39. 448. That is before the application of the Acts ? — That is before the apjjlication of the Acts. 449. The Act was only passed in the autumn of 1866?— Yes. 450. And only applied at the fag end of the year to a very few thousand men?--Yes. 451. Therefore, practically speaking, that figure is before the Act came into operation ?•— Yes ; in 1S67, it rose to 26; in 1868, to 30; in 1869, it fell to 26 ; in 1870, it fell to 25 ; in 1871, it fell to 20; in 1872, it rose to 24; in 1873, it fell to 23 ; in 1874, it rose to 24 ; in 1875, it rose again to 29 ; in 1876, it fell to 27 ; in 1877, it fell to 23 ; and in 1878, it rose to 26^. 452. The figures fell in 1866, before the appli- cation of the Act, to 23-39 ? — That is so. 453. And in 1878 the figures are at 26-64 ? — That is so. 454. Looking at those figures year by year, as well as in the groups of six years as to which you have instituted a comparison, you see no evidence, do you, of any effect produced on the amount of secondary syphilis in the Army by the Contagious Diseases Acts ? — I cannot see any in any way whatever. 455. Now, with regard to the decrease in primary sores themselves, there was a decrease going on before the Acts, was there not? — There seems to have been a decrease before the Acts. 456. To what have you been accustomed to attribute that ? — I think that has a great deal to do with people becoming more civilised. They wash themselves, and are much more cleanly than they used to be. If I may be allowed, I will state my reasons for thinking that at the pre- sent moment, in Paris, there are scarcely any soft sores at all to be seen. At the Hopital du Midi, there may be perhaps 60 soft sores in the whole course of the year, that is the male venereal hospital, whereas in 1838 there used to be about 30 soft sores to one hard one in Paris. At the present moment the soft sores have almost disappeared, on account of the people becoming much more careful of themselves, more cleanly, and, in short, more vigilant. 457. Have SELECT COMMITTEE ON" CONTAGIOUS DISEASES ACTS. 7 March 1881.] Dr. Dkysdale. \_Contmued. Chairman. 457. Have that cleanliness and vigilance been induced by medical superintendence ? — I am not aware of that : I think it is just that the people are less filthy, and the lower class of women are more civilised. Civilisation is making inroads in all directions, even among the poorest, and the consequence is,Vou have not the amount of soft sores you used to have ; they are caused by great want of care, by living pell-meU. Mr. Sta/isfeld. 458. In fact, you very often call these sores dirt sores ? — I would not like to use an}' term, but they are caused by utter carelessness; in 1870, for instance, in the IVaiico-Gerraan war, they appeared just in as great profusion as before, because the people were living in great misery and wretchedness around Pai'is, and this soft sore came down upon them like a plague. But since that time, 1875, and the like, there have hai-dly been any at all. 459. In regard to the soldiers of our Array at home, would you not be disposed to say that the improvements in barrack accommodation, specially in regard to personal ablution, general cleanliness introduced on the recommendation of Lord Herbert's Committee, had a considerable effect, quite independent of the Contagious Dis- eases Acts ? — I think everything of that kind would tend to get rid of it very rapidly. 460. If there had been no Contagious Diseases Act, I presume i'rom your evidence, that with these beneficial influences at work, you would have expected some reduction of the non-syphi- litic or local sore ? — I should have expected that to be almost done away with, if thev had added hospitals to the stations without any Acts at all. 461. You have said, as far as true syphilis is concerned, in your opinion, the Acts have been without effect ; but with regard to their effect upon venereal sores not truly syphilitic, do I understand you, you would look with equal con- fi.dence to a free hospital, open voluntarily to the women, and to attention to personal cleanliness? — I think voluntary hospitals would get rid of soft sores very easily, because they are very painful; women do not like them, they eat the flesh away, and the consequence is, no woman would go on with her trade with a soft sore if she could help it. 462. She would be more likely to conceal the true syphilitic sore, and to continue the commerce with men nnder those conditions, than if she had the less serious, but more painful, non-syphilitic sore ? — The hard sore, or the secondary syphilis, would often not prevent her in any way keeping on her trade, whereas the soft sore is painful, and no woman would remain out of hospital if she could avoid it when she had that, she would immediately go into it. 463. What reasons exist in your mind to sup- port the conclusion that this system must be a failure ? — The reason of it is this, that whenever you put the Acts in force in any fresh place, you immediately make an immense number of women conceal themselves ; they become unsubmitted to the A.cts, they leave the quarter, and then these women, as most of the women have, almost all the women, get true syphilis. 464. Is not there another reason, that the Act 0.44. M r. Stalls feld — continu ed. is only applied to women ? — That is, of course, an additional reason. 465. 1 ou have a disease arising out of contact of different sexes, and you apply your precaution to one sex only; is not that a system which must fail ? — Of course, it is quite clear. 466. It is sometimes argued that you do more in proportion in this way by examining women, because one woman has commerce with so many men ; is that in your opinion a sound argument ; may not one diseased man be a source of con- tagion to as manv men as one diseased woman? —Yes. 467. How? — By giving it to one woman who will give it to a number of men. 468. One diseased soldier diseasing one woman is the primary cause of the disease of a great number of women ? — Certainh-. 469. And whatever care may be taken periodi- cally of the health of the women if they are liable to be so diseased between times, the soldier may in that way indirectly propagate disease ? — Certainly. 470. Is there any inftillible method of ascer- taining the diseased or healthy condition of the women who are examined?- — If it is soft sore that is not at all difficult. 471. Take gonorrhoea? — Gonorrhcca is some- times an easy enough thing to discover, but in the general run of cases, when it is chronic, it is extremely difficult. 472. And they may conceal it by the use of lotion ? — Syringing out the vagina before ex- amination will get rid of the mucus, and often take away any appearances for a time. 473. A certain proportion of women who are examined pass the examining surgeon, although they are affected by gonorrhoea ? — That is well known. 474. And, in fact, it is practically admitted that the Acts have had little or no effect in the i-eduction of gonorrhoea in the Army? — I think that is so well known that no one contends that gonorrhoea has been in any way influenced by the Acts. 475. You have said that the chanci-oid may be easily discovered, but now take true primary syphilis, is that easily discovered ? — It is exceed- ingly rare that you see the first lesion of syphilis in a woman ; when you see women in a hospital you almost always see them with some secondary lesion, you can very rarely find out the primary lesion. 476. They have succeeded in concealing it, or they may be unsconscious of it ? — It is often such a slight affair that they do not notice it until the secondary things come out. 477. And that is not necessarily revealed by the use of the speculum? — No; it almost in- variably takes place on the external parts, so that it does not require the speculum. Mr. Fowler. 478. You mean the woman may be in a most dangerous condition and be jsassed without seeing it ? — A woman may have had a very slight sore, so slight that you would not remark it, but she may be syphilitic at the same time. 479. And maybe able to give contagion to the men ? — Certainly. D 480. Have 26 MINUTES OF EVIDENCE TAKEN BBFOEE THE 7 March 1881.] Dr. Drysdale. \_Continued. Mr. Stansfeld. 480. Have you yourself, in your own personal practice, found that it took considerably more time than you would think could be always spared for the examination of prostitutes to dis- cover the existence of a real chancre in a woman? — I have sometimes spent a very long time, per- haps 10 minutes, to try if I could discover any reason for the enlai-gement of the glands in the groin, and have not been able to find anything ; and then, afterwards, there has been syphilis. I have expected that it was syphilitic, but could not discover any primary lesion at all. 481. Could you cite to us any authorities in support of your view as to the difficulty of de- tecting true syphilis ? — There ai-e a great number of authorities. For instance, Bumstead says, " The sjjeculum, although of great assistance, does not infallibly reveal chancres. The diffi- culty of detecting a true chancre in women, formerly, gave rise to the opinion that the infect- ing chancre vyas free from induration, whereas on the contrary, these lesions are in reality quite constantly indurated.'' Now I would like to quote a passage from Professor Aitken's book, vol. i., p. 903, sixth edition. " Medical inspections tend imdoubtedly to greater per- sonal cleanliness, and may be the means of de- tecting soft chancres, and so may prevent their being communicated ; but the infecting sore, the true syphilitic one, can rarely be detected in the female." In support of his opinion of the diffi- culty of detecting an infecting sore in a female, Mr. Simon gives a similar opinion that such sores have often been overlooked on examination made especially for their discovery. That is my own experience. 482. You are quoting from a Return made by Mr. Simon, when medical officer of the Privy Council to the Privy Council ; he reported against the extension of these Acts to the general population ? — Mr. Simon's Report, page 8. 483. May a woman be in a syphilitic and in- fectious condition without any objective signs ? — A person with syphilis may not have any symp- toms for a certain time and then they may burst out again ; a month or two months may elapse lietween them. Mr. Osborne Morgan. 484. Being all the time in a condition to com- municate the disease? — They usually are in a condition to give the disease, for perhaps about two years, Mr. Stansfeld. 485. And there will be a portion of that time when the examining surgeon could not ascertain by one examination the infectious condition of the woman? — You might examine a woman to- tlay and find nothing the matter with her, and two or three days afterwards she might have some mucous patches, or something like that, which would be contagious. 486. Have you any other authorities upon this subject ? — The authorities I have are gene- rally known to the profession. I may state them. Dr. Laucereaux gives the same opinion ; Mr. James Lane, Mr. Henry Leed, and Mr. Langston Parker, Dr. Wilks, and Dr. Morgan, of Dublin, and also Surgeon Major Porter, and he Mr. Stansfeld- — continued. and some of the rest seem to think you ought to detain the women in the hospital, if you want to do any good with the Acts, for about two years. Sir Henry IVolff. 487. In how many cases on an average would a diseased woman escape detection ? — When she had anything like a discharge Avhich might be syphilitic in its character, she might continually escape detection. 488. Out of 10 cases, how many would an ex- perienced medical man detect ? — You mean of syjDhilis, not gonorrhoea. 489. True syphilis ?— I would not like to say ; I should say a certain proportion. Mr. Osborne Morgan. 490. Could you give us any idea out of 10 cases of true syphilis? — 1 think in most of the cases I could detect if a woman had syphilis. Sir Henry Wolff. 491. Would you omit to find it once in 10 times ? — Supposing a woman had merely falling of the hair or sore throat, that would not be contagious at the time ; she might have nothing the matter with the organs that would generally give the disease. Mr. Osborne Morgan. 492. What we ai'e veiy anxious to get at is in what proportion of cases would a diseased woman, of course I am now speaking of a woman who has true syphilis, coming before you or any other competent medical man, escape detection ; in other words, how often would you pass a diseased woman as sound ?— I think one would generally see some synwtoms or other ; but if you were examining her merely with the speculum, you might not notice it, because she might have nothing the matter with the organ. 493. Given a thorough examination of a woman such as, of course, you would consider it your duty to make, you would in nine out of ten cases detect the syphilis ? — If the woman had had syphilis for as long as seven months I think you would be continually wrong. If I had not had the case before, and she were to come to me for the first time. I might say I could not tell. 494. There are cases where you would make a mistake, but given ten or a hundred cases, how often would you be likely, taking everything into consideration, to make a mistake and pass a diseased woman as sound ? — It would depend upon the time; if it was in the early period of eruption, in the first three or four months, I should very rarely have any difficulty ; but if it was a little later you would come into the con- dition that she might be contagious for two years, but might be very slightly contagious at intervals. 495. Then do I understand you to put it in this way : in the case of a woman coming to you within the first three or four months of the development of the disease, you would have very little difficulty in ascertaining the fact of the disease ? — Usually speaking. 496. On SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 7 March 1881.] Dr. Deysdale. [ Continued. Mr. Fowler. 496. On the other hand, supposing she came late, you would continually err ? — I think I should be very likely to make a great mistake if I had not seen her before. Mr. Stansfeld. 497. The syphilitic woman who has not re- cently been affected by primary syphilis, is not only from time to time in an infectious condi- tion, or may be so during a period of two years, but during those times she is difficult to detect ? — During a very large portion of that time. 498. I'he woman with a soft non-infecting sore is withdrawn, is she not, by the Acts, from com- merce with men for a certain time ?— Yes. 499. And the number of women is thereby reduced ?- Yes. 500. And the commerce of these women, a proportion of whom would be affected with true syphilis, is thereby increased ? — Yes ; and 1 may add, I suppose, all of them have true syphilis. 501. You think that there are scarcely any public women that do not have true syphilis ? — Yes. Mr. Osborne Morgan. 502. You think that there are scarcely any public women that do not have true syphilis ? — That is my own experience. 503. Do you speak of public women generally ? — Generally. Chairman. 504. Common prostitutes? — I, think it is an exceptional thing if a woman who is a prostitute has not had true syphilis. 505. You do not say they constantly have it, but have had it at one time or other? — When once they have had it, they have had it for their life. Mr. Stiiasfeld. 506. I understand that in your opinion women of the town, common prostitutes, have almost invariably at one time or other of their career had true syphilis? — Yes. 507. Then they will so remain, as I undertand you, for a period amounting very often to a couple of years after having had true syphilis, during which time they would be dangerous, though during portions of that time it may be difficult, if not impossible, to detect their infec- tious condition ; that is wliat you mean ? — -Yes. 508. You do not mean that they will continue infectious during the whole of their lives ? — Not more than two years. 509. There is no doubt, is there, in point of medical opinion, as to the danger of what is called mediate contagion ? — I think so ; there is no doubt of it. 510. Will you explain the meaning of the term " mediate contagion" ? — Mediate contagion in medical works means that persons may give syphilis when they have not got it themselves ; that some person may have left contagious mat- ter in the organs of the female, and the next per- son gets it from that. 511. That is admitted, is it not? — I think so ; I could cite authorities. 0.44, Mr. Stansfeld — continued. 512. Have you, in your own practice, met with cases of men who, relying upon a false sense of seciu-ity engendered by the existence of these Acts, have visited protected stations and subse- quently come to you diseased ? — I have met with such cases several times ; commercial tra- vellers, for instance, who will make a point of going to one of the protected stations once a week or so, because they believe that tliey cannot pos- sibly have any disease. 513. And they have come to you with what class of disease ? — They have come to me with syphilis. 514. Generally with syphilis? — Always with syphilis. Mr. O'Shaughnessy. 515. You mentioned to us mixed sores, and you spoke of them as sores that might or might not give syphilis ? — Mixed sores would inevit- ably give syphilis, because a mixed sore is where a person has both. 516. Is it not a new fact in medical science that secondarj' syphilis may be contagious?— It has only been known during the last 25 years. 517. And is it not true to say that all this knowledge of the distinction between soft and real primary sores is, comparativeh' speaking, new, as a matter of medical science ? — Twenty- five years is the date of it. 518. If that is so, do not you think that there is an advantage iu giving opportunities of obser- vation to the profession on these matters ? — I do indeed. 519. I mean that you widen the field of obser- vation, and make more certain what is now be- coming known ? — I think so. 520. I think 1 understood you to say that there was no incubation, or very little incubation, in common syphilitic sores ? — There is uo incuba- tion at all in soft chancres. 521. If a man, then, goes with a woman who has got a soft chancre, he is likely to get it im- mediately from her? — He will come to tlie surgeon three days afterwards. 522. Will it not have infected him, so far as it can be called infection ; will he not have had the certainty of a soft chancre even before the three days, in consequence of the absence of any neces- sity for incubation ? — It will have been a soft chancre in a few hours, in 12 hours you can see it with a microscope. 523. And even before that 12 hours, before it has become apparent to the microscope, it will have fixed itself as a soft chancre upon him '' — Yes. 524. Now, if that be so, the probability is, that no amount of ordinary cleanliness on the man's part will free him from some risk of that soft chancre ? — If he washes himself of course he will remove the pus before it penetrates. 525. But we know that these soft chancres have decreased in number ; that is the general experience, I think, both on the Continent and in England ? — Yes. 526. I think you said that it is cleanliness on the woman's part that has led very much to the diminution of these soft chancres ? — I think, also, on the part of the male ; washing off secre- tions. D 2 527. But 28 MINUTES OF EVIDENCE TAKEN BEFORE TH] 7 March 1881.] Dr. Drtsdale. [^Continued. Mr. 0' Shaughnessy— continued. 527. But inasmuch as it comes without incu- bation and suddenly, it would be, to a large extent, ov/ing to increased cleanliness on the part of the woman? — I think so, to a great extent. 528. Do not you think that any system that Avoukl induce women to take increased care in cleaning themselves ; a fear of observation from the power of the Acts ; would be calculated to lead to a diminution ; and do not you attribute to the fear which women have of inspection under the Acts, the diminution, to a very large extent, of these primary sores ? — Anything that makes women cleanly will have that effect. I do not think it requires any Acts. 529. With regard to the effect of these primary sores, I understand that they do not afiect the constitution ? — Not in any way whatever. 530. But they lead to great lesions of the part affected ? — Sometimes, but not if treated quickly, they are a mere bagatelle if they are treated quickly. 531. But I suppose they would lead to inca- pacity for such business as a soldier would have IQ do ? — Not if he were taken into the hospital at once ; he may be cured in a few hours or in a day or two ; then when once cured there is no more effect than the bite of a flea. 532. Do you think that an infecting hard sore is in any degree amenable, like a soft sore, to cleanliness of habit ? — I do not think there is very much effect produced upon it ; it is not like a soft sore ; its secretions are so slight ; there is a o-reat quantity of secretion from the soft sore which may be easily wiped away. 533. Do not you think it is to some extent amenable to cleanliness of habit, and that regular and cartful Avashing after connection is to some extent, though not to a large extent, as in the case of the soft sore, Hkely to diminish the chance of a hard sore ? — Yes, I think if the male sex were to wash carefully after connection, they would get rid of the pus of either sore. 534. The female sex also ? — Yes, I admit that thoroughly. 535. Do you confine the cases where secon- daries are contagious to the cases where secon- daries are active in vagina ? — It is not so much in the vagina as round the vulva, and also when there is a discharge of a syphilitic nature. Mr. Fmolcr. 536. Mr. O'Shaughnessy has spoken of a change that might result from a change in the law ; the fear of these Acts, for instance, leading to greater cleanliness. I understood you to say that a great change had taken place in other places where there has been no change in the law ? — Quite so. 537. It would be difficult to connect this with any change in the law when the same thing has taken place in a country where there has been no change in the law? — Quite so. 538. You made an observation which I want to develope somewhat ; you said that one cause of the diseased condition of women was the clandes- tine nature of a prostitution which arises when there is a severe system of this kind? — I think that is the great cause of it. 539. Have you had any experience which would lead you to supj^ose that the result of a Mr. Fowler — continued, system like this is to make prostitutes afraid of going to the doctor for fear of being exposed ? — I live in London, and my practice is in London; I do not practise in any of the subjected towns, and I can only sjjeak of my own experience. 540. What you know of claiadestine prostitu- tion is not from your own experience, but from what you have read and heard ? — Yes, it is uni- versally known. Mr. Osborne. Morgan. 541. You have no personal experience? — My opinion is that it is thoroughly known, that there is no doubt about it ; that clandestinity is caused by the law, and that you cannot avoid it. Mr. Mopwood. 542. Among these diseases which these Acts were applied to correct was that of gonorrha2a ? — I believe so. 543. There are several ways in which a soldier may be made inefficient ; venereally considered, is gonorrhoea one of them ? — Cer- tainly. 544. Has that a large or a small relative im- portance in its effect on the efficiency of the soldiers, as compared with other forms ? — It is far more important with regard to efficiency than any of the others. 545. Is it more likely to disturb the personal physical activity of the soldier ? — It gives swelled testicles ; it is continually annoying the soldier, and making him quite inefficient. 546. It produces severe pain? — Very severe pain. 547. Then, in this respect, do the soft sores come next in importance in causing jjain or suffering? — Quite so. 548. Then the third categor}'; constitutional disease, is the one which least interferes with the outward efficiency of the soldier ? — Quite so ; it makes him weak, but it does not usually make him inefficient. 549. I understood yovi to say that it was rare to find that primary lesion of the constitutional disease ? — It is not at all uncommon to find it in the male sex ; it is usual to find it in the male sex. 550. I understood you to mean that the very first stai'ting point was difficult to find ? — A hard sore, or the primary lesion of syphilis, is only seen often in the male. 551. Then when you say it was rare to find it, you were speaking of the female ? — I was entirely referring to the female. 552. At a later stage, when you were asked whether in the largest jiroportiou of cases you would be baffled in your search to find whether it existed, you said that in most cases you would be successful? — In the secondary period. 553. Then were you speaking of two different times ? — I was ; it is excessively difficult to find the primary sore in the female, but it is not difficult to notice the eruptions and other slight secondary symptoms in the male. 554. When you Avere asked about detecting Avhether a woman was diseased or not, did you mean to imply that it was easy to find that she was diseased of a primary symptom ? — N o, I meant a secondary. 555. You SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 29 7 March 1881.1 Dr. Dktsdale. [ Continued. Mr. Hopwood — continued. 555. You were speaking at that time of the secondary symptoms !—I was. 556. As to those, you say it is usually easy to find them, but that there are recurring stages in which the female may be without them, and yet they may speedily supervene, and she may be dangerous to those who have commerce with her ? — Quite so. 557. I think you were asked about whether there would be any advantage in a system which afforded an opportunity for observation ? — Yes, for students to study venereal disease. 558. Is that, in your mind, a recommendation of these Acts, or is it possible to acquire that observation without any such system? — I do not think they would be likely to learn nearly so well as they would learn with ordinaiy practice at a lock hospital. 559. Referring to an inspection for ascer- taining the existence of secondary disease, you said that it might take you 10 minutes or so to investigate a particular case? — I spoke of a primary disease of the female. 560. Does that qualify your answer to me in regard to its being exceedingly difficult to find the primary lesion ? — No, it is the same thing ; sometimes it requires a long time, sometimes it may be discovered by a good deal of trouble, and at other times not at all ; as a rule, when women come to you with syphilis, you never hear any history of their first lesion. 561. They can give you no account when it fii'st appeared ? — Not in the least. 562. They only come to you with these symptoms developed? — That is it. Sir Henry Wolff. 563. You have said that the primary symptoms must be followed by secondary symptoms ? — luvariably, more or less. 564. In fact there is no such thing as pi'imary syphilis that is not followed by secondary syphilis ? — No. 565. You have not mentioned whether that is a theory of your own, or whether you are sup- ported by authorities ? — I should say that every- body who is a dualist agrees with it, and all the men of distinction in that branch of the pro- fession, I think, are dualists. 566. Therefore, when once you have got primary symptoms you have got syphilis, more or less ? — Yes, as I have said, the wolf is in the fold. 567. You consider a soft sore to be a merely local affection ? — I consider a soft sore to be just an external affair ; I may compare it to the itch insect, which is now known by modern research to be a small parasite ; I would compare the soft sore to a parasite which merely feeds upon the external parts, and never entei-s the constitution at all. 568. Then, supposing a soft sore to be ne- glected, what would be the result? — It would merely be cured in about six weeks or so. 569. It would cure itself? — Usually in about six weeks. 570. You say that no one has a hard sore more than once ? — Yes ; the expression is noii his in idem. 571. Therefore, suppose a person gets cured 0,44. Sir Henry Wolff — continued, of a first attack, how does it show itself on a second occasion ? — It would always be a further stage on. Suppose I have an eruption, and then I am cured of it, the first thing Avould be that my eyes might get affected. 572. That is the second stage ; but suppose a pei-son is cured entirely of his sy[)hilis, and he contracts it a second time, does he not have a hard sore the second time ? — He will never con- tract syphilis a second time. 573. What would he contract T — He might have a thousand soft sores, but only one hard sore in his life. 574. Ifamanis once cured of syphilis he is like a man who is vaccinated or inoculated, safe for the rest of his days ? — He is. He has thereby passed, as it were, his apprenticeship. 575. May 1 ask you, do women ever have in- durated sores ? — Every woman that has secondary syphilis must have had an indurated sore. 576. But it may not be perceived ? — It may not have been perceived. 577. My Hight honourable friend referred you to this report on the operation of the Contagious Diseases Act of 1878, column 31, in which you showed that the numbers in that year were 152"98 ; you are, perhaps, aware that the numbers of the Army increased in 1878 considerably over former years ? — I am afraid I did not know it. 578. Do you not think that, in looking to those statistics, you ought to take into consideration the numbers of the Army ? — I should not think that that had anything to do with the numbers of the wonien. 579. But it may have something to do with the number of times they have been ill and on the register? — It is the per-centage of the women who are ill. 580. But, if the practice of the women is greater, they are more likely to get the disease, are they not? — May there not be more women? 581. There are not more women; the number of the Army, in 1877, was 92,143, and the average number of women on the register was 1,859 ; in 1878 the mnnber of men was 101,129, and the number of women only increased by 6, number 1,865 ; therefore you see the numbers of the Army have increased in greater proportion than the numbei's of the women ; do you not think that, in these calculations it is desirable to take into consideration the increase or decrease of the Army in certain years, in proportion to the diseases ? — I should hardly like to give an opinion upon that. I would rather consider the per- centage of wonren diseased, and, looking at that, I see that it is not affected in any way. I should, therefore, at once draw the conclusion that the Acts had not influenced their health. 582. You see that, in the year 1865, the average number of women on the register is 406, and the annual ratio of disease is 237 ? — Yes. 583. In 1878 there were 1,865 women, and the ratio was lo2"98 ? — Yes. 584. In 1870, there were 2,977 women on the register, and the ratio was 148 '25 ? — Yes. 585. Which is a smaller proportion, although not very much, than in 1878 ? — There is not much difference. D 3 586. In 30 MINUTES Oi" EVIDENCE TAKEN BEFORE THE 7 March 1881.] Dr. Dkysdale. [ Continued. Mr. Stansfeli/. 586. In 1865 the proportion of women diseased is 237 ; that is a far larger proportion than in any subsequent year ?• — Yes, that is evident. 587. Was it not under the repealed Act of 1864, under which the only women who were taken up for examination were women suspected of being diseased ?— ^-That was the Act, the Ports- mouth Act. 588. Therefore you would expect a larger pro- jiortion of diseased women in 1864 and 1865 than in subsequent years? — Yes. Sir Henry Wolff. 589. Now we will take the ratio of admission of men to hospitals. If you refer to the Report of the Select Committee, 1880, page 55, you will see that in 1860 the average daily loss of service per thousand of strength from the different diseases combined was 23'35 ? — Yes. 590. Going down, you will find a gradual de- crease, rising only in one year, until you come to 1877, when it is 9-08; then in 1878 there is a slight rise, but that is admitted to have been owing to the calling out of the Reserves. I do not press that upon you, because, perhaps, you have not considered the question; but if you look at page 48, with reference to the year 1878, you will see a foot-note which says, " The ratio this year was so much affected by the calling out of the Reserves, that Sir J. N. Muir advised the Committee to omit it from the calculation " ? — Yes. 591. You will see that there is a difference between 23-35 in 1860, and 11-28 in 1873 ?— Yes, I see that. 592. Then, if you look at page 56, under the column 1860, you will find that in Devonport and Plymouth the total average number of sick with primary venereal sores, secondary syphilis, and gonorrhoea is 103-81?— Yes. 593. Now go to 1873, and you will find that gonorrhoea has fallen from 52-82 to 15-81 ? — Yes. 594. And the total of these averages in 1873 is 30-40, as against 103-81 in 1860 ?— Yes. 595. Gonorrhoea was at that time revealed, be- cause Mr. Cardwell's Order, which stopped the allowances, only began in 1874, I think? — Yes. 596. Then, taking Portsmouth, the number is in 1860 189-24 ; Aldersliot, 353-18 ; Woolwich, 228-31. Taking Devonport, Plymouth, Ports- mouth, Chatham, Sheerness, and Gravesend, Woolwich, and Aldershot, the total venereal disorders, call them what you like, in 1860 are much larger in number than the average numbers in 1873 at those places ? — I see the figures that you mention. 597. And you acknowledge these figui-es to be correct ?— Of course. 598. Are you of opinion that these Acts have had nothing to do with that general diminution ? — I think that they had no effect upon the gonorrhoea. 599. I think you will find that they have affected gonorrhoea, if j^ou will look at the table again ? — I thought that point was admitted ; I was asked the question before, and the Chairman said it was admitted that gonorrhoea had not been affected. Sir Henry Wolff — continued. 600. I am asking you for your opinion? — I have given you my evidence. 601. I want you to look at the statistics. If you will look at 1860, under gonorrhoea, you will find that at Devonport and Plymouth the number is 52-80, Portsmouth 93'07, Chatham, Sheerness, and Gravesend 76-58, Woolwich 90-61, Aldershot 176-26 ?— Yes. 602. Then, going to 1873, you will find that at Devonport and Plymouth the number is 15-81, Portsm(mth 30-21, Chatham, Sheerness, and Gravesend 16-98, Woolwich 25-13, and Aider- shot 61-87 ?— Yes, I see that. 603. I suppose you acknowledge the correct- ness of the returns ? - 1 have not the least wish to imjougn anything. 604. Then, without going into all the other places, is it not to be presumed that this very great difference in the Returns of the diseases, including gonorrhoea, is owing to the action of these Acts ? — Would you keep to one point at a time. If you refer to gonorrhoea, I think, as far as these stations go, it seems that there is a dimi- nution, but when I gave the statistics of gonor- rhoea before, upon the whole it did not seem to me that there was the slightest diminution. 605. I want you to observe that in 1860, when there were no Acts of this kind in existence, the returns of sick from these different diseases in 28 stations in the Home Army were much higher than they are at the present moment?— From all the diseases together. 606. And from all of these separately ? — That would be a difterent matter. Will you keep to the last one, gonorrhoea. 607. I will take Canterbury, in 1860, when the number for gonorrhoea was 20-26, and in 1873 the number was 6'17 ? — It would be impos- sible for me to go into this matter, but I told you in my evidence that once, when we had a discus- sion with Dr. Balfour, I said to him, " I have found myself that there is no diminution in gon- orrhoea by the Acts." That was in 1874 or 1875, and he nodded his head, and said there was none. 608. Now, will you take Table C, in last year's Report, p. 62. There the ratio per 1,000 at Devonport and Plymouth is 27-14 in'l860? — Yes. 609. And in 1873 it is 10-01 ?— Yes. 610. Would you like me to take gonorrhoea alone, or the aggregate of al) the diseases ? — I object strongly to the aggregate. 611. Then, taking gonorrhoea alone, in 1860, at Devonport and Plymouth, the number, was 13-81 ?— Yes. 612. Turning to p. 66, you will see that in 1873 the number was 5-21 ? — ^Yes. 613. In Portsmouth in 1860, the number for gonorrhoea was 16-29, and in 1873, 5-28 ? — Yes. 614. In Chatham and Sheerness in 1860 the number was 13-56, and in 1873 4-04 ; at Wool- wich in 1860, 13-17, and in 1873, 4-04 ?— Yes. 615. In Aldershot the numbers were 11-55 in 1860, and in 1873, 5-23 ?— Yes. 616. Now is not that a verv large diminution SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 31 7 March 1881.] Dr. Drtsdale. l^Continued. Sir Henry ^Folff — continued. in those years ? — It seems, if there is no ex- planation of it, a large diminution. 617. You find that in those places the diminu- tion of gonorrhoea has been very large ? — Yes. 618. Have yon any objection to go into the aggregate of all the diseases ? — My intellect can- not follow that. I do not undei'stand the Army Report because it has lumped together hard and soft sores, which to nie have nothing to do with each other. 619. They are all venereal disorders'? — Yes: they are all venereal disorders. 620. With hard or soft sores, or syphilis or gonorrhcea ? — -Yes. 621. They are all from the same act ? —Yes. 622. Therefore, whether of one nature of disease or another, the diminution or the in- crease would also come from the same act ; from his own acts I mean, in regard to women? — Yes. 623. I will now take the ratio. At Devon- port and Plymouth in 1860, the number is 27'14; Portsmouth, 32"22 ; Chatham, Sheerness, and Gravesend, 21-72; Woolwich, 33-26 ; Aldershot, 23-28. 1873, Devonport and Plymouth, 10-01 ; Portsmouth, 9-78; Chatham, Sheerness, and Gravesend, 957; Woolwich, 11-10; Aldershot, 14-04 ?— Yes. 624. You therefore acknowledge that in these 13 years the average ratio per 1,000 constantly sick from these disorders has diminished to that extent ? — I see it by these figures. 6^5. Would you deny that that comes from the operation of the Acts ? — Yes, because you find that at other places, not under the Acts, there is the same result. 626. What other places ? — London, for in- stance. Mr. Osborne Morgaii. 627. What is the diminution in London ? — In London in 1860 the ratio for gonorrhoea is 9-90, and in 1873, 4-32. In fact I hardly think that the returns are worth much in that respect, because it appears to me that gonorrhcea is a very slipshod affair. 628. The numbers you have given are for gonorrhcea alone ? — Yes. 629. Will you take the total? — 25-05 in Lon- don, and in the other cases 22-97. Sir Henry Wolff. 630. What other places are there ? — Take Edinburgh. In 1860 the figures are 7-81, and in 1873, 3-32. I really do not think that these statistics are of very much value, or of any value at all on that point. I think there is some great fallacy about the whole. 631. Is Preston a protected district or not? — It is unprotected. In 1860 the figures are 24-32, and in 1873, 24-76. 632. You were saying that the disease might be kept down equally well if women could go voluntarily to hospitals, instead of being forced to do so? — I do not think equally well but far better. 633. You said that the woman would not be cognisant of a hard sore herself unless she were examined ? — I think you would not keep down syphilis vei'y much ; in fact the Acts do not keep it down ; but if you had voluntary hospi- 0.44. Sir Henry iVolff — continued, tals you would keep down the soft sore. You might get rid of it almost entirely by voluntary hospitals. 634. With regard to the soft sore, you said that she might not be cognisant of it, and that a voluntary hospital would be as eifectual a method of curing her as an enforced examination where it would be found out ? — I think it would be more .tion and mucous tubercles. It would be very rare that he would discover a person with a hard sore, because the secondary symptoms last contagious for such a length of time. fi59. Should I be right in saying that cases of induration in women are comparatively rare ? — They must have always existed, but they are often so slight as to escape detection because the women do not notice them. Colonel Dighjf. 660. Is there any discharge ? — Sometimes scarcely any. Mr. Osborne Morgan. 661. In a work by Dr. Morgan, of Dublin, " Practical Essays on the Nature and Treatment of Contagious Diseases," it is stated, "In women, taking a thousand cases, I have seen only about twenty instances of what can be pronounced typical indurated sore as seen in men, and the records in the register of the Lock Hospital corroborate this observation ; " would that agree with yotir view ? — That is precisely what I have been saying. 662. Of course there are means besides this hard sore of ascertaining the presence of disease in the women, such as the state of the hair ? — The secondary eruption is just as easily detected in the female as in the male. 663. Of course women in that condition are highly contagious ? — Exceedingly contagious. 664. And might communicate the disease otherwise than by coition ? — Kissing will often produce the disease. 665. Of course these soft sores are not looked at from a constitutional point of view as a con- stiutional disease ; you would not say they were nearly so dangerous as secondaries ? — No. 666. At the same time they are very painful ? — Very painful. 667. Do they produce disease. Do they pro- duce what is called buboes ? — Y''es, they often produce suppurating buboes. 668. That would disable a man from work, I suppose ? — Certainly. 669. It might be likely to affect his constitu- tion or his condition afterwards ? — No, it does not aftect the constitution but might merely weaken him, like a broken leg, or anything else ; it is merely a local affair, not of any per- manent importance to a man's health. 670. I think you stated your opinion that if womeu could have an opportunity of voluntarily entering these hospitals, that would do more to put an end to the disease than any compulsory examination ? — I think it might easily put an end to soft chancre. 671. Are there not facilities in some towns, in London for instance, for those who wish to go into hospitals ? — It is very difficult. Until the workhouse infirmaries were instituted we had a perfect chaos in London, and it was almost im- possible for a woman to get into a hos25ital. 672. Do you mean to say that a diseased woman anxious to get rid of her disease has no means, except by going to a doctor, a private surgeon, of getting relief? — There are only the v/orkhouse hospitals, a few out-patient depart- ments, and a few beds in Guy's and Bartholo- mew's. 673. How is admission to the Lock Hospital obtained ? — I forgot the Lock Hospital. 674. Surely that is open to any woman? — It has not many beds ; there are very few beds in London. 675. Do you find women in your experience voluntarily going into these hosi^itals without pressure being put upon them? — If a woman had a soft sore she would go at once to a hosjntal, because it is veiy painful. 676. How SELECT COMMITTEE OX CONTAGIOUS DISEASES ACTS. 33 7 March 18.81.] Dr. Dkysdale. [ Continued. Air. Osborne Morgan — continued. 676. How do you reconcile that with the fact that you stated just now, that all these prostitutes are diseased? — i say they have all had syphilis ; syphilis is a disease that all prostitutes get. 677. True syphilis? — Yes. 678. As a matter of fact, do you think that prostitutes avail themselves of the opportunities and facilities which at present exist for admission into Lock Hospitals ? — Allow me to give you my own experience. At my own hospital, which is perfectly voluntary, the girls can go out to- morrow, but they stay in sometimes nine months or a year, or more if I ask them; almost the only ones that ever leave are the patients that come from the subjected districts ; they are invariably very hard to deal with ; they seem to consider it an honourable profession. 679. That is not quite an answer to my ques- tion. I wanted to know what proportion of women enter these hospitals, not how long they stay there ; what per-centage of women take ad- vantage of the opportunities afforded to them of entering these hospitals voluntarily ; could you give us any idea ? — I could not. 680. Are the hospitals generally full? — The workhouses are very well attended in that way. 681. A woman going to a workhouse hospital would always be received, I suppose ? — She must be. 682. Is there not another reason why this voluntary sj'Stem would not be so likely to succeed ; that a woman probably would not know, with the best intention, when she was diseased, so as to lead her to submit herself to hospital treatment ? — Women very often do not know that they are contagious in any way, but I think almost all of them would enter a hospital if they thought of it. 683. I take it to be your opinion that there would be this objection to the success of what we call the voluntary system, tliat the woman, how- ever disposed she might be to subject herself to hospital treatment, would not be aware in some cases, certainly in the case of true syphilis, of the existence of a reason for doing so ? — That is true ; I should merely say on the other hand that that is counterbalanced by the large number that will not go, because they are afraid of being detained. In the case of voluntary hospitals, they at once present themselves, because they are diseased, but if they are afraid of being de- tained they will not show themselves, and there- fore become clandestine. 684. The case I put is that of a woman who believed herself to be quite sound ; she would not submit herself to examination voluntarily ? — Certainly not. Mr. Cavendish Bentinck. 685. I understand you object to the classifi- cation of primary venereal sores in the Army returns? — Very strongly indeed. 686. Is it not the fact that in the case of any primary venereal sore making its appearance, a considerable time must elapse before its precise character is known ? — Not at alL When a pa- tient calls upon me, I know at once what the nature of the sore is. 687. Will you undertake to say the instant 0.44. Mr. Cavendish Bentinck- —conimned. a sore is shown to you, whether it is syphilitic or non-syphilitic ? — Generally speaking. 688. On the spot ? — Generally speaking. Per- haps very rarely not. 689 Is that opinion general amongst the medical jjrofession? — I believe it is the opinion of all men like Berkeley Hill, who are familiar with the subject. 690. What system of classification would you have. Would you divide the disorders into two categories ? — I would divide them into the soft sore and the hai-d sore, the hard soi-e meaning sometimes a sore not very hard ; the soft sore and the primary lesion of syphilis; the first symptom of syphilis. 691. Yon have stated in answer to my Right honourable friend and other Members of the Com- mittee, that you consider that secondaries are an absolute consequence of primaries ? — In- e'V'itably. 692. Therefore you do not agree with Dr. Routh, who was asked by the Judge Advocate General, " If they have reduced the primary syphilis by leading to the cure of primary sores, does it not follow that they prevent secondary syphilis?" and he replied : " Indubitably, if you could cure every case. (Q.) And pro tanto to the extent to which they enable medical men to cure primary syphilis, you prevent secondaries ? {A.) Certainly." Then I asked, '■' Therefore, if the primary syphilis was effectually cured, no secondary syphilis would come." And the reply was, " Certainly." ( Q.) " If Dr. Routh is worth his fee, you never would have secondaries from a primary sore? {A.) You would not." Do you agree with that opinion '.' — No. 693. With reference to the figures, I will not enter into that wilderness again, but are you not aware that these primary venereal sores have been considerably reduced since the Acts came into operation ? — I am aware of that. 694. Therefore, to that extent the Acts have done a great deal of good ? — That does not follow. 695. Why does it not follow ?— I have already said that in other places where the same Acts have been going on for a long time, they have almost entirely disappeared. 696. I am referring to England and the Army regulations ; you must not take me to the civil population ; we are dealing with the results of the Acts as applied to the military, and you have read to me a statement in Table II., showing that primary venereal sores have been reduced from 170 to 53. Have you any reason to doubt the correctness of those figures ? — Not the least. 697. Then if you show that primary syphilitic venereal sores have been reduced from 107 to 53, does it not follow that a great deal of good has been done ? — So far as that is concerned they have been reduced, but how they have been reduced is the question. 698. Have they not been reduced by the operation of the Acts ? — I do not think so. 699. Why not? — Because I think they were reduced very much before the Acts commenced. They were reduced from 104 to 75 per 1,000. 700. Is not a decrease from 75 to 53 a con- siderable decrease ? — That is in the next years. E 701. You 34 MINUTES OF EVIDENCE TAKEN BEFORE THE 7 March ISgl.] Dr. Drtsdale. [ Continued. Mr. Cavendish Bentinck — continued. 701. You took three periods of time ; the first number was 106, then when the Acts were in partial opei'ation, the number was reduced to 76. in the next six years to 53 ; that is a con- siderable reduction, is it not, from 75 to 53 ? How do you make out that that reduction is not owing to the operation of the Acts ?— It is not my part to make it out. 702. You come here to give evidence? — My part Is simply to give you my idea that part of the result may have been due to any Act, but that a great part of it must have been due to superior cleanliness, and to the better barrack accommodation, because I find that after Lord Herbert's Acts the number was very much decreased to the year 1866. I also find else- where that cleanliness and good habits on the part of the men and women, and higher civilisa- tion, get rid of it. I presume that that has been going on in the same way, therefore if the Acts have done something they cannot have done nearly the whole. They must have done a very slight portion of It. The numbers would have been exceedingly leduced had there been no A^cts. I do not know how much credit I should give to the Acts, and how much not. Mr. Oshorne Morgan. 703. Do you say that the Acts have increased the disease ? — I think they have increased it very much. They may possibly have decreased soft sores. Mr. Cavendish Bentinck. 704. You have no grounds of your own for maintaining that these Acts have not caused this decrease? — No. 705. Therefore, the Acts may have caused the decrease for aught you know ? — I admit it. 706. Yoiu" contention is that the decrease has been only in soft sores '! — That is my conten- tion. 707. The ground upon which you arrive at that opinion is the non-decrease in secondaries ? — Precisely. 703. You do not suppose that all these secon- dary cases were attributable to primaries which were contracted in the Army? — I cannot tell you, but I know they must have had primaries, and these primaries are contained in that number o3. 709. It does not follow that the primary was contracted in the Army. The Army is a fluctua- ting body since the short service system has been introduced ; I am advised by high medical autho- rities that secondaries may make theii- appearance at any period between six months and 20 years. Is not that so? — Not secondaries. What we call secondaries usually disappear at the end of the second year ; then come in the groups of ter- tiaries, deeper lesions. 710. In order to make out that the non- decrease of secondaries is any test as regards syphilis in the Army, you must show that the primary symptoms which preceded those secondaries were contracted in the Army ? — Precisely. 711. Are you able to show that ? — I should be able to show it easily if the Army Ileport were Mr. Cavendish Bentinck — continued, well drawn up, and I hope that what I say will be of some use in that respect in future. If the Army Reports were well drawn up I should know what the number 53 with regard to primary sores means. I should find that it would probably be divided into two parts, 25 cases of hard sores, and say28 cases of soft. If any of us could alter the form of the Army Keports, we might be able to answer that question ; at present I have no means whatever of answering it. 712. Therefore, the amount of secondary syphilis is no test of the number of primary sores which have been treated by the Anny surgeon ? — It seems to me the only test you have. 713. Allowmeto put this beforeyou. A. number of these soldiers arrive from foreign stations, from China and India, where there are no Contagious Diseases Acts ; it is absolutely certain that in a number of these secondary cases the primaries have been contracted elsewhere, abroad? — Cer- tainly. 714. Therefore, can you put forward the amount of secondaries as a true test of the pri- mary cases that have been treated by the army surgeons in the first instance? — It seems the only test we can get. 715. But a very fallacious, misleadinir test? — These Blue Books are not worth the paper they are written on. 716. There is a military provision which goes by the name of Lord CardwelFs Order? — Yes ; I believe it had something to do with stopping the pay when the soldiers were in hospital. 717. It stops the pay where the patient is diseased with a primary sore or with gonorrhoea, but not when he is suffering from secondaries ? — Yes ; that was in 1873. 718. Do you not think it likely, as it has been shown in evidence, that many men to avoid losing their pay would conceal their primary symptoms ?— I am sure of it. 719. Then they would not come before the surgeon before they were disabled by seconda- ries ? — The tendencies of all such laws are well known. The tendency of a law like that is to make a man conceal his condition. 720. Then you will admit that many secondary cases must have come into this particular cate- gory, of which the primaries have been caused by concealment under Lord Cardwell's Order ? —You mean that there are more secondaries than there ought to be. 721. In consequence of concealment of pri- maries under Lord Cardwell's Order ? — I do not see what concealment has to do with that, because you would have secondaries whether they were concealed or not. 722. It has everything to do with it. A man conceals a primary under Lord Cardwell's Order to avoid losing his pay, and then it developes into a secondary ? — It always will do so. 723. I ask you whether you do not think it very likely that many of these secondary cases would arise in that way ? — I have said that secondaries always follow after primaries. 724. I want to show you that secondaries are no measure of primaries in consequence of the great difficulty there is in bringing primaries under the control of the army surgeon ; many of these SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 35 7 March 1881.] Dr. Drtsdale. \Continued. Mr. Cavendish Beniinck — continued, these secondary cases that you say are a test of the fallacious workings of the Act must find themselves in that category from concealment of primaries from the army surgeon ? — I should think that has had a very disturbing influence on the statistics. 725. You have said, and I agree with the ob- servation, that there ought to be an early exami- nation of soldiers ? — I did not venture to suggest that. 726. Supposing there is no early examination of soldiers, is not the best thing to do to cure them as speedily as jiossible after they are ill ? — That is the business of medicine. 727. Is there any suggestion that you can make with regard to improving the Acts in that respect? — 1 think the army surgeons attend to their own business very well, and I dare not, as a civilian, offer any advice to them on those points. 728. So far as you know, you entirely approve of the mode in which the army surgeons conduct their professional duty ? — I consider them a highly educated and fine body of men. 729. You know, I suppose, that they are unani- mously in favour of the Acts ? — I have not the honour of knowing army surgeons individually, therefore I cannot tell. 730. What is your opinion?— My opinion is that Mr. Myers is in favour of the Acts. 731. Have you ever known an army surgeon opposed to the Acts ? — I have not the honour of a very large acquaintance with army surgeons, therefore I do not know ; I have no statistics as to their opinions. 732. Have you ever known one opposed to the Acts? — I do not remember. 733. Did I understand you to say that you thought women would go voluntarily to hospitals ? — I know that they do, and they are very glad to get into them. 734. Are you not aware that when they have been in hospitals a short time, in many cases they discharge themselves ?■— I am quite aware of that, if there is not much the matter with them. 735. Have you read the evidence of Dr. Bond, a medical gentleman of great experience, who was examined before the Royal Commission, and also before this Committee ? — I have not read it ; I have seen references to it. 736. Do you recollect that he said that it was an impossibility to keep diseased women in hos- pitals ? — Yes. 737. Do you agree with that ? — I think there must be some fallacy in it, because I find the girls in my hospital stay with the greatest pleasure, or without any difiiculty whatever as long as they are ill. Mr. Stansfeld. 738. You were asked by Sir Henry Wolff to compare the figures, particularly of gonorrhoea in certain districts from 1860 to 1878, and in the cases to which he drew your attention there was generally a very considerable diminution in the proportion of gonorrhoea. Now if instead of looking at the protected stations to which Sir Henry Wolff drew your attention, you had directed your attention to the unprotected sta- tions and to large towns, would you not have 0.44. Mr. Stansfeld — continued, found precisely the same results ? — It seemed so to me, exactly the same. 739. So that whatever inference is to be drawn from those figures and that reduction, applies to subjected and unsubjected stations alike ? — Pre- cisely. 740. Is there not also another fallacy in the comparison, that it is made between the year 1860 and the year 1873? Is it not a fallacy to compare the figures of those years, and to refer the difference, if the difference is any diminution in disease, entirely to the operation of the Con- tagious Diseases Acts? — 1 think so, because the Acts were not in force at all then. They only began to be in force in 1866. 741. It was in 1867 that the Act was passed for the compulsory examination of women, and it only gradually came into operation ? — Yes ; you may say 1868. 742. I believe it only came fully into opera- tion in 1870 ?— Yes. 743. So that the comparison is a fallacious one ? — That is my opinion. 744. Then with regard to the effect of the Acts upon gonorrhoea, there is no doubt, I believe, in the opinion of the medical advisers of the army, as in evidence before this Committee ; will you take the Medical Report of 1872 and read what is said there ? — " With regard to the prevalence of gonorrhoea, the fact remains that the average ratio of admissions for the eight years from 1865 to 1S72 was higher at the pro- tected than at the unprotected stations." 745. Then in the Medical Report for 1873, do you find any explanation of the subsequent fall of gonorrhoea, and to what is that explanation re- ferred? — There is reason to believe that the fall of the rate of admissions for gonorrhoea in 1873, is connected with the issue of the Royal Warrant, in the month of October in that year, du-ecting that the pay of soldiers, admitted into hospitals with venereal diseases, should be forfeited during their stay there. 746. Will you have the kindness to turn to Sir William Muir's evidence in reply to my questions, and read his statement of opinion upon that subject? — " (Q.) Therefore down to the year 1873 the figures show, and it is your opinion, and the opinion of the Medical Department of the Army, that the Acts have produced no reduction in the amount of gonorrhoea? {A.') Very little. (Q.) None? {A.) I should say none." 747. One more question with regard to the proportion of secondary syphilis and primary sores, in the period following upon Lord Card- well's order ; there is a sudden and heavy reduc- tion of primary sores, and there is no reduction in secondaries ; that is so, is it not ? — It must be so. 748. Then there was an inducement in that order which stopped the pay of the soldier to conceal primary affection ? — Yes. 749. There was no inducement to conceal the secondary ? — So it appears. 750. Your inference would be therefore that the figures of secondary syphilis are reliable rather than those of the primary sores ? — Of course, E 2 751. Taking 36 7 March 1881.] MINUTES OF EVIDENCE TAKEN BEFORE THE Dr. Drysdale. [ Continued. Mr. Stansfeld — continued. 751. Taking the figures of secondary sypliilis as the more reliable of the two, there is no decrease, is there, during the period of six years of full operation of the Acts, compared with the previous six years, when they were gradually coming into use ? — No, they are both the same, 25. 752. But there is a very large increase, if you take the proportion of secondary to primary sores ? — Very large. 753. Your inference I take it is that secondary syphilis, and therefore true syphilis, primary or secondary, has not been affected by the Acts, but that the Acts on the one hand, and Lord Cardwell's Order on the other, have reduced the real or admitted number of primary non-syphilitic sores ? — That appears to be so on the face of it, Sir H. D. Wolff. 754. I have prepared, with the assistance of Colonel Tottenham, a paper in which I have taken the average per 1,000 of the years 1860 and 1873, of the protected and unprotected dis- tricts ; we have been obliged to omit Windsor and Wai'ley, because they were not in the first. Sir H. D. W'bZ^— continued. I have given an average of the decrease in the jDrotected districts in 1860, as 2-l'603, and in 1873, 10'302 ; and in the unprotected districts, 20-106; and in 1873, 13-030. I will ask you to check it, and say whether it is correct ? — Yes. Mr. Cavendish Bentinck. 755. Let me ask you whether secondary syphilis does not arise from an infinite variety of causes, such, for instance, as the constitution of the patient ? — It has nothing to do with it. 756. 1 meau the original constitution of the patient himself? — It has notliing to do mth it. 757. Has it anything to do with his conduct ? ■ — Nothing whatever. 758. Therefore, however careless, or however drunken a man may be, it will not affect his liability to secondary syijhilis? — Not his liability, but it will affect the character of it ; it will make it severer if he drinks or is dissipated. 759. Will the state of the atmosphere have anything to do with it ? — Nothing, except as re- gards the severity. 760. Natural causes such as I have mentioned will not affect the existence of the disease, but only modify its intensitj' ? — Precisely. SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. Wednesday, \Qth March 1881. MEMBERS PEESENT: Mr. Cavondish Bentinck. General Burnaby. Mr. Burt. Dr. Cameron. Mr. Cobbold. Colonel Digb)'. Dr. Farquharson. Mr. William Fowler. Mr. Hop wood. Mr. Massey. Mr. Osbome Morgan. Mr. Ernest Noel. Mr. O'Shaughnessy. IMr. Stansfeld. Colonel Tottenham. The Eight Honourable W". N. MASSEY, in the Chaik. Professor Henry Lee, called in ; and Examined. Mr. Stansfeld. 761. You are, I believe, a Fellow and late Member of the Council of the Royal College of Surgeons ? — I am. 762. Were you Professor of Surgery and Pathology at that institution? — I was. 763. And Surgeon to King's College Hos- pital ? — I was. 764. And Consulting Surgeon to the Lock Hospital '/ — Yes. 765. Do you now hold the appointment of Consulting Surgeon to St. George's Hospital and the Queen Charlotte's Lying-in Hospital ? — I do. 766. You have had, have you not, considerable experience in the diagnosis and treatment of venereal diseases ? — Very considerable. 767. Were you appointed by the Council of the Hoyal College of Surgeons Professor of Pathology and Surgery? — I was. 768. And also appointed by the Medical Society of London to deliver the Lettsonian Lectures on Syphilis in 1875? — I was. 769. Did you write the articles on Gonorrhoea and Syphilis in Holmes' Surgery? —I did. 770. Are you the author of a book which has been already much quoted before the Committee, entitled "Lectures on Syphilis"? — I am. 771. Are you also the author of "Practical Pathology," in two volumes, and several other medical works? — I am. 772. Have you carefully studied the operation of the Contagious Diseases Acts in this country, regarding them from a hygienic point of view ? — I have studied them. 773. When I say " carefully," I presume you have not, year by year, gone consecutively and in detail into all the statistics ? — I have not. 774. What I mean is that you, as a medical man specially interested in this subject from a medical point of view, have carefully considered the operation and the influence of those Acts ? — I have. 775. And you have considered them, 1 pre- sume, with special reference to the facts and 0.44. Mr. Stansfeld — continued, opinions and expectations upon which they were founded when introduced? — I have. 776. What can you tell us about the medical expectations upon which those Acts were partly founded when they were introduced? — When those Acts were introduced it was generally sup- posed that by inspection a surgeon could tell whether a patient was infectious or not, and it was upon that idea that the Contagious Acts originally were founded, both abroad and here. 777. Was there a theory at that time held by many eminent men that real syphilis could only be communicated by contact with the secretion of a primary sore? — It was the universal opinion at that time upon the Continent, and most English authors followed that opinion. It was the opinion of the great Professor Ricord, whose oj)inion everybody received at that time. 778. Has that theory now been demonstrated to be unsound? — It has been demonsti'ated to have been entirely unsound. 779. In fact that theory is no longer held by any medical authority ? — No, I should think not; none that I am acquainted with. 780. Is it not practically universally admitted by medical men that syphilis can be conveyed by the secretions of persons who long ago passed through the primary stages ? — Certainly. I would submit these diagrams to the Committee, and I may have occasion to refer subse- quently. These represent inoculations from the secretions of the mucous membrane of a syphilitic woman which presented nothing pecu- liar at all as far as ocular demonstration was con- cerned. It was taken from the common muco- purulent discharge of a syphilitic woman, and it has produced what is called the characteristic inoculation; but there was nothing like a primary sore, and no affection of the mucous membrane that could be recognised as syphilitic. 781. I understand from you that the almost universal opinion of medical men at this day is that syphilis may be communicated by the se- E 3 cretions MINUTES OF EVIDEbfCE TAKEN BEFORE THE 16 March 1881.] Professor H. Lee. [ Continued. Mr. Stansfe.ld — continued, cretions of persons who have long passed the stage of primary syphilis ? — Certainly. 782. And, in your judgment, that change in medical scientific opinion has very considerable bearing upon the question of the utility or use- lessness of the Contagious Diseases Acts ? — It has a very great bearing. 783. Will you tell the Committee what is the classification of the venereal diseases which you yourself are prepared to adopt ? — I may say in the study of all diseases we must, if we reaUy want to understand them, consider them in their uncomplicated forms; and these are, firstly, gonorrhoea, vhich is a discharge from the urethra ; secondly, there is the local venereal sore, which does not infect the constitution; thirdly, there is the true syphilis, which, unless influenced by treatment, always affects the con- stitution. Mr. Oshorne Morgan. 784. You said "unless"? — Yes ; that is very material, unless influenced by treatment, and proper treatment, of course. 785. The third is the true venereal sore which aifects the constitution, subject to this, that it may be affected by proper treatment ? — It may be influenced by treatment. Mr. Stansfeld. 786. Will you describe the essential charac- teristics of these three forms in such a way_ as to make us acquainted with those characteristics, and the differences between them ?— I need not describe gonorrhoea, I presume. 787. It is hardly necessary; but will you dis- tinguish between the local, venereal, non-syphililic sore, and true syphilis, primary and secondary ? — The local venereal sore, which in my publica- tions I have always called a suppurating sore, always commences within two or three days of the application of the poison. It always runs on to ulceration, and to a loss of substance: that is peculiar, because the other forms do not. It assumes something of that character {shoioing a diagram). 'Ihere is a loss of substance ; a clear, definite, sharp outline, and a good deal of secre- tion from the surface. That sore is always in- oculable again upon the same subject, or upon other subjects. The inoculation when repeated becomes less and less, but they may be reproduced an indefinite number of times, and are never fol- lowed by constitutional symptoms. Professor Daniellsen in Norway inoculated a large number of lepers who had never had syphilis. He ino- culated them a great number of times with this particular poison, and they none of them had any constitutional syphilis except one, and in that case it was found out afterwards that a mistake had been made in the poison ; that the poison of real syphilis had been taken instead of that from the local sore. Chairman. 788. Is it difficult to distinguish between the local sore which is innocuous, and the true syphilitic sore ? — In what we call virgin consti- tutions, that is to say, constitutions that have not been previously affected, it is always very easy to distinguish them. If the constitution Chairman — continued, has been previously affected, you get all sorts of complications. 789. Do I understand you to say the expe- rienced surgeon can clearly distinguish between the soft and the syphilitic sore? — Clearly. Mr. Stansfeld. 790. The characteristic of the soft sore are loss of substance and formation of pus and ulcera- tion? — Yes; and the rapidity with which it succeeds to inoculation. 791. But to the eye the distinctive character- istics would be loss of substance and ulceration ? —Yes. 792. Now, will you come to true syphilis ? — True syphilis appears, in a virgin constitution of course, in about ten days to seven weeks after inoculation. 793. By the term " virgin constitution," you mean one not already syphilised ? — I do. 794. What is the first symptom ? — It always appears as a pimple or an abrasion. It differs from the local sore, which almost always appears at a pustule or suppurates at once. Chairman, 795. Upon the organ ? — Upon any organ which is infected. I have here a diagram of a characteristic of the local sore. There is an in- crease of substance ; not a loss of substance, as in the case. Mr. Osborne Morgan. 796. The primary symptoms may appear any- where ? — I have known them to appear on the tongue. That was the case of a lady who was perfectly a virgin, and she got it from a spoon. Shakespeare knew that. He says: " As long as I live, will I forget to drink after thee." We are only coming back to the knowledge they then had. Mr. Stansfeld. 797. This primary syphilitic sore will appear at the point where the contagion has been effected ? — Certainly. 798. It may not necessarily be upon the gene- rative organs? — No ; it may be anywhere. 799. It will be at the spot where the poison has come into contact with the mucous mem- brane ? — Not necessarily with the mucous mem- braue. 800. With the skin?— The local form of disease when naturally contracted, generally appears on the mucous membrane; the true syphilitic poison may be imbibed through the skin without any breach of surface. 801. Wherever that poison has come into contact with the human body, whatever portion of the surface it has come into contact with, it may produce primary syphilis ? — It may produce it. It is not nearly so likely where the skin is whole as where it is abraded; but still it may produce it. 802. The most salient distinction between the first symptom of syphilis and the local non- syphilitic sore is, that in the case of syphilis it is a pimple ; and in the case of a local sore it is a pustule ? — Yes. 803, Or SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 39 16 March 1881.] Professor H. Lee. [ Continued. Mr. Staiisfeld — continued. 803. Or in other words, am I right in saying, in the case of local sore, there is a loss of sub- stance, and in the case of syphilis there is a gain of substance ? — That is so. 804. What follows, in point of symptoms ? — After a short time, in true syphilitic, the corre- sponding absorbent glands, wherever they may be in the body, not necessarily in the groin, but in whatever part of the body they may be, become enlarged. The same kind of action occurs, in- crease of substance, but no suppuration. It is quite characteristic. 805. The characteristic of the non-infecting sore being suppuration ? — Not in the absorbents; in order to produce suppuration in these there must be some additional irritation. Thousands and thousands of inoculations have been made with pus from the non-infecting sore, and it is very seldom indeed that there is any suppuration or enlargement of the glands. There must be some additional irritation. 806. Did not 1 understand you, going back to the local non-syphilitic sore, to say that it gave rise, at an early date, to the formation of pus? — On the part inoculated. 807. And in the case of real syphilis, subsequent to the enlargement of the glands, there would, of course, be a development of what you would call secondary symptoms P^There would, with about the same certainty as the eruption of small pox would follow inoculation of small pox, pro- vided, also, it is not interfered with by treatment. 808. Am I right in saying in the case of true syphilis, unless there be some accidental cause of irritation, or some cause of weakness in the patient's own constitution, it is not accompanied by suppuration? — It is not ; there is often at some periods of the case, as after vaccination, some little suppuration at the seat of the sore, but no suppurating bubo. I have here two plates re- presenting primary syphilitic sores perfectly cha- racteristic, and in neither case is there any sup- puration. 809. Now, with regard to treatment ; take the non-syphilitic sore ; what does that require to effect a cure ? — It only requires cleanliness; it always heals of itself within a ievf weeks. 810. Remaining purely local during the whole of that period ? — Yes. Mr. Osborne Morgan. 811. Without any medicine at all? — Yes. Mr. Stansfeld. 812. Does it generally incapacitate a person from following his ordinary avocations ? — It does not. I have here the representation of a case in which I inoculated a gentleman's arm, and he allowed me to take the drawing of it afterwards. He followed his business during the whole time, without the slightest inconvenience. Mr. Cavendish Bentinck. 813. Is that the soft sore ? — That is the soft sore. 814. A non-syphilitic sore ? — A non-syphilitic sore may have accidental complications which may make it very severe ; but a simple uncom- plicated non-venereal sore is a simple local effect, and if not irritated, does not at all incapacitate a man from doing his duty. 0.44. Mr. Stansfeld. 815. Syphilis is a blood disease ? — Essentially. 816. And affects the entire system ? — It affects the entire system. 817. And it may last for what period of time ? — Mr. Pope says, all the life, and it is quite true it may last a man's lifetime if not cured. 818. With regard to the treatment necessary to effect a cure, that treatment, I presume, would have to begin very early, would it not ? — Some surgeons wait for the development of secondary symptoms before they really begin the cure, but that is, I believe, because they are not quite sure whether the primary symptoms are going to develope into secondary or not. 819. I take it in that way. Let us sujjpose that the surgeon in charge of the case waits tiU the secondary symptoms develope themselves ; then would, or would not, the treatment neces- sitate precautions which would interfere with the daily ordinary vocations of the patient? — Cer- tainly, if you are to cure the patient, not simply treat him. Mr. Osborne Morgan. 820. Is it the case that primary symptoms are always followed by secondary symptoms. Put the case of a man or woman coming, under most favourable circumstances, to the most skilful sur- geon, would he be able to cure primary symptoms so completely as to prevent secondaries ?^They can be cured so that the patient himself and none of his friends would know that he had ever had anything the matter with him. A medical eye will generally detect at some period when the secondary symptoms would otherwise have ap- peared, some little deterioration of health; he will either get a little thin, or a little out of sorts. 821. For all practical purposes primary symp- toms may be cured in this sense, that secondaries may be prevented ? — They may. They are as a matter of fact. 822. You can cure primary symptoms in such a way that the patient will cease to be contagious ; would you say that ? — I might cure him in such a way that the inoculated sjDot would not be con- tagious ; but it would not in the least follow that he was not contagious altogether, as I think we shall see by and bye. 823. I want to know whether it is possible to treatprimary syjshilisjthatis true syphilis, in such away that from the moment of the cure the patient would cease to be contagious ? — Certainly not, because the secondary symptoms are due, and they themselves are contagious. 824. They cannot be prevented. Then I am afraid I must take your first answer with a little qualification, because I thought you said the patient might be cured at the primary stage in such a way as to exclude, practically, the occur- rence of secondaries ? — I beg your pardon. I understood you to refer to the primary sore only. I now say, decidedly yes. I constantly allow patients to get married who have gone through the course ; I did yesterday. Mr. Cavendish Bentinck. 825. After primaries? — After ^^rimaries, with- out any secondaries. Mr. Stansfeld. 826. Syphilis, if not eradicated, I take it, is of E 4 very 40 IMINUTES OF EVIDENCE TAKEN BEFORE THE 16 Marcli 1881.] Professoi- H. Lee. [ Continued. Mr. Stansfeld — continued, veiy much greatov importance than venereal sores ? — Very much. 827. It affects the constitution of the patient ? — It affects the constitution of the patient, and may be communicated to others, and may be communicated to the patient's chiklren. 828. Kow, you have spoken of the inoculation of syphilis as well as of the local sores ; does the inoculation of syphilis bear an analogy, which you think worthy of remark, to the inoculation by the vaccine virus ? — It does. 829. After inoculation of syphilis, is the patient protected for a time, as he is protected by vaccination from small pox ? — He is, for a time. Any inoculations that succeed are of the most trivial character. There are some of them that have been made from real chancres, and they produce a kind of abortive pimple, if they produce anytliing. It generally fails altogether if nothing but the secretion from the infecting sore is taken. If there is any irritating matter mixed with it, then it succeeds, and produces something like the inoculations which I first showed. Those are inoculations from the mucus of the vagina on another syphilitic patient. 830. Did I understand you as saying that these two affections are entirely distinct? — Entirely distinct, as much as measles and small pox. 831. And there is no such thing as protection by inoculation from the non-syphilitic local sore ? — After a great number of inoculations have been made, the skin seems to get accustomed to it, and will not receive any more as it would if the patient's skin were repeatedly blistered, or if you were repeatedly stung by mosquitoes ; after a time it "cts inured to it, and the mosquito sting does no harm. 832. Besides the soft or non-syphilitic chancre and the harder syphilitic, we have heard of the mixed chancre ; what is that ? — It occasionally happens that some spot is inoculated by both kinds of poison at the same time ; then the poison from the soft chancre produces its legi- timate effect, and after that is over, the charac- teristics of the hard chancre make their appear- ance. They both run their course regularly and definitely without interfering with each other, although the inoculation has taken place upon the same spot. 833. But they are two distinct chancres ? — They are two distinct chancres. Mr. Osborne Morgan. 834. Two different diseases at the same time ? — Yes ; but that must not be confounded with the reinoculations new formed on a syphilitic subject. The first is the mixed chancre, ab initio ; the second is something that occurs in con- stitutional syphilis, and the two must not be mixed together in our descriptions. 835. In the case of what is called the mixed chancre, which you say is really a combination of two chancres, is that usually accompanied at once by a suppuration ? — At once. 836. And that, of course, is not the case with true syphilis ? — That is not the case with true syphilis. Mr. Stansfeld. 837. We have had some medical evidence before this Committee on the question, I am Mr. Stansfeld — continued, disposed to call it the vexed question, of the duality or unity of the venereal poison. Surgeon Myers, of the Coldstream Guards, has expressed before tliis Committee the opinion that the dualistic theory is dying out, and he cited certain authorities on his side of the question ; since then we have had other authorities cited to us by the witness. Dr. Drysdale, who preceded you ; will you give the Committee the benefit of your opinion on this question of medical science? — I have no doubt whatever that the dualistic theory is the correct one. 838. Have you written and lectured upon that very subject? — I have. 839. Are you prepared to say that the dualistic theory is supported by the great majority of medical authorities ?— On the Continent it is now universally received. 840. And in this country? — And in this country by the great majority of medical autho- rities. M. Ricord himself, who was the great authority for the single theory, has now entirely abandoned it. 841. Therefore, speaking as a medical man familiar with this subject, and with medical opinion on this subject, you are prepared to state to the Committee that, so far from the dualistic theory dying out, it is the theory of unity which is dying, or has died out ? — That is so. 842. You hold, therefore, and the profession generally holds, that the true syphilitic chancre and the local venereal sore are essentially diflferent diseases, resulting from different and distinct kinds of poison ? — That is so. 843. And that no sore of either kind can be converted into the other ? — That is quite clear. Mr. Osborne Morgan. 844. One is constitutional, and the other not ; is that the right distinction ? — It requires a little definition of terms, but that is quite right as far as the words go. 845. The mixed sore is, of course, capable of undergoing a characteristic change, because it really is, as you have explained, two sores, and not one ? — That is so. 846. Each sore following its own nature to the end ? — That is so. 847. Does it follow, upon these facts and views, in your opinion, that an exact proportion is always maintained between real primary and secondary syphilis? — Provided the inoculations occur in what we call a virgin constitution, a con- stitution previously uninfected, and, provided the disease be not influenced by treatment, the secondary symptoms follow as surely as the small pox eruption follows the inoculation of small pox. 848. In fact, what I understand you to mean is this, as has been explained to us already by another professional witness, that primary and secondary syphilis are simply syphilis at different stages ? — Different stages of the same disease. 849. Of course, you may check or cure that disease earlier or later, according to the time at which you have been enabled to take it hand, and according to the character and success of your treatment ? — That is so. 850. So many questions have been interpolated with regard to this expression of your opinion, that primary syphilis may be cured, that I will at SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 41 16 March 1881.] Professor H. Lee. [ Continued. Mr. Osborne il^ort/a?; — continued, at once put a question to you on that part of the subject. I presume that one conclusion wliich I should be entitled to draw from the expression of that opinion is, that in your mind it is of essential importance that the disease in the soldier should be made known to the medical authorities and treated at the earliest possible period? — Cer- tainlv. 8.51. It is In the case of a soldier, is it not, that it is most possible to secure that early discovery and succesful treatment? — Necessarily. 852. Now, you have told us that a man or woman who has once been syphilised is, to a cer- tain extent, protected from renewed syphilisation for a considerable number of years ?— For a con- siderable time. He may be cured, and then he may be infected again. 853. During that time that person will not always, but frequently, be capable of conveying disease by contagion ? — Before he or she is con- stitutionally cured — certainly. 854. Passing for a moment from the case of the soldier to the case of the woman with whom he consorts, unless you assume that you get posses- sion, for the purpose of treatment and cure, of the woman immediately on her first attack of primary syphilis, you will not be able to effect the object of her complete cure : she will have been already syphilised. Is that so ? — She will be sure to have secondary symptoms. 855. Or she may have had secondary symptoms ? — Or she may have had secondary symptoms. 856. Then the disease, of course, may show itself in a very modified form. If a prostitute has had true syphilis, I understand from you that though that is not a permanent protection, she is not likely to have frequent repetition of primary and syphilitic sores ? — That is so. 857. If you deal with such women as we deal with, such women in a subjected station, the sores which are found upon these women in the great majority of cases would be non-syphilltic? — That is so ; provided there be a sore, which is a non syphilitic sore in the great majority of cases. 858. One distinction between the syphilitic and the non-sj'philitic sore is this : the non- syphilitic local sore may he constantly repeated, but the syphilitic sore, though it is capable of repetition, is not frequently repeated ? — That is quite clear. 859. It follows, therefore, does it not, that the sore which must be found and treated, for the most part under the Contagious Diseases Acts, in prostitutes consorting with soldiers, must be the soft non-sypl'.ilitic sore? — That is so; but there may be also some abortive innoculation, such as I have shown here, from the real syphilis, or inoculations from non-infecting sores, but it will not be true syphilis again. 860. Now, after the expression of your view upon the dualistic theory, I need hardly ask you whether you apiDrove or disapprove of the method adopted by the army medical authorities, of grouping together in their returns both forms of local and constitutional disease ? — It is impos- sible to draw any clear deductions from such statistics unless those diseases be separated ; we might as well have a statistic of fevers without its being stated what fevers they were. 044. Mr. Osborne Morgan — continued. 861. The classification adopted by the army and medical authorities, I understand you to hold to be unscientific and necessarily defective ? — I do ; and I may say that there is no record of whether a person has had syphilis before, which is a very material factor in drawing deductions from statistics. 862. Taking the total number of what are called primar}' venereal sores, and which are often referred to inaccurately as cases of primary syphilis, what proportion do you suppose are really syphilitic ? — Some years ago, I should say that the proportion was about three local sores to one really syphilitic sore. The local sore, from some cause or other, has lately diminished very much in all classes of society ; and I should saj^ that now the proportion is very nearly reversed ; that there are three infecting sores, or some modification of the infecting sores for one really local sore. 863. Therefore, outside the Contagious Dis- eases Acts, and outside the army, you have ob- served the same comjaarative reduction in the primary sores which are non-syphilitic, which we see in the Army itself? — That certainly is so, independent of any Contagious Diseases Act. 864. Are you able to attribute that to any cause you can specify ? — I think public attention has been directed especially to it, and people have been more careful, especially with regard to cleanliness and washing, and so on. 865. The inaccurate classification, or non- classification, of the venereal diseases, syphilitic and non-syphilitic, in the Army Returns, makes them, does it not, valueless as regards the ques- tion of the increase or decrease of real syphilis in the Army ? — You can form no judgment at all with regard to what is called there the primary disease, which, of course, cannot all be primary if there is no secondary. 866. I do not know whether it is within your knowledge, but at one time there was a depart- mental order issued, calling upon the Army sur- geons to distinguish between syphilitic and non- syphilitic cases ; is that within your knowledge ? — It is not. 867. I will ask your opinion. I understand you to say the present classification is unscien- tific. Do you believe a really scientific and proper classification of these maladies is prac- ticable and possible ? — I certainly think so. 868. Would you yourself undertake to distin- guish between true syphilitic cliancre and non- syphilitic local venereal sore within some period of time that you can approximately define? — In uncomplicated cases I certainly should. 869. And would this be the great majority of cases ? — The great majority of cases in private practice, certainly. As to how far it would be in the Army, I have not so much experience, 870. Is it your opinion that an army surgeon of sufficient training, having given attention to this particular subject, ought to be able to distin- guish between the one sore and the other, and to classify those maladies in a correct and scientific way ? — Certainly, between those two sores. 871. With regard to the two-fold object with which these Acts were originally introduced and passed, what did you understand it to be ? — F First 42 MINUTKS OF EVIDENCE TAKEN BEFORE THE 16 March 1881.] Professor H. Lee. [ Continued. Mr. Osborne Afor^aw— continued. First to diminish the amount of disease, and secondly to save the efficiencv of the soldier. s72. And the saving of efficiency means keep- ing down the numbers permanently in hospital from diseases of this kind ? — That is so. 873. Now with these views, what should you sav was the true test of the success or failure of these Acts ; their operation upon true syphilis or upon soft sores or gonorrho?a ? — The true test would be their operation upon real syphilis ; secondly upon gonorrha:a, and in a very minor degree upon the local form of the disease which requires no treatment. 874. Take true syphilis ; do you believe the true test of their success would be above all their eflect upon true syphilis : first, because that is the most serious ? — That is so. 875 And, secondly, because it is a disease the proper treatment of which induces the greatest interference with the ordinary occupation and life of the soldier ?— That is the most im- port ajit. 876. I understand you to place gonorrhcca next ? — Yes. 877. Why do you place gonorrhoea before the primary non-syphilitic sore ? — Because it re- quires treatment, and it is liable to certain com- plications, such as stricture. 878. Does it incapacitate the sufferer more for the time than primary non-syphilitic sores?- — Yes. 879. And you place last and lowest, those primary sores which are non-syjihilitic in their character ? — Certainly. 880. You are aware that a certain reduction has been shown in these primary sores ? — I am. 881. Have tou formed any opinion as to whe- ther tlie reduction is in the syphilitic or non- syphilitic sores in the Army ? — From the fact that the non-venereal sore has decreased through- out all classes of society, I have of course come to the conclusion it has equally decreased in proportion in the Army. 882. Has yom- attention been drawn to the ligures of secondary syphilis in the Armv ? — It has. 88.3. What do you understand those figures to show ; that there has been any decrease efl'ected in secondary syphilis in the Home Army or not? — My opinion is that there has been very little, if any, decrease of syphilis in the whole of the Home Army. 884. And every one of these cases of secondaiy syphilis must have been preceded by a condition wluch we call primary syphilis? — That is so, necessarily. 885. Therefore, as far as we can judge from the statistics of secondary syphilis, we have no evidence of a decrease in primary syphilis? — That appears certain. 886. And the reduction, therefore, that has been effected in the Army and elsewhere, has been a reduction in the local and non-venereal sores ? — That is so. 887. I understand therefore, in your opinion, as a medical man, the Acts have not succeeded in affecting and reaucing the amount of true syphilis in the Army ? — From all the evidence I have had before me, I think they have not ; I have here the most recently published tables, published at the end of last year, giving the Mr. Osborne Morgan — continued, diminution of syphilis before the introduction of the Acts, during the time that they were par- tially in operation, and after they were entirely in operation ; those are the statistics upon which, together with their own, the municipality of Paris have abolished their Contagious Diseases Acts; these statistics are much more comprehen- sive than ours, because they include both. 888. With regard to the reduction in jn-imary non-syphilitic sores, are you cognisant of any sanitary measures other than the Contagious Diseases Acts, which have been introduced into the administi-ation of the Home Army, which would be likely, in your opinion, to have con- tributed towards such a reduction ? — I of course know of Lord Herbert's Acts, but I think the principal result has been brought about by so- briety ; I am told that there are 25,000 total abstainers in the Army, and the majority of these diseases are caught when men are tipsy. 889. Cleanliness and sobriety, and all the con- ditions which have been created since Lord Her- bert's time, in the administration of the Home Army, for promoting cleanliness and sobriety, would in your oi:)inion naturally tend to the reduction of these cases in the Army? — Certainly. 890. Another distinction between the local venereal non- infecting sore and the real syphilitic sore is, that the non-syphilitic sore is much more evident, and much more jiainful and incon- venient? — That is so, much more than the real syphilis when subjected to friction or irritation. 891. Any person would usually diagnose in their own case the presence of the non-syphilitic sore ? — They would certainly know of its existence, and be glad to find any asylum offered to them. 892. Because of the inconvenience and paia in continuing their avocation until that sore, which is capable of easy cure, is cured ? — That is so. 893. So that you would be prepared to attri- bute a considerable j)ortion of the diminution of this form of disease, to the increase or existence of special hospital accommodation for the women, without any reference to their compulsory attend- ance ? — Certainly I would ; I believe the disease is propagated to a great extent by these poor women being obliged to ply theii- vocation, before they are properly recovered from their natural period of separation ; they have no home to go to, and they resort to their old avocation. The least drop of blood mixed with any of the venereal secretions, gives them a virulence which they never would jjossess before, and, therefore, if you give them an asylum or refuge until that period is passed, you in so far reduce the chance of con- tagion. 894. During that monthly period they are ex- cused from examination ? — They are. They cannot be examined, or at least they say they cannot. 895. And before that period is completely over, is the moment of their most infectious and dangerous condition? — That is so. 896. With regard to gonorrhoea, it is, within your knowledge, up to 1873, the date of Lord Cardwell's Ortler, it is admitted by the Army medical authorities that no reduction had been effected ? —I know that ; I have it in my own reports. 897. In SE1.ECT COMMITTEK ON CONTAGIOUS DISEASES ACTS. 43 16 March 1881.] Professor H. Lee. [ Continued. Mr. Osborne Morgan — continued. 897. In the Armj Medical Reports compari- son is made between 14 selected subjected and 14 unsubjected stations ; do you approve of the selection and the comparison in question? — I think that comparison must be utterly fallacious. If a law were passed to-morrow, that all people suspected of having small-pox, or having small- pox, should be sent to a hospital in AYestminster, there would be far less small-pox next month in Westminster than elsewhere, but the amount of small-pox in London, as a whole, would be just the same. You would be simply removing the disease to another locality ; under the contagious disea.ses it might fall upon the civil population chiefly. 898. I think you hardly apprehend the mean- ing of my question. What I wanted to ask you was this : Do you, speaking as a medical man, consider it a fair or accurate thing, to compare a military camp, where there is a large military population and a small civil population, with a large city like London or Manchester ? — I cer- tainly do not. 899. You have justly said that those com- parisons you hold to be unreliable, because the condition of the one district may be affected by the condition of the other ? — Yes. 900. For instance, is not this proved in your knowledge, that diseased jjrostitutes wUl quit a subjected station to avoid examination, and pass into an unsubjected station? — I aui quite sure they will, and I may mention that the lower class of prostitutes would do this, because no woman, however debased, will ever allow herself to be examined, if possible, while she has dirty linen ; they do not mind if they get clean linen, but they will always avoid police supervision if they have not. 901. So that the comparison, originally- un- sound, in your mind, is further confused by incidents of that chai-acter ? — It is so. 902. Do you recollect any case cited in any of the medical journals to which you can refer ? — There was a case where a regiment, some 440 strong, came from India, free from disease ; they were to have landed at Portsmouth, which was a protected district, but instead of that, they landed at the Isle of Wight ; the women, in order to avoid the operation of the Contaojous Diseases Act, as I suppose, flocked from Portsmouth to the Isle of Wight, and within one twelvemonth, every third man was laid up in hospital. 903. And in spite of that exodus from Ports- mouth, we find no improvement in the subjected districts in respect to syphilis or gonorrhcea ?— I believe that syphilis is quite as prevalent in Ports- mouth as it ever was, and gonorrhoea also. I heard an instance the other day, where a woman had been sent to hospital as suspected, she was sent out of hospital as having nothing the matter with her ; and my informant, who came up direct from Portsmouth, in a great state of mind about it, said she diseased eight men straight off. The way in which that could be done, perhaps I shall state hereafter. 904. You have expressed a very clear opinion that the .^cts have failed in a hygienic point of view. Will you give us your view of some of the chief reasons for such failure ? — -I think one of the chief reasons, perhaps the chief reason, is 0.44. Mr. Osborne Morgan — continued, the impossibility from examination of saying whether a woman is infectious or not : as in the case last quoted, in which the woman was sent out as having nothing the matter with her. The first drawings, which I showed, represent characteristic inoculations from the vaginal se- cretions of woman. There was nothing in the mucus membiane of the vagina characteristic of the disease ; but she was syphihtic herself, and therefore these inoculations succeeded. 905. The non-syphilitic simple sore is certain of detection ? — You can always find that out. Patients diagnose that themselves, because it is painful to the touch. 906. Is there any system of periodical examin- ation that you know of, or can conceive, or sug- gest, which would certainly detect every other form of venereal disease ? — Certainly not. 907. Take the case of gonorrhoea, is it possible or impossible, certainly to diagnose gonorrhoea ? — In a woman it is very often utterly impossible. That was Hunter's opinion : it was also Babbing- ton's opinion, who edited Hunter's works ; and I think everybody who has had much ex- perience must come to the same conclusions, that it is quite impossible to distinguish, in many cases, leucorrhcea from gonorrhcea. 908. Would leucorrhcea give gonorrhoea to a man? — That is rather a deep Cjuestion. If a woman had leucorrhcea, the least drop of blood with her secretion, would give a man infection verj' much resembling gonorrhcea. That is a re- finement. It would not give him the ordinary gonori'hoea. 909. And besides this impossibility of dis^ tinguishing- leucoiThcea and gonorrhcea in the woman, is not it proved that, by the application of the syringe and lotions, a woman may remove all marks of gonorrhoea from her person ? — She may remove every symptom. 910. In the case of primary non-venereal sores women diagnose their own cases, but in tlie case of gonorrhoea they are able to conceal it? — It depends upon the vinilence of the disease : if it is very active it comes under the same category as a local venereal sore ; it is very painful, and they are glad to get an asylum during the time that it lasts. But the real disease, as far as the possibility of contagion is concerned, will last long after they suffer any inconvenience them- selves. 911. As to the infecting chancre, is that easy to detect in the fen;ale ? — Very much less so than in the man. 912. Is it often detected with difiiculty ? — Often with diSiculty ; sometimes not at aU. 913. It is certain in a proportion of cases to escape detection ? — Practically it does escape detection. 914. Is it not often small? — It may be very small. 915. Single? — And single. yl6. Superficial, painless, and non-suppura- ting?- -That is so. 917. With regard to the secretions of syphilitic women, they may be removed, like the symptoms of gonorrhoea, by syringing the parts ? — Cer- tainly. 918. A syphilitic woman may remain a long time in an infectious condition after all local ob- F 2 jeetive 44 MINUTES OF EVIDENCE TAKEN BEFOKE THE 16 March 1881.] Professor H. Lee. [ Continued. Mr. Osborne Moryan — continued, jective signs of the disease have jiassed away ? — For a very long period. 919. Is this particularly likely to be the case with the low class of jn-ostitutes with whom sol- diers and sailors consort? — It is so, certainly. 920. Take the cases of real syphilis; could you give any opinion as to the proportion of those cases of syphilis which are contracted from women who present no local characteristics ? — I should say more than half were so conti-acted where there is no primary disease visible. 921. Would you say more than half would be contracted from women who would pass the ex- amining surgeon ? — If he confined himself to the local examination, that would be so. 922. And such woman so passed by the ex- amining surgeon would be especially dangerous in this sense ; would she not ; that she would receive a greater number of customers on account of her supposed safe condition ? — That, no doubt, is practically so. 923. Can you conceive of any practical system of periodical examination Avhich would prevent mediate contagion ? — I certainly could not ; mediate contagion follows often so very soon. 924. Have you defined mediate contagion ? — I will take the definition that has been already given ; I know what is meant by it. 925. If the system of examination suggests an idea of security from this danger, it is altogethei" a delusive idea ? — As far as that is concerned, certainly. 926. Is it not true in this way, that a woman may be the means of conveying disease of each kind from one man to another, while she herself remains uninfected ? — That is so. 927. Is it equally true of women from whom all local symptoms of syphilitic disease have passed away? — It is certainly true of them. 928. They are in a hardened condition, and less likely to be infected themselves ?■ — They cer- tainly are much less likely to be infected. 929. in this way the disease of one man, by means of the one woman, herself remaining un- infected, may be communicated to a great number of men? — That undoubtedly is true. 930. There is another case on ivhich I should invite your opinion of fhe failure of these Acts to those of us who believe in their failure, and that is that they are only applied to one sex ; is that, in your opinion, a cause of failure ? — That is so, certainly . 931. Being applied to one sex, are they applied to all the members of that sex who may com- municate that disease? — Certainly not. Com- paratively very few women or men are subject to periodical examinations. 932. So that what we have is a system of periodical examinations under the Acts applied only to one sex, and only to a portion of that sex engaged in common with soldiers and sailors ? — That is so. Those who are not subject to exami- nation, perhaps, are more likely to give syphilis than those who are, because they have been more recently infected. Those who have recently caught the disease, and have recently had secondary symptoms, are more likely to give the disease than those who had it a long time ago. 933. I do not quite follow your argument ? — There are a certain number of women examined. Mr. Osborne Morgan — continued, and a number who pursue their avocations clan- destinely without being examined. The examined women are those, I take it, who have been on the pact a long time. Women who have recently come on do it clandestinely. They have con- tracted syphilis, provided they have it, much more recently than the others, and, therefore, their secondary sym^jtoms are more liable to give the disease, perhaps, than the very old stagers. 934. Your general conclusion is, as stated by the departmental witnesses, that the system of examination must be confined to one sex, and, in your opinion, that is a system which must inevi- tably fail ? — I believe it has failed hitherto. I do not know what may be in the future. 935. Do I understand it to be your opinion that a system of examination confined to a por- tion of one sex, with the object of preventing disease arising from the contact of the two sexes, is certain to fail ? — It has failed, hitherto. 936. Can you conceive of such a system of examination applied only to one sex which should succeed? — It has never entered my head to con- template any system which would go that length. 937. Has it come within your professional knowledge that the Acts have induced an undue sense of security in men which has not only in- creased sexual vice, in so-called protected dis- tricts, on the part of civilians, as well as soldiers and sailors, but has, in many cases, proved illu- sive as a protection ? — That is so. I have had many cases of gentlemen complaining to me that they have got diseased, when they thought they were in a protected district. 938. Gentlemen who have gone to a protected district, imagining that there they would be safe ? • — That is so. 939. And they have found that a delusive hope ? — Certainly. General Bumaby. 940. They have gone to the protected district accidentally, and not for the special purpose? — They happened to be there ; I do not think they had gone there on j^urpose in cold blood. .Mr. Ernest Noel. 941. Did I understand you to say the Paris Contagious Diseases Acts had been abolished? — Yes. 942. Is there no periodical examination in Paris, now ? — There will be no police examina- tion after the 31st of December this year. Dr. Cameron. 943. You mentioned that whereas formerly, according to your experience, there were about three non-infecting sores to one infecting sore ; there are now three infecting to one non-infect- ing?— Somewhere about that proportion. 944. You mentioned that one great cause for the reversal of the proportion was the diminution in non-infecting sores. Has there been any in- crease, do you think, in infecting sores ? — The proportion has greatly increased. 945. I wish to ask whether you think there has been any increase of infecting sores to help to reverse the proportion, or whether the re\'ersal of the proportion is entirely due to the diminu- tion of non-infecting sores ? — My opinion is the diminution SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 45 16 March 1881.] Professor H. Lee. [ Continued. Dr. Cameron — continued, diminution of the proportion depends upon the less frequency of this non-infecting sore. 946. There was one point I do not think you were examined ujjon, that was the period which, accoi'ding to your experience, ordinarily elapses between primary symjitoms and the manifesta- tion of secondary symptoms? — If not treated by mercur}', which 1 believe is the only real re- med}', it always appears, I believe, within six months. 947. You gave one illustration whicli I thought was hardly appropriate. I probably did not un- derstand you. I think, you said, if people with small-pox were sent to a sraall-pox hospital in Westminster, there would be less small-pox in Westminster, but more in London. But do the cases of small-f)OX and syphilis run at all upon parallel lines? — Very parallel. 948. Is not the small-pox contagion very much more subtle, and diffused iu a perfectly different manner ? — I believe it is diffused in a perfectly differeut manner : but as to being more subtle, i do not know anything more subtle than the poison of syphilis. It requires contact in order to be communicated. 949. How would the isolation of a certain number of persons - in Westminster increase small-pox in London ? — Because those who did not want to go to hospital in Westminster would go to the City, or elsewhere. Among the number of suspected persons some would really be infected, and tlie contagion would then be thrown on the surrounding civil population. 950. Of course, people labouring under small- pox are not in a position to go about and choose their own locality, as persons may do who are affected with syphilis? — That is true; they are not, certainly after their disease has developed itself. 95 L You spoke about a woman who after being cured, had diseased eight men, and you said you would come to the details of that occur- rence hereafter. I want to know Avhat was the nature of that case ? — I simply gave it as it was told to me by a gentleman who had come up hot from Portsmouth. He said. " A woman was run in, and sent out of hospital as having nothing the matter with her, and there she has been and diseased eight men, one after another." 952. You know nothing of the particulars of the case ? — ^It is so very difficult to prove : you would have to get the woman, the men, and the surgeon. 953. What would you think would be the most likely method of accounting for it ? — I think the most likely thing was that she had not completely recovered from her peiiod of separa- tion, and that gave her secretions a virulence whicli they otherwise would not have. 954. What is your opinion as to the specificicity ■of gonoiThffia ? — I think it is a specific disease. . 955. I asked you particularly about the period which elapses between primary and secondary symptoms, and I asked it with this view : to clear up a point which has been made. You have said that secondary symptoms are not diminished in troops stationed in protected districts, but it is virtually the same in protected and non-protected districts ? — I do not think I have said that. I beheve, taking the whole Army, that syphilis has not diminished, or very very slightly. 0.44. Dr. Cameron — continued. 956. Has it increased in the non-protected portion of the Army ?— I suppose it has ; I do not know. I have got the tables here. 957. I thought, perhaps, that you knew ? — I have no better knowledge upon that subject than the Committee has. 958. What I wished to ask was, it has been said a number of the cases of secondary disease occurring in protected districts occur among persons who received their primary infection iiefore coming into those protected districts, and that they went to swell the number of secondary cases appearing in the returns ? — That is quite possible : but at the same time a soldier might get primary disease at one station, and go to another district before he was cured, and then he would appear twice over in the returns. Mr. Hopivood. 959. With regard to the proportion of times that primary syphilis is followed by secondary symptoms, you say if under the most favourable conditions you have a patient with the symptom of primaries upon him, you would entertain a hope of curing him, so as to prevent the evidence of secondaries following ? — That is so. 960. Does that apply only to the evidence of the secondaries, or to constitutional secondary disturbance itself? — There is some permanent effect left in the constitution the same as after vaccination ; there is an effect left upon the con- stitution which prevents the vaccine poison taking again, but there is no external manifestation. 96 L To that extent, is it true to say that every case of true primary syphilis will be followed by some secondary symptom? — Every case of true primary syphilis, if not influenced by treat- ment, will be followed by secondary symptoms. 962. I was taking the case in which you were successful in influencing it by treatment? — That is another thing. 963. I think I understood you to say you could have a case in which you might cure the patient so as to avert the evidence of secondary symptoms from himself or his friends, but that still there would be a state of constitution which would be evident to a practised medical eye ? — At one period only. 964. I mean the period at which ordinarily the secondary symptoms would have made their appearance ? — That is generally the case ; not always. 965. Would not you call that appearance a secondary symptom in itself, taking it scien- tifically ? — Yes, I suppose it would come under that designation. 966. If that be scientifically truly described to be a secondary symptom, it is your opinion that every case of true primary syphilis is followed by secondary symptoms ? — In some cases, very i'evf, that depression which I have men- tioned as occurring at the period when secondary symptoms ought to appear, even that does not appear ; but excluding them, secondary symptoms always do follow. 967. May I say in the vast majority of cases there is some secondary symptom? — In the vast majority ; it is only those which are very care- fully treated in which there is no real mani- festation of secondary syphilis. p 3 968. Only 46 MINUTES OF EVIDENCE TAKEN BEFORE THE 16 March 1881.] Professor H. Lee. [ Continued. Mr. Hopwood — continued. 968. Only those that have the exceptional ad- vantage of being very early indeed brought to the surgeon .' — That is so. 969. That increases the number of those in which the proportion of secondary symptoms occur after primary ? — Yes. 970. It must be so if you assume that there are unusual advantages to bring about that desired result ; the majority of the cases have no unusual advantages ? — Certainly. 971. With regard to the classification by tlie army surgeons, if we have a note of a dozen or a hundred cases of primary sores, ought they not to be able to give lis from their observation the history of each of those cases as to whether they eventuated in secondary symptoms ? — I think they could give it. 972. They have the advantage of having the man under training, under orders, attending the hospital, and they can watch his case from week to week?— Certainly. 973. Are they not bound, if it is a doubtful case, to bestow attention uijh a view of ascer- taining whether it is a case of constitutional disease ? — I should have thought so ; but I be- lieve they are obeying orders. The classification is adopted as it was given by the College of Physicians, and physicians were formerly sup- posed not to be much practised in this disease. 974. Is it possible if another classification were adopted that the particular history of each case might be fairly followed out and recorded ? — Certainly. 975. That would give us a very true and correct answer as to what proportion the cases of constitutional syphilis bore to those of primary sores ? — That would be so. 976. With regard to the diagram you have shown, as I understand you to say, that is the result of an inoculation made by you from the mucous dischai-ge of a woman on whom there were no ordinary objective symptoms of second- aries ? — No objective symptoms where we took the discharge from. 977 Is that inoculation performed on another subject? — On another subject. 978. And that other subject, non-syphilitic? — I would not venture to do that. No. Another syphilitic subject where I could do no harm. 979. I thought once syphilised, your view was, it was diflScult to inoculate with virus so as to produce a chancre ? — The secretion from an in- durated sore will produce very little effect indeed upon a person who is already syphilitic, but if any other secretion gets mixed, then the inoculation will produce this kind of appearance {referring to a diagram). That differs in the first ])lace from the local sore of which I have given a diagram, in that there is no loss of substance ; it differs from the primary chancre in that the indiu-ation has not got a definite outline, but it has got an increase of substance ; it is a kind of blind boil — the eflect of the mixture of the constitutional disease and the local irritation. The inoculation with common pus, with no disease in it, will some- times give a result like that, 980. Unless there were that intermingling of local irritation Avith the syphilitic poison you could not inoculate a subject already syphi- lised? — Not from the true syphilitic poison. If Mr. Hopwood — continued, the syphilitic chancre be instated in any way, then it will give an inoculable secretion, but not otherwise, The local form of disease may of course be inoculated. 981. As to the soft sore, speaking generally, it can be cured by cleanliness ? — That is so. 982. There are some forms, I suppose, that grow by complication into phagedcenic or other diflficult cases which actually require the sur- geon ? — Oh, yes. 983. As to the gravity of the constitutional form of disease in the civil population, of course in individual instances it is very grave, but have you formed a judgment as to whether it has ex- tended of late years in the civil population or de- creased ? — I have seen a great deal more of it than I used to, but that may depend upon other causes. 984. It might depend, of course, upon the ex- tent of your reputation ? — It is possible. 985. As to the gravity of the types of disease ? — Much less grave, because much better treated. 986. Tiie proportion of grave cases that come before you is much reduced, and you attribute that to the beneficent effect of surgerj^ generally and modern treatment ? — Yes. Dr. I'arquharson. 987. You told me just now that the dualistic theory was the accurate one ; that is your opinion ? — It is so admitted on the continent. 988. I think we have an exception in the case of M. Clair ?— I only know this ; I have fre- quently spoken to continental doctors, and they' have said, " II n'en est plus question," " Do not discuss that any more." 989. M. Clair holds to the unity of the virus ? — 'Vhe other theory is universally taught in the schools. 990. You said it was universally on the con- tinent , but that is hardly so, because 1 can give you an exception ; then you say it is the same in this country ; that is merely an expression of your own opinion (of course a very valuable opinion), but it is not universally acknowledged here in England? — I do not suppose that there is any question universally acknowledged on anyone sub- ject, with reference to which you will always find one or two people to dissent, especially among medical men. 991. Is not it the case that Mr. Jonathan Hutchinson, the two Mr. Lanes, the late Mr. Gascoyne, the late Professor Syme, the late Sir Wilham Ferguson, are all authorities believing in the unity of the virus, and is it not the fact that at the discussion at the Pathological Society upon this subject, Mr. Jonathan Hutchinson went so far as to say that dualism was dead ? — 1 think he did, and I think he excited a great deal of surprise by saying so. 992. Was it not the case that the tone of that discussion generally followed Mr. Hutchinson's opinion / — Not with regard to that point certainly. 993. Is it not so that cases do occur frequently in which you get secondary symptoms following a sore in which no traces of induration can at any time be detected; that is to say, a sore which is soft and always remains soft may give secondary symptoms?— The term "soft" must be defined ; that sore that I have described as a local venereal sore, and which has been inocu- lated SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 47 16 March 1881.] Professor H. Lee. [ Continued. Dr. Farqiiharson — continued, lated hundreds of times with these characteristics ; when it occurs upon the skin, is never followed by secondary symptoms. 994. Is it not tlie case that a sore which in all its essential properties has been believed by men of scientific reputation to be a soft sore, has been followed by constitutional symptoms. I think I may refer you to two cases reported in the Clini- cal Society's Transactions, in which exactly what I have said happened ? — -I had a case yesterday brought by Dr. Clarke, who is on the Senate at Whitehall, where there were undoubtedly second- ary symptoms where I could find no sore at all, and no history of any. 995. You have not had an opportunity of in- specting the hard sore in these cases ; there might be a hard sore which had passed away ; but is it not so that a considerable number of soft sores •would produce secondary symptoms ? — I have mentioned the case of the lepers in Norway, who although inoculated many many times never had syphilis, with the exception of one in whose case the virus had been taken accidentally from a hard sore. 996. Then you do not care to give an opinion as to whether you can get secondary symptoms following a primary sore ? — I say very decidedly no, if you make the soft sore according to my definition. There are certain parts upon which the real syphilitic sore does not indurate, and the glans penis is one of them ; you may get a per- sistent brown discoloured thickening of the mucoixs membrane (as is represented in this diagram), without the usual characteristic induration. This is very certainly followed by secondary syphilis. 997. Do you know that before Mr. Skey's Commission, 27 skilled witnesses stated that they had seen cases, and were convinced that soft sores would produce secondary symptoms ? — I saw the Keport of that Commission, and that Report as published contradicted itself in many particulars, some of which I have pointed out in the second volume of my Practical Pathology. I do not think it was a satisfactory Report at all. 998. But the individual opinions of these men must be taken for what they are worth? — The Report contradicted itself. 999. I am only asking as to the fact of the possibility of getting secondary symptoms from that source ? — I say so far as I have defined it, you never get secondary symptoms. 1000. Do you think it was justifiable for the Army Medical Department to draw up their nomenclature in the way they have done ? — I think it was justifiable then, but I do not think there is much difference of opinion now. Many of the gentlemen you have mentioned were not very conversant with primary syphilis. Sir William Fergusson was an operating surgeon all his life ; he was a colleague of mine at King's College, but I venture to say he had very little time to give to the consideration of syphilis. 1001. ^Ir. Jonathan Hutchinson and the two Mr. Lanes, Mr. Samuel, and Mr. James, are authorities of large experience ? — Yes ; Mr. Lane, sen., originally, many years ago, took up the single theory, the unicist theory, and that he stuck to, and the younger Mr. Lane followed him ; but I am satisfied the weight of evidence is now quite against that theory. OAA. Dr. Farqiiharson — continued. 1002. Then I think we are justified in saying it is really au expression of your o.vn opinion, and not the general outcome of the professional opinion on this point ? — I am sure it is the expres- sion of the opinion of the profession generally. 1003. Would it not be inconvenient, consider- ing the occasional difficulty of deciding whether a sore is hard or soft, or would be followed by infection, to make the weekly return as at present ? — They could not do it in the first week or so, but 1 think they ought to be able to state it in uncomplicated cases after that. 1004. In ordinary cases it would not be easy? — Not within the first few days. 1005. In connection with the mixed chancre, you think that it is generally acknowledged by medical men? — It is acknowledged by men who have made experiments, I think ; I do not think medical men generally have seen very much of that. 1006. Are there any experiments to prove that such a thing can really exist? — Certainly, I believe so. 1007. Can you give me any references?- I have no doubt I have got some. 1008. Is it not the case, if you take a primary indurated sore, irritated so that it will furnish purulent secretion, that that purulent secretion inoculated on another person will really com- municate soft sore? — That is a very important question. I was the first person who performed that experiment, and the result is this : generally speaking, scarcely any result follows, but some- times when the fluid is sufficiently irritating to produce irritation, then it is that kind of in- oculation which is neither a primary sore nor is it a soft sore ; there is an increase ol substance instead of a decrease, it wants the sharp outline of the infecting sore. In fact it is very like a blind boil ; it is a different kind of inoculation to either of the other two. 1009. Is it followed by constitutional infec- tion? — I have no doubt it would do so if done upon any person who was not affected before ; but, of course, all these experiments are performed upon people who have been infected before. 1010. That, of course, throws a little doubt upon the evidence as to the mixed sore ? — No, I think not. 1011. Mr. Stansfeld asked you about the exa- mination of a syphilitic woman, who would com- municate not a hard sore but a soft sore ; that is to say, a syphilitic woman, being re-infected, would communicate to another person a soft sore, and not a hard one, supposing a syphilitic woman contracts a syphilitic sore ? — It will not have the same character as the disease originally had ; it may be an abortive inoculation, or it may be something like a blind boil. 1012. Not unlike soft sore ?— Not unlike soft sore. 1013. Would the result of that infection to anotber person be hard sore or soft? — It would be the hard sore, but provided the two poisons were in the woman at the same time, that is a circumstance under which she might give the mixed sore. 1014. Of course it is all the more important that a woman of that kind should be examined ; would not the soft sore she had be easier of detec- tion in her pei'son than the hard sore, which we F 4 are 48 MINUTES OF EVIDENCE TAKEN BEFOEE THE 16 March 188L] Professor H. Lee. [ Continued. Dr. Farquharson — continued, are told is very difficult of detection ; being of a more irritating and painful nature, would it not be more readily detected than a hard sore ? — I think we are not talking about the hard sore now, we are talking about the kind of pustule produced by the inoculation of syphilitic matter ; that is quite different from the mixed sore. 1015. A soft sore might deceive an ordinar}- number of practitioners, who are not so experi- enced as yourself? — It might, but still I think the diseases are quite distinct in themselves. 1016. We are told there has been a good deal of decrease of soft sores in the service, on account of the sanitary precautions ; were not those sani- tary precautions carried out, both in the pro- tected and the non-protected districts simul- taneously ? — Yes. 1017. Was it not shown at that time there, was a very much greater reduction in the amount of non-infecting sores in the protected than in the non-protected districts, both being under the same hygienic rules and precautions ? — It might be so. 1018. That cuts away the argument that the reduction of soft sores is due to hygienic condi- tions introduced into the army ? — I am not in a position at present to carry out the argument. I merel)^ wish to state the facts as far as 1 know them. 1 should think it is very likely in a pro- tected district that these precautionarj- measures wOLild be more effectively carried out than in a non-protected district. 1019. Is it not the case that there has been in the country a diminution of secondary syphilis, calculated at the rate from the time before the Acts came into operation, that is to say, before 1866, the ratio of secondary disease was much greater than it has been since the Acts came into full operation? — Since the Acts came into opera- tion there has been very little, if any, diminution of real syphilis, and the ratio of decrease, which obtained before, has not continued. Mr. Osborne Morgan. 1020. Are you speaking of the protected dis- tricts or of the country generally ? — Of the Home Army generally. Dr. Farqitliarson. 1021. Taking the whole of the Army before and after, is it not the fact that there has been, I will not say a very considerable, hut a consider- able reduction of secondary syphilis throughout the Service? — From the tables I have seen my impression is that there has not. 1022. Of course we both admit it would be difficult to argue from the secondary symptoms as to the efficiency of the Acts, because secondary sypmtoms as ailecting the soldiers might have been caught before enlisting, or they might have come from primary sores communicated in unpro- tected districts. Of course, having a number of young soldiers on the short service system, we know that they are much more liable to be affected with disease than older men, thei-efore the argument is difficult to follow in that case. May not we fairly admit that as a possible source of iallacy outside of statistics altogether, if as you say the primary and syphilitic infecting sore is now three to one of the non-infecting, and thfit by inspecting women you can check the syphilitic Dr. Fai-quharson — continued, sores, would it not follow that if you get hold of a primary sore, and prevent the woman from spreading it, you must diminish syphilis ?— I have already stated that the primary sore of real syphilis gives very little pain ; it has a period of incubation of from some ten days to three weeks, and the woman would not i:>resent any objective symptoms during that time; it would be no use examining her then, and even then it might be very difficult to detect it. 1023. Then you do detect it in a certain number of cases? — Yes. 1024. Then a particular woman whose sore is detected, and is put into hospital, you must admit is prevented from giving a sore to men ? — That is so, but the vast majoi'ity of cases of diseases are contracted by men from women who have long passed that period. You very seldom in a woman of that class see a real indurated sore, for the reason that they have concealed the tirst sore they have had, they have not come into public, and afterwards, whenever men get the disease from their secondary secretions, the women have long passed the primary stage, and you very seldom do see a good indurated sore in a woman. 1025. According to the careful examination now pursued, there may be something which will induce the medical men to detain them in hos- pital? — There might be something, but that something would be rather what she said herself, or some constitutional symptom, enlarged glands, or falling off of the hair, rather than anything that a medical man could find out by local insjjection, provided the patient wished to conceal the symptoms. 1026. If you had a woman coming to you with enlarged glands and these symptoms, would not that be sufficient evidence to induct; you to detain her in hospital ? — Certainly. 1027- A certain number of women vv'lio are able to impart infection, come to be detained in the hospital, and therefore these women are prevented from spreading disease, therefore we may argue that these Acts must in some degree check se- condary syphilis? — I do not follow that conclu- sion ; it may check the syphilis in one particular district where the Acts are in operation, but it does not follow that, taking the surrounding dis- tricts with it, the whole amount is reduced. 1028. At all events this woman herself is pre- vented from spreading disease, and if she is treated according to your careful method of treat- ment she is turned out cured? — Yes. 1029. Then there is so much disease in the country less ? — Yes. 1030. Do you agree with the opinion stated very strongly by another medical witness who appeared here, as to the extreme difficulty of detecting hard sores in women, if they do exist ? — Yes, often they are very difficult to detect. 1031. Isnotthe hard sore invariably attended by some enlargement of the glands in the groin ? — Yes. 1032 If a woman came to you and you detected these enlarged glands in the groin, wouldnotthat be sufficient to put you on the scent and enable you to find out a sore which j-ou might have missed in a more cursory examination ? — Certainly. 1033. Then the difficulty is not so great as it appears at first sight ? — It is in this way ; very often those affecting sores are verj high up in the SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 49 16 March 188 1. J Professor H. Lee. \_Cuntiniud. Dr, Farquharson — continued, the vagina, and the lymphatics from the woman do not go into those glands in the groin, so that the glands in the groin are not affected. 1034. Have you any practical knowledge of the way in which examinations are conducted in the protected districts by surgeons ?— I have heard various reports, but I do not know any- thing of my own knowledge. I have heard from a cajitain that when a regiment comes in, a battalion is taken and they tell them off: " Now No. 2, 4, 6, 8, 10, you go lo hospital and be ex- amined," and that that is the examination of the regiment. I do not know whether that is true, but that is what I have heard. 1035. The examination of the women I mean? —Oh, no. 1036. I think you have stated, in many cases one-half would escape detection ; is that proved, or is that only an expression of your opinion? — It is an expression of my experience. I say more than one-half of the cases of real syphilis are communicated by seretions of patients who have syphilis, and do not present any primary lesion which should be characteristic of syphilis. 1037. Do you think a woman having a secre- tion, which would be syphilitic, would not pre- sent some secondary lesion, such as tubercules, which would be sufficient to put the surgeon on the scent ? — She might, and probably would, but also she might not ; but I think it is the second- ary lesions that are rather to be looked for than any, primary sore. 1038. I may venture to say, from what I have heard, the examination is conducted very carefully, not only by local examination of the part supposed to be effected, but of the throat and body ? — I have no doubt many arniy sur- geons do their work very thoroughly, but whether that could be depended upon throughout the whole army would be another question. 1039. ft] any of these surgeons in charge of protected districts are not army surgeons, but leading civil practitioners of the jDlace, like Mr. Swain, of Portsmouth, and such men may be trusted to do the examination thoroughly ? — I know Mr. Swain, he was a pupil of mine, I am quite sure he might be trusted. 1040. Would you think that one-half escape detection under that mode of examination? — If a patient were thoroughly examined all over, and gave her correct history, I think she would, during the existence of her symptoms, not escape detection. 1041. Why should you say that a one-sided examination must totally fail ; would it not be better to say it is less likely to be completely successful than one in which you have an exami- nation of the men also ? — There is no doubt the disease is much more easily detected in men, from physical reasons, than in women. 1042. I think it is admitted that under the careful medical examination which, probably, is conducted, the disease is pretty generally de- tected ? — No, I have not admitted that at all, and I do not believe it. 1 believe a woman who is syphilitic, and from whom all signs of primary and secondary syphilis have gone, if she has not been thoroughly cured, if there is the least drop of blood in her secretions, she would again be- come syphilitic, and communicate the disease to 0.44. Dr. Farquharson — continued. any number of men, and that is quite outside the Contagious Diseases Acts. 1043. Do you believe so very strongly in the infectious nature of syphilitic blood?— I do. 1044. On what ground ? — I have published cases where the blood itself has been inoculated, and lias produced these regular series of symptoms. 1045. Experiments conducted by yourself? — No. 1046. In France ? — No, in Italy. It requires, in order to prove anything, that it should be in- oculated upon a person who has not had syphilis before, and thfit is mucli too serious an experi- ment for anybody to undertake here : but it has been done ; and with regard to vaccination, the same thing has taken jjlace. It has been very frequentl}', accidentally, done where the syphi- litic blood has been inoculated together with vaccine poison, and has produced very serious results, all sorts of secondary symptoms follow- ing- 1047. Was it not the case that in some experi- ments conducted abroad there was considerable difficulty in inoculating syphilitic blood ? — There has alivays been a difficulty about it; but as to the possibility of it, that has been proved, though of course the cases are very few. 1048. Is it not the case that out of 24 attempts there were 18 failures on that occasion ? — I should tliink even more than that. The cases where the blood only has been inoculated on patients pre- viously unaffected have been very few. 1049. Do not you think if the blood from the vaginal secretions, which niay convey syphilis, is in a sufficiently virulent state to convey the dis- ease, that at the same time some modification must appear on the skin, or mucous membrane of the person from whom the blood is taken ? — No, certainly not. 1050. In all those cases that I refer to, the persons from whom the blood was taken pre- sented tubercular and other syphilitic symptoms ? — The observations I made refer to the simple admixture of blood, not necessarily diseased blood, but blood from any source, mixed with diseased secondary secretions. It is the blood mixed with these secretions that gives them the virulence. 1051. The secretions which are derived from the blood are more virulent than the blood itself? ■ — It is the mixture of the two ; taken for granted the blood itself would not be inoculable, the blood and secretion together may be inoculable. 1052. The secretion without the blood would not be inoculable ? — It might not be so inocu- lable ; the blood gives a virulence to it which it had not before. 1053. I do not know whether I may ask you a question or two about the case at Portsmouth; I do not know whether you attach much im- portance to it ; 1 think, ivithout very full evi- dence, we can hardly accept it. I should like to know whether the man who came to see ^'ou had himself been infected by the woman v. horn he accused? — Not that I know of. 1054. There was no connection proved between himself and woman? — Not that I know of. 1055. Was the woman inspected by any medi- cal man to show that she had anj^ lesion upon her at the time ? — She was sent to a hospital. G 1056. After 50 MINUTES OF EVIDENCE TAKEN BEFORE THE 16 March 1881.] Professor H. Lee. \_Co7itinued. Dr. Farqiiharson — contmued. 1056. After she came exit ?■ — 1 think these infections were produced immediately she came out of the hospitah 1057. She was not inspected by a medical man afterwards to prove whether she had any disease on lier, or not? — She came direct from the hos- pital ; she had I suppose, been inspected before she left the hospital. 1058. She had been out a couple of days ? — No, it was directly, as far as I learned. 1059. Was there any evidence about this woman except information conveyed through a third person? — No. 1060. Was there any evidence that these men had not had connection with other women ?■ — I know nothing, except what I have told you. 1061. Under the circumstances, the case is not deserving of any serious consideration ; it is entirely unsubstantiated by evidence? — In order really to substantiate it you must have the woman up, you must have the authorities up, and you must have all these eight men up. 1062. Then it is an unsubstantiated case ? — I think that is a question npon which everybody may form his own judgment. 1063. If it had been a better case it would have been of extreme importance. Might I ask if your informant had any medical knowledge ? — No, I do not think so. 1064. Do you know whether he had made any inquiries ? — He seemed up in what was going on at Portsmouth, and he gave me that as an in- stance of how the Acts were working. 1065. Did he at any time give any expression of opinion against the Acts ? — No, he did not to me, he only gave it as an instance of how the Acts were working. Colonel Tottenham. 1066. There is only one question with regard to figures which I should like to ask you. I understand you to say, in your opinion, the working of the Acts did not reduce the amount of disease in the army after they were first in- troduced ? — The amount of syphilis in the whole army. 1067. Is that so ? — That is my impression. The operation of the Acts has not reduced the amount of syphilis in the whole army, or very slightly if at alh From some tables I have here, at one time the amount of syphilis appears actually to have increased under the working of the Acts. 1068. Has your attention been drawn to those figures, supplied by Sir William Muir, page 55 and following? — I have not got those individual figures, but 1 have the resume of them published at the end of last year. 1069. W^hat is that? — It is a report of the Prefecture de Paris, in which they have in- cluded all their own statistics and all ours. 1070. It is a report on the statistics of French disease? — It gives our own stations, the increase or decrease during the partial operation of the Acts, and subsequently. 1071. I think we must confine our attention to the report which is before us. AVould you turn to page 62 of the Peport for 1880, lieturn C. Take the j'ear 1860, which is the first year on that page. If you look in the fourth column you will find the total for each of the respective Colonel Tottenham — continued. stations in the margin. You observe the total in Devonport and Plymouth was 27' 14 ? — Yes. 1072. Now, on page 66, take the year 1873, do you find the total opposite Devonport and Plymouth is 10"01 ? — That is so. 1073. That is a decrease of nearly 200 per cent. ?— Yes. 1074. if you take the next one, Portsmouth, on page 62, do you find the total 33 22 ? — Yes. 1075. Turn then to page 66 and the year 1873 ; do you find the total to be 978 ? — That is so. 1076. Being a decrease of over 300 per cent. ? —Yes. 1077. I do not think it necessary to go all the way down, but take Shorncliffe, the figure is 24-67 in 1860, and in 1873 it is 7-64 ; Colchester is 29'88 in the first year, and 9*27 in the second year, and the others are approximately the same ; in the face of those statements, do you consider that the disease, as made out by the statements which have been handed in here as authentic, has not decreased within that period ? — Those statements refer to particular districts only, and not to the whole army, and I think the conclu- sion to which I have come is the right one, that the disease which is the most dangerous, far from diminishing in the English army, has actually increased. 1078. W^hat I want to get at is this : you are aware that these are authentic figures which have been furnished ? — I accept them. 1079. Are you aware that these first fourteen places are the protected districts? — Yes. 1080. And do you dispute the fact that in those protected districts, between the years 1860 and 1873, the decrease in the disease was as stated in those reports? — I quite take it as stated. 1081. In the face of those statistics, do you still hold to the belief that in those districts disease has not decreased ? — I believe it has materially decreased, the same as I said small- pox would have decreased in W^estminster if everybody suspected of having small-pox had to go to hospital, because the small-pox patients would go to some other district. 1082. Do you think it is likely that out of these districts the infected persons should have disappeared? — A great many of them, the poorest, and those who had not clean linen, would get away from police surveillance. 1083. You would hold that the decrease was owing to infected women having left the district rather than to there being fewer cases of infected women ? — That is my opinion. 1084. In fact you hold that these statistics are fallacious ? — '1 hey might lead to a fallacious con- clusion, but I have no doubt the figures are given bondjide. 1085. They are misleading? — They are mis- leading very materially. 1086. Supposing you take an unprotected dis- trict ; if you found in the unprotected district the same thing had occurred, would you still hold the same opinion ? — I think that probably has already been explained by the general dimi- nution of the local venereal sore in protected, unprotected, and general society at large. 1087. For instance, if you take the three last for 1862 and 1866, in the unprotected districts, Athlone, SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 51 16 Marcli 1881.] Professor H. Lee. [ Continued. Colonel Tottenham — continued. Athlone, Dublin, and Belfast, you find the figures are in Athlone 19'52 as against 4"49 ; in Dublin 26-02 against 20-60, and in Belfast 19-15 against 15-20 ? — I have no doubt in the total, putting all venereal cases together, there is a decrease, and for the reasons I have stated, but that does not aifect, necessarily, the most important disease, namely, syphilis. 1088. At all events, you do not dispu+e the decrease in venereal diseases of all kinds has been equally found to exist in the unprotected districts as well as in the protected districts ? — I have no doubt that the disease has diminished, taking them altogether in both. Mr. Fowler. 1089. If you turn to page 48 of that Return, Table No. 3, you will see Mr. Lawson's name ? — Yes. 1090. This is a ratio per 1,000 of secondary syphilis; you find in 1860 it was 32-73, taking the whole army, and it fell to 26-64 in 1878?— It is so. 1091. Then during the year before the Act was enforced, there was a fall to 32*73 in 1860, and in 1863 it went to 35-94 ; then if you start from 1863, just about the time the first Act was passed, in 1864, you find 35-06 ; and in 1869, when the Acts were partialllv enforced, vou find it fell to 26-22?— Yes. 1092. Between 1859 and 1878 there is actually no fall ; there is a slight increase, is not that the case?— One is 26-22, and the other 2664. 1093 I had not the pleasure of hearing your whole evidence, but 1 gathered from what I did hear that, in your opinion, in a very large pro- portion of cases, and those the most serious cases, it is extremely difficult for any surgeon, however skilful, to be sure that a woman is free from disease when he finds her in such a condition that he cannot detain her ? — That is so, certainly. 1094. And therefore the machinery laid down by these Acts must, to a large extent, be in- secure ? — That is so. 1095. Dependence cannot be placed on the machinery laid down as securing freedom from disease as the result of examination ? — That is certainly so, in my opinion. 1096. We had it laid down the other day by one surgeon that in half the cases the evidence would be unsatisfactory and unreliable ;■ would that be very much your view ? — I should think one-half the women who go out of hospital might still be contagious, practically speaking. 1097. Of course we do not mean to say that they would be, but there is no security that they would be ? — That is so, in my opinion. Mr. Osborne Morgan. 1098. Dr. Eouth carried it a little further; he said, " Given ten women carefully examined by the most competent medical authority, the presence of true syphilis will escape detection in the case of five ; should you go so far as that ? — If the examinations were confined to local in- spection. 1099. Of course I mean a thorough examina- tion by a competent authority ?— That involves the question which I brought out previously. 0.44. Mr. Osborne Morgan — continued. A woman may go for months without having any appearance, and without being infectious. Mter- ■vvards, a drop of blood in her secretions, if the disease has not been properly cured, will cause her to become infectious again. 1100. Given 10 diseased women who come to you ; I take you as a thoroughly competent examiner ; and they are examined, should you make a mistake in five cases out of 10 and fail to detect true syphilis ? — Certainly not. 1101. In what proportion do you sav you would fail to detect it ? — I think i could always make it out. 1102. You would detect them all?— I think so. 1103. I think you said your practice was general and hospital practice ? — Yes. 1104. I presume you have not had practice among private soldiers? — A great number of officers. 1105. You have not practised in the protected districts ?— No. 1106. I suppose you are not personally ac- quainted with Portsmouth ? — No. 1107. And with regard to that particular case to which Dr. Farquharson has been examining you, I presume you would say that all you know of that case is what we should call " from hear- say " in a court of law ? — I did not say so. I am accustomed to sift evidence, and I know pretty well when a person tells me the truth. 1108. You did not sift that case?— No ; I took it as stated. 1109. You said, T think, that the cases of true syphilis were to these local venereal sores in the proportion of three to one ? — Yes ; according to my own experience. 1110. If that were so, would not it follow, looking at these Army Returns of so-caUed syphilis, in which local venereal sores are not dis- tinguished from true syphilis, that the cases of true syphilis wouldthen also be to the cases of venereal sores as three to one '>. — What I said was, that formerly the ratio of the local venereal sore to the true infected sore was as three to one ; but now gradually the proportion has been re- versed. 1111. That being so, finding, we will say in the year 1878, a certain number of cases returned as syjihilis, without distinction between local vene- real sores and true syphilis, I suppose it would follow that in that return you would assume the cases of true syphylis would be to the cases of local venereal sores in the proportion of three to one ; would not that be so? — Very nearly; but in those cases which are not put down as true syphilis must be included all the cases of abor- tive syphlitic inoculation in persons alreadv in- fected. 1112. Well, now, I am afraid I must ask you a question again with regai-d to the chance of era- dicating primary syphilis ; assuming that a patient came to you in the early stages, I suppose you might feel satisfied that the secondary stage of the disease would be arrested altogether ? — I should not to begin with. It would depend on how the jmtient carried out the treatment. 1113. Take a man or woman in hospital, ascer- tained to have primary true syphilis, treated by yourself or any other competent surgeon, I should presume in some proportion of cases the G 2 disease 52 MINUTES OF EVIDENCE TAKEN BEFORE THE 16 March 1881.] Professoi- H. Lee. \_Co7itinued. Mr. Osborne Morgan — continued. disease would be altogether arrested, so that no secondary symptoms would follow ? — It would be so. No (.bjective symptoms would follow. 1 1 14. In what proportion of cases? — When you said treatment, it depends very much upon the length of the treatment. Mr. Pearson, who was the great authority in his day, always used to keep the patients under the action of mercury for something like two months. Sir Benjamin Brodie used to do the same, and I generally do it myself But a patient may be treated with mercury, and that treatment may be discontinued at the end of three or four weeks, and then you do not get the curative effect. 1115. Assuming that he is under the care of a person thoroughly competent to deal with his case ; take, for instance, the case of a hospital patient ? — I do not know that hospital jiatients go through that prolonged course of treatment as a rule. 1116. Given a treatment in hospital by a most skilful surgeon for a sufficiently long period, the chanres are the disease would be arrested in its primary stage, and would not result in secondary symptoms? — That is certainly so. 1117. Is it not a fact that this local venereal sore sometimes does lead to very inconvenient and painful results in the shape of bubo ? — The simple sore is scarcely ever attended with incon- venience. Thousands and thousands of inocu- lations have been done, and there has never, as far as I know, been one suppurating gland. 1118. Would you go so far as to say that these local venereal sores need not to be treated at all? — If you keep them clean. If there were com- plications, any inflammation or secretions added to them which would produce inflammation, then they would become serious. 1119. Do not thev lead to suppurating buboes ? —Yes. 1120. They are verj^ nasty things? — Yes. 1121. They would incapacitate a man' — Of course they would. 1122. You spoke about sobriety as leading to a decrease of venereal diseases generally ; I sup- pose sobriety would tend to decrease true syphilis as well as the venereal sores? — To a decrease of exj:)0sure to syphilis. Men get exposed when they are tipsy. 1123. Did I understand you to say that your calculation was, that there had been a decrease of the syphilitic disease in the protected, and an increase in the unprotected, districts? — I did not give any opinion upon that. 1124. You spoke of mediate contagion ; is that a commiOn jn'ocess, that communication of disease by what is called mediate contagion? — I fancy it is among the soldiers. I know nothing of it of my own knowledge, but I think it is among soldiers. 1125. I presume j'our knowledge of the work- ing of these Acts is derived rather from what you have read, than from what you have seen?^ — Yes : I think it is. 1126. You spoke of the importance of having hospitals to which women could go voluntarily ? — Yes. 112r. Do you fiud, as a matter of fact, that women do voluntarily, Avhen they suffer from disease, go into those hospitals already provided Mr. Osborne Morgan — continued, for them ? — That is so, I believe. I am talking chiefly with regard to the civil population ; but I believe that all the hospitals that could be provided would be filled. The women would diagnose their own cases and go there. 1128. They would go there when suffering from the more painful, and not from the less painful, disease ? — Naturally. 1129. So that they would be more likely to go there to be cured of local venereal sores than of true syphilis? — Certainly they would. 1130. One word about the examination of men; I confess I do not quite understand to what extent you propose to cai-ry that ; in the case of women you have to deal with a class carrying on a particular profession, whom you may presume to be diseased, but there is no cor- responding class among the men ; you could not presume of any man, soldier or civilian, that he was diseased ; you would have no right to do that ? — No ; I do not think you could of any man. 1131. I want to know whether there is not in the case of common women an element which is entirely absent from the case of any man, namely, that you have a right to assume that they arc diseased, and, therefore, for their own protection and the i^rotection of the public, you have a right to examine them ; is there any class of men as to whom you have the right to make the same presumption ? — I think you have a right to assume that a certain number in every regiment are diseased. 1132. And, therefore, you have a right to examine the whole of the regiment ? — I think so. 1133. But you propose to examine men gene- rally, do not you ? — I do not think I have said anything about that. 1134. I understand you to say that you have a right to assume that a certain number of men are diseased in a regiment ?■ — I think you have a right to assume that from the tables. 1135. You condemn severely this classification which has been adopted by the army officers ; can you tell me how that classification came to be adopted ? — It came from the College of Phy- sicians, as I understand. It was a classification made by physicians, who foi-merly were not sup- posed to treat this disease at all. They do so now ; but still they are not supposed to be authorities upon it. 1136. I need scarcely ask whether you are a physician yourself? — I am a surgeon. 1137. It is the fact, I believe, that these medical cases have to be returned every week by the medical officer ? — Yes. 1138. That being so, at so early a stage of the disease coidd anyone pronounce a clear opinion upon it ? — They could not certainlj^ at an early stage. 1139. You said in the case of true syphilis the symptoms did not make their appearance until between 10 days and seven weeks ? — From 10 days to seven weeks. 1140. W^ould a woman be able to communi- cate the disease before the outbreak of those symjitoms ? — I think she might ; it is a very nice point; but I think she might; I have no evi- dence to eive upon that. 1141. So that, in fact, until the active de- velopment of the disease you would not say she could SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 53 16 March 1881.] Professor H. Lee. \_Conti.niLed. Mr. Oshorne H^ organ — continued, could communicate the disease ? — That might be mediate contauion. 1 142. Is not it the case, as stated by several witnesses, that in these enthetic diseases there are considerable fluctuations, almost unaccount- able year by year, so that to take a correct datum you ought to take several years together ? — You must necessarily ; from the time of the Roman Empire down to the present diseases have fluctuated : "ut variant morbi nos et variabus artes, mille mali species mille salutis erunt." Mr. Cavendish lientinck. 1143. I did not quite gather from your evi- dence whether you are in favour of the principle of these Acts or not ; that is to say, \yhether you would approve of them if they were ex- tended more than they are now? — I think the only answer to be given to tliat is to see how much good they have done at present ; if they have done good hitherto, they may do more good ; if they have done no good hitherto, I do not think they are likely to do good if extended. 1144. What is your opinion at the present moment? — I have never, until very recently, given any opinion as to the Contagious Diseases . Acts, but the evidence which I now have before me leads me to believe that they liave been of no use. 1145. And, therefore, you do not think they would be of any use if extended?— I do not think so. 1146. With regard to the principle of the Contagious Diseases Acts, you are aware that the opinion you have just given is not that of the majority of your profession ? — I am quite aware of that. 1147. And especially the leaders of the pro- fession? — With regard to tlie leaders, that term requires definition. A great many of the leaders of our profession, such as Sir William Jenner, Sir William Fergusson, Sir William Gull, and so on, have really seen very little of syphilis, esp)ecially in the primary forms. Their names carry great weight, but I would not trust them to treat a primary case. 1148. But you know their opinion is in favour of the Acts ? — I have an idea that it is. 1149. You also know the entire body of army surgeons are in favour of the Acts, and they are of opinion that they have done a vast amount of good ? — I believe that to be their opinion. It is an esprit de corps, and depends upon what some have seen in their own particular protected dis- tricts. 1150. Now, upon the question of soft sores, you say the soft sores are non-syphilitic? — The soft sore I have defined is non-syphilitic. 1151. And you have also said you cannot distinguish the nature of them for some days? — ■ That is so. 1152. That is to say, if a patient came to you with a pimple or some incipient feature of disease, you might treat it at once, and think he was syphilitic? — I should not do that until I had made up my mind as to what it was. 1153. Y'^ou might try to eradicate it, might you not ? — I do not think burning will eradicate true syphilis, because, as I have said, it has a period of incubation of from 10 days to seven 0.44. Mr. Cavendish Bentinck — continued, weeks before it shows itself. The disease is already in the system, and burning any parti- cular inoculated spot would not eradicate that disease. Caustic will eradicate the local disease, but then that will get well of itself, and does not require so severe a remedy. Mr. Osborne Morgan. 1154. Then burning is absolutely valueless? — It makes a clean sore which heals in time. Mr. Cavendish Bentinck. 1155. Y'ou would not undertake to judge of the exact character of this manifestation, cer- tainly within a week or eight days of its first appearance ? — Certainly not In the majority of cases : in some cases you know at once. 1 156. Consequentlv if army surgeons are bound to return the particulars of all their cases within eight days, they would be rather restricted? — Certainly they would. 1157. Has your attention been called to the evidence of Dr. Drysdale ? — I have not seen his evidence, but I have heard one or two things about it. 1158. I wish particularly to call your atten- tion to the first answer he gave in reply to an examination by myself. I asked him, " Is not the fact that, in the case of a primary venereal sore making its appearance, a considerable time must elapse before its precise character is known " ? His reply is, " Not at all. When a patient calls upon me, I know at once what the nature of the sore is." You do not agree with that opinion ? — I adhere to the opinion that I formerly gave. 1159. In the category of soft sores there is what is called a mixed sore ? — Yes. 1160. That is frequently followed by very serious results? — By constitutional symptoms. The proper mixed sore is followed by secondary symptoms. 1161. And is the soft sore, that which is not followed by syphilis, and therefore not a syphilitic sore, followed by suppurating buboes ? — Occa- sionally. Very seldom, except there be some other cause of irritation. 1162. And by extensive ulceration? — Very seldom, indeed, in uncomplicated cases. In com- plicated cases you get a great variety of serious symptoms. 1163. What is a complicated case? — In the first place, where a person's constitution is at fault, but generally where a person has had old syphilis and gets a kind of re-infection again, not a thorough re-infection, but he gets an infection chat does produce a great deal of local mischief in his already syphilised constitution. 1164. Assuming real syphilis not to have been diminished, has there been a large reduction in these primary venereal sores which are not of a syphilitic character? — Quite so. 1165. Therefore, to that extent, the Act has done a great deal of good ? —That does not fol- low, because it has obtained where the Acts are not in operation. 1166. There is not the same reduction where Acts are not in operation ? — There is in private practice. G 3 1167, I must 54 MINUTES OF EVIDENCE TAKEN BEFORE THE 16 March 1881.] Professor H. Lee. [Continued. Mr. Cavendish Bentinch — coatinued. 1167. T must ask you to look at tlie statistics ; you will see a reduction of from 30 to 40 per cent, in the pi-imary sores ; that is admitted by everybody ; then the opponents of the Act attri- bute that to non-syphilitic sores alone ? — What I was about to say was th.it there has been the same reduction in the civil population. 1168. We do not know anything about that? — But I do. 1169. I ask whether, as regards the army, you are not of opinion that, by the reduction of pri- mary venereal sores, great good has been eifected? — I think the same amount of good would have been effected by other means, if the diminution had gone on as it did before the Con- tagious Diseases Acts were introduced in the army. 1170. As 1 understand, one of your principal reasons for the reduction of these non-syphilitic sores is the general cleanliness introduced into the army through Lord Herbert's Orders ? — That is one reason ; but 1 also lay very great stress upon the increasing;- sobriety of the army. 1171. Let me ask you whether these ablu- tions have anything to do at all with saving men from infection ? — Certainly they have. 1172. How? —Ablution washes the poison off before it inoculates; any poison washed off soon has much less chance of infecting the system. 1173. But not unless it is washed riff very soon ? — I do not know how soon. 1174. I understand from medical opinion tliat unless the ablution is done speedily no good effects result? — True syphilis is verj^ often im- bibed through the skin, and for that to take place, I expect a considerable amount of time -would be required. 1175. We are now dealing with soft sores; I understand and it has been alleged by other wit- nesses, and also by yourself, that the introduc- tion of Lord Herbert's Orders, and the habits of greater cleanliness in the army, have prevented infection from soft sore ; do you think that ab- lution is of any use at all unless it comes very soon after infection?—! should say decidedly ; but how long it would take I am sure I could not say ; of course it is much more likely to be effective when done soon. 1176. And the soldier would have no means of doing that Lord Herbert's Orders would not assist him in the matter ? — No ; I suppose not. 1177. The cleanest man in the world, if he goes and visits one of these women who is in- fected with a contagious soft sore, unless he performs the ablution very speedily it will be of no use to him ? — It is a question of degree of security, I think. 1178. Unless the ablution comes very speedily after the performance, in the majority of cases it would be of no effect? — I think they had better wash late than never. 1179. I want you to answer my question? — If you put that question definitively that it is of no effect, I do not agree, because it may have some effect after one, two, or three hours. 1180. To be effective, it ought to come speedily? — To give anything like security, it ought to come speedily. 1181. Would it afford any considerable dimi- nution in the disease if it came later ? — It would have an influence. Mr. Cavendish 5e«ft«cA— continued. 1182. An influence? — In this way : There are many things to be considered ; if people are dirty, the dirt gives a nidus for the poison to rest in ; a clean person would have much less chance of carrying away poison. 1183. As I understand, the ablution to be really effective must come soon after the opera- tion ? — To afford any amount of security. 1184. Now we come to syphilis ; I understood from your answer, that a large proportion of those who have primary disease -will escape secondaries if they are properly treated ? — If properly treated and for a sufficient period. 1184.* Dr. Routh in his evidence in reply to my question, " If a doctor is worth his fee, you never would have secondaries from a primary sore," answers, " You would not." I apprehend your opinion is in a certain number of cases, and a proportion of cases which no human foresight can foretell, it is by no means certain ? — It is by no mean certain. 1185. Then at Question 691, I asked Dr. Drysdale, " You have stated in answer to my Riglit honourable Friend and other Members of the Committee, that you consider that second- aries are an absolute consequence of primaries"? and he says, " Inevitably." I understand your opinion would be half way between those two, that is to say, you consider that while second- aries may be escaped, no amount of foresight or skill can possibly tell that they shall not follow ? — That is where they are properly treated. Where they are not treated by mercurj', I be- lieve the secondary symptoms follow as certainly as a small-pox eruption follows inoculation. 1186. Everybody believes that in a single number of cases, if a patient is jiroperly treated, and he is a favourable subject, he may escape secondaries altogether ? — Oh, certainly ; any manifestation of secondaries. 1187. They are not the inevitable conse- quence ? — They would be, if not treated. Mr. Oshorne Morgan. 1188. Dr. Drysdale said that in all cases secondaries inevitably followed primaries? — I do not agree with that. Mr. Cavendish Beniinck. 1189. I understand you to say, in your opinion, the Acts have not in any degree diminished real syphilis ? — As far as my present opinion goes. 1190. And you have founded that opinion upon the fact, that although primary venereal sores have been considerably reduced in sub- jected districts, yet as far as you are able to judge secondary syphilis has not been ? — That Is so. 1191. Are you aware the amount of syiDhllls in the subjected districts is no test In this matter ? — I shall be hapjjy to take the facts at your hands. 1192. That secondary syphilis Is no test of the amount of syphilis In the subjected districts, unless you can trace those secondaiy cases to primary cases which have already been treated In the subjected districts? — But taking the whole togethei-, they must bear a relation to one another. 1193. How SELECT COMMITTEE ON CONTAGIODS DISEASES ACTS. 55 16 March 1881.] Professor H. Lee. \_Continued. Mr. Cavendish Bentinck — continued. 1193. How are you to tell tliat all the second- ary cases which appear in any subjected districts are not derivable from primaries contracted out of those districts?— If you take the two districts together, you get the mean between the two. 1194. The mean is not capable of any such calculation ; a whole regiment gets primaries in an unsubjected district; they- go into a subjected district, and they are registered immediately as secondaries in that district ; you must not blame the Acts here for the secondaries? — They have migrated, and therefore you have them put down to the district to which they do not belong ; but soldiers with primary disease migrate also, and they are put down in the same way. 1 195. You cannot charge the Acts with second- aries, because the army surgeons have had no control whatever over these primary cases ? — The army surgeon would treat a soldier if he were not in the subjected district. 1196. What I was pointing out is in the sub- jected districts, the true test is, the secondary cases must be referable to primary cases in the subjected districts ? — Of course, the primaries have not all occurred in any one district, but they have all been treated ; those in the subjected districts, and those in the unsubjected districts have alike been treated by army men. 1197. But then the secondaries are put down to the subjected districts?— I say, per contra, cases of primary syphilis in the subjected dis- tricts migrate to other districts which are not subjected ; there is the mutual interchange, so that I do not know that there is much difference one way or the other. 1198. Supposing the cases in subjected dis- tricts of secondaiy syphilis have undergone a considerable reduction since the Act, would you stand or fall by that ? — No ; I only wish to take the facts as they are. I should calculate whether they would fall in the same ratio as they did before the Acts. 1199. Do you abide by the test as to the suc- cess or failure of these Acts, by the statistics with regard to secondary syphilis ? — Not only ; that is one very great element but not the only one. I think whether gonorrhoea has increased or decreased is a very serious element. 1200. You admit that the primary venereal sores have considerably diminished? — That is just what I have not admitted. They are not primary because a great many of them have no secondaries ; they are local venereal sores. 1201. You admit the soft sores have very con- siderably diminished ? — Yes. 1202. If you can show me that secondary syphilis has also diminished, your objection to the Acts is removed ? — It must depend upon in what proportion they have diminished ; they may have been diminishing in equal proportions before the Acts were introduced. 1203. With regard to the Lock Hospital, your opinion seems to be, the women would enter a Lock hospital if sufficient accommodation was provided ? — That is my opinion. 1204. Are you of opinion that a woman who had once entered a Lock hospital, ought to be detained until cured ? — That is giving an opinion upion the Contagious Diseases Acts ; you cannot detain her without the operation of the Act. 0.44. Mr. Cavendish Bentinck — continued. 1205. You would detain her until she was completely cured?— I do not think any real good comes from forcible detention. 1206. Would you allow a woman half cured to go out of hospital? — She will go out if she wants to, do what you will. I have had some experience of that. 1207. She does not go out in these hospitals? — I do not know ; I should think very likely. Chairman. 1208. Supposing a woman is sent to hospital suiFering from the worst form of contagious disease; would you think it a hardship to detain that woman to prevent her going loose into the world and propagating a deadly poison ? — I think it very desirable that she should be detained. 1209. Would you object to detain her by force, to compel her to remain until she was pronounced cured by professional authority, or pronounced to be at least no longer in a condition to spread infection ? — I think that involves a very serious question. 1210. It involves the Avhole question of the utility of the Lock Hospital ? — Not the whole, but a great part of it. As it is, I am quite satis- fied that a great many women do come out of hospital supposed to be cured that are not cured, Mr. Cavendish Bentinck. 1211. Even these army hospitals? — That is my impression ; but I am sure it is so out of other hospitals. 1212. Are you not of opinion that the rules ought to be made more stringent, so that they should be kept until it is absolutely certain that they are cured ? — You might have to keep them a very long time. 1213. Would you keep them or not? — It is a very complicated question ; I really have not thought it out. 1214. You would rather not answer the ques- tion ? — I would rather not answer that question; for I have already said, a woman who has once been syphilitic, and is apparently cured, might from some accidental circumstances some months hence become contagious. 1215. You do not think it is unreasonable to keep her? — No ; I should certainly do it if I could. 1216. What do you know about the Isle of Wight case ? — I read it very carefully, and took a note of it at the time. 1217. You do not know anything of it per- sonally ; only from hearsay ? — It was published. I think we had some discussion over it at the time. 1218. You do not know that the women went from Portsmouth? — Not from personal know- ledge ; it was so stated in the report. 1219. Do not you think that is rather a reason for putting the Isle of AVight under the Con- tagious Diseases Act? — You would have had next to have put the county of Sussex or of Hampshire, or some other counties under the Act, and that would have to go on. 1220. That is rather a reason for extending the Act ? — I do not know. G 4 1221. I understand 56 MINUTES OF EVIDENCE TAKEN BEFORE THE 16 3Iarch 1881.J Professor H. Lee. yContinued. Mr. Cavendish Bentinck — continued. 1221. I understood you to say the contagious women went over to the Isle of Wight, and so put a number of soldiers on the sick-list ? — I do not think it would ever do to extend it to any large portion of the population. Nothing that goes against our higher instincts ever does any good ; and it certainly is against our higher instincts for one class of men generally to pro- vide a clean class of women for another. 1222. I suppose you see a good deal of Uni- versity men in your practice ? — Not manj-. 1223. Taking Oxford and Cambridge, do not you think if Oxford were protected by the Acts, and Cambridge was not, that there would be a great many more people diseased at Cambridge than at Oxford? — I think it would be of great use in removing the women out of one of those universities ; but whether the amount of disease in the surrounding districts would be greater or not I cannot say. Chairman. 1224. Let me ask you one question. As- suming that these Acts have been of any use in diminishing disease, do you consider the periodical examination of the prostitutes within the pro- tected district, is an important part of the system ? — I do not attach so much importance myself to the local examination. 1225. Supposing a prostitute was brought before the surgeon, who had been found with no external indication of disease, do you not think that he should proceed to an internal examina- tion ? — Yes. 1226. May I ask in your own practice, if a woman was to consult you, whom you had reason to believe was infected, and yet you ob- served no external indications, would you he- sitate for a moment to examine her internally ? — I very seldom indeed do it, and very little real information is gained by it. 1227. Supposing you had reason to believe that she was infected, and she exhibited no external indications of disease, would you not think it your duty to proceed to examine her internally ? — There muist be some indications of disease for me to suspect that she was diseased, and I should go upon that ; if I suspected her to be diseased, I must have some reason for sus- pecting her, and upon that I should form my opinion, and in the majority of cases, the internal examination would not add much to my informa- tion ; in some cases it is very important, and is the gist of the whole matter, but they are very few. 1228. I am supposing a case in which you had reason to believe, you had information before the patient consulted you, that she was infected, and you examined her externally, and found no indi- cations of that particular disease, would you, in pursuance of the information you had previously received, think it necessary to institute an in- ternal examination ? — Certainly, to determine a definite point. 1229.- Are you aware of the mode in which the visiting surgeons under these Acts in pro- tected districts examine the women ? — I suppose it is in the same manner as it would be done at the Lock Hospital. Chairman — continued. 1230. In fact you would consider a surgeon did not discharge his duty, by a perfunctory exa- mination of a woman he supposed to be diseased? — If he were called upon to determine the point, but I do not consider that an examinatien twice a week would be necessar3\ 1231. But you do consider it an essential part of a surgeon's duty to examine a woman inter- nally if he has reason to suppose that she is in- fected ? — If he is called upon to determine that, certainly. Mr. Osborne Morgan. 1232. Is it the case that respectable women are sometimes subjected to these examinations ? — A real lady never objects to them if necessary, it is the other people who object to them. Mr. Stansfcld. 1233. In answer to a question by the Judge Advocate, you admitted that in ordinary practice soft sores had diminished more than according to the statistics they had done in the army ?■ — I believe that to be so. Mr. Oshorne Morgan. 1234. You know nothing about the army prac- tically. You stated generally, that soft sores or local sores had diminished in proportion to real syphilis, so that the proportion is now three to one of real syphilis, about that : you do not speak of the army, because you have no knowledge of army practice ? — I have the statistics all before me. 1235. Your only knowledge of the army is derived from these statistics, which make no dis- tinction bet\yeen soft sores and true syphilis? — Quite so. Mr. Stansfeld. 1236. You expressed the opinion that soft sores had largely diminished among the civil population ? — Yes. 1237. It is in evidence before us that these soft sores have also diminished in the army, but it is not in evidence before us thai syphilis has diminished in the army ; what would your in- ference be from that fact ? — That the local sores had diminished from a common cause, which the Contagious Acts did not touch. 1238. The question has been raised as to whether secondary syphilis has increased or not since the Acts : will you have the goodness to return to the Report of this Committee of 1880, page 48, Return No. 3. Take the years from 1859 to 1866 inclusive ; do you not find a des- cending scale of ratios for secondary syphilis per 1,000 men of from 35-86 to 24-77 ?— That is so. 1239. Taking the year 1866, is it within your kno'H'ledge that the first Contagious Diseases Act was passed at the end of the year 1864? — It is not within my own knowledge. 1240. You may take it so from me. Will you also take it that that A ct did not set up periodical compulsory examination of women, and applied only to sending to hospital women already sus- pected of being diseased ? — Yes. 1241. And that it was applied very partially before its repeal by the Act of 1866 ? — Yes. 1242. Practically SELECT COMMITTEE OX CONTAGIOUS DISEASES ACTS. 57 1« March 1881.] Professor H. Lee. \_Continued. Mr. Stansfcld — continued. 1242. Practically speaking, therefore, the year 1867 is the first year of the present Acts ? — It would be so. 1243. In 1866 we are brought down, wltliout the operation of the existing Acts, to the number of admissions per 1,000 men for secondaiy syphilis being 24"77 ? — Yes. 1244. Now, turning to 1878, what do you find the proportion of admissions ? — Mr. Lawson says 26-64. 1245. Therefore, if you compare the year 1866, before the earliest existing Act was in operation, with the year 1878, you get an in- crease, and not a decrease, in the proportion of secondary syphilis in the Home Army. Is that so '.' — It is an increase of two per thousand of the whole force mentioned iu the return. 1246. If 1878 be taken as an exceptional year, the year 1877 will show a smaller figure ; but the year 1876 will show a figure of 27*4 ? — Yes. 1247. iS'o doubt it is considered fallacious to compare one year with another. I propose to compare an average of all the years from 1866 to 1878, with the year 1878 or the year 1876. Will you take it from me that the average of those years is 25'79? — -Yes. 1248. Supposing that to be a correct figure, the proportion of secondary s)'philis in 1876 and 1S78 is higher than the average of all the years from 1866 to 1878, inclusive? — That is so. Mr. Stansfeld — continued. 1249. You were asked whether you thought it was reasonable to require that all soldiers should be examined periodically, to ascertain the exist- ence or non-existence of venereal disease upon their person, as it was not to be presumed that they were diseased ; whereas it might fairly be presumed that a woman whose profession it was to be a prostitute was diseased ? I will put another question to you. Assuming that that is a sufiicient reason for not examining soldiei-s, do you not think the non-examination of soldiers is a reason for the failure of the Act ? — That is so. 1250. It maybe impossible or unadvisable to examine soldiers, but viewing the subject from the hygienic point of view, is it not your opinion, if the soldier is not examined, you cannot expect successfully to deal with this evil ? — That is so. Mr. Osborne Morgan. 1251. I understood you to say the cases of true syphilis to local sores are now about three to one ? — That is a rough guess. 1252. If in a column you find undistinguished, forty cases of venereal sores, I suppose you will infer that thirty would be cases of true syjihilis, and the other ten local sores ? — There would be only ten local sores, the others might be in a great degree abortive inoculations or modified re-infec- tions. 0.44. H 58 MINUTES OF EVIDENCE TAKEN BEFORE THE Monday, "lUt March 1881. MEMBERS PRESENT : Ml'. Cavendish Bentinck. General Buruaby. Mr. Burt. Di-. Cameron. Mr. Cobbold. Colonel Digby. Dr. Farquharson. Mr. William Fowler. Mr. Hopwood. Mr. Massey. Mr, Osborne ISTorgan. Mr. O'Shaughnessy. Mr. Stansfeld. Colonel Tottenham. The Right Honourable W. N. MASSEY, in the Chair. Inspector General Laavson, called in ; and Examined. Mr, Osborne Mortjan. 1253. When you were examined before this Committee on 16th July 1879, you gave evi- dence as to the returns of venereal affections for the 14 protected stations as against 14 unpro- tected ? — Yes. 1254. In answer to Mr. Shaw Lefevre, I think you stated that you were willing to take as the basis for your observations the retiirns of the whole of the unprotected stations, provided they could be made available? — Yes. 1255. Have the returns for all the unpro- tected stations been published since you gave your evidence ? — Since I gave my evidence there is a Eeturn (A. No. 3) in the Evidence of 1880, page 55, which gives the returns for the entire home army. 1256. That is one of the Papers handed in by Sir William Muir?— Yes. 1257. Will you look at that, and show the Committee, if you can, how far the views which you submitted to them in 1879, are borne out by this more extensive range of facts ? — I have in this return the facts for the whole of the force at home, and it is necessary to obtain the facts for the stations not under the Acts, which is done in this way. I take the returns which were put in in 1879; there is a return at page 157, giving the admissions for 14 stations succes- sively brought under the Acts, and by subtract- ing these from the returns for the whole army, as a matter of course we got the remainder for all the other stations. 1258. In that way you effect a separation of the stations under Acts from those not under the Acts?— Yes ; this return, in page 157, does not contain London until 1867. To meet that in my first examination I included London, and that is given in a Return at page 59, which was the one I used ; that is for six years, including London in the stations not under the Act ; but, in fact, that would not affect this return, be- cause these are the whole of those, only it ex- cludes Windsor, which, subsequently to 1867, came under the Acts. 1259. Before that it was included in London ? — Yes ; and there is one fact which it is neces- -continued. A.; in 1863, the number of is 8,774 ; that " 7 " is found to be a clerical error; it should be 8,174. Mr. Osborne Blorgan— sary to mention in Return ■primary venereal sores" returned Mr. Stansfeld. 1260. How do you know this ; are you con- nected with the Army Medical Dejjartmeutnow? — I had the thing examined into, and I requested the officer at the Army Medical Department to get the Director General to write officially to the Clerk of the Committee communicating the fact; the object was to let the Committee know, inde- pendently of me, that the question did not rest upon my statement alone. 1261. Of course, it is of extreme importance that all these figures should be reliable ; I un- derstand you to say that is a mistake ? — Yes : it was fully examined into. Colonel Tottenham. 1262. Does that figure affect any others? — It will throw 600 more into the "gonorrhoea et sequela3.'' Mr. Osborne Morgan. 1263. Do I understand you to say, 600 cases, which ought to have come under " gonorrhoea et sequelse," have been classed under " primary venereal sores " ? — I presume so ; that is in making the total upon the table. Mr. Stansfeld. 12G4. That is a mere guess, is not it ; the total might be wrong, the total for the year 1863 ; you would query that figure of 11,605; you would not say more than that ? — That was merely the information that I had ; the total of this class' was taken, and after deducting what is expressly put down for sores and secondary syphilisi the remainder of the enthetic class is put under that column, embracing all those other things which, at that time, were classed under venereal affections. 1265. Am SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 59 21 March 1881.] Inspector General Lawson. \_Continued. Mr. Osborne Morgan. 1265. Am I correct in stating this to be the substance of your evidence : you are certain in the case of primary venereal sores there has been a mistake made of putting 8.774 for 8,174, and you think it probable it has arisen in consequence of the same number, 600, being omitted under the head " gonorrhoBa et sequelae " ? — In fact, I may say I am certain of it. Chairman. 1266. You assume the original figure, 8,774, was a correct aggregate figure, but the distribu- tion was erroneous? — There was at that time a class regularly nominated the enthetic class, which embraced all the venereal affections toge- ther, and, of course, taking the primary sores and secondary syphilis from that class, the remainder is what is put down as " gonorrhoea et sequela. " Mr. Oshorne Morgan. 1267. Can you put in any return of your own showing the comparative prevalence of venereal diseases of all kinds in the protected and unpro- tected stations ? — There is one little thing with regard to gonorrhcea I may as well explain. The gonorrhcEas here given are " eonorrhcea et sequelce." If we take the gonorrhoeas as returned in the returns of 1879 from this wefiud an undue amount remaining to stations never under the Acts, which arises from all these sequelas included in this return, and to avoid that I applied to the Director General to get a return of gonorrhoeas alone, and from that return I have subtracted the gonorrhoeas given in the return of 1879 from the total, leaving the remainder of the gonorrhoeas for the other stations. 1268. Have you any return which will show the comparative prevalence of venereal disease in the 14 prescribed stations and in all the un- protected stations ? — I have got such a return to give the Committee. This is a return giving the return of admissions for primary venereal sores and gonorrhoea in the two sets of stations. ( Table No. 1 was handed in.) 1269. Not for secondaries? — Not for second- aries ; that is another affair ; that will come up in a separate form. This return gives the primary venereal sores and gonorrhoea in the 14 stations which came under the Acts, and at all the remaining stations never under them. 1270. This is the return of admissions under all stations, not 14 selected stations, but all the unprotected on one side and, in the other column, all the protected? — All the stations in the country. Mr. Stansfeld. 1271. You are not under the impression that we have these figures for the first time, surely ? — These figures have never been discussed in that form before. Colonel Tottenham. 1272. May I ask with what object that was made ? — It was made as I had expressed to the honourable Member for Eeading that I should be willing to take the whole stations never under the Acts, instead of the 14 stations never under the Acts, for comparison, and as soon as this return was published, which was doue in 1880, 0.44. Colonel Tottenham — continued. I took that return and wrote out the materials, the same as I had done for the previous 14 stations, and now my object is to put before this Committee what this return shows. 1273. It is a return made solely for the in- formation of this Committee ? — Solely. Mr. Osborne Morgan. 1274. Objection was taken to a comparison between the 14 protected stations and 14 un- protected stations which were selected? — That was the case. 1275. Can you state, shortly, what inferences you draw from this return ? — Tliere is one question which has been raised which is very material to the consideration of that and other returns, that is, that the grouping of the sores is unscientific and has been strongly objected to. We have had a good many statements upon that point. It so happens that I can put before the Committee a simple recoi'd of an occurrence which took place under my own notice, in which the numbers have been preserved and the facts. I was in charge of the depot of the 47th Regiment in the west of Ireland a great many years ago. We had a very severe outbreak of syphilis in that corps, and I was enabled, from having it under observation the whole time, to ari-ive at the characters of the sores to a large extent, and the number of cases of secondary syphilis that occurred, and the circumstances under which they occuri'ed. The depot went to Castlebar on the 20th and 21st July 1842, and though the strength was only 254 men, no less than 90 men were attacked between that time and the 24th of November with primary venereal sores. The ad- missions decreased in frequenc}' after that time, and we left Castlebar for Boyle on the IGth March. In the twelve months ending 31st March 1843, we had had 129 admissions for primary sores in these 254 men; three of these were re-admissions, so that there were only 126 cases. The great majority of these were contracted at Castlebar, but at Castlebar we had only 23 cases of secondary syphilis. The depot remained at Boyle till the 2nd Octobei", and ultimately came to England, where we joined head quarters on 3rd January 1844. During these nine months, 23 cases of pi'imary venereal sores only were admitted, and 26 cases of secondary syphilis, the last of which was in July. There were thus 149 cases of primary .venereal sores during the 21 months, and of these 27 are stated to have been indurated ; that was at that time considered the characteristic of true venereal sore. Three, which were not indurated, presented secondary syphilis before the primary sores were closed, and consequently, as was common then, they were continued under the designation of primary sores. During this period there were 49 admissions for secondary syphilis, and, including the three just mentioned, 52, but as three of these were re-admissions, there were only 49 individuals in all affected with this form of the disease. Supposing that each of the 27 cases of indurated sore had been followed by the constitutional affection, there would be still 22 cases of that form of disease attributable to other forms of sore, but in reality there was a greater number. In the reports it is expressly stated that excoriated sores were more frequently followed by secondary disease than any other H 2 form 60 21 March 1881.] MINUTES OF EVIDENCE TAKEN BEfOEE THE Inspector General Lawson. Continued. Mr. Oshurne Morgan — continued, form of primary affection, and as all the indurated sores were submitted to a prolonged course of mercury, until the hardness had disappeared, their liability to be followed by the constitutional aifection would be greatly diminished. These facts show conclusively that a much larger pro- portion of constitutional disease arises from sores other than the recognised indurated sore than is frequently supposed, and as these cannot be dis- tinguished from others that do not implicate the system until the constitutional affection becomes manifest, it is clear that in statistical investiga- tion there is no mode by which error can be avoided but by grouping all primary sores together, as has been done in the Returns of the Army. Mr. Hopwood. 1276. You refer to reports ; whose reports are you speaking of? — My own reports, which I wrote of this occurrence at the time. Mr. Osborne Morgan. 1277. You give what you have just now stated as a reason why you cannot distinguish between what are called soft and hard sores ? — In a great many instances^ when the sores have become in- durated, you have no doubt about it ; but there are a great many other instances that are fol- lowed by secondary syphilis, in which induration does not appear, and you cannot tell that they will be followed by it, until you see the secondary symptoms come out. I doubt whether anybody could tell what these sores will come to when they first come under his notice. It may be months before he has the means of making a distinc- tion. 1278. We have had some very conflicting evi- dence as to the possibility of curing true primary syphilis, i. e., that winch if left untreated, would certainly be followed by constitutional symp- toms; what opinion would you give as to that. Assuming the case of a man or woman treated under favourable circumstances in the early stages of the disease, would it be possible to eradicate from the constitution what is called primary syphilis ? — I think, and my own experience leads to that conclusion, that in a certain number of cases, it is difhcult to say what nxmiber, by proper and careful treatment you will stop the course of the disease before it has gone on, I will not say to affect the constitution, but to appear in the form usually described as secondary syphilis. 1279. Assuming proper hospital treatment, would you, in a substantial number of cases, eradicate the disease ? — I should not like to say eradicate, but we should stop all the apparent symptoms. Dr. Farquharson. 1280. You would prevent secondary symptoms appearing at all in a particular case? — In a certain number of cases. 1281. In a few cases? — In a few cases. We cannot exactly tell the number of them, but we certainly can stop any further development of the disease beyond the primary symptoms. Mr. Osborne Morgan. 1282. In any case you would, by ^oroper treat- ment, very substantially mitigate the severity of the disease ? — I think so. 1283. I have been looking at these figures, and I suppose you would say that to sub-divide the whole period of 18 years into three periods of six years each, and compare those periods with each other is the only fair way of testing these matters, because as enthetic diseases fluctuate so much from year to year, it would not be fair to take one year and compare it with another ? — You must take a number of years to get something like a mean of sufficient extent to work upon. 1284. I see you have divided here the period between 1860 and 1878, that is 18 years, into three groups of six years each, and you show in the case of protected stations the primary sores fell from 109 in the first period of six years, that is to say, from 1860 to 1866, to 65 in the second period, from 1867 to 1872, and to 39 in the last period ? — Yes. 1285. That is to say, they have declined in the protected districts from 109 per 1,000 in the first six years to 65 per 1,000 in the second six years and to 30 in the third ; that is correct ?— Yes. 1286. Now I turn to the unprotected stations, and I find that the decrease in admissions for these sores in all these stations is from 103 in the first six years to 93 in the second six years, and to 71 in the last six years ? — Yes. 1287. Is not it the fact, that the diminution has been in the case of the protected stations, as compared with the unprotected stations, in the ratio of very nearly two to one ? — Very nearly two to one for primary sores. I can give you the exact proportion. I may, in the first place, mention one point which, perhaps, some mem- bers of the Committee are not acquainted with ; that is, that up to 1872 we had the primary sores as they occurred; but from the end of 1873, the pay of the soldier who had the primary sores or gonorrhoja was stopped, and that led to a very material reduction in the nimiber, without affecting their subsequent consequences. That applies to primary sores and to gonorrhoea. 1288. And you would, I suppose, assume that that accounts for a certain diminution, both in the protected and unprotected stations ? — Cer- tainly. In fact, the large decrease between 1873 and 1878 is, in great measure, due to that. 1289. Will you give the exact proportion ? — In all the stations not under the Acts, the ratio per 1,000 for primary sores, from 1861 to 1866, was 103, and from 1867 to 1872, 93-6, giving a fall of 9 '4, or a reduction of 9 per cent, in the incidence of the disease over the country. 1290. There were two reasons, were there not, why these periods of six years were taken ; in the first place we have 18 years to deal with ; therefore, it is convenient to divide them into periods of six years; and there is another more im- portant reason, namely, that in 1866 the beginning of the second period, the Act of that year, which. made periodical examinations comjjulsory, was passed, and came into operation in 1867, and that, of course, was a very important disturbing ele- ment of calculation ? — In fact that was what led to the selection. 1291. Then, I suppose, In 1873, the beginning of the third period. Lord Cardwell's Order came into SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 61 21 March 1881.] Inspector General Lawson. [ Continued. Mr. Osborne Morgan — continued, into operation ; that also would be a disturbing factor ? — Yes. 1292. We are now speaking of all the unpro- tected stations, and of admissions for primary sores only ; you have said in the second period, opposed to the first period, the admissions per 1,000, in the unprotected stations, had fallen at the rate of 9 per cent. ? — Yes. That indicates the incidence of the disease over the country. 1293. You take these figures as showing fairly the general incidence of the disease in the Army ? — I give them as so doing. 1294. Having dealt with the diminution of dis- ease in the unprotected stations, which you say is at the rate of 9 per cent, between those two pe- riods, now come, if you please, to the figures given for admissions in the protected stations, for pri- mary sores, for the first and second periods of six years ? — In the protected stations for the first period they are 109'7, and for the second 65"4. 1295. What reduction does that represent ? — That is a reduction of 43"7, which is equal to 40 per cent, of the first number ; and if you take 9 per cent, from that it falls to 31 per cent. Mr. Stansfeld. 1296. What is the diminution in the second district as compared with the first ? — It is from 109-7 to 65-4. 1297. What is the diminution per cent. ? — A diminution of 40 per cent, upon itself; but it falls to 31 per cent, as the excess of reduction at those stations. 1298. I am sorry I do not follow that ; we have a reduction of 9 per cent, in the second period, as compared with the first, in unprotected stations ; and what we want next to know is the reduction in the jjrotected stations ? — The num- ber is 43 ; but the per-centage is different from the number ; it is 40 per cent. I have given two comparisons in my notes, of which I am only giving one now, and it is difficult to take the facts out and dissect them in that way. The diff'erence between the protected stations and the unprotected is 34'9, or 31 per cent, of the rate prevailing at these stations before the application of the Act. Mr. Osborne Morgan. 1299. Should you say the difference between the diminution of admissions for primary sores in the protected and the unprotected stations is represented by a diff"erence of 40 per cent, and 9 per cent.; is that so ? — Yes. 1300. What is the difference per 1,000 or per 100 in the diminution of admissions for primary sores in the protected and the unprotected stations ; of course these figures speak for them- selves, but it would be convenient if you could give the exact diff'erence in the diminution ? — You should take the actual fall and divide it by the higher number, as you would any number, to obtain the fair per-centage. Of course with 109, 40 will give a smaller per-centage. Colonel Tottenham. 1301. You are working out two averages in fact ? — Two averages. Mr. Osborne Morgan. 1302. Now, I take you to the third period during which Lord Cardwell's Order came into 0.44. Mr. Osborne Morgan — continued, operation, and there I find that whereas the fall in the unprotected stations is only from 93-6 to 71-2 in the protected stations (speaking still, of course, of primaries only), the fall was from 65-4 to 39-2 ; what comparative diminution does that show in the protected and the un- protected stations between the period beginnino- with 1867 and ending with 1872, and that beginning with 1873 and ending with 1878? — I have not calculated that, and for the simple reason that the number of cases concealed and not reported is so great that any calculation would be erroneous. 1303. Then we must take these figures for what they are worth ? — Yes. 1304. You think the effect of Lord Cardwell's Order is the disturbing element in the calculation and it is useless to compare them ? — It is useless to compare them. It led to a very great re- duction, and we lost our hold of the thing at that time. 1305. Would you say those figures are value- less ? — I would not say that, hut we could no longer keep up the same comparison as we did before. 1306. Now I will come to gonorrhea ; I find for the first period the ratio of admissions per 1,000 in protected stations was for gonorrhoea 125, and in the uprotected stations 108 ; from the other columns it would appear that for some reason which I cannot pretend to give, the stations which are brought under the Acts were more liable to venereal disease of both kinds than those that were left unprotected ? — Certainly. 1307. Perhaps it was for that reason that they were brought under the Acts ? — That was one reason. There were large bodies of troops at most of them, and for that reason they were the most prominent stations and were selected for the Acts. 1308. In making these calculations you have to consider that the 14 protected stations, as they are now, 'wouXA prima facie, and in the absence of any preventive agencies, present more unfavour- able returns in the absence of protected than unjDrotected stations ? — No doubt of it. 1309. I see that there has been a fall in gonorrhoea in the protected stations from 125 to 1 14 ; that is a small decrease ? — It is not large, certainly. 1310. But it is a considerably larger duninu- tion than in the unprotected stations ? — ^Yes, 1311. Because there the fall was only from 108 to 15? — The fall at the protected stations is about 8 per cent, of the numbers, and at the other stations it is 3 per cent. 1312. Now I come to the next period, when Lord Cardwell's Order was in operation ; does not that Order apply equally to protected and un- protected stations ? — Certainly. 1313. Therefore whatever operation it would have, it would act in the same way in both cases? — Both cases. 1314. I should have thought that taking that into consideration, you might fairly compare the two classes of stations dm-ing those six years when Lord Cardwell's Order was in operation, for given the same disturbing element, still it disturbed both places equally ?— They may be compared with each other at that time, but you cannot extend the comparison to the pi-evious periods. Ho 1315. Comparing 62 MINUTES OF EVIDENCE TAKEN BEFORE THE 21 March 1881.] Inspector General Lawson. [ Continued. Mr. Osborne Morgan — continued. 1315. Comparing them with each other, I find that in the case of gonorrhoea, the admissions in the protected stations are 69 as against 73 ? — That is so. 1316. I take it the net result is, that whereas for the first period of six years in the protected stations, the admissions for gonorrhoea were sub- stantially in excess of the admissions for gonor- rhoea in the unprotected stations, in the last years, from 1873 to 1878, the admissions for that disease in the protected were considerably less than those in the unprotected ? — That is so. 1317. The inference you draw from that as regards gonorrhoea, is that making every allow- ance for Lord Cardwell's Order, the Acts have substantial!}' tended to diminish gonorrhoea ?• — ■ Decidedly. 1318. The fall is in the protected from 125 to 69 cases of gonorrhoea, and in the unprotected from 108, which is less than 125, to 73, which is more than 69 ? — That is so. 1319. Now let us go back to primary sores. I suppose you would say it was possible and fair to compare the admissions for the last period of six years, when Lord Cardwell's Order was in operation, in the two classes of stations ? — Cer- tainly. 1320. There I find, referring to primary sores, that during these last six j^ears the disproportion has been much more remarkable, because I see that whereas the admissions for primary sores in the unprotected stations were as high as 71, in the protected stations thev were as low as 39 per 1,000?— That is so. 1321. Is it possible to attribute that enormous disproportion in the decrease to anything but the operation of the Acts ? — I do not think so ; there is nothing else that I can see to account for it but that; all the other things that have been alleged fail when j^ou come to examine them. 1322. It has been stated, and it would appear from the figures, that to a certain extent the dis- ease has diminished all over England owing to sanitary precautions, increased morality, and va- rious causes ? — Do you mean in the Army ? 1323. I am speaking of the population gene- rally ? — In the population generally the disease has rather increased over England. 1324. In the Army you might, I suppose, assume that owing to improved morale, and better sanitary arrangements, the disease has diminished ; would that be so ? — No, I do not think that that could be borne out to any extent ; there is no doubt a great many means have been introduced which tend to drag soldiers out of the slums ; but these have been introduced at the stations never under the Acts quite as fast, and to a similar extent, as at those which are under the Acts ; so that anything derived from that would apply to both. 1325. Am I right in saying, speaking gene- rally, that every cause which would operate to de- crease disease in the Army in stations under the Acts would operate equally on stations not under the Acts ? — These sanitary and other measures have been applied to the same places, and should diminish them in the same way. 1326. So that, of course, making allowance for exceptional cases, for large towns like London and Manchester, you would say that there is no other way of accounting for the striking dispro- Mr. Osborne Morgan — continued, portion in the diminution of these diseases in the protected and unprotected stations except by attri- buting it to Acts themselves? — Except the Acts; with regard to comparisons between Manchester and London, and some of the camjDS, I have never made such a comparison ; the comparison of Manchester is Manchester from 1861 to 1866, as against Manchester from 1867 to 1878, and you take the differences between those two periods to show what has been the difference of incidence on the country of the disease so far as Man- chester can show it, and so on with all the other stations; they are not compared directly; you merely take the two jDeriods ; one shows the in- cidence at one period, and at another period the same places show a different incidence. 1327. Is it a fair inference from these figures to say that, putting the Acts aside, the protected stations would be likely to show larger returns of the disease than the unprotected ? — I have no doubt if you put these Acts aside you would, in a few years, go back to the style of thing that you had in the early six years. 1328. You would find if you repealed the Acts in these stations the same jDrevalence of dis- ease that you had before the Acts were in opera- tion? — The stations that are now under the Acts would go back and accumulate an amount of dis- ease in excess of what stations never under the Acts at present show. 1329. You cannot account for the results evolved out of these Tables in any other way ? — I cannot. 1330. These returns are confined to primary sores and gonorrhoea ; have you any returns of secondary symptons ? — Yes ; here is a return to show the privnary sores and secondary syphilis, arranged on the same principle. ( Table No. 2 was handed in.) The primary sores occur in certain numbers, and the secondary syphilis occurs in a pretty fixed proportion. This Table shows the number remaining in hospital. I find here that, taking the protected stations, the ratio of men remaining in hospital for secondary syphilis is for the first period 2-70? — Yes. 1331. Now, going to the unprotected stations, I find that it is 2-63 ?— Yes. 1332. Still showing a greater incidence of the disease in the case of the protected stations? — Yes. 1333. Now, coming to the second period, we find in the unprotected stations the number fell from 2-63 to 2* 19, but in the protected stations it fell from 2-70 to 1 -86 ?— Yes. 1334. Now I come to the next period, during which Lord Cardwell's Order was in operation, and that seems to have had very little effect upon secondaries ? — It did not apply to secondary syphilis ; it was merely for primary sores and gonorrhoea. 1335. In the third period there was scarcely any fall at all in the unprotected stations, it was from 2'19 to 2-16? — It was a very trivial redac- tion. 1336. In the protected stations it fell from 1-86 to 1-78, a slight fall?— Yes. 1337. So that, taking the first, and comparing it with the third period, there has been a very much larger diminution in the amount of men in hospital for secondary syphilis in the protected than there has been in the unprotected? — Yes, much larger. 1338. Can SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 63 21 3Iarck 1881.] Inspector GcBeral Lawson. [ Continued. Mr. Osborne Morgan — continued. 1338. Can you tell me about how much ; 50 per cent. ?— Not quite so much as that, but very considerable. 1339. How do you account for that dis- crepancy ?- That the Acts have reduced the syphilitic sores, and with that the secondaiy syphilis, being the natural consequence of the primary. 1340. May I take it, therefore, in reducing primaries they necessarily reduce secondaries ? — They necessarily reduce secondaries. 1341. In your opinion would it be right to say the Acts have had no effect in reducing the preva- lence in the Army of secondary symptoms ? — On the contrary, they have had a very considerable effect, as is shown by this, and this does not show the whole effect. As in the case of the 47th, ■we saw after we had left Castlebar and gone to Boyle as many cases of secondary syphilis occurred at the new station, which were clearly the result of the previous station. Between these sets of stations that are under the Acts and those which are not, you have the same sort of trans- ference going on. So long as the ratio in the stations under the Acts was high, there was a transference to those not under the Acts ; and on the contrary', when those under the Acts became smaller, there was a transference the other way, and that is very material to a considerable extent. 1342. You have got two returns? — Yes. 1343. You have a return of the number of men admitted per 1,000 for primary sores ? — Yes. 1344. You hare another return showing the number of men treated in the hospital daily for primary sores ? — Yes. 1345. These returns, of course, cover both the protected and the unprotected stations? — • Yes. 1346. May I take it, without cross-examining you as to the increase, that jou find, as you would expect to do, that the ratio between the protected and the unprotected for the different years given in one return is maintained in the other return ? — It is maintained in general terms. 1347. I see, in the first six years, the ratio of the men daily in hospital for primary sores in the protected stations is 7'96 ? — Yes. 1348. As against 7 "47 in the unprotected stations ? — Yes. 1349. Showing, therefore, that the original rates in the protected was greater than in the unprotected ; is not that so ? — -Yes. 1350. Now I will come to the second period, and I will take first of all the unprotected stations; there the number in the second period is absolutely stationary; vou have 7 '47 as against 7-47 ?— Yes. 1351. Now go to the protected ; instead of the number beinn; stationary, you have a drop from 7-96 to 5-15 ?"— Yes. 1352. Then we come to the third period, and I find that there is a fall in the unprotected stations from 7 "47 to 5" 19 ? — Yes. 1353. Would that be accounted for partly by Lord Cardwell's Order? — I fancy almost com- pletely. 1354. Turning to the protected stations, the fall is from 5'15 to 3"2? — It is not absolutely greater, but it is greater relatively. 1355. I suppose that this return showing the 0.44. Mr. Osborne Morgan — continued. comparative increase or decrease of the disease in all the unprotected stations as compared with the 14 protected stations, is a fairer way of getting at the facts than that which you have put in before taking 14 selected stations? — It gives you a broader basis for the incidence of disease in the country. 1356. Taking these returns as opposed to the former returns, should you say that these returns that you have now put in are more favourable to the Act? — They show ratios lower throughout than the others ; the ratios here given are lower than those for the 14 stations, but they go on otherwise fluctuating exactly the same. 1357. What do you take to be the result of these returns as compared with the former returns. Do they shoM' substantially that the Acts have oj)erated beneficially ? — -They show substantially that the same thing has taken place that the former returns showed. Mr. Stansfeld. 1358. What was your answer to the question as to whether it speaks strongly in favour of the Acts ? — I say that the ratios are lower, and the difference between them and the Acts is rather less than between the others and the Acts. 1359. Therefore, it does not show quite so advantageously for the Acts? — Not quite as high in favour of the Acts, but still very deci- dedly. Mr. Osborne Morgan. 1360. What number of stations are there not under the Acts? — I believe about 100 alto- gether. 1361. And those 100 stations, I suppose, em- brace towns of every variety and stations of every number ? — Stations of every number. Wherever you have a detached battery with two or three artillery men in it, that is reckoned as a station. Colonel Tottenham. 1362. Surely the number of stations is very far exceeding 100? — It may be, but there are a con- siderable number of them. 1363. There are over 70 line battalions in this country, and each of those would represent a station? — At Aldershot you have perhaps 30, and at Portsmouth and other jDlaces you have a large number. Mr. Osborne Morgan. 1364. I think it was stated by Dr. Nevins that some of the stations never under the Acts have lower ratios of admission for primary venereal sores than others which were under the Acts ? — I have looked at that. 1365. Have you any remark to make tqion it? — Dr. Nevins put in several returns. 1366. I suppose if you were to pick and choose one particular station you might always find one out of a hundred to suit your theory? — ^Yes. The fact is, there are a number of these stations that have a very small sick list to them ; there are others with a much higher sick list. 1367. A village would naturally have a much smaller return than a town ? — Yes. H 4 1368. Would 64 MINUTES OF EVIDENCE TAKEN BEFORE THE 21 March 1881.] Inspector General Lawson. [ Continued. Mr. Stansfeld. 1368. Would you say that was the reason why the department selected 14 unsubjected sta- tions ? — No ; they were selected as having above 500 men. As to the statement by Dr. Kevins, he put in a return showing these things in the Evidence of 1880^ page 47, Table 2. " In that return there is only one ratio correct, and that is the last one. He returns, for instance, an average ratio 35 at Dover and at Pembroke, but it turns out, taking his own basis, on work- ing it out that it is 52 at Dover and 31 at Pem- broke ; but as I tell you the whole return is wrong, except the last one. Mr. Osborne Morgan. 1369. Of course, that is a serious imputation upon Dr. Nevins' accuracy ; are you prepared to prove that ? — Perfectly. 1370. Will you do so ?— Yes. In the first place, I may say, Dr. Nevins has founded this return vi\>on a return given in page 156 of the Evidence of 1879. It gives the rate of admis- sions into hospital per 1,000 mean strength, for primary venereal sores, every year from 1867 to 1878. He has taken the 1) years from 1867 to 1877. He has taken the total of these ratios, and dividing them by 11, he arrives at what he calls the ratio he has put iu this table. Taking Dover, which is the first number, the sum of the 11 ratios is 575. Colonel Tottenham. 1371. Why do you say 11 years ; why not 12, including 1878 ? — He limited it to 1877, as there was a question whether 1878 did not embrace too lai-ge a number, owing to the calling out of the Reserves. Mr. Osborne Morgan. 1372. Would you give me the total number for Dover ? — Five hundred and seventy-five ; that number, divided by 11, gives 52. Dr. Ji[evins gives 35. Colonel Tottenham. 1373. Have you any idea how the 35 is arrived at ? — No. 1374. Could it be arrived at by any other manipulation of the figures ? — No ; he gives the description of the way in which it is formed. Mr. Stansfeld. 1375. If you turn to page 49, you will find another table prepared by Dr. Nevins, and the exjilanatiou of the difference between the two. Table No. 6 is an alternative table, prepared with an explanation of the difterence of the principle in the method of preparation of the two ? — There are two ways of making the calculation, and he has adopted a different method in each case. In this case he has taken the mean of the ratios for single years, which is not correct ; but even as he has taken it the figures are wrong, upon his own method, in Table No. 2. In No. 6, he has adopted the proper means of taking the numbers for each yeai-, and dividing them by the total strength. Mr. Osborne Morgan. 1376. What ought Woolwich to be; it is 58? — Fifty-three. Mr. Stansfeld. 1377. The method which you say is incorrect is this : he takes the ratios, adds them up, and divides them by the number of years ? — Yes. 1378. He is incorrect if the number of men varies ? — Yes ; the numbers are so far out that they do not even agree with his own direc- tions. 1379. You will give us what you think are the correct figru-es, I suppose? — No. 6 is really correct ; I have nothing to say against that so far as the figures are concerned ; but this other is manifestly wrong. 13S0. Then the best thing would be to con- sider No. 2 as erased, and to take the alternative Table, No. 6, which, in my opinion, is the proper method of calculating ? — That is what should have been done at the time. j\Ir. Osborne Morgan. 1381. You say that Table No. 2 of Dr. Nevins is incorrect, according to the principle which he has adopted / — Certainly. Mr. O'Shaughnessif. 1382. Do not these mistakes in principle ap- pear to be against Dr. Nevins' own case ? — There is such a jumble upwards and downwards. 1383. i'ake the first 1 — One is above and the other below. Mr. Osborne Morgan. 1384. In the evidence before the Committee there was a table giving the ratio of primary venereal sores from 1860 to 1864 at the stations which came under the Acts? — Yes. 1385. I believe it is contended that the reduc- tion from 1865 at those stations was due to the continuance of the same agencies which had led to the reduction before 1864 ? — Yes. 1386. And that it was not attributable to the influence of the Act ? — -I have seen that evi- dence. 13S7. Have you any observations to offer upon it ? — Dr. Nevins embodied that in a diagram, a copy of which is in his evidence ; and he was very doubtful, apparently, as to what the value of the diagram was, and left it to the Committee for what it was worth ; he states, as an explana- tion of it, th.at it clearly bears out the conclusion that the disease fell according to the theoretical line which he has put ujdou it, and he attributed that fall to the introduction of means for occupying the soldiers, for improving their moral and social condition ; now this diagram is one which any- body who is not very familiar with the manipula- tion of diagrams would be easily deceived by ; it has got a very great vertical scale, and a very small horizontal one, and there are no means of tracing the influence from year to year readily upon it ; to meet that difficulty, I have prepared a diagram myself, embodying the fiicts that he has given, and some further facts which are of importance in the question, a copy of which I will put before the Committee. ( The same loas handed in.) 1388. Will SELECT COMMITTEE ON COXTAGIOUS DISEASES ACTS. 65 21 March 1881.] Inspector General Lawson. [^Continued. Mr. Osborne Morgan — continued. 1388. Will you explain this diagram ? — In the upper part. I have inserted the number of pri- mary sores that came under treatment every year at 14 stations that were never under the Acts. That is the thick dotted line. To show how far they agree with the whole of the stations never under the Act, I have included the whole of the stations never under the Acts in the thin line, and by looking at them you will find that every movement in the one is perceptible in the other, saving one movement in 1864. There is, iu fact, a practical agreement between the pro- gress of the two. 1389. You are dealing with all the stations? — "With all. That is simply to show to the Com- mittee the relation between these two. Coming to the lower part of the diagram, I have in- serted in the thick line the primary sores for the 14 stations. 1390. Before you pass from this topic let me ask you one question : does it appear from this diagram that for all practical purposes you may take it that the disease has held the same course in the two classes of stations, except that in the protected there have been fewer cases than in the unprotected ? — That is it. Every fluctuation is obvious except that one in 1864. 1391. The fluctuations have been the same ? — Yes, but less pronounced. 1392. Now continue your explanation of the diagram ? — In the lower part you have the thick line which indicates the admissions at the stations under the Acts. That virtually agrees with Dr. Nevins' line, but it is put upon a scale in which the horizontal scale is equal to ten vertical instead of five on his. Colonel Tatienham. 1393. Is this a distorted scale? — It is not the same vertically as horizontally. It gives the same height for five as for one year horizontally ; I gave the same height for ten, and it lengthens it out. The thick line is the line for the admis- sions at the stations that came under the Acts. The dotted line running through that is the dotted line which Dr. Nevins has introduced in his own diagram. The thin line is the line for the admissions at all the stations never under the Acts. If you look at these you will find that from 1860 to 1866 there has been a fall at both classes of stations. There was, to start with, a lower ratio at the stations never under the Acts, and that kept on until 1862, when there was a slight rise, and it became nearly coincident with that at the stations that came under the Acts. This went on until 1866, and as the second Act, which introduced compulsory ex- amination commenced at the end of 1866, you see what the result has been, that at the stations under the Acts there was a slight increase in 1867, but that at the whole of the stations never under the Acts there was a much greater in- crease. The following year there was a fall at both, but a greater one at the stations under the Acts . The following year, again, when a greater number of stations were coming under the Acts, while the stations never under the Acts made a decided rise, there was a decided fall at the stations under the Acts. From 1870, when the 0.44. Colonel Tottenham — continued. Acts were in full force, you see that in 1870, 1871, 1872, and 1873, at the stations under the Acts, there has been very little fluctuation indeed. His theoretical line, which he supposes represents that fall, crosses this. Afterwards, when the stoppages of pay commenced, there was another cause of the full, in 1873. Then there is another rapid fall which affected both the stations never under the Acts and the stations under the Acts. That continued until 1878, when there is again a rise. 1394. That was the year of calling out the Reserves, 1878 ?— Yes. Mr. (yShaughnessy. 1395. There is a rise in 1877? — There is a rise in 1877 in both, but not to any great extent ; it appears to me that, looking at this return, no one can doubt that something has afl'ected the stations under the Act from 1866-7, that has led to a constant and decided diminution of disease at them, as against the rest of the country where the Act has not been applied. Dr. Nevins's contention that that was owing to the introduction of sanitary means of ablution and so forth is inapplicable, because these measures were not introduced at the stations under the Acts alone, but they were introduced at other stations all over the country at about the same rate and about the same time. Mr. Osborne Morgan. 1396. They were not confined to any particu- lar stations ? — No. 1397. We may take it shortly that the pro- tected stations started with considerably higher ratios of disease, and have come down to much lower ones?^ — To very much lower ones, and you see by the diagram the pei'iod when that com- menced ; you see when the measures to which we attribute it came into force. 1398. What do you take Dr. Nevins's dotted line to mean ; his theoretical or imaginary line ; does it mean the course that the disease would have followed if there had been no Act ? — He says the Acts have nothing to do with it. Mr. O^ Shaughnessy. 1399. Does that theoretical line show what Dr. Nevins thought should have occurred only in [he protected stations ? — Only in the protected stations ; not in all. Mr. Foicler. 1400. There was an improvement in the sani- tary condition of the Army about the time that this refers to ? — Yes, it extended to the whole of the Army. 1401. Great attention was paid to it partly in consequence of Mr. Skey's commission ? — That had not much effect in that respect ; it was in providing lavatories for ordinary personal ablution. Mr. Osborne Morgan, 1402. Would you not assume from Dr. Nevins's own argument and evidence that this theoretical I decrease 66 MINUTES OF EVIDENCE TAKEN BEFORE THE 21 MaTch 1881.] Inspector General Lawson. [^Continued. Mr. Osborne Morgan — continued, decrease would have taken place in the unpro- tected as well as in the protected stations ? — Certainly, if it had any existence at all. 1403. I mean the influences at work in the two classes of cases were identically the same ? Certainly. 1404. Now adopting- for the moment the theore- tical line as perfectly correct, you find, as a matter of fact, do you not, that in the subjected stations it has been to a certain extent followed out? — In the subjected stations. 1405. But in the non-subjected stations there is a wide departure from it? — There happens to be a coincidence in the stations that are subjected, but it has nothing to do with his idea for which there is no authority whatever that I know of. 1406. But your diagi-am, if it be correct, shows that this theoretical decrease which ought to have prevailed in all the stations has certainly not prevailed ? — It has not prevailed. 1407. The whole hinge of the case seems to rest on this; there are certain influences at work which I suppose would have a tendency, by im- proving the sanitary condition of the soldiers and their moral character, to lower the amount of disease : 1 want to know would those influences or would they not be equally at work in the subjected and in the non-subjected stations ? — Certainly, they were applied to each at the same time. 1408. If they would have a particular eflect in the subjected stations, would it not be a necessary inference that they would have the same eflect in the non-subjected stations? — Cer- tainly. 1409. Carry that a step further ; you find, as a matter of fact, that in the subjected stations. Dr. Nevins's siu'mise turns out pretty nearly right, and that in the non-subjected stations it is very wide of the mark ? — Altogether. 1410. It appears in evidence that at several stations under the Act gonorrhcea has been more common than it has at others where the Acts have not been in force ; have you any remai-k to make upon that?— Dr. Nevins submitted a table for gonorrhoea, of the same nature as he has done for primary sores {Return 5, page 49). In this return he has arranged the stations under the Acts, and the stations not under the Acts, linking together those that have nearly the same ratio, but he has omitted, as he did in the case of primary sores, to examine what was the rate of primary sores at the stations under the Acts before the period lie selected. I had calculated in detail the figures for a return with regard to primary syphilis, but not with regard to gonorr- hoea, as I thought it was not v>-orth while to take up time. I can give the facts with regard to primary sores if it is desired. 1411. I should like you to do so? — I have a Keturn (No. 6) which gives the number from 1867 to 1877, including a period when diseases were concealed. He gave another (No. 7), which embraced a period from 1870 to 1873, when the Acts were in full force, and when there was no question about concealment of disease. 1412. Do I understand you to say that in order to form a correcD estimate you ought to take the ratios of admission at these stations that Mr. Osborne Morgan — continued, were afterwards protected, before any of the Acts came into operation? — Yes. 1413. And what would the result show? — I have taken the six years, 1861-66, as being the period before the Acts came into operation for all the difl'crent stations, and comparing that with what we have in this Return, No. 7, you get these results. At Fermoy there is here a ratio of 50-9, and for the period 1861 to 1866 it was 48 '4, showing a rise of 5 per cent. Chatham and Sheerness, which had the same ratio in 1870-3, in 1860-61 had a ratio of 90-7, showing a reduction of 44 per cent, against a rise of 5 per cent. Mr. Hopwuod. 1414. What are you comparing with ; you have some reports by you ? — i have taken the figures myself. 1415. From where? — From the different returns, showing the admissions for primary sores for the six years from 1861 to 1866. Mr. Osborne Morgan. 1416. Have you tabulated them, and are you going to hand them in ? — I did not intend to do so, but they can be handed in. 1417. From where have you taken the figures ? — From the Army Medical Reports. 1418. Are those in evidence ? — No; there is the whole thing calculated by myself. 1419. Do I understand you to say, speaking generally, that if you were to take the amount of fore the Acts came into force, and compare it disease in some of these protected stations be- with the amount of disease before the Acts in the unprotected stations, the amount of disease before the Acts in the protected stations would be shown to be much higher ? — Very much higher. 1420. I am speaking of two stations where since the Acts have come into operation the disease is the same ? — That is what I am referring to. In the case of Fermoy and Sheerness the disease, according to this return, was 50'9 at each. 1421. Would that apply to other stations as well ? — i"es ; I could give you half-a-dozen others, and make the same comparison. The Isle of Wight, from 1861 to 1866, had a ratio of 56'8, whereas now it is 55 7. 1422. It has remained almost stationary ? — Yes ; there is a reduction of 2 per cent. 1423. Now give me a station under the Act? — Woolwich in this return has a ratio of 53"3 ; in 1861-66 it had a ratio of 104 '2 ; that is a reduction of 44 per cent, as against a reduction of 2 per cent. 1424. Give us another instance ?— Pembroke Dock from 1861 to 1866 had a ratio of admis- sions of 57-5; from 1870 to 1873 it was 31-9, showing a reduction of 45 per cent. Mr. Fowler. 1425. I believe there is a very small force there? — Under 1,000 men. Shorncliff'e, which had a ratio of 30-3 in the latter period, had a ratio of 86'5 in the former period, a reduction of 65 per cent, as against 45 per cent. 1426. What SELECT COMMITTEE Olf CONTAGIOUS DISEASES ACTS. 67 21 March 1881.] Inspector General Lawson. \_C'jntiriued, Mr. Osborne Morgan. 1426. What is the fall in Shorncliffe ?— It has come froix 86"5 down to .30-3, "vvhich is a fall of 65 per cent. 1427. You have spoken of primary sores, would the same thing apply to gonorrhcea also ? — It does apply to gonorrhasa to a large extent. Without goiuCT into the details I will give you a general statement. 1428. What is the force at Shorncliffe ? — From 1861 to 1866 it was 3,000 men ; from 1870 to 1873 it was 2,500. 1429. Now give me the result at all these sta- tions of the admissions for primary sores ? — At the 14 stations never under the Acts, from 1861 to 18 G6, the ratio for primary sores was 114"1, and from 1870 to 1873, 107-9, showing a reduc- tion of 5 per cent. At the 14 stations which came imder the Acts, the ratio from 1861 to 1866 was 109"7, and from 1870 to 1873 it was 52'5, showing a reduction of 52 per cent. Jlr. Fowler. 1430. That is for primary sores only ?— For primary sores only. That leaves 47 per cent. in favour of the Acts between those two periods. The gonorrhoea table is No 5. I did not go into a comparison of all these because it is of no use. Taking the period from 1861 to 1866 the ratio at the 14 stations not under the Acta was 109, and from 1867 to 1877 (this is for that period) was 101, or 7 per cent, reduction. At the stations under the Acts the ratio from 1861 to 1866 was 125-1, and from 1867 to 1877 it was 92-2, a reduction of 26 per cent. 1431. You show in the table how you arrive at this, I suppose ?— It is merely taking the numbers as arrived at in the usual way. Mr. Osborne Morgan. 1432. May I take it generally that, in your opinion, in order to make these tables handed in by Dr. Nevins, a correct basis of calculation, you ought in each case to take into consideration the respective prevalence of the disease at the subjected and at the non-subjected stations be- fore the Act came into operation ? — Certainly ; you can have no idea of the alteratioB with- out it. 1433. In order to appreciate the effect pro- duced by the Acts ? — Certainly. Mr. Hopicood. 1434. Those figures you get from reports which you have, but which we have not ? — They are all published and presented to Parliament; the medical reports and the figures are taken from them. 1435. You have taken these figures and tabulated them from the Army [Reports ? — Yes, they are published every year. 1436. And you are prepared to put them in the hands of the Committee ? — Certainly. 1437. We have never had it in that form yet; that is so, is it not ? Mr. Osborne Morgan. 1438. Have you examined into the frequency of secondary syphilis as shown in the Return A, handed in by Sir William Muir ? — Yes ; I have examined the table minutely. 0.44. Mr. Osborne 3Iorc/an — continued. 1439. Have you compared it with the results which you laid before the Committee on your former examination ? — Yes. 1440. Do they agree? — They agree very closely. In the former examination I showed that from 1861 to 1872 in a strength of 857,378 men serving at home the admissions for primary sores were 73,238, and for secondary syphilis 24,742, the primary sores being in the ratio of 85'4 per thousand, and the secondaries 28-9. That is as nearly as possible three primary to every secondary case, and that pi-oportion held for shorter periods until the stoppage of pay again interfered with the results. 1441. You know that evidence has been laid before the Committee that your statement that secondary syphilis had been reduced in propor- tion to the primary venereal sores up to the period of 1873 was erroneous? — That evidence has been put before the Committee. 1442. Have you any remark to offer upon it? — I must continue the line of remark I have been parsuing, because it develops that. The evidence was to the effect that this ratio of three primary sores to one secondary case was main- tained not only in the 12 years, but when you divide the 12 years into periods of three years, four consecutive periods, we found the same ratio very closely, and when we came to the other period after the stoppage of pay, from the number of primary sores being much reduced, of course the secondary syphilis apparently rose largely. I have taken the facis in this lleturn A, and sub- jected them to exactly the same process, and it comes to this, that with 945,260 men under observation, the admissions for primary sores were 86,915, and for secondary syphilis 28,807. Dr. Cameron. 1443. From 1861 to 1872, fjr the whole service at home ?^These were for primary and' secondary sores. 1444. Primary and secondary sores of what force ? — The force that we had the returns of at that time. 1445. From 1861 to 1872?— Yes, I am now giving the numbers from this more recent return, which embraces everybody at home, which the pre- vious return did not do. Itis a much larger number and a broader basis. The previous return, I may add, only gave the number for the regiments that had been in the country for a whole year. A regiment being j^art of a year in the country was not included. The present returns include everybody, however long or short the time may be. 1446. What are the ratios ? — The ratio for pri- mary syphilis over the laroer number is 92-0 per 1,000, and for secondary syphilis 30-5, still as nearly as possible three primai-y sores to every secondary sore ; and when you examine for the shorter periods the same proportion holds good. If we take the period from 1861 to 1863 we have 117-6 primary and 36-7 secondary; that is a ratio of 31 per cent. ; if we take from 1864 to 1866, the next three years, the primaries were 94-7 and the secondaries 320, 34 per cent.; from 1867 to 1869 the primaries were 88-9 and the secondaries 30-3, 34 per cent. ; from 1870 to 1872 the pri- I 2 marles MINUTES OF EVIDENCE TAKEN BEFORE THE 21 March 1881.] Inspector General Lawson. \^Conii./nied. Dr. Cameron — continued, maries were 68"3 and the secondaries 23'5, again 34 per cent. After the stoppage of pay the jjri- maries were 54*4 and the secondaries 25 5,47 per cent. ; from 1876 to 1878 the primaries were 52-7 and the secondaries 25'8, 49 per cent. In both these cases of course there are a large number of primary sores no1 reported, and the secondaries seem to rise in proportion. Mr. Osborne Morgan. 1447. Putting aside the period when Lord Card- well's Order came into operation, and the dis- turbing effect which it exercised, there has alwaj-s been, has there not, a corresponding fluctuation in the two forms of the diseases ?— Yes, very closely. 1448. The secondaries being the consequence of the primaries, would not it, putting the tables aside, and reasoning a priori, seem to follow that the two forms of disease should bear the same ratio to each other? — Quite so ; that is what one would naturally suspect. Of course there may be a difference in the varieties of primary forms. 1449. I suppose it might also depend upon the treatment, because I think you said that if the primaries were well treated, you might arrest a certain number of cases altogether ? — Yes. 1450. But still, the two diseases being related to each other, you would expect something like a corresponding fluctuation between the two? — Certainly. 1451. But in addition to the primary syphilis, •which is followed by secondary syphilis in most cases, there is another kind of venereal sore ■which does not, "as we have been told, affect the constitution at all ? — Yes. 1452. Of course you would have to eliminate those, in the calculation you are making, from the primary sores ; when you speak of primary sores I suppose you mean the true venereal sore? — No ; the terra primary sore is used to embrace both sorts. I have used it in that way through- out. 1453. Still, I suppose that the proportion be- tween the true and the pseudo-syphilis, the con- stitutional and the non-constitutional primary syphilis, would be about the same, would it not? — Yes, these returns show that it is the same, nearly. 1454. Take first of all the cases of primary syphilis, and then the cases of secondary syphilis, you have said, and proved, that one follows the other in a certain ratio ? — Yes. 1455. But under the head of primary syphilis, I think you said you included a sore which was not constitutional? — Yes ; we call them primary venereal sores in order to avoid the question of then- being syphilis. 1456. Those would not be followed by secon- dary syujptoms ? — Not at all. 1457. Can you give me some idea of the pro- portion which these primary venereal sores which are not followed by secondaries bear to those which are followed by secondaries, and are con- stitutional? — These returns have shown that. The whole of the primary sores for these 12 years were three, followed by one case of secondary ; hence we infer that the actual number of primary infecting sores in them must have been Mr. Osborne Morgan — continued, somewhere about one in three. Of course we have no positive evidence upon that, but that is the general inference. When we come to the fact that a large number of primary sores did not report themselves, the consequence was that instead of the ratio being three primary to one secondary as I mentioned, it was 47 and 49, that is about two primary to one secondary. Mr. Foialer. 1458. Then you take only the worst cases coming before you ? — -One third of the cases were concealed. 1459. The worst cases would be reported, I suppose ? — Yes. Mr. Oshorne Morgan. 1460. A man could not conceal a very bad case, I suppose? — He is not likely to do it; it would be very painful. Dr. Cameron. 1461. I see in this table of Dr. Nevins's, No. 3, a number of figures of the ratio per thousand of secondary syi.hilis occurring under your name ; and, looking at the last three figures, for instance, 1 find that the ratio for 1876, 1877, and 1878 has a total of 77"7, which would give an average of 28'8 ; you would give the ratio for the years from 1876 to 1878 now as 25'8 ? — These returns are formed upon the more limited num- ber that we had. 1462. This is corrected ? — This is formed upon a larger number, and includes the whole force. Mr. Osborne 3Iorgan. 1463. Yoti spoke of the disturbing effect upon your calculation of Lord Cardwell's Order ; is there any other source from which you can obtain trustworthy evidence of the fluctuations in the incidence of syphilitic disease since 1873 ? — Yes ; but there is an important point still to bring out. Dr. Nevins's objection I have not meddled with yet. He objected to my statement here. He made no objection whatever either to my figures or to my calculations ; but he has put before the Committee a return which he supposes shows that my calculation is altogether erroneous. Mr. Stansfeld. 1464. Did Dr. Nevins deny the proportion of three to one ? — I will iiive you his figures. He has given in this table the ratio per 1,000 ad- missions for primary venereal sores (Table 4, page 48), There is first a column showing the ratio per 1,000 of venereal sores ; in the second column there is the theoretical ratio per 1,000 for secondary syphilis. That he represents as being a fair showing of my theory, or, at least, my statement, for theory it is not. In the third column he gives the actual ratio per 1,000 for secondary syphilis. Mr. Hopwood. 1465. I do not find that he refers to yourself; he works it out himself, but he makes no reference to you ? — It has a bearing upon what I have mentioned. SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 69 21 March 1881.] Inspector General Lawson. [ Continued. Mr. Hopicood — continued, mentioned. I object to this altogether, because Dr. Nevins has adopted an expedient which he himself describes as most fallacious. He has not contested either my figures or my arithmetic, which he ought to have done, to show that my inference was wrong. He has taken the ratio of 1860 for secondary syphilis, which happened to be 4"18, instead of three. 1466. Where do you find that? — If you divide 130-80 by 31-30, you will find that it is 4-18. 'You will find it in a second paragraph of his note, where he gives you the formula. He says that my calculations were all wrong. Now, my cal- culations showed that the proper number to divide by was three, and, as a matter of course, dividing it by 4-18, you must get a result con- siderably lower ; but that does not affect the accuracy of what I put forward : in fact, it is a fallacy that I am surprised at his putting before the Committee. Dr. Cameron. 1467. Is there any explanation how the ratio between secondary and primary syphilis in 1860 was so much higher ? — It is one of those fluctua- tions that we find. It is clear that if you had 12 consecutive years, taking the total numbers, they would give you three to one. It is erroneous to take a single year, whicli diflers from all those, to regulate the relation. Mr. Osborne Morgan. 1468. I think all the witnesses on both sides have said, that those enthetic diseases fluctuate from year to year, ai^d that your only chance of obtaining a correct statement is to take a period ? -^I do not know that the witnesses on both sides have said so. It has been pretty frequently asserted that we may take a year, and I reso- lutely object to that. 1469. I want to know whether there is any other source from which j-ou can obtain trust- worthy evidence of these fluctuations in the incidence of syphilitic disease over the country since 1873 ? — We can get it by referring to the returns of the Registrar General. 1470. These, of course, embrace death among the civil population, and, therefore; include per- sons of all ages ? — They include persons of all ages ; 74 per cent, of the deaths are children under one year of age. 1471. Seventy-four per cent, of the deaths attributed to syphilis are those of children un- der one year of age 1 — Yes. During the first three months, they form about 40 per cent. of the total. If we take the table given in the Registrar General's Report (the Report of 1878 is before me), you get, at page 23.5, the deaths per 1,000,(;00 persons living I'rom syphilis, for each year, from 1863 to 1878. Up to 1865, the increase in the deaths from syphilis had been very great. The attention of the profession had been a good deal directed to it about that time, and they gradually discriminated cases as due to syphilis which previously they had not done, so that up to that time the natural fluctuations are obscured by this rapid increase. From 1865 and 1866, -vfe find that they have fluctuated largely : but there are periods of fluctuation that we can now distinguish. From 1866, for instance, 0.44. Mr. Osborne Morgan — continued, they rose to 79; in 1868 they were 88 ; in the next year they were 85 ; and they fell to 77 in 1871. That corresponds with one of the fluc- tuations that they had in the primary sores in the Army. There was a minimum, so to speak, in 1866, and another in 1871. 1472. Are those fluctuations unaccountable ? — We have never been able to account for them yet. The ratio was 8o in 1872, 80 in 1873, 85 in 1874, 90 in 1875, 89 in 1876, 86 in 1877, 88 in 1878. 1473. Have you the returns for 1879?— The ratio is 81. 1474. I should gather from that, that syphilis, so far from diminishing among the civil popula- tion, has been rather increasing? — Rather in- creasing, if anything ; and it may be observed that these fluctuations have agreed with our ex- perience in the Army. 1475. So that, in fact, the fluctuations which are found to occur in the Army, are borne out by the fluctuations in the general population ? — Yes ; observing the same periods. 1476. Is it the fact, that there are deaths which are not put down as due to syphilis, but which possibly, or even probably, may be traced indirectly to the j)resence of syphilis in the system ?— It is the general belief in the profes- sion at the present day, and they are discovering more and more of such cases. 1477. Therefore, the returns of death from syphilis, in the Registrar General's Report, do not, in your opinion, exhaust all the deaths indi- directly attributable to that cause ? — By no means. 1478. Can you show from these sources Ts'hat correspondence there is between the fluctuations of this disease among the civil population and the military since 1873, so as to supply the chasm made by the operations of Lord Cardw ell's Order ? — Yes. The Registrar General's Report shows that, in 1875 and 1876, and so on, there is a considerable rise from 1871. Mr. Fowler. 1479. It seems now to have come to the old point again ?^The number is 81 in the civil population in 1879. Air. Osborne Morgan. 1480. In 1866, what was it?— It was 77. Mr. Foiuler. 1481. It has got back almost to the old point again? — Yes, nearly. There is a considerable rise in the meantime. Lord Cardwell's Order has prevented our tracing the comparison up to 1878 between the primary sores and secondaries, to show that there had been an actual increase of syphilis ; but the Registrar General's returns enable us to see that there was such an increase in the general population, though the military returns could not enable us to trace it. The apparent increase of syphilis in the Army, from 1873 to 1878, corresponded to this increase amongst the civil population. Mr. Osborne Morgan. 1482. Could you show us any correspondence between the fluctuations of the disease among the civil and military population since 1873 ? — Yes ; iu 13 the 70 MINUTES OF EVIDENCE TAKEN BEFORE THE 21 J^arch 1881.] Inspector General Lawson. [Continued Mr. Osborne Morijan — continued, the Keturn No. 2 that J have given in, you will find in the last column, in 1873, the ratio for secondary syphilis wa? 1*98 per 1,000 ; in 1874, 1-9] ; in 1875, 2-53; in 1876, 2-44; in 1877, 1-94; in 1878, 2-18. 1483. You are now speaking of unsubjected stations ? — Yes. 1484. You have a correspondence between the cases of syphilis in the unsubjected stations, and the deaths from syphilis registered among the civil population generally ? — Yes. 1485. In the Appendix to the Evidence before the Committee in 1880, there is, at page 56, Eeturn B, showing the number constantly sick from primary venereal sores and secondary syphilis at 14 unsubjected and subjected stations ; have you examined that return ? — Yes. 1486. With what object? — With a view of seeing whether the subjected station-; and the unsubjected stations proceeded in the saiue way under the varying fluctuations of the disease, and if they do not to find out what is the differ- ence ; to arrive at that, I added ujd all the num- bers of the stations under the Acts and sub- tracted them from the corresponding numbers in Return A, so as to get the numbers for the sta- tions under the Acts against those for all the rest of the service ; now in those returns we do not have Windsor separate from London, from 1867 to 1872, so that it was necessary to take a portion of the disease at London and add it in for Windsor, to include it in the Return I have given of all the stations under the Acts ; that has been done in proportion to the admissions for primary sores ; Windsor, subsequently to 1873, has the r.umbers set down, and I have taken those numbers as they stand ; that return gives us virtually what I have been examined upon already; that for the ]>eriod from 1861 to 1866, under the Acts, the men remaining for secondary syphilis were 2'70 ; the numbers for primary sores being at the same time 7 '96, the per- centage of secondary cases being 34 per cent. From 1867 to 1872 the primaries had fallen to 6"15, and the secondaries to 1'86, 36 jier cent. of the primaries ; after the stoppage of pay had commenced the primaries fell to 3'02 remaining in the hospital, and the secondaries to 1-87, or 59 per cent, of the primaries ; at all the stations never under the Acts, from 1861 to 1866, the primary sores were 7*47, and the secondaries 2-63, or 35 per cent. ; from 1867 to 1872 the J)rimaries were 7 "47, and the secondaries 2-19, or 29 per cent. ; after the stoppage of pay com- menced the primaries were 5" 19, and the se- condaries 2'16, or 41 per cent. ; by these vary- ing per-centages you will see the fact, which is an important one to observe in this case, that as the stations under the Acts began to have their numbers diminished for j)rimaries, the ratios for secondaries increased. 1487. Showing the correspondence between the two forms of the disease ? — No. Not alto- gether the correspondence ; but on the other hand, the numbers at those stations never rmder the Acts diminished, there being, as in the case of the depot I mentioned in the earlier part of the examination, a constant and large transfer- ence of men with secondary syphilis from one set of stations to the other, though that syphilis Mr. Osborne Morgan — continued, was due to venereal disease contracted in the original station. 1488. So that, in fact, a man might be found suffering from secondary symptoms in a protected station, and the germs of the disease might have been contracted in an unprotected station ? — Certainly. 1489. And of course vice versa ? — And vice versa. 1490. Have you any means of eliminating those cases, and referring them back to the localities where the primary disease was con- tracted ? — I think so. 1491. What is it? — I have shown you already that the primary disease was to the secondary in the whole army at home from 1861 to 1872 as three to one within very narrow limits, and this is unaffected by the large diminution of primary sores at the stations which come under the Acts. It follows that the ratio of three to one must have been that actually existing between primary and secondary cases at the stations which come under the Acis (if it had not been ycu would have had a change In ratio), and that this ratio had remained unaltered after the Acts were applied, though the primary sores under these were greatly reduced. This being so, the ad- missions for primary venereal sores at either set of stations may be taken to indicate the quan- tity of secondaries that you might expect to arise from them ; and having got the primaries at a given station, you calculated the total quantity of secondaries, and they should be distributed between the two sets in proportion to the number of primary cases occurring at each. • Dr. Cameron. 1492. Is not that begging the question as lo duality? — It does not rise upon that. Whether the virus be dual or single, all that I have put before the Committee would apply to either. Mr. Oshonie Morgan. 1493. You say that true venereal primary sores bear to pseudo-syphilis a certain propor- tion that you can arrive at, and that therefore although you group them together you could infer what number was attributable to each form of the disease '.' — We cannot exactly tell the num- bers, but we say, " Here are 60 cases of primary venereal sores ; we cannot separate each indi- vidual sore from the others, but we can say, according to the united experience of 12 years, for the whole army, that these 60 cases should be followed by 20 cases of secondaries." 1494. You infer a certain proportion of actual constitutional primary cases? — A certain pro- portion. 1495. That proportion if spread over a certain number of years would be regular? — Very regular, unless there be a change in the relative numbers, but in that case we should find a change in the ratios. 1496. Would it be your experience, according to what was stated by one of the witnesses, that whereas non-constitutional sores had decreased very much, constitutional sores followed by secondai'Ies had increased very much ? — By no means. According to this return, even under the repressing influence of Lord Cardwell's Act, the SELECT COMMITTEE OK CONTAGIOUS DISEASES ACTS. 71 21 March 1881.] Inspector General Lawson. [^Continued. Mr. Osborne Morgan — continued, the primary sores, taking them altogether, diminished from 3 to 1 to 2 to 1. 1497. What do you mean by primary? — Pri- mary venereal sores ; the whole ; we cannot separate them. 1498. Would it be possible at the particular stage when you have to make your returns; I believe they are made weekly ? — Yes. 1499. Would it be possible to separate the two classes ? — No, it may be months before you can separate them, in fact you cannot separate them until you see the constitutional symptoms come on. 1500. Therefore, even adopting the dual theory, it would be impossible to make the re- turn so as to distinguish accurately ? — Quite im- possible. 1501. Is there anything else you would like to add ? — Acting upon the principle I have laid down I have prepared a E-eturn, No. 4, which gives the ratio per 1,000 of primary sores at stations under the Acts and for those never under the Acts for these six-year periods and other periods. Comparing these with the primary venereal sores remaining in hospital in Return 2, as has already been done for these actually in the station returns, the following results were ob- tained. Taking the stations never under the Act, from 1861 to 1866, there were 7*47 per 1,000 primary venereal sores under treatment, and there were cases of secondary syphilis, 2'57, that is, 34 per cent, of them. From 1867 to 1872 there were a^ain 7'47 primary sores remaining, and 2'41 secondaries, or 32 per cent. For the period when the pay was stopped the primary sores were 5'19, and S(?CGndary syphilis had risen to 2 "60. Taking the stations that came under the Acts there were 7'96 venereal sores remain- ing, and 2-74 of secondary syj^hilis, or 34 per cent. From 1867 to 1872 the primaries were 5"15, and the secondaries 1-69, or 33 per cent. From 1873. to 1878 the primaries were 3'02, and the secon- daries r43, or 47 per cent. .The result of that is, that while secondaries actually had fluctuated from 2-57 from 1861 to 1866 at sta- tions never under the Act to 2-41 in the next six years, they again arose to 2 '60 in the last six years. 1502. The proportion between the number of cases of primary venereal disease and the cases of secondary syphilis is very regular in the army ? — Very regular. 1503. It would follow, would it not, as a neces- saiy inference, that, during that period secondary syphilis had been reduced proportionately with primary soies ? — That is what I should maintain. Dr. Cameron. 1504. You did not give the fluctuations in the protected districts but in the unprotected?— The last figures were in the protected districts. Mr. Osborne Morgan. 1505. If you show a reduction of secondary syphilis, would it not follow that there must be a corresponding decrease in the description of sores which preceded it ? — Undoubtedly, very large ; and there is a reduction in the last six years at the stations under 'the Acts, while there is a positive increase at the stations never under them . 0.44. Mr. Oshoriie Morgan — continued. 1506. You have shown that there was a great reduction in the jirimary venereal sore« at the stations under the Acts after they came into operation ; now do you consider these smaller numbers as embracing the ordinary non-infecting sore as well as that which leads to the constitu- tional disease ? — Yes. 1507. Much in the same proportion as when the Acts were not in operation? — Certainly. There is no evidence to set that aside. 1508. With regard to the saving of men's time under the Acts, you are aware that Sir William Muir, in a note to his evidence, states the average saving of men's services at 14 protected stations ; a doubt has been expressed as to the correctness of his estimate ; can you give the facts upon which it was based ? — Yes. 1509. What are they ? — The facts were taken from the Army Medical Department Report of 1872. Sir William Muir had the numbers of men who had been in hospital for five years, and he made his calculation upon those numbers. The ground that he took for his calculation was correct. The number in hospital daily for primary sores was 9'16 in the stations never under the Acts, and 4*19 at stations under the Acts, the difference being 4-67 per 1,000. That gives 193 for stations under the Act, and if ex- tended to the other stations not under the Act, it would be 1 12, which, in round numbers, is exactly what Sir William Muir stated, 305 in all. 1510. Looking at Returns A. and B. put in I)}' Sir William Muir, could you tell me whether those retui'ns could be ai-ranged so as to give the numbers daily in hospital from all forms of venereal disease at 14 protected stations under the Act, and at all the station-^ not under the Act?— Yes. 1511. So that j'ou could give us the total loss of service from this class of disease under the different conditions to which they are subjected ; could that be arranged ? — That can be arranged. I have prepared a return, and will jjut it in. 1512. These Tables A. and B. can be extended so as to show the number daily in hospital at stations which -came under the Acts, and at all the stations never under the Acts ? — Yes. 1513. Comparing the results in the case of the 14 protected .and all the non-protected stations, what should you say was the average saving of service in the protected districts for the period from 1868 to 1872, the period to which Sir William Muir limited himself? — This does not give the same period as he has given ; I have taken it for the three six-yearly periods we have had to deal with. 1514. Will you give me from that table the saving in the strength of the army fairly attri- butable to the working of the Acts ; in other words, what is the saving in the strength of the army in the 14 protected, as contrasted with all the unprotected stations? — This return gives the totals for all the venereal affections in the sta- tions under tlie Acts, and also for those not under the Acts. Taking the 14 stations under the Acts and all the stations not under them, these columns give the sum of the ratios actually daily sick in hospital, including everybody sick from venereal complaints, and, of course, that is the total loss of service ; the saving is the difference between them ; to get at the difference between 1 4 them 72 MINUTES OF EVIDENCE TAKEN BEFORE THE 21 March 1881. J Inspector General La"WSON. \^Cotitinupd. Mr. Oshoriie Morgan — continued, them you must submit them to these operations ; you find, for instance, at the stations which came under the Acts from 1861 to 1867,21-1 people were constantly sick in hosi-'ital, and at the stations never under the Acts 20'43 ; there is an initial diifer- ence which, of course, you must take into con- sideration; the difference must be found (its ratio), and you must apply a similar correction to any subsequent numbers. 1515. Taking the period from 1860 to 1863, and from 1870 to 1873, which gives the full operation of the Acts ? — Yes. 1516. Tou have contrasted the period during which the Acts were not in operation, and the jDeriod in which they were in full operation ? — Yes. 1517. "What is the result? — From 18(10 to 1863 the daily loss of service at the stations under the Acts was 23-90 per 1,000 ; the loss at the stations never under the Acts, for the same period, was 19-89. 1518. Again showing that those which after- wards became the subjected stations, were more subject to the disease than the non-subjected sta- tions ? — Yes. There is 4-01 ; a difference of one- fifth of the amount at the stations not under the Acts; one-fifth higher. The plan to go on is to take, as I would immediately do, the ratio for the stations at a subsequent period for stations not under the Acts. Add one-fifth of this amount, which would be necessary to make it comparable with the others, and then take the difference. 1519. What I want to get at is this : taking these three years from 1860 to 1863, and the three years from 1870 to ls73, what, if any, in- crease in the saving has there been ? — -You add one-fifth to the 13-73, which is the loss of service at the stations not under the Acts ; that would be 15-44. The number actually in hospital at the stations under the Acts was 11-31 ; the difference is the saving ; that would be 5'13 saving at that time. 1520. You are speaking of the subjected sta- tions ? — Yes ; of course the comparison is all towards them. 1521. Would there be any in the non-sub- jected stations? — They are reduced from 19-89 to 13-73. 1522. Taking this note of Sir William Muir's, which was based, I think, upon a comparison of 14 selected unprotected stations, with the 14 protected stations, I want you to extend the comparison to all the unprotected stations ? — That is what I have done ; but it is not for the same period as mentioned there. 1523. What period are you now speaking of? — From 1860 to 1863, as compared with 1870 to 1873. 1524. Is it the result of the returns which you have handed in, speakmg generally, that the stations which were afterwards subjected to the Acts were peculiai-ly liable to these venereal diseases ? — They were much more liable than the others ; more than the stations that were never under the Acts. 1525. That is, before the Acts a larger num- Mr. Osborne Morgan — continued, ber of men, suffered from venereal disease in what were afterwards the subjected stations than at those stations where the Acts were not applied ? — Yes. 1526. And one of the reasons why the Acts were introduced at those stations was that they were, for some reason or other, exposed to a greater incidence of the disease ? — Yes. 1527. Then, 1 suppose, it would follow that in calculating the beneficial operations of that Act, you ought to take into consideration the fact that before the Acts came into operation those subjected stations were obnoxious to the disease than the others ? — Decidedly so ; you must take that into consideration. 1528. That would be one of the circumstances to be taken into consideration in weighing the beneficial opieration, if any, of the Acta ? — Decidedly ; that is an essential circumstance. 1529. I do not know whether there is any other observation you wish to offer ? — As the explana- tion I have given may not be quite clear with regard to the return, I propose to give a full explanation as to how it is to be used. As the loss of service differed considerably in the thi-ee groups before the Acts came into force, this dif- ference has to be noted and the results for sub- sequent periods at the corresponding groups cori-ected accordingly. Thus, the actual daily loss of service at the stations which came under the Acts from 1860 to 1863 was 23-90 per 1,000. The loss at all the stations never under the Acts for the same period was 19-89, being 4-01, or one- fifth of its amount leus than at the former. At the 14 stations never under the Acts the corre- sponding loss was 22-15, 'being a difference of 1-75, or l-13th of its amount less. These frac-. tions, of the ratios for other periods, require to be added to those to make them comparable for the same period with the stations under the Acts. Thus the loss of service at the stations under the Acts for 1870 to 1873 was 11-31 ; but for all the stations under the Acts 13-73, which, on adding one-fifth, or 2-75, becomes 16-48, and subtracting 11-31, the remainder, 5-17, is the saving under the Acts. Taking the 14 stations never under the Acts, the loss of service in 1870 to 1873 was 17-59, which, on adding l-13th, becomes 18-91, and subtracting the 11-31, the remainder, 7-60, is obtained for the saving under the Acts. I may say that the years 1870 to 1873 wei-e charac- terised by a reduced incidence of the disease over the country, and a longer series of observa- tions is necessary to fix the actual saving Avith greater precision. 1530. Of course when you speak of the inci- dence of the disease all over the country you are speaking of secondary disease, because you only have the deaths given ; your sole data are the deaths which would only result from secondary disease ? — They only result from secondary dis- ease, but of course their varying incidence must have shown a varying incidence in the disease which led to them, and that would naturally affect the civil population as well as the military. SELECT OOMMITTEE ON CONTAGIOUS DISEASES ACTS. 73 Monday, 28th March 1881. MEMBERS PRESENT ; Mr. Cavendish Bentinck. Mr. Burt. Dr. Cameron. Mr. Cobbold. Viscount Crichton. Colonel Digby. Dr. Farquharson. Mr. William Fowler. Mr. Hopwood. Mr. Massey. Mr. Osborne Morgan. Mr. O'Shaiighnessy. Mr. Stansfeld. Colonel Tottenham. The Eight Honourable ^Y. N. MASSEY, in the Chair. Inspector General Lawson, called in ; and further Examined. Mr. Osborne More/an. 1531. You have laid several tables before the Committee, and I believe vou are desirous of presenting some fresh tables? — Yes; there is one table which I was asked to produce at the last meeting, which I now put before the Committee. One of the Members of the Committee asked me to give a return of the frequency of primary sores and gonorrhosa at the stations under the Acts, from 18^1 to 1866, with a view of referring to some remarks that T made on the Paper of Dr. Neviiis. 1 hand in the Paper No. 5 (vide Appendix). The honourable Member for Glas- gow, after the last meeting of the Committee, asked me for a return of the admissions for secondary syphilis at the stations under the Acts, sepai'ate from the rest. I was not aware at the moment that there was such a table in existence, but on making the inquiry suggested by him I found that there was such a table. I now put before the Committee a copy of that table, show- ing the admissions for secondary syphilis at all the stations under the Acts, from 1860 to 1878, and at all the stations not under the Acts, for the same period. I have attached a second table to that, which is merely an analysis referring to the periods previously brought forward, that is from 1861 to 1866, 1867 to "1872, 1873 to 1878, and also from 1860 to 1863, and from 1870 to 1873. 1532. From what sources have these tables been compiled? — This (No. 6a) is derived from the Army Medical Department. I have obtained it since the last meeting of the Com- mittee. Table B, which accompanies it, is merely an analysis in my own hand of the facts and details in lieturn A. The outcome for the Com- mittee is that from 1881 to 1866, at the stations under the Acts, the admissions for secondary syphilis were 37'4 per thousand ; from 1867 to 1872 they were 24-5 per 1,000; from 1873 to 1878 they were 22-0 per 1,000. Going to the stations that were never under the Acts, from 1861 to 1866, the admissions for secondary syphilis were 30-7 per 1,000; from 1867 to 1872, 29-4 per 1,000 ; and from 1873 to 1878, 30-2 per 1,000, showing a great decrease at the stations under the Acts ; while at those not under the 0.44. Mr. Osborne Morgan — continued. Acts the numbers are virtually the same through- out, or at least there is very little difference. At the stations under the Acts the decrease was from 37-4 to 22-0 per 1,000. 1533. These are admissions for secondary syphi- lis alone ? — Yes, the number of cases that came under treatment. Cliairman. 1534. Men who have brought secondary syphi- lis with them? — And who contracted it at the stations. These are actual admissions, without any attemjjt to separate those who came. Mr. Osborne Morgan. 1535. You say these are actual admissions ? — ■ Yes, without any qualification whatever. Mr. Foivler. 1536. You mean the admissions of persons who were ill at the time of this disease, or who became ill during the process, having been taken in for ordinary sores ? — Every person who reported himself or who came under treatment for that disease. 1537. Do you distinguish the cases of men be- coming ill, it being not known at first what the disease would turn out to be, or do you mean people actually suffering at the time from dis- tinct secondary syphilis? — This is for secondary syphilis ; a case is never so returned until second- ary syphilis actually appears. 1538. I mean does the ' return include those cases which become cases of secondary syphilis during the process of treatment, or only those that were distinctly suffering from it when they were admitted ? — I presume those only suffering when they were admitted. As soon as the j^ri- mary sore heals, if it heals before the secondaiy is cured, the man would be what is called dis- charged for the primary, and re-admitted for the secondary, and so he would be counted. Mr. St.ansfdd. 1539. That would be merely a transaction on the books ? — That would be merely a transaction on the books. K 1540. Therefore MINUTES OF EVIDENCE TAKEN BEFORE THE 28 March 1881.] Inspector General Lawson. \^Continvcd. Chairman. 1540. Therefore it includes all secondaries ? — It includes all secondaries tliat come under treat- ment. Mr. Fowler. 1541. iVot merely admissions, but the people under treatment ? — That comes to the same thing ; everybody who is admitted is put under treat- ment ; this is merely our mode of expressing it. 1542. Would it not make a considerable dif- ference in the figures? — No, it makes no difference in the figures. Mr. Stanafeld. 1543. Can you distinguish between the cases newly admitted with secondary syphilis, and the cases of secondary syphilis showing themselves in persons already in the hospital ?— I do not quite understand how you would limit it ; do you mean, supposing a man to be in with a primary sore for treatment, and secondary syphilis afterwards appearing, do you wish to include that ? 1544. "Yes; I want to know whether you dis- tinguish between the cases beginning with pri- mary sores and those which, as far as the statis- tics' of the district are concerned, begin with secondary syphilis? — If they have secondary syphilis, in the great majority of cases they have had primary sores previously at some time or other. This includes everybody. 1545. Could you distinguish between those two classes of cases ? — You might estimate them. 1546. Do the records of the hospital show the difference ? — No ; they would seldom show it. 1547. I understand you to say, that where a case of primary sore is treated in hospital, if it -turns out to be really syphilistic, and secondary symptoms set in, the man is discharged as suffer- ing from primary sores and readmitted for secondary syphilis ?• — Certainly. 1548. That is one class of cases? — Yes. 1549. All those, I take it, could be identified in the statistics, could they not ? — I will not say in the statistics ; they could be identified if the individual bad marked the thing at the time. 1550. Wotild that be on record? — It would be on record, if you could lay your fingers on it. 1551. Then you cannot answer the question? — Practically that would not be found, because for a long perioil people were not required to make anv notes of these cases further than to keep the notes of the admissions. 1552. In each hospital, I suppose, you have a history of every case, with the name of the patient?— No; at one time it was not required to keep a j-ecord of venereal cases. 1553. In these cases there is upon the books a record of the discharge of the patients? — A nominal list is kept when the man comes in and what is the disease; but the detailed thing which we call a " case," which is the clinical history of the case from day to day, for venereal cases for a considerable number of years that was not required. 1554. I thought you said that if a man comes in for ])rimary sores, and secondary syphilis sets in, he is discharged, and he is put down as a new entry ? — Certainly. 1555. Then, surely, you can identify those Mr. Stansfeld — continued, cases ? — They might be identified, provided yoti had the books by you. 1556. And you could from the books sever that class from the class of those who come into the hos[>ital with secondary syphilis already upon them? — You might do that; but, practically speaking, I do not think you cotild do it, because the books are so long, it would involve such an immense amount of labour that I suppose you could not get three or four clerks to do the work in a year. Mr. IV. Folder. 1557- Do you mean to say that that man would be entered twice over '.' — Certainly, with the fresh disease. It is a record of diseases, not of men. 1558. He would be entered once for the priniarj^ and once for the secondary ? — Yes. 1559. And re-admitted ?— Yes. Mr. Osborne Morgan. 1560. For the second stage of the disease? — Yes. Mr. Fowler. 1561. It would be treated as a new case? — As a new case, and those new cases are entered in the documents now before you. Dr. Farquharson. 1562. When a man is discharged, are the medical history sheets preserved ? — They are preserved to a limited extent, how far I do not know. To go over those and take them out would be a work of very great labour. I would not say that it could not be done. Mr. Osborne Morgan. 1563. But to connect cases of secondary syphilis with cases of primary sores in the same individual you say would be a work of great labour ? — It would have to be taken out from individual documents, jjrobably many hundred thousand. 1564. And, practically, you say that would be impossible? — I do not think it could be done without a great deal of labour. 1565. It is not done ?— It is not done. 1566. You Avere proceeding to explain some figures? — I had given the figures from JS61 to 1878 by six-j'earl}' periods. There are four- j-early periods. From 1860 to 1863 the cases of secondary syphilis that came under treatment at stations that came subsequently under the Acts were 40 per 1,000; from 1870 to 1873 at the same stations, they were 20'3 per 1,000. At all the stations never under the Acts from 1860 to 1863 they were 30-5 per 1,000; from 1870 to 1873 they%vere 27-5 per 1,000; showintc a reduction of three per 1,000 there, and nearly 20 per 1,000 at the ojinosite set of stations at the same time. 1567. Do those numbers include the cases im- ported into both the protected and the unprotected districts ? — They include everybody. 1568. From the protected to the unprotected, and vice veisd ?— Yes ; just as thej- stand. There is one point I should like to mention. The other day I put in a return. No. 4, which was to esti- mate SELECT COMMITTEE OX COXTAGIOU8 DISEASES ACTS. 75 28 March 1881. J Inspector General Lawson. [ Ci-ntinued. Mr. Osborne Morosing, for instance, you take "3 off it; then, instead of 1 "86 you would have 1"56; that goes to the opposite side and doubles the difference. 1726. You have given us for the first time (for medical departments have not before entered upon this kind of statistics) returns of secondary syphilis, station by station ; what I want to know is, whether, in your view, it is sound, statistically, to debit each station with these 0,44. Mr. Stansfeld — continued. cases ; I am referring to your Return, No. II. ? — Satistically, if you are dealing with the thing as it stands, this is quite right; but with the clear idea that you are dealing there with quan- tities imported ; and as soon as you have the means of eliminating that importation, to get at the truth, you require to eliminate it. Mr. Oshorne Morgan. 1727. Have you any idea how often men are moved from one station to the other ? — Some- thing like six-tenths of the troops in the kingdom are at stations under the Acts ; and there are some- thing like four-tenths at stations not under the Acts. I suppose the number moved in the course of the year will be a little under the total of the troops in the unsubjected stations. 1728. What is the average duration of time that a regiment is stationed at a camp like Al- dershot, for instance ? — About a year usually ; some may be a little more and some may be a little less. Mr. Stansfeld. 1729. Do you mean that regiments are changed about once a year ? — Eegiments are changed about once a year, usually ; of course there are exceptions, but that is about the general rule. 1730. I understand that you would not say that these figures of secondary syphilis in your Table, No. IL, are to be taken as absolute statis- tical facts from the point of view of the question what station ought to be debited with them, in- asmuch as some allowance would have to be made, and what that allowance may be you are not prepared to say ?^I am not prepared to say positively what it ought to be, because it involves a number of points upon which I have not been able to get positive information. 1731. I asked you the other day whether you thought it was possible to distinguish between imported and other cases, and 1 think your answer was to the effect that it was possible, but that it would be very laborious ; have you any- thing to add to that answer ? — No, that would be my answer now. When I say that it is possible, I believe it would be if all the documents were extant, but a great many of them may not be extant. 1732. As to the debiting of the stations, you do not put it very strongly ; you do not quite agree with my Right honourable friend the Member for Whitehaven, who, in examining Professor Lee, at Questions Nos. 1191 to 1199, asked whether it was not out of the question to debit any particular station with its secondaries ; but you would adhere to the modified opinion which you have just expressed ? — Certainly. It is like any other operation of that sort ; if you got sufficiently detailed facts, you might eliminate them one from the other. 1733. The difference we have seen between those two groups of stations in the constantly sick of secondary syphilis is that, taking the average of the second period compared witli the first in the subjected stations, you have 1'86 per thousand; and in the unsubjected stations, you have 2*19 per thousand ? — Yes. 1734. In point of efficiency that difference is L 2 about 84 MINUTES OF EVIDENCE TAKEN BEFOKE THE 4 Jpril 1881.] Inspector General Lawson. [ Continued. Mr. Stansfeld — continued, about -33, is it not, in favour of the subjected stations ? — Yes. 1735. Therefore, so far as efficiency is con- cerned, it would not come to a question of any particular moment ; it would be an advantage of one-third of a man per thousand ? — It would be one-third of a man per thousand per day for that single thing. 1736. As to this difference in favour of the subjected stations, supposing that the whole dif- ference is to be credited to those stations, might not the transfer from the subjected to the unsub- jected stations of one or two regiments very badly affected, pi-oduce a difference of that kind ; if you turn to your evidence in 1879, at page 17, in answer to Question 409, you gave us some particulars of an inquiry that you undertook at Aldershot in the year 1868. There you found, for instance, if I recollect aright, two regiments, side by side, with nothing to lead you to guess that one regiment ought to be more or less seri- ously affected than the other ; in the one case you found 142 admissions per thousand, and, in the other case, 23 ? — Yes, the maximum of the whole of them is 142 ; that is not in three regiments, but \\\ one regiment out of several regiments. 1737. That immense difference was discovered in regiments living side by side, and both, of course, equally under the protection of the Ac(s ? —Three of them were in the North Camp, and the remainder in the South Camp, but they were under the protection of the Acts. Mr. Cohhold. 1738. Were they the same age? — About the same age : there might have been a little differ- ence in the ages. Mr. Stansfeld. 1739. Am I not correct in saying that the opinion you expressed was, tliat there was nothing that you could discover in the habits of the regi- ment as to sanitary precautions to account for those differences ? — I think I mentioned that there was nothing apparent, but that, I believe, the cause of the difference was that the men who suffered least were particularly careful as to ablution immediately after they had incurred the risk of contagion to which they might have been exposed. I think that came out ultimately. 1740. That is not material for my present argument ; but the transfer of a few such regi- ments as that which had 142 per thousand would very seriously affect such figures as these, would it not? — Yes, but there is only one regiment out of seven, and it you take the transfer of the other six it would bring down the average. 1741. A transfer of that kind v^ould produce upon those figures a very decided effect, would it not? — Undoubtedly ; but you must take the transfers each way. 1742. And you must assume that these trans- fers balance each other in respect of this con- sideration? — No; if you transfer 10,000 men from a place where the average of secondary syphilis is only 1*86 per day, to a place where the average is 2*19, they will carry less with them than the 10,000 from the 2-19 place bring with them. 1743. Is it not true that, in the year 1868, as Mr. Sta}isf eld — continued. is stated at page 156 of the Report of 1879, the admissions at Pembroke Dock, which is an un- protected station, were only 35 per thousand ? — Y'es. 1744. If you had taken a regiment of soldiers from Pembroke Dock to Aldershot, there being an average of 35 at Pembroke Dock, and if you had transferred back to Pembroke Dock your regiment with 142 per thousand admissions for primary sores, it would have told very much against Pembroke Dock and in favour of Aider- shot, would it not ? — Decidedly so ; but you will recollect that, with the six other regiments who went to other stations, it would tell the other way. Y'^ou must take the mean number upon those totals. No doubt if you immediately send such a regiment to such a place you will imme- diately produce a large number, but in dealing with them here we merge all that and get at the mean. 1745. Will you turn to your Summary, Table II., at the bottom, where you adhere to your plan of six year periods ; in the first period under the Acts you have the ratio of secondary syphilis 2 "70 per thousand, and in the second period r86 ? — In the unsubjected stations you begin with 2"63, and you go down to 2*19, the greater fall being in the protected stations. 1746. I think there are some little inaccuracies in these figures, and that it will confuse us least if I jjoint out to you what I think those inaccu- racies are, and perhaps you will look at them afterwards ; they do not make any great diffe- rence in the figures, but I want to draw some deductions from my corrected figures? — If there are any inaccuracies I shall be most happy to correct them. 1747. In the year 1861 in the column of secondary syphilis, you have got 128, I make it 148 ; I suppose that you have applied the same process in each year ? — I will explain exactly the process that I have adopted. 1748. It is hardly worth while to discuss the process ? — In a single year there would be no difficulty about it, because I have all the facts. 1749. In the year 1861 I make out that your 128 ought to be 148 ; will you just mark that, and look at it afterwards ? — If you will allow me I can settle the thing at once I think ; the way that I arrived at these figures was this ; I took the column in the No. 3 Return, in the evidence of 1880, the average number constantly sick from secondary syphilis. The number was 242 in the year 1861, and in page 56 of Return B., the number of those constantly sick from secondary syphilis at the stations under the Act, totals up to 127 "7 : that is 128 in round figures ; so that I have taken the number directly from what is stated here in the Return ; but it is only on that ground that you object to it I under- stand. 1750. In the year 1861, according to my in- formation, there are some little inaccui'acies in your figures, but that only applies to the year 1861 ?— Then if you will turn from the Table, No 3, on page 55, to the Return B, on page 56, you will see the number of those suffering from secondary syphilis reported at the different stations in hospital that year ; and adding up those numbers (Windsor is not included), there SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 85 4 April 1881.] Inspector General Lawson. l^Conlinued. Mr. Stansfeld — continued, are 127-73 ; that is 128 in round numbers, as I have them. 1751. I do not think that it would be advisable for us in all these cases to go into the process of calculation ; it would be an endless affair ? — But here is the process done ; if I have been wrong in adding up these figures, let anybody add them up. 1752. I presume that it is a mere clerical error if my accountant is right ; do you not find that it is 148 ? — {After examining the figures). It would seem to be 1 47 ; that would increase the ratio by 20, and it would increase the ratios altogether. 1753. Will you let me now give you the figures, and will you take a note of my figures ; that 128, according to our calculation, should be 148 ? — Certainly ; so far as I can see just now. 1754. Then the ratio per thousand for second- ary syphilis, instead of 2*49 we make it 2'88 ? — It will raise it, of course. 1755. Then take secondary syphilis ; in the stations not under the Acts we make the num- ber 94, instead of 1 14 ? — It will reduce the number by 20. 1756. Then we make the ratio per thousand of secondary syphilis 2*50, instead of 3'03 ? — Yes, of course it will reduce it. Mr. O^Shavghnessy. 1757. Then is there a mistake also in the sta- tions that are not under the Act? — Y^es, they will be decreased. Mr. Stansfeld. 1758. Then the result, I understand, is this : that in the period of six years between 1861 and 1866, if you take the subjected stations, your 710 ought to be 730 ?— It would be 20 more. 1759. And your 2-70 ought to be 2-77? — It will be increased, of course. 1760. And iu the unsubjected stations your 516 ought to be 4 96, aud the ratio per thousand of secondary syi^hilis should be 2"53, instead of 2'63 ? — Of course, they will be altered right through. 1761. In fact, you may call it a clerical error; it is nothing but a slip in addition. Assuming those minor corrections to be accurate, the fall in the subjected stations, comparing your first and second periods, is from 2'77 to 1'86 ; that is a fall of -91 ?— Yes. 1762. In the unsubjected stations the fall is from 2-53 to 2-19; that is a fall of -34?— Yes. 1763. In both of those cases, that is, in the period from 1861 to 1866, before the Acts? — Yes. 1764. Now, coming to the comparison of the second and third periods in the subjected stations, you begin with 1-86 and then drop to 1'78? — Yes. 1 765. That is a reduction of "08 ? — Yes. 1766. In the unprotected stations, you begin with 2'19 and you drop to 2"16, being a reduction of -03 ?— Yes. 1767. Between those two reductions you seemed, in your evidence the other day, to draw a distinction, and you referred to one as a slight reduction, and to the other as, practically, no 0.44. Mr. Stansfeld — continued, reduction at all ; I mean that you thought that there was some difterence between the two ? — The difterence is twice as great under the Acts as not under the Acts ; that is all. In fact, it is nearly three times as great. 1768. But if you take the proportion of fall, you will find it identical, will you not ? — No, it cannot be. 1769. What I mean is this, that if you compare the fall in each case in the period before the Acts with the fall in each case in the period after the Acts, you will get an identical proportion, that is to say, '91 is to "34 as "08 is to '03; is not that so ? — I have not wrought that out, but it may be so. 1770. Supposing that to be the case, you have the same proportion of the rate of diminution be- tween those two iiToups of stations, both before and after the Acts ; in the subjected stations the fall from the average of the first six-year period to the average of the second six-year period is •91, and in the unsubjected stations the difference is '34. When you compare the second and third periods in the subjected stations you get a fall of •08, and in the unsubjected stations of "03. AVhat I say is, that ^91 is to ^34 as •OS is to •03 ? — That may be ; but it does not carry any effect upon those numbers. 1771. If those figures of mine are accurate (aud I have no doubt that j'ou will test them afterwards) is not this true, whatever inferences you may di-aw from the fact ; that you have exactly the same projjortion of rate of diminution comparing the subjected and unsubjected stations in each of those periods, the one before and the otiier after the Acts? — That may be a contin- gency, but it does not at all affect the bearing of the question as it lies here. 1772. That is somewhat a matter of opinion, I suppose. Now I will come to your Table No. 6 b., and your Table No. 3 ; comparing those t(vo tables there is a greater fall in admissions for secondary syphilis, comparing the subjected with the unsubjected stations than there is iu the proi)ortion constantly sick ; is not that so ? — Will you be kind enough to refer me to some particular period. 1773. You show, in your Table No. 3, the ratio per thousand constantly sick, and in your Table 6 b., you show the admissions, do you not? —Yes. 1774. If you compare those, do you not find that in the protected stations there is a more rapid diminution in the admissions than in the constantly sick, comparing the subjected with the unsubjected stations ? — Yes, there is. 1775. What follows from a comparison of those two figures of greater proportionate diminution in primary admissions than in the constantly sick ? — It follows that there is a very consider- able importation into the stations where there has been a great reduction of primary syphilis from those where there has been a less reduction. From the nature of things it must be so. To put it in another way ; in the subjected stations, so long as the admissions for primary syphilis are more numerous than at the unsubjected stations, they will export more secondary syphilis than they import ; but as soon as the stations that are unsubjected have a higher rate of admission for L 3 primary MINUTES OF EVIDENCE TAKEN BEFORE THE 4: April 188}.] Inspector General Lawson. [ Continued. Mr. Stansfeld — continued, primary sores than those that are subjected, the stations that are not under the Acts will export to the other stations more than they receive from them. 177G. But you are comparing the admissions for primaries with the constantly sick from secondaries? — I will take the secondaries; it will come to the same thing. 1777. If you have a more rapid diminution in the number of admissions for secondaries than in the number constantly sick, does it not follow, as a matter of calculation, that the average duration of the cases increases ? — You must go into the question of how far there has been a trauference from other stations. Mr. O^Shaughnessy. 1778. Does not each admission after a transfer rank as a new admission ?— No, it depends upon how it is. If a man has been under treatment, say in London, for secondary syphilis, and he goes to Aldershot, he is not a new admission there ; he remains in hospital, but he is not put in as an admission at Aldershot. Mr. William Fowler. 1779. But you said, the other day, that it often had been done so ? — No. 1780. When you shift from primary to secon- dary, they are entered twice ? — I am talking now of a person who has secondary syphilis in London, and who goes to Aldershot, labouring under it. Of course, if a man has had primary syphilis he is returned for secondary syphilis ; secondary syphilis being a separate disease. 1781. And he is entered twice ? — He is entered as for two diseases ; but if a man, having had secondary syphilis in London, and having been already under treatment for secondary syphilis in Loudon, goes to Aldershot, he is not shown there as a fresh admission. Mr. Stansfeld. 1782. Then he remains on the London books, does he ? — He is transferred to Aldershot ; he does not remain upon the London books. He disappears from the London books, but he ap- pears in the Aldershot books fi'om the date of his arrival there, only he is not shown as an admis- sion there. Mr. Osborne Morgan. 1783. He would come in as an admission in London ? — He would come in as an admission in London, but he remains under treatment after he has gone to Aldershot. 1784. You are now speaking of the cases of continued secondary svphilis, and I understand you to say that a man who has been treated for secondaries in London, and is transferred to Aldershot, is not treated as a new admission ? — No. 1785. But I think you told us before that, if a man had been treated for primaries at one station, and then afterwards he comes ill of se- condaries, and is admitted for secondaries, that is treated as a new admission ? — Clearly so. Mr. Stansfeld. 1786. Do I rightly understand from you that the numbers of admissions reducing more rapidly than the numbers of constantly sick, is no proof Mr. Stansfeld — continued, that the duration of the cases in hospital has in- creased ? — If you can eliminate your importa- tations, and iind out what is the number of cases actually under treatment due to the place, then you would be able to arrive at that point ; but without it you cannot arrive at that point. Then there is another point ; it is clear that, if a man has contracted syphilis in London, and he goes- to Aldershot, the secondary syphilis that he comes under treatment for there, will not be at all affected, whether he is under the Acts or not; it is due to something else before he has come under the Acts. 1787. But what bearing- has that upon my present point ? —You are asking me about the duration of the case. If he has gone from a place wliere he is not under the Acts, having contracted syphilis there, and if he gets secon- daries under the Acts, the fact of being under the Acts would not at all aifect the dura- tion of the case. 1788. But what I want to ask you is this ; we can draw inferences from it afterwards ; if you find that in the protected stations the primary admissions decrease more rapidly than the con- stantly sick, is not the inference clear that the cases are of longer duration ? — You must, as I say, eliminate the cases that are imported ; that is a thing that has not been done, and you can proceed to no further deductions until you have done that. 1789. You have no hesitation in debiting the stations with secondary syphilis for the purposes of your own calculation? — I have given the six largest, in order to put the Committee iu pos- session of the results, and I have cautioned the Committee that that contains importations which I cannot eliminate. 1790. Why should you not apply the same kind of rule to this calculation, and ascertain the average duration of cases in the hospital in one case and in the other ? — Simply because I cannot fairly eliminate the importations. 1791. But that does not prevent you from giving these rettirns of secondary syphilis, although it is equally true that you cannot eliminate importations there? — I should be giving the Committee a statement including a fallacy, which I do not want to do. 1792. But the fallacy is the same surely in your own table ? — No, because my table is given with the express statement that that is there, and that I cannot eliminate it. 1793. Could you not construct a table ex- pressly giving the same statement ? — If I give a table giving a statement as to the duration of the cases, it would be of no value. 1794. Then is this Table of yours. No. II., of no value ? — It is of value certainly, so far as the facts go. 1795. The value would be the same in both cases, because the danger of mistake is the same in both cases? — The danger of mistake is the same m both cases, but I should be giving that with a mistake, and I know that it contains matters which I cannot eliminate ; but the fact is that I have no reason to suppose that the duration of the secon- dary syphilis in one station differs from that in another, unless it might be, as I mentioned the other day, that there was a slightly greater pro- portion SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 87 4 April 1881.] Inspector General Lawson. [Continued. Mr. Stansfdd — continued, portion of secondary syphilis from tte cases that you meet with under the Acts. 1796. Then if I told you that cases of se- condary syphilis remained longer under treat- ment in the subjected stations than the un- subjected stations, you would be somewhat surprised ? — I should say that you had made a calculation from certain things which embraced a fallac_r, but 1 cannot conceive why secondary syphilis should be worse in the subjected stations than in the unsubjected stations, save that there is a little more syphilis apparently amongst the females in the subjected stations than amongst those at stations that are not subjected; that we brought out the other day ; I stated in my evi- dence the other day that I withdrew Table No. IV., because I found that it contained a fallacy, and I stated, at the same time, what was mentioned in it. It is at No. 1568, and this is what I say, " There is one point that I should like to mention ; the other day I put in a Return, No. 4, which was to estimate the numbers re- maining in hospital, eliminating the imported cases. It was based upon the remarks I had previously made as to the common ratio subsisting between primary cases and secondary cases throughout the whole Army. The return I have just put in has presented some new facts on that matter. I find, on looking at it, that the nearest approach I can make to it is that at the stations under the Acts from the period there mentioned, the secondaries were 36 per cent, of the primaries, whereas, at stations that were never under the Acts, the per-centage was a little lower, about 33 per cent. 1797. But I understand you just now to say that you thought that the syphilis might be some- what severer at subjected stations, and you attributed that to the existence of a greater amount of syphilis amongst the women ; I do not recollect your giving that evidence before? — It was with reference to the fact here mentioned. Of course this would tend to show that there was, to a certain extent, a greater change of secondary syphilis resulting. 1798. But there are no facts here about the women ? — That is a conclusion which is based upon this. Dr. Cameron. 1799. Do you mean that the primary sores were divisible into two classes, viz., true syphilis and other sores? — This, of course, has reference merely to secondary syphilis. 1800. But I understood you to say that there was more syphilis amongst the women ? — Yes. 1801. I imagined that you were opposed to the theory of the duality of syphilitic sores ? — No, I am not strongly opposed to that theory. 1802. Then you admit the duality ? — I am in- clined to admit that. Mr. Osborne Morgan. 1803. You mean that there is a sKghtly greater chance of catching the true syphilis as opposed to pseudo-syphilis in the protected stations than in the unprotected stations? — Yes, that in 100 cases you have 36 cases of primary syphilis at subjected stations, instead of 33 at unsubjected stations. 0.44. Mr. William Fowler. 1804. A man runs more danger of catching true syphilis in the subjected stations than in the unsubjected stations ? — To the extent of 36 against 33. 1805. Therefore you withdrew your Table ? — Yes, I withdrew my Table. Mr. Stansfeld. 1806. Turning again to Table No. VI. B., you have in that table the ratios per thousand of admissions for secondaries ? — Yes. 1807. We have been dealing hitherto with constantly sick. In the first period of years you get 37*4, and you fall in the second period to 24-5 ?— Yes. 1808. That is the average ; but have you worked out those figures year by year; can you give me the admissions year by year, from 1861 to 1866 ? — No. I cannot give you the admissions year by year, because they would ultimately liave to come into this form, and it is no use taking that trouble ; in fact, I have not had the time to do it, for this only came into my hands very shortly before I came here. 1809. If I were to say that, on working out these figures, I had found that in the year 1865 the admissions were 30-80, and in the year 1866 26 '03, you would probably admit it for the moment, subject to coiTection ? — I have got the nimibers for the whole of the stations together, not for the separate stations. 1810. You have not got it for the stations under the Acts ? — No, not separately. 1811. You have, comparing the first with the second period, a fall in the admissions for secon- dary syphilis from 37 "4 to 24- 5 ? — Yes. 1812. I find that, in the year 1866, the ad- missions were 26'03, so that practically speaking you get a greater proportion of that diminution for the year 1866, and therefore, before the operation of the Acts ? — Yes. 1813. Take the per-centage of secondaries to primaries in the same table ; in the second period as compared with the first, there is arise, is there not, of 3-3 ?— Yes. 1814. What is the rise in the unprotected stations ? — The rise in the unprotected station is from 29-8 to 31-4. 1815. In fact those are the figures which you yourself just gave, and they show that in the stations under the Acts there was a tendency in those two periods to increase the proportion of secondaries to primaries in the stations under the Acts ? — Yes. 1816. If you take the third period, after Lord Cardwell's Order, that tendency shows a marked increase, does it not? — There is a large increase, but then you are immediately in face of the im- portation. 1817. But let us deal with facts ? — As a matter of fact, as soon as you come to Lord Cardwell's Order, you come to an increase of 18-6 in the subjected districts ? — Yes. 1818. In the unsubjected districts your in- crease is only 11 ? — That is so. 1819. So that the tendency in the subjected stations to increase the proportion of secondaries to primaries is still more marked after Lord Cardwell's Order than before ? — It appears upon this table to be so ; but it is including that ques- L 4 tion MINUTES OF EVIDENCE TAKEN BEFOEE THE 4^;;m7 1881.] Inspector General Lawson. [ Continued. Mr Stansfeld — continued, tion which I have talked about, of the importa- tions which will diminish those not under the Acts and increase those under the Acts. 1820. Almost every one of those figures are affected by this question of importation ? — That is a most important point to bear in mind in this case. It does not prevent your looking at those returns, but it qualifies every inference that you draw from them. 1821. But viewing it largely the difference is so great between the increase in the proportion of 18'6 and 11 that you would say, would you not, that within the time subsequent to Lord Cardwell's Order that difference between the two groups of stations was still more marked than before? — It is very marked, I admit; but I cautioned the Committee against drawing any conclusion from that in face of the importations, because tliat modifies the thing altogether. 1822. Have you got there what we call Mr. Le Fevre's Table ; will you look at the ratios of admission in that table per thousand for second- ary syphilis in the subjected stations; you begin with 33"13 in 1S65, and j'ou get down to 24'10 in 1870?— Yes. 1823. Between the year 1865, and in the year 1870, when the Acts came into general operation, you get a reduction in respect of secondary syphilis in the stations under the Acts from 33'13 to 24"10 ? — This table is not comparable with any of the tables which we have been deal- ing with hitherto. 1824. I will take it by itself. This is a re- liable table, I take it? — This table is, to a certain extent, reliable. It has been gone over since, and several errors have been found in it, and they have been corrected as far as they could in the tables that appear in the Report of the Com- mittee. 1825. Those errors are not errors of any moment, are they .' — Some of them are con- siderable. The return was not before the Com- mittee, and therefore it was not in my power to mention it ; but since the return has come into my hands I have made inquiries upon that point. 1826. In the questions that I put to you upon this return, if it occurs to you that the figures are incorrect, perhaps you will say so ? — Of course I could not say whether they are correct or not, in the short time I have had the returns in my hands ; but I have seen the working sheets of my department, and found that considerable errors v/ere indicated. 1827. But I suppose there is no error in these ratios of secondary syphilis, beginning in lb65 with 33"13, and going down in 1870 to 24-10? — There may be no error there, but you must re- member that this applies to only a very small proportion of what we have been dealing with here as stations under the Acts, so that there is really no comparison between them. 1828. I have not yet drawn any inference ? — I merely want to give a caution which, I see, will have to be brought up before long. 1829. I will take these facts, and, if the figures are incorrect, I cannot help it ; they are the Army Medical Department figures; you have given us that caution, and we will ask the Depart- ment to correct the figures, if necessary ; in the Mr. Stansfeld — continued, year 1865 you have the ratio of admissions for secondary syphilis 33"13, and in 1870 vou get down to '24-10 ?— That is so. 1830. Then, after that there is no similar re- duction to that in the period following really upon the full operation of the Act, and you end, in 1878, with a ratio per thousand of 21*72? — I think, if you look at 1871, you will find there is a reduction to 17"2y, 1831. Is it not true that in every subsequent year you have a considerably higher figure ? — Yes. 1832. And that there is, after 1871, at any rate on the whole, no tendency to a diminution of the ratio ? — They increased to the year 1875, when they reached the maximum, after which they began to diminish again. 1833. In the unsubjected stations there is a slight increase during the same period, is there not ?— Yes, there was a considerable increase. 1834. There is an increase of four, is there not ? — It goes up to 34 in 1875. 1835. But in 1878, which was the last year, it is 32-70?— 32-70. 1836. If you take the constantly sick you will find different figures, will you not ; and here is that curious difference between the admissions for secondary syphilis, and the ratio of men con- stantly in hospital ; take the last year, 1878; it you take the stations not under the Acts you find that the ratio of men per thousand constantly in hospital for secondary syphilis is 1 -46 ; in the stations under the Acts it is 1-59 ? — Yes. 1837. And, generally speaking, you will ob- serve, will you not, that there is, as I have said, a rapid and decided diminution in the admissions for secondary syjjhilis, but not an equivalent diminution in the numbers constantly sick in the j^rotected stations ; for instance, take the year 1865; you find the ratio per thousand 33-13; you come down, we will say, to 1870, from 33-13 to 24*10 ; you have not come down proportion- ately in the constantly sick, have you ? — Very nearly the same amount. It is one-lburth or one- third. In fact, the constantly sick have dimi- nished more rapidly than the admissions. )838. But if you compare the stations under the Acts with the stations not under the Acts, do you not find this marked distinction : that there is, in the stations not under the Acts, as great a diminution in the number of constantly sick, but that there is not that diminution in the ratio of admissions per thousand ? — There is some error in regard to that last figure in 1878. It is one of the points that I have specially pointed out. 1839. As some of those figures are not accu- rate, I will only ask you whether it is not true that, in the unsubjected stations, the admissions bear a greater proportion to the ratio constantly sick, than in the subjected stations ? — I have not gone into that, individually, but the thing is possible. 1840. I have done so, and what I find is that there are more admissions in proportion to the number constantly sick in the unsubjected stations than in the subjected stations ; and my inlerence, which you say is subject to the doubt about importations, is, that the cases are longer under treatment in the subjected stations? — No, I do not think I said that. 1841. Would SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 89 4 April 1881.] Inspector General Lawson. [ Continued. Mr. Stansfeld — coutinued. 1841. Would you have the goodness to go into that calculation and let us have the results? — I can go into it if the Committee desire ; but iu all these things we must bring them into an average to get rid of the peculiarities of individual years, and I have gone into the calculations of those averages, and it appears to me that the Com- mittee will have to come to that in the end, and they may as well take it at once. We must, iiltimately, bring the thing to an average. 1842. I prefer to take the whole series rather than the six-year periods? — We will take the whole series, if you wish it. 1843. Now, I want to put to you a question or two upon the subject of the saving of efficiency, upon which you have expressed very decided opinions. In answer to Question 1509, you are there defending a calculation of Sir William Muir's, which appeared in the Army Medical Dejjartment Report for 1872? — Yes, at least the materials for it did. 1844. You say : " Sir William Muir had the numbers of men who had been in hospital for five years;" that was from 1868 to 1872, was it not ?— Yes. 1845. " And he made his calculation upon those numbers. The ground that he took for his calculation was correct. The number in hospital daily for primary sores was " (on the average of five years) ''Q-IG in the stations never under the Acts, and 4"49 at stations imder the Acts, the diiFerence being 4'67 per 1,000." That gave you your saving oF 193 men for stations under the Acts ? — Yes. 1846. Then you said, " and if extended 1o the other stations not under the Acts it would be 112," and that 112 and that 193 made a saving of 305, which was Sir William Muir's calculation ? — Yes, Sir William Muir gave that calculation without these odd numbers which I have added in ; he made it 300. 1847. But you assumed there, did you not, that if it had not been for the Acts the average would have been exactly the same in the two groups of stations? — That is what he has as- sumed. 1848. And you endorse that assumption? — I limit it by saying that you should take the stations before hand, and find what the average between them before there were any Acts at all had been, and correct the subsequent numbers by that average. 1849. I take Sir William Muir's calculation, and you approve of the result; he finds in the years between 1868 and 1872 that in the sub- jected stations there was an average number of men in the hospital of 4-49, and he finds, in another totally different class of stations, in- cluding London, and all the great towns, that there is an average of 9'16. He takes the dif- ference, and he assumes that, if it were not for the Acts, instead of having an averas^e of 4"49, you would have an average of 9*16 for the sub- jected stations. Upon that calculation he gets first of all at the 193 men ?— I gave 193 ; I think he gave 190. I took a more exact calculation ; he gave it in round numbei's. 1850. You start with different conditions in these two groups of stations in the very first year ; you find that in the subjected stations you 0.44. Mr. Stansfeld — continued, have the number constantly sick 5'09 ; in the unsubjected stations the numbers are 8-03, which indicates the fact of an initial difference between those two groups of stations ? — There is no doubt that there is an initial difference, and that is the reason why you take the ratio from the averages between those two sets of stations before the Acts commenced, to see what the difference is. 1851. I am now dealing with Sir William Muir's calculation ? — Sir William Muir omitted that particular correction which, I think, ought to be applied. Mr. Osborne Morgan. 1852. Do 1 understand you to mean the com- parative incidence of the disease in the protected and unprotected districts before the Acts ? — Yes. 1853. That is omitted in Sir William Muir's calculation ?— It is omitted in Sir William Muir's calculation : it is a small affair which I noticed ; of course you must correct the subsequent results for that difference. Mr. Stansfeld. 1854. Take the subjected stations in the years 1868 to 1872 ; if we want to know the saving of efficiency in those districts, is not the accurate method to ascertain what reduction has been effected in the numbers constantly sick in those districts in that period of time ? — You must ascer- tain the difference, and then you must compare the two sets of stations at the end of the period, as you did at the first. 1855. In 1868 you have the number constantly sick 5'09 ; in the year 1872 it has dropped to 4"o6, that is to say, you have dropped '5 ; that is to say, you have effected a saving in those districts in that period of years of half a man per thousand '.' — Yes, that is of course those districts between the same periods and compared with themselves. 1856. Then the average number during that period was 41,319 men, was it not? — Yes. 1857. Then according to my calculation, the saving which you effect in these districts between 1868 and 1872, is a saving of half a man per thousand in 41,319 men, that is to say, a saving of 21 men? — That would be confined to those districts solely without any reference to anything else. 1858. That is so far as those districts are con- cerned? — Yes. 1859. But then you get your 112 men, which you add to the 193, and to get them, you assume, do you not, that if the Acts had been extended to the 14 unsubjected stations, you would have had precisely the same figures as in the subjected stations ? — Suppo.sing the Acts had been applied to those stiitions, the inference was that the disease in them would be reduced from what it was to what it was at stations under the Acts. 1860. And that is the process by which you get your 112 men? — Yes. 1861. At the beginning of this period, in 1868, you start with an initial figure of constantly sick, with primaries of 8'03 ? — That is in those stations. 1862. Would it not be more correct, statisti- cally speaking, to assume the same rate of dimi- M nutioa 90 MINUTES OF EVIDENCE TAKEN BEFORE THE 4 April 1881.] Inspector General Lawson. \_Continued. Mr. Stansfeld — continued. nutlon in those stations as in the subjected stations ? — You must not assume anything, but take the rale you find. 1863. 13ut I mean to get at what your savine; wouki have been ? — You must take the rate as you find it. 1864. But you do not take the rate as you find it. What j'ou do, is this : in the unsub- jected station you say, if we had had the Acts then, instead of having an average of 9'16, we should liave an average of 4-49 ? — That is the presumption. 1865. Although, at the beginning of the period j'ou begin at the unsubjected stations with an initial figure of 8"03 instead of 5 "09 — Yes. 1866. Therefore, your calculation is based entirely ujjon the assumption that if the Acts apjDlied to the. unsubjected stations, you would have precisely the same figure as at the subjected stations, in spite of the great diflerence in the character of those two groups? — We found a much greater difference before the Acts were applied, but that is the basis of the argument. 1867. Beginning with 1868 you have, in the unsubjected stations, constantly sick witli pri- maries, 8'03. I will assume that the Acts would have produced the same rate of reduction there that they produced in the subjected stations, and that would have been a reduction, would it not, of half a man per 1,000 ; and in these stations, be- ginning with the higher figures, it would have been a reduction of about three-fourths of a man per 1,000 ? — 1 hat does not meet the point at all. 1868. Do you disagree with that method of calculation ? — Decidedly. 1869. But would not my figure be right? — It might be; calculating the proportion, that is easily arrived at. I only wished to guard myself against admitting that that is a proper calculation. 1870. I, do not think you are in the habit of making unnecessai-y admissions. Admitting my calculation to be correct, I get a saving of efiSciency which might be atti-ibuted to the Acts of three-quarters of a man per thousand on 23,894 men ; that is to say, a saving of 18 men : so tliat, according to my metliod of calculation, there could be only attributed to the Acts a saving of 21 plus 18; that is 39 instead of your saving of 305 ; and I suppose you would admit that the question would turn upon which was the correct method of calculation of the two? — Yes; certainly. 1871. Have you ever referred to Dr. Nevins' Table in the Report of 1880, at page 53, show- ing the figures of efficiency. I do not think that you question the accuracy of that table. What Dr. Nevius finds is this; if you begin with 1870, when the Acts were first generally applied, and take the average of the years to 1877 in the stations under the Acts, you begin with the constantly sick for primary sores, 4-46, and you drop in 1877 to 3-51 ; that is a drop of -95. If J'OU take the stations not under the Acts you begin with a proportion of 9-74, and you drop to 7'87 ; being a drop of 1'87 ? — Yes. 1872. That is to say, according to Dr. Nevins' calculation, the fall in the number constantly Mr. Stansfeld — continued, sick, and therefore the increase of efficiency is as 1"97 in the non-subjected stations to 1 in the subjected stations ? — That is his mode of calcula- tion ; but the mode he proceeds upon is utterly wrong. 1873. How is it wrong? — Because what he gives here as the state of things in 1870 at sta- tions under the Acts is the condition of the stations produced by the previous operation of the Acts. He has quite left out of sight alto- together what the Acts have done for the stations, and that is what we want to find. 1874. What you mean is, that in this kind of calculation, you ought to go back before 1870 ? — You ought to go back and find what was the ratio of disease at stations under the Acts before they were applied, and what has been the ratio of disease since ; and you would expect, if nothing- had interfered with them, that those two ratios would have been substantially the same for the period after the Acts were applied. 1874. *But your statistical theory is that you ought to take periods before and after the Acts, and compare the averages of those periods ? — Certainly. 1875. My theory, on the other liaud, is that you ought to ascertain for the period before the Act, whether you were upon a descending series, and if you were upon a constantly descending series it would not be statistically accurate to take the average of that period, and compare it with the subsequent period? — But how could it be told that you were in a constantly descending period if }-ou introduce the Acts and disturbed your averages ? 1876. But the figures show that? — The figures show you the influence of the Acts ; but if those figures had not been there, nobody could say that the thing had been constantly descending. On the contrary, the progress of the disease in the country shows that it would have as- cended. 1877. The figures for primary sores in stations under the Acts begin in 1860 with 146 admis- sions; then you have 142, 117, 107, 102, 25, 87. The difference between you and me is this, is it not, that in your oijinion if the Acts had not been introduced, that descending ratio would not only have stopped in 1866, but would have been reversed ? — Yes. 1878. And so would have gone back again from 87 to 146, so as to have got the same average in the second period as in the first. My theory is that, on the contrary, that would not have been the case, but that some further reduction would have taken place ; that is really the difference between us ? — That is the difference between us. 1879. But your whole argument, whether it be as to the increase of the efficiency of our Army, or as to the reduction of the disease, depends upon this assumption, does it not, that the re- duction since the Acts has been owing entirely to the Acts, and that the existence or non- existence of the Acts is the whole difference between the two groups? — No, I have mentioned, and repeated frequently, that there has been a large decrease in the incidence of the disease in the country, but, that after abstracting that, we still SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. SI 4 April 1881.] Inspector General Lawson. [ Continued. Mr. Stansfeld — continued, still find a substantial decrease attributable to the Acts. 1880. But conditions atfecting the country at large would affect both groups of stations equally? — Distinctly. 1881. Therefore the difference in your mind between the two gpjups is, that in the one case the Acts are applied, and in the other, not ? — Yes, certainly. 1882. But are there not other differences ; you have already admitted very frankly that there is a very great difference between the sanitary con- ditions and the conditions wdth reference to the liability to disease of soldiers living in barracks in or near large towns or cities, and of soldiers living in camps? — There is a greater likelihood of contracting disease in large towns usually ; but some of the camps have had very high ratios ; Aldershot had a very high ratio at one time. 1883. But what I want to gather from you is this : if you get a number of men, say at Aider- shot itself (there may be some special danger at Aldershot) collected together in camp, and having no city population near them; every soldier may be there under strict discipline, so to say, in a ring fence ; but if you have such men in London you cannot do it ? — It is a ring fence with a great many apertures in it. 1884. But would you, or would you not, agree with me that, making allowance for those gaps, there ought to be a better opportunity for dis- cipline in a camp than close to, or in, a large town ? — In what way am I to receive the word " discipline " ? 1885. Discipline as to the habits of life of the soldier? — In short, that there would be less temptations. 1886. Yes, or there may be more occupation ; call it, if you like, less temjDtation , of course temptations are either positive or negative from a condition of idleness in the person who yields to the temptation ; I will take it in both ways ; you would say that in a large town there would be greater temptation ? — Yes, 1887. With reference to the recommendations of Lord Herbert's Committee, is it possible to state to this Committee that those recommenda- tions have been carried out quite equally at large stations ? — Cei-tainly, they were introduced and carried out gradually at all the stations over the army ; of course, to a greater extent at the large stations, but equally at the large stations, whether under the Acts or not. 1888. The bulk of the non-subjected stations are small stations ; would you not, upon the whole, expect to see completer and better sani- tary arrangements in large camps and subjected stations than in the bulk of the comparatively small non-subjected stations? — Yes; I should say that Dublin, London, Cork, and Edinburgh are quite as good; they were introduced much about the same time, as fast as Parliament voted money for them being carried out. 1889. For instance, besides sanitary arrange- ments in our soldiers' barracks, we have arrange- ments to keep them out of temptation by giving them means of innocent enjoyment and occupa- tion ? — Yes. 1890. Would you mean to include those ap- 0.44. Mr. Stansfeld — continued, pliances ? — Certainly, the whole of those things were applied about equally. 1891. In the large towns; but in the small stations? — Quite so; not quite so much in the very small stations, but at every considerable station those were introduced as fast as they could get the money. 1892. There is one great diffei-ence between the subjected stations and the unsubjected sta- tions ; in the unsubjected stations there are no hospitals for women, are there ? — In some there are ; at Liverpool there is a hosj)ital ; at Glas- gow, I understand, there is a hospital ; in Edin- burgh, I am not sure whether there is one or not. 1893. But you have no hospital arrangements in the unsubjected stations for the use and for ti;e cure of women with whoui soldiers consort? — Yes, there is in Liverpool such a hospital; in Glasgow there is such a hospital ; in Edinburgh, I believe, there is a ward for that purpose. 1894. You mean civil hospitals ?— Syphilitic hospital^. Lock hospitals ; in Dublin there cer tainly is one. 1895. But you would not compare those pro visions of hospitals, or medical care and treat- ment, with the amount of similar treatment in subjected stations ? — Certainly not. 1896. Therefore that is a clear advantage to the subjected stations ? — Decidedly so. 1897. Supposing that we were considering the Acts entirely from the point of view of the ques- tion of compulsion, then the only way to institute a fair comparison between the unsubjected sta- tions and the subjected stations would be to assume equal hospital and medical provision in the unsubjected stations, but no compulsion? — That is to test the efficacy of compulsion. 1898. To test the efficacy of comj^ulsiou ? — That wotdd be one way of doing it, certainly ; in fact, to give the people voluntarily a chance of going under treatment. 1899. I mean that, supposing j'ou could show a considerable advantage in subjected stations, it would not be fair to compare them without taking into consideration the fact that you might have equivalent hospital and medical pi-ovisiou in the unsubjected stations without that portion of the Acts which is objectionable to many people, that is to say, the principle of compulsion ? — That might be, but dealing with the Acts as wc have them we get a certain result. 1900. There is, lastly, one other great dis- tinction, is there not ; we have been told by Sir William Muir that, when a regiment goes from an unsubjected station to a subjected station, the soldiers are examined in order that they may not spread disease ; but that that precaution is not taken when the transfer is from a subjected station to an imsubjected station ; that is so, is it not? — Yes, that is so. 1901. Supposing that a regiment goes from an unsubjected station to a subjected station, would you make it quite clear to us how these cases are dealt with ; does the examination of the soldiers take place after they have reached the subjected station or before? — When they reach the subjected station. 1902. Therefore, the first effect of that ex- M 2 amiuation 92 MINUTES OF EVIDENCE TAKEN BEFOEE THE 4 April 1881.] Inspector General Lawson. [^Continued. Mr. Stansjeld — continued, amination is to increase the number of admissions in the subjected stations ? — Yes. 1903. They are not continued on from the un- subjected station ? — They are not detected. 1904. Therefore those cases begin by being fairly debited to the subjected station ? — Yes, certainly. 1905. But the advantace which the subjected station gets out of this proceeding is, tliat these men are not left at liberty to spread disease amongst the women, and through the women amongst the men again? — Certainly. Mr. Osborne Morgan. 1906. Are the diseases that you speak of, I mean that which are ascertained on the ari-ival of the men, debited to the subjected station ? — Yes, they are. Mr. Stansfeld. 1907. And what happens is that they do not adopt the same precaution when a regiment goes into an unsubjected station ; it seems to be con- sidered a matter of no moment? — They are not examined when they reach an unsubjected station. Mr. William Fowler. 1998. Do I understand you to say that in all cases, when they come to an unsubjected station, the men are immediately examined? — Yes, at once. Mr. Osborne Morgan. 1909. But not vice versa ? — Not vice versa. Mr. Stansfeld. 1910. When a man goes away on furlough from a subjected station and returns he is ex- amined? — Yes, if he be away for more than three days. At Aldershot every man is examined on coming back again. Colonel Tuitenham. 1911. Is it not the case that regiments are ex- amined either monthly or fortnightly?- — It is not now ; it was at one time. That practice has been given up since 1859. Colonel Dighy. 1912._ Excepting in the Foot Guards?— Ex- cepting in the Foot Guards. In the Army gene- rally it has been given up since 1859. "The Foot Guards are under a different administration from the Army generally, and of course they adopt their own regulations. Colonel Tuttevham. 1913. Why has that practice been retained in the Foot Guards ?■ — They found such an amount of disease that they thought it prudent to check it as much as possible. 1914. Are the Foot Guards under a separate medical administraiion ? — Separate altogether. The Foot Guards are not under the Commander in Chief in tlie same way as the rest of the Army. Mr. William Fowler. 1915. Have you found the examination of the men useful ? — I examined the men for many years, and my impression was that when the ex- amination was done away with it would lead to a great deal of concealment of disease ; but, after that, I was abroad at the Cape in charge of a station, and I had charge at Aldershot for five years, and, watching the effect of it, I came to the conclusion that my fears that the disease would increase really were not grounded in fact. 1916. Still the examination enabled you to ascertain the cases which you would not have known otherwise ? — No doubt. At the same, when I was a regimental surgeon, I found out very few cases by examination, but I was very particular in having every man punished who came to me who had not reported himself as soon as he was sick ; and that I found far more efficacious than the other. 1917- You had a fear that they would conceal the disease ? — Y'es 1918. And you thought that they had not con- cealed it, but your punishing them, if conceal- ment was found out, was more effectual than the periodical examination '? — Yes, that was when I was a regimental surgeon. 1919. I understood you to say that you alarmed them sufficiently to compel them to tell you ? — They knew what I should do, and that was more erticient than trusting to its being de- tected once a week. 1920. At the same time you said that you knew that tlie examination of a regiment im- mediately they came to some stations or went on furlough, enabled you to delect a great many cases that you would not otherwise have found out ? — I would not say that exactly, but it enabled us to detect cases at a particular time. Mr. Farquliarson, 1921. Is it not the case that there is a specific examination now for venereal diseases ; there is a general inspection once a month by a medical officer who can pretty well tell by the appear- ance of the men whether they are suffering from venereal disease ? — I do not know that there is an examination of that sort. Of course the sur- geon sees the men on jjarade. Mr. Stansfeld. 1922. In your evidence on the last day, j^ou spoke of the deaths from syphilis among the civil poj)ulation, and you thought you saw evidence in the proportion of deaths in the different dis- tricts of the Registrar General in support of the favourable ojieration of the Contagious Diseases Acts ?— Yes. 1923. You spoke of the Registrar General's second district whicli includes, I think, most of the subjected stations ? — The second district in- cludes Woolwich, Chatham, Gravesend, Sheer- ness, Portsmouth, Aldershot, Shorncliffe, Dover, Canterbury, and, in, fact, all the Eastern Counties. 1924. And you said that, in the Registrar General's second district, including all those subjected districts, there was a diminution of 14 per SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 93 4 April 1881.] Inspector General Laavson. [ Continued. Mr. Stansfeld — continued. per cent. ? — I include the fifth district also, which is the south-western counties. 1925. You take the district of the Registrar Genei'al in whicli the j^rotected districts are, and you find in those districts a fall of 14 per cent, in the number per million of deaths from syphilis ? — Yes. 1926. Seventy-four per cent., I think, of those are deaths of children under one year ? — Yes, that is in England, generally. 1927. Can you give me the population of those second and fifth districts ? — I can give it to yoii in general terms. The actual population of those districts in the year 18 ?2 was 4,100,000, in round numbers. 1928. Of both districts together ?— Both dis- tricts together. That was in 1872. Of course that is corrected from the population in 1871. The population in 1871 for the south-eastern district was 2,167,726, and for the fifth district it was 1,880,777. The population, corrected to the middle of 1872, which is for the period from 1870 to 1874, the middle period is 4,100,000 in round numbers. 1929. And those are the districts in which, practically, all the subjected districts are to be found? — Yes, except Colchester. 1930. Can you give me the population of those protected districts ? — I cannot gi\'e you that, because it goes into the population in the regis- tration districts in which those protected stations are, and I have not gone into that. 1931. But what kind of proportion would their population bear to this 4,100,000 ? — Very much less than that. 1932. Can you give it to me at all, approxi- mately ? — There was a paper upon the subject prepared by an officer of the Registrar General's Department some years ago, and he took the actual registration districts, which, of course^^ he has access to, which I have not, and the numbers that he gave as the enumerated population of those II stations were 492,408 in the year 1861, and 551, 341 in the year 1871; that is just over half a million. Tiiose were the districts in which the places were immediately situated. 1933. What I want to see is the projjortion of the population of the protected districts to the Registrar General's districts ; and it would seem that they are about one-sixth of the population ? — Between one-seventh and one-eighth. 1934. We will call it one-seventh ; if tiie fall of 14 per cent, on the ratios per million of deaths in that district with a population of four million and upwards has been entirely caused by the Acts operating upon rather more than half a million, you must multiply that 14 by six, or seven, to get at the reduction in the protected districts ? — By no means. 1935. Why not? — Because a great many of those who left the protected districts with syphilis in their constitutions were cured in the protected districts, and went to their country jilaces with- out syphilis, or at least with syphilis in so modi- fied a form that it was no longer capable of being- communicated to children. 1936. Are you speaking now of men, or women ? — Women. 1937. And your argument is, that women were cured of secondary syphilis? — Yes. 0.44. Mr. Stansfeld — continued. 1938. And so eflSciently cured that they went into unprotected districts ? — Districts beyond the immediate circle of the places where the Acts were in operation. 1939. Then is it your view, that the effect of the vicinity of a protected district upon the sur- rounding districts is to improve, venereally speaking, the health of the women in the sur- rounding districts ? — Certainly. 1940. You are aware, are you not, that we have it in evidence that one effect of the Acts is to induce the women to leave the district, in order to avoid submission to the Acts ? — A cer- tain number do that, but it has never been defined what number. 1941. For instance, the Act of 1869 extended, the radius of the protected districts, in order to get a greater hold upon the women, did it not ? — Quite so. 1942. Is it not within your knowledge that the impression on the minds of those who live just outside of a protected district is very fre- quently that they suffer from the proximity of the protected district ; have you not heard of cases of that kind, where women who were diseased, in order to avoid being kept in hospi- tal, have gone away into the adjoining neigh- bourhood? — That is quite possible, of course. 1943. Then, it would seem, that the mere proximity of a protected district is not likely to improve the health of the country which sur- rounds it? — One or two, or a very small propor- tion, of the women might go out ; but if, instead of 10 per cent, going out, you sent only 5 per cent., or a small per-centage, you will deci- dedly improve the health of the neighbourhood by curing that 5 per cent, in the places where the hospitals are. Mr. Osborne Morgan. 1944. It acts both ways? — It acts both ways; but the majority of the action will be in favour of reducing the disease amongst the women. Mr. Stansfeld. 1945. You do not think then that it would be sound to say, that the whole of the reduction must have taken place within the protected sta- tions ? — By no means. 1946. Could you pursue this investigatioUj and give us the Registrar General's ratios for deaths in the districts covered by the Acts sepa- rately from the surrounding districts ? — I cannot give that, because I have not the means at my disposal ; they are not given in the reports ; he only gives the deaths for the divisions and coun- ties separately ; he does not separate the children. 1947. Do you suppose that the Registrar General could give us these particulars ? — I dare say that he has got ail the details which are not available to me. 1948. Those particulars would throw a some- what clearer light upon the subject, would they not '.' — Yes, no doubt. I, of course, had not those materials, and I was obliged to use what I had. 1949. Would you wish to ask for those parti- culars, or should we make a direct application to M 3 th3 94 MJNUTES OF EVIDENCE TAKEN BEFORE THE 4 April 1881.] Inspector General Lawson. \ Continued. Mr. Slansfeld — continuetl. the Registrar General for them ? — It would be infinitely better for tlie Committee to make the application. The Committee are the proper people to ask for them. 1950. Can you give us, for each station, the average time of each case of secondary syphilis in the hospital, taking each of the 14 subjected stations and each of the 14 unsubjected stations? — It would take a great deal of work, and you would find a great deal of discrepancy in it ; you would not be able to make anything of it if you got it. You may take the mean of the thing, and calculate upon the mean ; but, as to taking the individual stations and calculating them, it would be simply a waste of time. 1951. I want to arrive at a clear view of the length of time which those cases take in stations under the Acts, and in stations not under the Acts ? — We could give you that, and it would involve no great trouble, or we could give the averages. I have given you the return for the six-yearly periods for both classes of stations, separately, but you would have it with all this fallacy about the importation. 1952. Supposing that you were to give us the ratio per thousand of admissions in each station for the whole period, we have got all the other materials to make the calculations for secondary syphilis ? — That could be done, I fancy. The admissions I have given you in one of the returns that I have put in. 1953. Not station by station ? — No, I have not got them station by station : I have given you them under the two sets of stations in Table No. 2, at page 2 of the return banded in by me. 1954. Therefore, you could not enable us to compare the lengtli of the cases in hospital in the 14 subjected and the 14 unsubjected stations ? — We can do so, taking them in the mass. 1955. But not station by station ? — Not station by station ; and I will tell you frankly that I do not think it would be worth your while if you got it. 1956. Would you undertake to do it in the two groups ? — I will do it in the two groups if you will explain to me exactly what you want. 1957. I want to know the progress and the duration of cases in the hospital, comparing the two groups of stations, those protected and those not protected ? — What meaning am I to attach to the wora " progress t 1958. If I have it year by year, that shows the progress ? — If I am to take these years indi- vidually, and to take the secondary syphilis ad- mitted and the secondary syphilis remaining, and proceed upon those for the two groups, I can do it ; but I frankly tell you you will find a mass of discrepancies which you will be able to make nothing of. You must, in the end, come to the average of a group. The fact is, that though the secondary syphilis, as a rule, maintains a pretty fixed proportion to the number of primary cases, you find that the secondary syphilis does not regularly occur in the same years in the largest numbers. I can give you an illustration of that, I think. 1959. Could you pirepare a Paper giving that information {handing a Paper to the Witness)? — I will apply and get this for you, if you wish it ; Mr. Stansfeld — continued. but I cannot, from the information now in my possession, do it. It will take some time to pre- pare. Dr. Cameron. 1960. Will you explain to the Committee what were the figures upon which Sir William Muir based his calculations? — The figures that we employed in the evidence in 1879 were derived from what is called, in that book, the Appendix, which only embraced regiments that had been in the country for the whole year. 1961. I see in the Statistical Report of the Army Medical Department for the year 1860 that that system of considering only regiments which had been in the country for a year was adopted with a view to avoid certain sources of error ? — Yes. 1962. Therefore, the figures which you get by adopting that system should be more trustworthy than those obtained by reckoning all the troops together, whether they have been a year in the country or not? — They should be more trust- worthy, and they afibrded greater facilities for raakinfi: sure that the returns were correct. 1963. It is very desirable that we should have the matter treated from all points of view ; but I suppose that, if you were to compare the two sets of figures, Sir William Muir's and yours, in point of trustworthiness, you would rather draw deductions from the results in Sir William Muir's than in j'ours ? — Both sets of figures are Sir William Muir's ; but, in the evidence that I have put before the Committee on this occasion, I have made use of the figures that represented the whole disease in the army, and that was at the request, or at least on the jsroposal, of the honourable Member for Reading, and also on the representation of the Right honourable Gen- tleman the Member for Halifax, that we were not giving the whole facts. Therefore that further basis was selected to give the whole facts and to meet his views. 1964. But the return which has been handed in by Sir William Muir, I suppose, is based upon facts ? — This is quite another business. This return of Mr. Shaw Lefevre gives the number at the stations under the Acts as they came under the Acts, leaving all those that were not under the Acts as not being under them. Now, it was objected at a very early period by Dr. Nevins, in one of his publications which was handed in to the Committee, when he was examined, that that was fallacious. Upon considering his objections I thought that they were in that respect well founded, and to meet that I, in some articles that I was writing in the medical papers at the time, took the stations under the Acts from the very commencement, and arranged them by them- selves, and continued that right on, and that has been the practice that has prevailed ever since. 1965. What I want to know is the exact differ- ence between these figures of Sir William Muir's and the figures in your statement ; for instance, what I particularly ask you about is, with re- lation to the statistics of secondary syphilis ; Sir William Muir's figures show, for instance, that the ratio of men constantly in hospital during the six years from 1873 to 1878 with secondary syiDhilis SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 95 4 April 1881.] Inspector General Lawson. [ Continued. Dr. Cameron — continued, syphilis was 1'78, and that is exactly what you have got in your return ? — Yes. 1966. But, in the unprotected districts you give the ratio of 2-16 and Sir William Muir's figures work out a ratio of 2-6 ? — Is that merely taking the sum of the ratios that are found there ? 1967. It is taking the sum of tlie ratios? — Then there is a source of error. I have wrought it out by taking the total number of men for those periods and the total number of admissions for those pei-iods, and, v/orking the population that way, which is the correct way of doing it, that will give you different figures. 196S, I see that your figures are different? — The figures in that return are somewhat, different from the return which you will find in the evi- dence of 1880. 1969. I see that your figures are different; take the figures for 1878, which are given in Eeturn No. 1, page 2 ; in the protected disti'icts you have a total number of troops in each case of 55,813?— Yes. 1970. Then you come to the number of cases of primary syphilis in hospital daily ; when you come to the ratios per 1,000, you give a ratio per 1,000 of 2-90, and Sir William Muir's return gives a ratio of 3'14 for the same set of men for the same year ; how do you account for that dis- crepancy ? — There are 162 primar}' cases, and there are 175 in this case. That, I presume, is one of the slips that is in this paper, because these facts have been gone over again and corrected, and we found a considerable number of slips in them. 1971. Take the year 1875, I think you have got the same number of troops in each case? — 48,606. 1972. Then you have got the ratio in your return 2*57, and in this return it is 2"65 ; how do you make that out? — Simply that, upon correct- ing this return, which they have done in a subse- quent one, the numbers came out as I give them. I have used the numbers from this one, p. 55, 1880. 1973. This one of Sir William Muir's was handed to us later than yours ? — Y"es, I have gone upon the Report of 1880. 1974. I understood that this return was based upon a different set of figures primarily, but upon taking a number of the figures, we find that they are identical ? — The bottom number, which em- braces the figures for the whole army, should be the same as this Return A, Appendix 3, in the Report of 1880 ; but in arranging this return in Appendix 3, they went over these facts again and they found certain errors in them, which they corrected, and I am told that this represents the present state of things. That return was not sent in to the Committee, but it was sent to a member of the Committee, in the year 1879, and this Eeturn, JNo. 3, came direct in 1880. 1975. If you take the number of the troops in the protected districts in the year 1870, in each return it is 41,580; in 1871 it is 54,096 in each case ; in 1872 it is 50,794 in each case ; in 1873 it is 48,039 in each case; in 1874 it is 48,136 in each case ; in 1875 it is 48,606 in each case ; and, I think, for the next three years the figures are identical ; but before 1870, apparently, the figures are entirely different ? — Before 1870 you are in this condition : that, in the returns I have been 0.44. Dr. Cameron — continued. dealing with, all the stations that come under the Acts have been put together. 1976. I understand now that, from 1870, your figures are identical with Sir William Muir's. They are all Sir William Muir's figures in this Return, No. 2 ? — Certainly ; except for the errors that they found in going over them. Mr. William Fowler. 1977-8. Take the case of stations not under the Act; the strength is 45,316 in both returns in the year 1878 ; the cases in hospital daily, according to your figures, are 99 ; is not that so ? — Y"es. 1979. But Sir William Muir's figures give it as 66 ? — Yes. 1980. And you give the i-atio per 1,000 as 2' 18, and he gives it as 1"46 ? — Y'es. 1981. That is a discrepancy, which at first sight seems so preposterous, that one does not know how^ to deal with it ? — The remark is per- fectly legitimate for you to make ; that is a dis- crepancy, and upon examining this return and comparing it with the other, I found out that there had been a marked error in it, because I made the inquiry, and such is the explanation I got and give. Dr. Cameron . 1982. Had you this Mr. Lefevre's Eeturn be- fore you when you compiled your own figures ? — No, I only saw it three days ago. 1983. We find out that, from 1873 to 1878, the figures happen to be the same ; you give the ratio of gonorvhaia, et sequela from 1873 to 1878 at 3'83 in the protected districts? — In the re- turns that I gave I did not include the sequelm ; that is taken from another return ; however, you will find many discrepancies in it. 1984. Y'ou give a ratio in the protected dis- tricts from 1873 to 1878 of 3-83; working out Sir William Muir's figures, I make it 3 48? — Allow me to remind you that both sets are Sir William Muir's figures ; but one return was sent in two years ago, and the other return was sent in less than one year ago. 1985. Calculations made two years ago upon facts that occurred two years ago are surely quite as likely, if not mo; e likely, to be correct, than if you set to work and rummaged up your facts at a later date? — There is no doubt that they should have agreed, but as I did not make them I cannot help it ; I did not see that return until Friday , morning, and on comparing it with the return which 1 have acted upon, I found that there were a number of discrepancies, and I made inquiries about those discrepancies, and saw the working sheets and found that there were corrections upon them; I quite agree with you that they should have been the same from the commencement ; but as I did not make them I am not responsible for them ; the arrangement is difl'erent, but they should have agreed. 1986. I shall not trouble you with more sta- tistics, but I want to ask you a question or two on an important medical point ; there are two theories about venereal sores ; one set of autho- rities adopt the theory that all venereal sores are syphilitic, and another set adopt the theory M 4 that 96 MINUTES OF EVIDENCE TAKEN BEFORE THE 4 April 1881.] Inspector General Lawson. [ Continued. Dr. Cameron — continued, that they are divided into two classes, of which one only is syphilitic ? — Yes. 1987. I think you told lis that in consequence of the fiicts set forth in this return of yours, numbered 6 B, you have come to the conclusion that you must admit the duality of venereal sores? — I think, so far as I am acquainted with it, the evidence is rather in favour of the dualitj'. 1988. But in making the return which you withdrew in favour of this one, you adopt a system of arriving at your secondaries by divid- ing tlic primaries by one figure, viz., 3 ; that ■ivould indicate that at that time you conceived that out of a given number of jirimaries you should have had the same number of secondaries ? — I did not conceive, because I took tlie actual number of primaries recorded for 12 consecutive years, and the actual number of secondaries re- corded for 12 consecutive yeai's, so that that was the fact independent of any conception of mine. 1989. But you applied the same thing to the two sets of stations ? — I did. 1990. And I reminded you at the time that that was begging the question as to the duality of venereal sores, and you denied it ? — I think you will find that, if I said anything, I said what I now state, that I am rather inclined to favour the dual theory. 1991. That is very important; admitting the duality of the disease, you are aware that certain witnesses have given evidence before us that the reduction in venereal sores in the protected stations arises from the detection and cure of the non-infecting class of sores, and tliat the specific syphilitic sore really remains undiminished ? — Yes, that is the statement, 1992. Some of the witnesses have gone further, and we have had evidence to the effect that every truly syphilitic sore is followed by certain second- ary symptoms ? — Yes, tliat has been stated. 1993. What is your opinion? — With regard to the certainty of secondary symptoms following an unquesticnable primary venereal sore, ray opinion is, that by adequate treatment, you will diminish the number of secondaries following such sore. 1994. If you include, for instance, syphilitic cachexia amongst your secondaries, do you think that they can get rid of that altogether by treat- ment ? — Syphilitic cachexia is a thing mixed up with the constitutional peculiarities of the indi- vidual ill addition to the syphilis. 1995. Of course any cachexia may be, and is, mixed up with the constitutional peculiarities of the individual, but syphilitic cachexia must be dependent upon syphilis?— I would not like to say that. It is cachexia in the individual who has had constitutional syphilis, but tiie two elements are most likely combined. 1996. Ilyou admit that, I suppose you would be inclined to admit that there is some sort of secondary after every true syphilitic sore? — I believe that, in ceitain cases, you can stoj) it, but I would not like to give the number of cases in which it can be done. 1997. You have, I suppose, the same treatment in the military hospitals in the protected and un- protected stations ? — Yes, virtually the same, on Dr. Cameron — continued, account of the same individual shifting from one to the other, 1998. You show here a very much larger ratio of secondaries to primaries in the protected than in the unprotected districts ? — Yes. 1999. How do you explain that? — I gave an instance illustrating it that occurred to myself in the West of Ireland, where I had a vast number of primary sores in one station, and a small amount of secondary syphilis. I went to the other station, where I had a very small number of primary sores, and an equally large proportion of secondary syphilis as in the station that I had left, where the primary sores were chiefly con- tracted. A secondary case is a thing which occurs two or three or four months after the primary sore has healed, 2000. You, as I understand, explain the higher ratio by the transfers ? — That is so, to a considerable extent. 2001. Is there any other explanation that you can give '/ — Nothing beyond that ; the cases will occur very mitch as the primary cases are occur- ing at the place where they are. 2002. May I take it that you consider that the transfers constitute the exjjlanation alto- gether ? — No. You may have an increase of jjrimary sores at a station, or series of stations, and you will have, resulting from that, whether they occur at the same station or elsewhere, a l^roiDortionate number of secondaries. 2003. What I want to have distinctly stated is, whether you explain the high ratio of secondaries to primaries, in the protected dis- tricts, by the transfer of cases in which the primary sore had been contracted? — I think that is the chief thing. 2004. If there is anything else, will you mention it? — I have admitted that the seconda- ries seem to follow in the protected districts in a slightly higher ratio, that is to say, in a ratio of 36 to 100,^instead of 33 to 100, so far as I have been able to get the facts as to the admissions of secondaries at the two sets of stations. That would give, in the protected districts, about one- eleventh more of the secondary cases than you would have from an equal number of sores as they occur in the unprotected districts. 2005. But the really important thing, I sup- pose, is the transfer ? — That is the really im- piortact thing. 2006. Have j^ou ever worked out what the result of the transfers would be ? — I have endea- voured to work it out. 2007. I have tried to work it out, and it seems to me that the transfer must tell in favour of diminishing the ratio below its proper proportion in the protected districts, and increasing it above its prosier proportion in the unprotected districts ? — It must operate the other way, 2008. Let us work it out ; in the unprotected stations you have got a much higher ratio of primaries than you have in the protected sta- tions ; that is admitted ? — Yes, in later times. 2009. If you lake 1,000 men from an unpro- tected station and draft them into a protected station, you increase the number of primaries in that protected district, do you not? — No. 2010. Suppose that you draft 1,000 men from an SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS, 97 4 April 1881.] Inspector General Lawson. \_Cofitinued. Dr. Cameron — continued, an unprotected station to a protected station, and vice versa, replace them by 1,000 men from the protected station, and send them into the unpro- tected station, will not the result be to give you fewer than the normal primaiy cases in the un- protected district, and more than the normal pri- mary cases in the protected districts ? — No ; I think j'ou do not notice that if you take 1,000 men from the protected districts, we will say from the year 1870 to the year 1873, which is a period when the Act was in force, and we had not Lord Cardwell's Order, the 1,000 men in a twelvemonth in the non-protected district would have had 86 cases of primary syphilis. The 1,000 men in the stations under the Act during the same period would have had 52'5, that is to say, there is a larger number of sores in the non- protected districts than in the protected dis- tricts. 2011. What I want to get is the effect of the transfers ; must not the effect of the transfers always be to increase, abnormally, the number of primaries in the protected districts, and to de- crease the number of primaries in the unpro- tected districts ? — That is what I have been saying all along. 2012. Then we are at one there. "Would not the necessary result of that be to show that your ratio of secondaries to primaries is abnormally and unfairly low in the protected districts, and abnormally and unfairly high in the unprotected districts ; in other words, does it not show that your ratio of 56 in the protected districts should be something more like 60 or 70, or whatever it may be, and that your 42'2 ratio in the unpro- tected districts should be something less? — No. 2013. Then how do you make out that ? — We dealt just now with the primaries, but while your 1,000 men in the unprotected districts had 86 f)er 1,000 primary sores, they would have, as a consequence, upon that 86 per 1,000 a fixed or tolerably fixed proportion of secondary symp- toms. Part of these would be developed in that district and part of them would be developed in the other district. The 52'5 men in the disti'icts under the Acts would have a fixed proportion of secondaries developed in proportion to the inter- course. 2014. Then you are again begging the ques- tion of the duality of the disease ? — By no means. I admit it. It is quite immaterial to the argu- ment. 2015. It is altogether material to the argu- ment ; what I want to show is this : that if you admit the duality of the disease, you can explain the facts ; if you do not admit the duality of the disease, I want to hear the explanation ? — Then, if you do not admit the duality of the disease, I maintain that the duality, or the unity of the disease has nothing to do with these things. We know from the experience of the whole army only about one case of secondaiy syphilis appears for every three cases of primary. Then there must be something that keeps two-thirds of those Dr. Cameron — continued. cases from developing into constitutional syphilis if it be all the same virus. 2016. Let us keep to the point; the point is this : I say that the transfers increase abnormally the number of primai-ies. Supposing that 1,000 men go from an unprotected to a protected dis- trict, they carry with them a larger amount of primary sores, do they not, than the men in the protected district? — The primary sores will have got partly healed, because they heal up in a short time. 2017. Then has Lord Cardwell's Order any effect? — Decidedly, because there were a great number of primary sores which were not re- ported. 2018. And when this regiment goes from an unprotected to a pi'otected district, the whole number of sores which have not been reported are examined and detected, are they not? — They are examined and detected. 2019. Then have the numbers increased by that ? — That is just a point about which I want to give you a caution. These sores will heal and are healed in a short time, so that a very small number of them will come to be transferred at that period. 2020. But how long do you consider to be the time between impui'e coitus and the appearance and the cure of a true venereal infecting sore ? — It has been stated, and the belief at the present time is, that the true venereal sore takes 10 days to a month before it appears. 2021. You are aware that a very large num- ber of people. Professor Lee, for example, would state that 10 days is too short a period? — Pro- fessor Lee goes for 10 days. Mr. Osborne Morgan. 2022. That is, when the local infection makes its appearance? — Yes; the true venereal sore. He admits that what is called the local sore will appear in two or three days, but the true vene- real sore is a pimple, which may occur from 10 days to a month after infection. Dr. Cameron. 2023. How long do you say that the two classes of sore would last ? — They last, taken together, from the evidence that we have, about 28 days ; that is taking the two sores together. 2024. I suppose that if you said taking six weeks from the period of infection to the period of cure it would not be at all too long ? — No ; that is for a true venereal sore. 2025. We will take them together ?—Theu the mean period would be rather less than that, but the true venereal sore would take longer ; the sore might heal but it would leave induration, which you would require to treat, 2026. What would you say would be the mean period ? — The mean period would be about :j8 days. 0.44. 98 MINUTES OF EVIDENCE TAKEN BEFOEE THE Monday, 2nd May 1881. MEMBERS PRESENT ; Dr. Cameron. Dr. Cobbold. Colonel Digby. Dr. Farquharson. Mr. William Fowler. Mr. Massey. Mr. Osborne Morgan. Mr. O'Shaiighnessy. Mr. Stansfeld. , Sir Henry WoltF. The Eight Honourable W. N. MASSEY, in the Chair. Inspector General Lawson, re-called; and further Examined. Chairman. 2027. I BELIEVE you have a Paper to hand in which was asked for at the last meeting of the Committee ? — A Eeturn was asked for at the last meeting of the Committee by Mr. Stansfeld and Mr. Hopwood, and I will now -^ut that Return in {the same ivas handed in). There is one point which I should like to mention with regurd to Return No. 6 A., which I handed in previouslj'. That Return is based upon a Return which I obtained from the Army Medical Department; but in compiling the Return which I have just handed in I found that the secondary syphilis for Windsor was included with London for 1867 and 1868, and it was proper to transfer a portion of those cases from London, which was not under the Acts, to Windsor, which was under the Acts. I carried the alterations right through in No. 6 B., and the Return which is now printed has all those correctly. Dr. Cameron. 2028. I asked you if you could let me have a Return showing the statistics of gonorrhoeal sequelae ; have you been able to obtain such a Return ? — The Return has been in preparation, but it is rather a complicated one, and it has not been completed yet. I have been inquiring about it this morning. 2029. Would you inform the Committee whether there is any difference in the treatment of the different venereal diseases throughout the Army, or whether they are all treated upon one uniform principle ; that is to say, is syphilis both primary and secondary, uniformly or generally treated in the same way ; does every surgeon, in treating gonorrhoea, act upon his own discretion, or does he act according to regula- tions ? — He must act according to his own discre- tion, so far as applying remedies go. 2030. But 1 am asking you as to the general nature of the remedies ; for instance, as you are aware, Carmichael went in largely for cold water in the treatment of syphilis ; would a surgeon be allowed such latitude as that ? — Certainly ; it is left to his own judgment entirely as a medical man. Dr. Cameron — continued. 2031. But what is the general mode of treat- ment of, say, primary venereal sores ? — Venereal sores are generally treated by local remedies until some evidence of constitutional symptoms appears. 2032. A member of the Committee asked a question leading one to infer that mercury was never used in a case of primary sores, and that an expectant treatment was always resorted to ? — I would not like to say that that was always the case, but 1 believe that that is the general practice. 2033. Then does the Director General, for instance, recommend a certain line of treatment? — No, it is left entirely to the medical man in charge of the case. 2034. Have you any idea as to the length of time for which an ordinary primary sore would remain unhealed if it was not treated ? — That would depend very much upon what the man did, and whether he was carei'ul in keeping it clean, and so forth. 2035. I supjiose three or four weeks would not be too long to take? — Taking one case with another, I should think not ; in fact, I am certain it would not, because, even with the best treat- ment, it will take nearly that time. 2036. Then we might take longer, say six weeks ? — It might be six weeks ; I will not be positive upon that point, because it is a point that we never wait to try. 2037. But I am referring to the large number of cases which under Lord Cardwell's Order must escape detection ; and my reason for asking the question was its bearing upon the difference of the ratios of secondary to primary syphilis in the protected and the unprotected districts ; would you state from the Return No. 6 B. what the ratios in those districts respectively are ? — The percentage of secondary to primary venereal sores in the period 1867-72, in the stations under the Acts, was o7'6. 2038. Against 31-2 In the unprotected districts ? — That is so. 2039. And in the latest years, from 1873 to 1878, it was 56 in the protected districts, and 42 "4 in the others. — Yes. 2040. I think SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 99 2 May 1881. J Inspector General Lawson. [ Continued. Dr. Cameron — continued. 2040. I think, you informed the Committee that when troops marched from an unprotected to a protected district, they underwent an examination ? — Yes, on going into a protected, district. 20-41. So that all the primary disease in the body moved would be detected, and would go to swell the amount of primary disease in the hospitals in the protected districts ? — Yes. 2042. And it would thereby diminish the ratio of secondaries to primaries by increasing the primaries, and leaving the secondaries the same ? — It would so far have that effect. 2043. Therefore, that is one cause which would lead us to infer that the ratio of secondaries to primaries, as stated in this column, is rather under the mark than over it? — So far as that immediate question goes ; but of course there is a much larger question to come against this. 2044. On the other side, in the case of the movement of the troops from a protected into an unprotected district, they do not submit to any examination, I suppose, either on leaving the protected district or entering the unprotected district ? — Usually they do not submit to any examination on leaving the protected district ; it is optional with the protected disti-ict to examine them or not ; J believe that they are not gene- rally examined. 2045. Then you would have a month or six weeks' accumulation of primary disease acquired in the protected district sent into the unprotected district, would you not? — Yes. 2046. It w^juld not appear in the return of primaries in the protected district ? — No. 2047. But the results would appear in the amount of secondary disease ? — It might appear in the amount of secondary disease in the unpro- tected district. 2048. It would, therefore, swell the amount of secondary disease in the unprotected district, would it not ? — By the amount to which it was carried. 2049. Without correspondingly increasing the amount of primary disease ? — No, that is the point which I wanted to explain. 2050. But in hospital?— In the unprotected district you would have, exactly as in the pro- tected district, cases that went there, and although they were not detected by medical inspection, the men might still come forward and report themselves. 2051. I quite understand that, but we have had it stated again and again that the effect of Lord Cardwell's order was to bring about the concealment of disease ; is not that so ? — Yes. 2052. And that is especially likely to occur with a disease often entailing such slight inconvenience as primary syphilis, is it not? — Yes. 2053. Then my^ argument appears to be cor- rect, that the transference of men from a pro- tected to an unprotected district would not increase the number of admissions for primary syphilis in the unprotected district, but would increase the result in secondaries ? — It would increase the result in secondaries, but I cannot admit that it would not increase the result in primaries as well. 0.44. Dr. Cameron — continued. 2054. But not to the same extent as If the men had been examined ? — Quite so ; and the dif- ference between the two is a very small differ- ence. 2055. Would not that, pro tanto, render the figures in the last column of this Return, the per- centage of secondary or primary sores in unpro- tected districts, higher than they should be '.' — Certainly it would tend to show that ; though I give that, of course, with the reservation that this forms a very small portion of the total. 2056. I merely ask vou whether it would not be so, pro tanto'i — Certainly, 2057. Therefore, pro tanto, the ratio given in the protected district comes to be too low, and, pro tanto, in the unprotected district it comes to be too high ? — Yes. 2058. Therefore we have it that in the pro- tected district you have a ratio of over 56 of secondary to primary syphilis? — Fifty-six per cent, on the primaries admitted. 2059. As you admitted, there are more than that 56 per cent. ? — Still we are dealing with ratios backwards and forwards, and it is neces- sary not to mix up the one ratio with the other ; ray object is merely to keep them clear. 2060. You have admitted that the ratio given was, pro tanto, too low in one case, and, pro tanto, too high in the other case ? — Yes, no doubt. 2061. You said, I think, that in the case of a movement of a body of troops from an unpro- tected district to a protected district you have an examination, and all the men with primary venereal disease are discovered and are sent into hospital ? — Yes. 2062. The effect is, therefore, abnormally to increase the number of primary cases ad- mitted into hospital in the protected district ? — Yes. 2063. And by tliat amoimt to diminish the ratio of a given number of secondaries to the primaries? — Certainly, that would be the effect, so far as it goes. 2064. And you have the converse effect in the other case ? — Not exactly the converse effect. 2065. You have got, so far as it goes, the con- verse effect ? — So far as it goes. 2066. What I ask you, therefore, is (and it seems to me to be a matter of mathematical deduction); must it not, therefore, follow that the ratio of secondary disease found in the protected district to the primary disease recorded there is higher than the figures shown by the method necessarily adopted ; that is to say, above the 56 ? — Yes, it will be higher by that little sum, whatever it may be. 2067. And it will be lower in the other case than 42 ? — It would be, to a certain extent, lower. 2068. You have, therefore, a difference of effects shown in the protected district and the unprotected district greater than the difference between 56 and 42. As a medical fact, given the same disease, the same patients, and the same general treatment, should you not have the same results where you come to that with thousands N 2 of 100 MINUTES OP EVIDENCE TAKEN BEFORE THE 2 May 1881.] Inspector General Laavson. [ Continued. Dr. Cameron — continued, of cases ? — By no means : because the primary disease is a thing which makes its appearance shortly and for the most part in the district where it is contracted ; but the secondary disease is a thing which may not appear from two to 12 months after, and in the mean, I should say from four to six months, is the period which elapses between the contraction of the primary disease and the appearance of it. 2069. But that is not my question : given the same disease, the same patients, and the same treatment, should you not have in this large number the same result? — This is essential to that understanding of the case ; that there is a large transference of people between the time of their contracting the primary disease and displaj-ing the secondary disease, and that trans- ference has the effect of sending a large number of secondary cases from the stations where they are contracted into the other set of stations before they are manifested. 2070. But as you have just admitted, the effect of those transfers is to augment tlie ratio in the protected district, and to diminish it in the unprotected district? — That is in the case of primary symptoms ; but I am now giving you one of those things that come in to completely dissipate that by something far greater. 2071. That would be so if the movement of troops had the reverse effect of that which you admitted that it has ? — No, if you have a set of stations where you are contracting syphilis at the rate of 100 per thousand per annum, and another set of stations where you contract syphilis at the rate of only 50 per thousand per annum, and you take 1,000 men from the places where they are contracting at the rate of 100 per thousand, they will carry a far larger number of secondary syphilis with them than they will from the place where they are only contracting at the rate of 50 per thousand. 2072. But as you are aware there is another theory, viz., that the two classes of venereal sores are not the same, and that the detachment tliat takes venereal sores with it at the rate of 50 per thousand, takes venereal sores which will even- tuate in syphilis ; whereas the detachment which takes venereal sores at the rate of 100 per thou- sand brings with it 50 which are non-infecting, and 50 which are infecting. I do not say which theory is correct; but is there not such a theory ? — Such a theory has been advanced, but without any adequate reason. 2073. But would not that theory explain tiie difference of the ratios? — No, I gave you a case that occurred to myself in the West of Ireland, where I had a certain number of men under my own observation, and there was a large quantity of primary syphilis m one place and a small pro- portion of secondary syphilis ; and when we went to another station we had a large development of secondary syphilis, and the priniaiy cases were very few ; and that must take place ; there is no help for it. 2074. I repeat that question that I put before : given the same disease, the same patients, and the same treatment, should you not have the same results ? — Certainly ; we should have the Dr. Cameron — continued. same results, provided that you keep the people at the same stations. 2075. Given the same disease, the same men, and the same treatment, what earthly difference can it make in the result ? — The fact of whether a station is under the Acts or not under the Acts makes all the difference. 2076. I put the question without any allusion to the effect of the answer; I simply ask you whether, given the same patients, the same treat- ment, and the same disease, you should not on a million cases have the same results?— I admit that on your postulate you should have the same results. 2077. A question of considerable importance, as it seems to me, is what will be the effect of short service; what was the length of service 10 years ago, and what is it now ? — Ten years ago it was 10 years' service, and now I believe it is nomin- ally six years, but it has been varied a good deal, and of course it alters with regiments going abroad. 2078. With regiments at home, what is it? — Regiments at home are so much composed of young men, and men of longer standing, that you cannot be positive as to all the men having one length of service. 2079. The shorter your term of service the smaller must be your amount of secondary syphilis ; is not that so ? — That is doubtful. 2080. I think you said secondary syphilis takes from six to 12 months? — It takes six months, on the average. 2081. Supposing that it takes six months on the average, you must always have the results of the last six months' primary disease appearing after the men have left the Army? — Yes, that is so in the case of those who have only contracted it six months before leaving. 2082. rio far as secondary syphilis is concerned, you must have the result of the last six months' primary syphilis contracted in the Army making its appearance after the man has left ? — Yes. 2083. And six months must constitute a larger fraction of six years than it does of 10 years ; nearly twice as large ? — Yes. 2084. Therefore that should have a result, should it not, in diminishing the ratio of secon- dary disease ? — It would have a very small result. 2085. It would be a diminution of one -sixth, would it not ? — It would not diminish the result by one-sixth, because most of those men have con- tracted primary syphilis long before they have been si.x: years in the Army. 2086. The secondary syphilis arising out of the last six months' primary syphilis does not make its appearance in the Army Returns ? — Quite so. 2087. Therefore you have the difference be- tween six and ten?— You would not have nearly that amount. The greater portion of those men have contracted syphilis before they have been three years in the Army. 2088. How do you explain that ? — Simply by the fact that they are young men, and they get in the way of it and they get it. 2089. Of course that is true to a certain extent ; but I presume that the older soldiers are not altogether pre-eminently moral ? — True, but neither SELECT COMMITTEE OX CONTAGIOUS DISEASES ACTS. 101 2 May 1881.] Inspector General Lawson. [ Continued. Dr. Cameron — continued, neither are they pre-eminently intangible, and they have felt the consequences of previous indiscretions. 2090. At what age do they enter the Army ?— From 17 to 26, or more. 2091. And I suppose a man, after having served six years, would still be a very young man ? — He would be 23, supposing that he joined at 17. 2092. And he would be apt to be thoughtless and indiscreet ? — Quite so. I do not mean to say that he is otherwise. 2093. However, you admit that short service will give you a smaller number V — It will give a very slightly smaller number of cases of secondary syphilis. 2094. Could you tell me generally the nature of the gonorrhoea! sequelas ? — There is what is called orchitis and stricture, which is a thing which takes a considerable timq to come on. 2095. Is stricture classed as one of the sequelse ? — Yes; and there may be inflammation of the bladder with it, which is not at all common. 2096. Would you class gonon-hceal rheumatism as one of the sequela3 .'' — Gonorrhoeal rheumatism is not frequent, but it is classed amongst the sequelEe and gonorrhoeal ophthalmia also. 20!t7. Do you class all those as sequelaj : is stric- ture always classed as a gonorrhoeal sequelaj? — Yes, that has been hitherto classed as one of the sequels. Mr. IVillinm Fowler. 2098. In your evidence in 1879 I think you said that you considered that the 14 subjected stations and the 14 selected unsubjected stations might be compared ? — Yes. 2099. In your diagram which is contained in your table, I think the upper line is the 14 stations never under the Acts, and the lower line the stations always under the Acts ? — Yes. 2100. Those run very parallel all through? — ■ Yes. 2101. But you will admit, will you not, that those never under the Acts are decidedly lower than the others? — Certainly. 2102. I do not know exactly why you selected those that were the highest, and did not take the whole ? — -The 14 non-subjected stations were originally selected as containing 500 men. The selection was not made by me, but was made in the Army Medical Department Office, by Dr. Balfoui-, who was then in charge of the Statistical Department, and took those stations containing 500 men as having a sufficient number of men to justify some inferences frona them. 2103. I want to understand exactly your evidence on another point: from 1860 to 1863 I think you will find, if you take the stations under the Acts, and those not under the Acts, there was a continuous fall in both classes of stations, practi- cally a parallel fall; and that was before the Acts, was it not ? — That was before the Acts. 2104. And therefore it could not possibly be caused by the Acts ? — No. 2105. And yet the fall was then going on rapidly ? — Yes. 2106. In 1863 to 1866, the date of the second Act, there is a fall going on also in both sets of 0.44. Mr. William Foivler — continued, stations? — There is a considerable rise in 1864, and the fall to 1866 in the 14 stations never under the Acts is decided ; similarly there is a rise at all the stations never under the Acts ; but at the 14 stations which come under the Acts there is a fall without any rise, though with a little irregu- larity. 2107. Then if the first Act of 1864 was the cause of the fall in the subjected stations, to what do you attribute the fall in the unsubjected stations? — I do not attribute the Act of 1864 alone as the cause or' the fall, but there is that which I think overrides the whole of this question, that is to say, the alterations in the incidence of the disease in the country which overrides these Acts altogether. 2108. You think that there has been an im- provement as regards the disease all over the country, and that that affects both sets of stations? — There was an improvement at that time ; from 1860, onwards, there was a gradual reduction in the incidence of the disease all over the country until 1866 at all the stations. 2109. That is your theory, but yoti have no evidence on that point ? — On the contrary, here is the evidence in this diagram. 2110. You think that that diagram shows that there must have been a cause at work apart from the Acts, and outside the Army ? — It is outside the Army. 2111. But I thought there was a great change as regards the character and conduct of the Army and the habits of the soldier at that time ? — I am not aware of it ; but this is not a thing that has happened in this Return for the first time ; on the contrary, it is very obvious from returns placed before the Committee in 1879, that the thing had gone on from 1830 to 1846, long before these Acts were thought of, so that this is not au isolated point by any means. 2112. Does that argument apply in the case also of the fall from 1869 to 1877, say, which is very similar ? — It applies there also ; if you look at the table at the side, the fall at the fourteen stations never under the Acts, was to 98 in 1866; it rose again to 115 the following year, with a slight fall again, and then in 1869 it was up to 128, and then it fell again to 1871; and we find a corresponding fluctuation in all three sets of stations ; further than that, we find from the Registrar General's Returns as to the general health of the country that the same thing took place with regard to syphilis. 2113. You admit that the principal fall took place before the Acts came into operation ? — Yes, certainly. 2114. And the fill has been continuous both at the stations under the Acts, and at the stations not under the Acts, down to 1877 ; at any rate, if I understand your answer, it comes to this : that the fall is not occasioned by the Acts princi- pally, but by other causes? — There is one large cause dominating everything, and that is the incidence of the disease in the country ; and before we can get at any influence of the Acts we must eliminate that. 2115. I should like to ask you a question with regard to some rather peculiar discrepancies that there are in the subjected and the unsubjected N 3 stations ; 102 MINUTES OF EVIDENCE TAKEN BEFORE THE 2 Maij 188].] Inspector General Lawson. \_Continued. Mr. JViUiam Fowler — continued, stations ; you will find, I think, that one of them hapjoened in the years 1862 and 1863 ; there was a rise in the one, and not a rise in the other ? — Yes. 2116. Then again in 1S66 and 1867 you find the same thing occurring, and in 1868 and 1869, just before the third Act passed, there was the same thing ; do you think that that had anything to do with the extraordinary movement of prosti- tutes just at the time the Act was passed; have you considered that point at all ; I daresay you remember the figures ; I will just refresh your memory, if you like, from Captain Harris's Report of 1880, page 4 ; you will find in the year 1869 the total number of registered women was 4,176, and 998 left the district. In the next year, 1870, there were 5,389 regislered women, and 1,558 left the district; that would materially affect, would it not, the figures of which we are talking ? — Yes. 2117. Between 1868 and 1870 there was an extraordinary discrepancy, there being 3,870 registered women in one year, and 5,389 in another: and 1,738 left the disti-ict in one year, and 1,558 in the other ; that would materially distui-b these figures, would it not ? — It is possible that that might affect tliem. 2118. Being soldiers' women they woiddgo to the unsubjected districts, would they not? — We have no evidence of where they went to. They might accompany a regiment, but we have no evidence upon that point. 2119. However, the fact remains unquestion- ably, that they did leave in large number? — I do not question that at all. 2120. You may not remember the case perhaps that was given in the Lords' Committee of 1868, when they left Portsmouth in large numbers, and went to Winchester, which was not under the Act ? — Yes, but thei-e could not be many at Winchester ; it is a small place, and they could not live there. 2121. If a considerable number of women come suddenly from a subjected district to an unsubjected district, that makes the comparison rather difficult, does it not?^ — That would, of course, introduce an element of disturbance. If you could get the exact number that left, and the places that they went to, you might be able to make some application of it ; but the number that would go, and where they would go to, we can- not assume without having some definite infor- mation. 2122. Still it is a disturbing cause, is it not, and one rather difficult to deal with? — It is a disturbing cause, without question. 2123. I think that you have given it as your opinion that there is an equality of condition be- tween the two classes of stations in all respects except the Acts ? — On the contrary, I think you will find that I made use of those stations for the purpose of getting at the incidence of the disease in the country by comparing one station at one time with the same station at another time. 2124. But I thought you said that there was an equality of condition between the two classes of stations, except m regard to the Acts ? — In what respect. 2125. Generally ? — I never said that. Mr. Osborne Morgan. 2126. I think you stated distinctly that the stations which were afterwards subjected, would prima facie show, independently of the Acts, a larger incidence of the disease than the stations not protected ? — Yes. Mr. IViUiam Fowler. 2127. But the equality of conditions, as re- gards the general condition of the stations, as far as regards the conduct of the Army and everything connected with the Department and the management of the troops, and so on, was equal, excepting as to the Acts ? — So far as the management is concerned it was so ; that is to say, the same amount of sanitary measures were introduced, and means for occupying the men, as far as they could be introduced, were adopted to the same extent, and at about the same rate, in both classes. . Mr. Oshurne Morgan. 2128. But did you not state that one reason why these protected stations were selected for the purpose of protection was, that the incidence of disease was greater there than at the other stations ? — They are lai-ge stations, and there was a greater jjrevalence of disease. ]Mr. William Foioler. 2129. That is, as regards the temptations sur- rounding the soldier ; I am speaking of the con- ditions generally for purposes of comparison ? — That embraces a good deal more. There has been a question raised that you could not com- pare one station with another; that is to say, M anchester with one of the camps ; now, I have never compared Manchester with one of the camps. 2130. But still we must have some equality of conditions to go upon, or we cannot legislate? — I showed you wherein the equality lay ; that I compared Manchester from 1861 to 1866 against Manchester from 1867 to 1872, and so on. Now you cannot have a faii'er comparison than com- paring Manchester against itself, and so with regard to every other station that was not under the Act. 2131. Then you grouped them together in your evidence of the 4th of April, and you said that the diftereuce in j-our mind was, that in one case the Acts were applied, and in tlie other they were not. I gather that you regarded the con- ditions as equal ?-- I expressly stated that I gave those places for the purpose of testing the altera- tion in the incidence of the disease over the country. 2132. We are told to compare a number of stations, subjected and non-subjected, and we are given figures, which we are told are sufficient for our purposes of legislation. There are two or three points on which I do not think it is quite so easy to compare them without great qualifi- cation. There is an examination of soldiers on entering a subjected station, and there is no ex- amination, as a rule, on entering an unsubjected station? — I believe not since 1859. 2133. That SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 103 2 May 1881.] Inspector Genei-al Lawson. [ Continued. Mr. Osborne Morgan. 2133. That is only on entrance, is it ? — Only on entrance. Mr. William Fowler. 2134. You would, therefore, debit the sub- jected station with ihe disease that you discover at once ? — Yes. 2135. You said just now to the honourable Member for Glasgow that the disease might have been contracted elsewhere; that is a disturbing element, is it not? — It is a disturbing element of which I have given the Committee due notice. 2136. But it exists?— I admit that. 2137. Then again you, at the subjected station, by examining the man at once and putting him into hospital, prevent his propagating disease ? — Yes. 2138. But in the unsubjected station you let tbe soldier go at once and jDropagate disease all over the place, without interi'ering with him ? — He may do so. 2139. Does not that interfere materially with the comparison ? — To a very small extent. Take one of these large towns ; if you reckon up the number of men of soldiers' age who are living unmarried in the town and doing the same as the soldier does, you will find that he is about one in 20 of the number. 2140. I think that does not affect my point at all? — I think it affects it most materially. The soldier is only the 20tli person that jjropagates the disease. You asked me whether he propa- gates the disease ; I will admit he will do so if he does not report himself ; but I maintain that the disease that he meets with there is not propagated by him except to a very infinitesimal amount. There are 20 other men of his own age who are propagating disease, and he has the advantage of their acts. 2141. Still you admit that he is pro tanto one of the propagators ? — Yes. Mr. Osborne Morgan. 2142. But he is an insignificant factor in the problem ? — -He is an insignificant factor. Mr. William Fowler. 2143. That is your opinion? — That is my opinion after having gone into the calculation. 2144. Still it is evident that to that extent that is a disturbing element in the calculation ? — Certainly ; it is a very small one, but it is a disturbing element, no doubt. 2145. I do not quite undei'stand a remark which I see you made some time ago, in which you spoke of an experiment; you consider the Acts as an experiment? — The Acts were introduced, and observation was made as to what their effect was. You may describe it in that language or you may describe it as an ex- periment, the result of which you are watching. 2146. In order to do that satisfactorily you must have the experiment under equal con- ditions, must you not? — You must not have the experiment under equal conditions ; you must alter the conditions to find what the effect of the alteration is. 2147. If you have one station to compare with 0.44. Mr. William Fowlei — continued, another, and the Acts are the factor of difference* you must have the other circumstances as like as you can, must you not ? — But you perceive I do not compare one station with another. On the one hand 1 make use of one set of stations to eliminate the incidence of disease in the country, and for that purpose alone, and having done that, we may then make use of the Acts to see what thej' have done beyond that. 2148. Do you give up the comparison of the two sets of stations ? — I never have compared them directly ; on the contrarj-, I have constantly stated what I now state, that the use of those stations is to find the alteration in the incidence of the disease in the country. So I stated dis- tinctly in my evidence of 1S79. 2149. With reference to the difference between the various stations, is there not ample hospital accommodation for women in the sulijected dis- tricts ? — Yes. 2150. Aud there is not in the other districts, excepting in the case of London and Dublin ? — There is elsewhere too, to a small extent. 2151. Then a woman cannot get the same assistance in the unsubjected district that she can in the other ? — No- 2152. Therefore, I suppose, you would say that she would go on spreading disease to a greater extent in the unsubjected district? — No doubt. 2153. And that would be unfavourable to the comparison? — Distinctly so. 2154. That makes a difficulty in the compa- rison, does it not ? — No, by no means. The use of the comparison is to show the value of the hospital. 2155. But it makes the figures tell against the unsubjected districts more than they ought to do, does it not ? — Not more than they ought. It makes them tell against them no doubt, but it shows that where the women are made to submit themselves to treatment, the disease has dimi- nished, and that is the whole case. 2156. Then taking the whole thing, you do not admit that the two sets of stations are under equal conditions for the purposes of the Acts ? — T do not compare them directly one with the other for the purpose of the Act.;. 2157. You give that up ? — I never have done so. 2158. Then you remark that the migration of prostitutes is another point which, as we said just now, disturbs the comparison a good deal ? — That will affect it, no doubt, to some extent. 2159. Notwithstanding all the care that has been taken in the subjected stations, I under- stand from your diagram that the fall from 1870 to 1877 has been pretty parallel in both sets of stations ? — The difference of fall commenced from 1866, and after that the difference went on increasing uutil 1870. From 1870 they have been pretty parallel. 2160. Notwithstanding all that has been done in the subjected stations for the purpose of dimi- nishing disease, the fall has been pretty much the same there as in places where nothing has been done ? — The fall has been owing to the altera- tion of the incidence of the disease in the country and the concealment of the disease, which would N 4 be 104 MINUTES OP EVIDENCE TAKEN BEFORE THE 2 Mmj 1881.] Inspector General Lawson. [ Continued. Mr. William Fowler — continued. be higher in places where you have a large number of cases than in places where you have a smaller number of cases. You will find that in 1878 there was a very much greater rise at all the stations which had never been put under the Acts than at the stations under the Acts. 2161. I notice that; but I put tne year 1877 in order to eliminate that peculiar difficulty arising from the Reserves being called out ? — I apprehend that it is due to more than that, although I am aware that that has been stated as the cause. 2162. I always understood that these official returns were given to us for the purpose of com- paring diiferent sets of stations ? — That is very true ; but they are given to you to compare those stations as far as you may legitimately do so. 2163. Then the figures alone are of no use? — The figures alone, without proper explanations of what the effect of the figures is, would not be of much use, and I apprehend that I come here to state what the figures teach statistically. The subject is a very complicated one, and unless a person goes into it fullj' he will commit no end of errors by taking the figures as they stand without being able to interpret them. 2164. "With regard to some of ihese peculiar subjected stations, 1 see that they have higher ratios of disease than some of the unsubjected stations? — Yes. 2165. Taking, for instance, the period from 1870 to 1873, which was pretty free I'rom dis- turbance, Athlone and Pembroke have lower ratios than seven out of the 14 subiected stations? —Yes. 2166. And Aldershot, which is subjected, is higher than Edinburgh which is unsubjected; and Windsor, which is subjected, is higher than Hounslow and Belfast ; do you think that arises from the peculiar circumstances of the situa- tions? — If we take a period anterior to the application of the Acts in Return No. 5, and if you will refer also to Return No. 7, in the evidence of Dr. Nevin in 1880, at page 30, I shall be able to answer that question. Mr, Osborne Morgan. 2167. That is for the period before the Acts came into operation ? — Return No. 5 is for the period from 1861 to 1866. If you will refer to any one case in that table I shall be able to give you a reply to it. They are bracketted there to a certain extent one with the other. Mr. William Fowler. 2168. There is Athlone?- — Athlone there has a ratio of 27 per thousand. Athlone in the other table you will find has a ratio of primary venereal sores of 91 per thousand. 2169. That is in the old period? — That is before the Acts were in force at all. 2170. But Athlone is an unsubjected station? — Athlone is an unsubjected station and a small station. You will find in these smaller Individual stations great fluctuations in that way. 2171. And there is no way of accounting for these fluctuations ? — There is simply the general fact that if you take a single station you may Mr. William Fotoler — -continued, hit the mean or you may not hit the mean ; but if you take a nauiber of them you will get the mean from them. If you compare tliis table of Dr. Nevin's with the table which I have given, you will find that in nearly every case where there is a station under the Acts there has been a great reduction ; whereas in the cases he men- tions there has frequently been an increase. j;172. At Pembroke I do not think there is very much difference; Pembroke is 31 in Dr. Nevin's Return, and in the other it is 57 ?— It is ; there is a fall in that case, but comparing it with another place, at Dover, in the one list the number is 35"3, and in the other list you will find that it has come down from 99-9 or from 100 you may say ; so that the fall is very much greater in those stations which have been under the Acts than in those which have not been under them ; and that is brought out still more strongly by putting them altogether in a single group. ^ 2173. Of course these isolated places are very difficult to base an opinion upon, but I did not quite understand the way in which you put it the other day. There is one curious thing which I have noticed which I cannot quite make out. In Sir William Aluire's evidence there is an Ap- pendix, at page 156 of the Report of 1879, which says tliat there were no admissions for dise9.se at 31 stations, having an aggregate average annual strength of 2,141 men; is not that rather a remarkable fact ? — No, it is quite compatible with correctness. Those stations embrace a great many small places where you have six, or seven, or eight men, who are generally selected men, old and married men, who, of course, have very little likelihood of contracting disease. 2174. Y"ou mean to say that these figures are very difficult to work, because of the great dis- crepancies of conditions and circumstances ? — They are difficult to work if you attempt to base any conclusion upon a small mnnber. 2175. I have been surprised to find the enor- mous difference between one regiment and another in the same camp; take Aldershot for instance : in 1868-9, when the Acts were in operation, the different regiments I see varied from 23 per thousand to 142 per thousand ; how do you account for that under exactly the same circumstances ? — Y'^ou find these differences, and, finding them, you must get such a mass of people together as will neutralise the one against the other, and you must deal for that reason in all such matters with the largest number of people you can get, and the longest pei'iods you can get, to suit the purpose. If you venture to draw conclusions from one Tegiment or the other, you would be very far wrong ; but if you take the mean of those regiments it will be very close to the mean of the whole camp. 2176. If you compare, for instance, the lowest subjected station witli the highest unsubjected station in similar years, you do not find so much difference as you do between two regi- ments in the same place and under exactly the same circumstances ? — That is a fact, which we observe, and there is no disputing the fact. 2177. Does not that create an immense diffi- culty in using those figures ? — By no means. In dealing SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 105 2 May 1881.] Inspector General Lawson. \_Continued. Mr. William Fowler — continued, dealing with statistics you deal with averages, and you are obliged to throw tlie figures into averages to get rid of such discrepancies as you are alluding to. 2178. Does not the condition of the men de- pend more upon their character ? — I believe it depends a great deal upon the character and upon certain measures which become regimental traditions, which are handed down from one man to another, and which influence the younger sol- diers to a great extent. That is, I fancy,, the mode of explaining this a|)parent discrepancy. 2179. But surely it is cue of those cases, is it not, in which figures are particularly liable to mislead ? — It is not figures that mislead ; the figures represent actual facts. If we are to try to account for them, we must take the facts first and then try and account for them afterwards. I have given the facts there. 2180. I believe I am right in saying, for in- stance, that in 18G8 the lowest subjected station was Woolwich, 46, and the highest unsubjected station was London, 148, and in 1869 the lowest subjected station was 41, and the highest unsub- jected station, Dublin, was 180 ; and none of those differences are as mucli as the difference between one regiment and another in the same camp ? — Such is the case, and we must accept it as a fact, for I assure you that it was a fact ; it was thoroughly examined. 2181. I do not dispute the fact for a moment. With regard to secondary syphilis, I observe in Table No. 6 b, about wiiich you were speaking to the honom-able Member for Glasgow, that the percentage of secondary syphilis on primary sores is considerably higher in the subjected than in the unsubjected stations ? — Yes. 2182. I do not think we have had any very clear explanation of that? — The explanation of that is simply this : that while in unsubjected stations men are exposed to a higher ratio of primary cases, the secondaries are not developed until an average, we will say of six mouths after the primary sore is contracted ; so that on leaving the station there are six months primary symp- toms due to that station which are only de- veloped in the next station that the man goes to. 2183. Then that would apply to an unsub- jected station ? — The same thing applies every- where. 2184. Supposing that it applies all round, yet you have more bad disease in the subjected than in the unsubjected stations ? — A certain percent- age, and for that reason ; because if you have two sets of stations beside each other, you will transfer a greater number of people with the po- tentiality, you may say, of secondary disease in them undeveloped from the higher ratio to the lower, than you will from the lower ratio to the higher. 2185. That would go against the unprotected district, would it not?— IS o, it would throw into the protected district a greater number of cases of secondary syphilis than are sent out of it. What you see thei'e is merely the balance between the two. 2186. I confess that although it may be clear to your mind it is not very clear to mine, and I 0.44. Mr. William Fowler — continued, do not understand it ; there seems to me to be something that we have not already got hold of yet, because I should have thought that sup- posing the Acts were successful, you would have a very much lower ratio of secondary syphilis in places where all these pains are taken, and where these hospitals are, and where there is so much care than in places where no pains are taken ? — But the excess of this secondary syphilis is the result of disease contracted in those very places. 2187. But you admit on the other hand that men carry disease from the unsubjected to the subjected districts ? — True, but to a very much smaller extent. 2188. What is the evidence of that ?— The evidence of that is that the primary sores in the subjected districts are very much smaller in quantity than in the unsubjected districts. 2189. But we are infoi-med by some witnesses that the two thinos are not in exact ratio ? — I am aware that Dr. Nevins has jDut that forward very strongly, but he has adduced no proof whatever in support of it. 2190. Are you aware that the proportion between the two things is not accurately kept up ? — The difference was greater between the two sets of stations, and of course the importations appeared much higher. If you take the earlier period of 1861-1868 the importation, I believe, was from the stations that came under the Act afterwards. It will be always from the stations that have the highest ratio to the stations which have the lowest ratio of primary sores. It must be so ; there is uo avoiding it. 2191. There is a curious discrepancy in these tables. You said in your evidence, I think in 1879, when you were asked to divide the sub- jected stations from the unsubjected stations, with regard to secondary syphilis, that it was im- possible, but afterwards that was given ? — If you will refer to the evidence of 1879, I think you will find that the reason assigned for its being impossible was that secondary syphilis which arose from disease contracted in one set of stations was frequently not developed until the men went to another set of stations, and that is what I am repeating now. There is comparatively little difficulty in giving the figures, but I cannot accept those figures as being an exact representa- tion of the case, and that was the reason all along for not giving them. Of course we never meant to say that the figures could not be given, but only that when you got them you could not make use of them. 2192. The second and third set of figures, I think of 1880 and 1881, in a table handed in by Sir William Mill, Table, No. 2, give a higher ratio in every year before 1871 for the two sets of stations, after which the ratio of the two sets agrees. These figures are higher than those which were given in the last tables that you put in ? — They are somewhat different. 2193. I recollect that we examined you on thatpoint before, and you said that the discrepancy was not very easy to account for ? — No, these had not been fairly checked over, and up to 1870 the numbers are differently grouped altogether from the other tables that have been given in. O 2194. Is 106 MINUTES OF EVIDENCE TAKEN BEFORE THE 2 May 1881.] Inspector General Lawson. [ Continued. Mr. William Fowler — continued. 2194. Is there any explanation that we have not had about that ; is it the fact that in the first set of figures only the forces were included which had been in England for one year ? — Yes, that is the figures made use of up to the time that this return came out. Only the regiments that were at home for a complete year were used. This Table, No. 3, for 1880 contains the whole forces at home. 2195. In the second and third Tables we have the whole forces ? — Yes. 2196. Is that quite satisfactory as regards secondary syphilis because it takes time to develop ? — Yes, but it went over the same period. 2197. Then you may have primary diseases coming from abroad which developes into second- ary ? — You may have a certain quantity of it ; but then you set against that a possible quantity exported, so that the one balances the other. 2198. But the former figures as I understand it were uufavoui'able to the Acts and these are slightly favourable? — I believe there is very little difi^erence. 2199. I want to understand the enormous difference in the figures given ; I asked you a question about it before ? — You are referring to another thing altogether. 2200. It was on this same table of secondary syphilis ? — If you will refer to Table, No. 4 on page 48, one of Dr. Nevin's tables in the Evidence of 1880, that was what you based your questions upon. 2201. There was a discrepancy as regards the number ; you gave 66 and the other was some- thing like 41. We do not want to go into that any further, excepting that I understand you admit that these discrepancies ought not to have existed and are not very easily explicable ? — There are very great discrepancies here, but they are j^erfectly explicable and ought to be explained. This is a table put forward by Dr. N evins to disprove the position which I stated in 1879, that from 1861 to 1872 the secondary symptoms diminished proportionally with the primary symptoms. I gave the actual numbers for the whole period, and I divided those numbers into four portions of three years each, and I showed that in each of those portions the same proportion was maintained. I will refer you to the part of the evidence because it is well that this point should be thoroughly understood. If you will refer to the Evidence of 1879 on page 19, Ques- tion 463, the Chairman asked me this ; " Now I will take you to the more serious form of the disease syphilis ; what is the proportion of cases of primary sores which develope into secondary syphilis? {A.) Taking the whole returns of the army from 1861 to 1872, there is a strength of 857,378 men ; and in these, during the whole of that period there was a number of admissions from primaiy sores of 73,238. The secondary cases in the same period were 24,742. Reducing those to the ratios per thousand, the primaries were in the ratio of 85"4 per 1,000; the secondaries in the ratio of 28*9 per 1,000, which is as near as possible three primary to every secondary case. (Q.) Do those proportions hold when you take shorter periods ? {A.) They hold Mr. William Fowler — continued, when we take shorter periods, until we come to the period when the stoppage of the pay inter- fered with our results. (Q.) And you find that that has upset all your calculations ? {A.) That upsets all the calculations. I may state the shorter periods, for the information of the Com- mittee. Taking the period from 1861 to 1872, and dividing it into periods of three years each, I find that from 1861 to 1863 the primary sores were 108"3 per 1,000 ; the secondaries were 34*3 per 1,000, which is 32 per cent, of the primaries. From 1864 to 1866, inclusive, the primary sores were 86'2 per 1,000." Then the right honour- able gentleman the Member for Halifax put this question to me, " Is this throughout the whole army ? " and my answer is " Throughout the whole army, at least that portion of it of which we have the returns. The secondary syphilis is taken on the return of the whole army. The primaries were 86"2 ; the secondaries were 29*9; that is 35 per cent, of the primaries. In 1867 to 1869 the primary sores were 82'9 ; the secondaries 28"7 ; that is 35 per cent, of the primaries. In 1870 to 1872 the primary sores were 65*4 per 1,000 ; the secondaries "23-1 per 1,000 ; that, again, is 35 per cent, of the primary sores. In 1873 to 1875, which is continuing the thing after the operation of the stoppage of pay, the primary sores were 54*4 per 1,000; the secondaries 25'5 per 1,000, or 47 per cent. In 1876 and 1878 the primaries were 52"4 per 1,000 ; the secondaries were 25'8 per 1,000, or 49 per cent." Now Dr. Nevins, in this Table No. 4, wishes to set aside those statements, and this is the Table that he has given to the Committee for the purpose of doing it. He has not here or anywhere contested the numbers that I gave or contested the arith- metic from them ; but he has here adopted a method which he has himself described as most fallacious, that is to say, instead of taking the periods of years which I gave as giving the real explanation of the fact, he has gone aside and taken another year, and he has divided each of those numbers by 4'18, and put it forth as a test of my theory. 2202. I do not want to go into the dispute between you and Dr. Nevins ? — It is not a dis- pute between us ; it is a matter for the Com- mittee. 2203. Probably when the time comes Dr. Nevins will answer that question, but as I under- stand it, there was a difficulty in dividing the subjected and unsubjected stations as regards syphilis, because of the passage from one to another ; that difficulty remains still, does it not? — Certainly. 2204. Therefore these figures are not very much to be depended upon? — These figures must be accepted with the full warning that they contain a great many transfers from one set of stations to the other. 2205. Then we must take them with a good many grains of salt? — You must receive them with caution. The transfers took place to a large extent, and they are all there. 2206. I do not want to labour this point at all, but I think you agree with me that there is immense difficulty as regards these ratios, on account of the passage from one set of stations to the SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 107 2 May 1881.] Inspector General Lawson. [ Continued. Mr. fVilliam Fowler — continued, the other, and the difficulty of proving accurately which has the larger ratio of the two ; and then as regards the going out of England and coming back again, that produces a considerable diffi- cuky, does it not? — With regard to the proof of it, I maintain that there is proof to a certain extent that the largest number of jjrimary sores leads to the largest number of secondaries, and the very statements that we have here made prove it. 2207. Prima facie it appears, does it not, that the worst form of disease is in the subjected stations ? — No, that is by no means established. The number of secondary cases admitted are very much reduced. 2208. Still the percentage is decidedly heavier in the subjected stations, is it not ? — Upon the primaries ; but that is a thing which you cannot found very much upon. 2209. I do not wish to put upon it more than it is worth, but there it stands. Now there is some discrepancy between the second and third set of statistics as to secondary syphilis. Sir William Muir's Table, No. 2 gives, for instance, in subjected stations in 1870, 77, and you give in Mr. Lefevre's Table, 72; in 1871, the numbers are 75 and 68 ; in 1872 the numbers are 81 and 83 ?— The Table that Mr. Lefevre had given to him had not been checked over, and I am told that this one has been checked over, and I corrected certain discrepancies in it. 2210. Some of them are very remarkable: for instance, for the whole army, Sir William Muir in 1867 gives 150, and Mr. Lefevre gives 184; and in 1878, 190 is put down in Sir William Muir's table, and 155 in Mr. Lefevre's? — But in 1867 the two tables are not comparable. The table that was sent to Mr. Lefevre gave the stations as thay came under the Acts, and in 1867 and 1868 there were several stations not under the Acts at all which came under them afterwards. In the Tables that I have dealt with I have taken the stations that came under the Acts, and kept them by themselves, so that the two are not comparable in that res])ect. 2211. I think I understood you to say in yoiu- last examination on this subject, that you con- sidered that the soldiers had more chance of con- tracting serious disease in the subjected than in the unsubjected districts ? — No, I do not think I said that. 2212. That may be a mistake of mine. Then the proportion of constantly sick from secondaries compared with the number of those sick from primaries, is of course larger in the subjected districts, whatever importance may be put upon that ? — That is only partially the case. 2213. In your evidence on the 4th of April, at Question 1804, I asked you this : " A man runs more danger of catching true syphilis iu the sub- jected stations than in the unsubjected stations?" and your answer was "To the extent of 36 against 33 " ? — That was with regard to that point. 2214. It tallies entirely with the evidence which you have already given that the proportion constantly sick from secondaries in proportion to primaries is larger at the subjected stations. I do not know that that is of any great moment, 0.44. Mr. William Fowler — continued, but it is a fact. I make it out that in the one case it is 1 to 2 '52, and in the other it is 1 to 2'80, but I do not know that it is a matter of very great moment, and it would not be fair to ask you before you had time to look into it? — The Table No. 3, that I put in, gives the ratio of constantly sick. 2215. I want to ask you one more question with regard to the fall before the Act, as com- pared with the fall since. I understood you to say that it was admitted on all hands that that fall took place quite apart from the Acts ? — Cer- tainly. 2216. And you attribute it to the general con- dition of things outside the Army, and not to the particular precautions taken about that time with regard to ablutions and the conduct of the Army altogether ? — I do not attribute it to that. 2217. With regard to gonorrhoea, I apprehend that you will admit from the Tables that the Act has had a very little effect upon gonorrhoja ? — It has had less effect upon gonorrhoea than it has had upon syphilis. 2218. But as I read your own Table, No. 1, the effect is practically just about this, that gon- orrhoea has gone on falling in substantially the same way where the Act is in operation and where it is not l — On the contrary, the fall has been greater where the Act has been in opera- tion. 2219. The fall has been greater to a certain extent, but the fall has been going on in both places ? — Yes. 2220. And the difference is so unimportant that it is not a matter which it would be impor- tant to legislate upon ? — It is less important decidedly than in the other case. 2221. That has been admitted over and over again by witnesses before Committee of the House on several occasions, and I do not want to dwell upon it and waste time. I am not sure whether I asked you a question with regard to Captain Harris's Report with respect to the increase of disease amongst registered women ; have you any theory at all upon that point? If you take the return of Captain Harris as just delivered, which is a continuation of his former return, giving the annual ratio per cent, of cases of diseases calculated upon the average number of women upon the register, you will see that they have been in the last six years rising: con- siderably. Take for instance the year 1875 ; they were then 127'43, and in 1880 they were 1 76*48. Then the annual ratio of cases of disease per hundred amongst women on the register has also risen from 65'44 to 87-59 ; I do not know whether you have any theory on that point at all upon those Tables of Captain Harris's ? — I have not studied these tables closely, and without doing that, and being well acquainted with the circumstances, I would not like to form a theory upon them. The fact is that I am not sufficiently acquainted with the details to be able to speak positively. 2222. Could you give me the references to the page and volume of the Registrar General's Report to which you referred in your former evidence ? — Yes ; the fluctuations of the deaths per million of people is in the Report of the O 2 Registrar 108 MINUTES OF EVIDENCE TAKEN BEFORE THE 2 May 1881.J Inspector General Lawson. [^Continued, Mr. William Fotoler — continued. Registrar General for 1878, at page 235. There are some other points that I mentioned with regard to syphilis in the counties, which I took from a series of his reports for several years, from 1865 onwards. Mr. Osboriie Morgan. 2223. You have been asked a good many questions about the transfer of disease from the protected to the unprotected districts, and vice versa. I presume that you will admit that, given a larger incidence of disease in District A. than in District B., the importation of disease from District A. to District B. would be greater tlian the importation from District B. to District A. ? — Certainly. 2224. Applying that to the case before us, assuming that there was a larger incidence of dis- ease in the unprotected than in the protected districts, I presume it would be a fair inference that the importation of disease from the unpro.- tected into the protected districts would be greater than that from the protected into the unprotected districts ? — Kecessarily so. 2225. Then, in estimating the influence of im- portation or transfer from one district to the other, you may assume, I suppose, that the im- portation would be greater from the unprotected districts into the protected districts, and that would have an important bearing, would it not, upon the figures that you have produced? — It has a most important bearing. It is that which causes the ratio of secondary syphilis to appear so high. 2226. As I understand it, the inference would be all against the protected and in favour of the unprotected districts ? — It would, so far as it diminished the ratios. It must increase those in the jjrotected and diminish those in the unpro- tected districts. 2227. Importation, so far as it affects the ques- tion at all, would increase the amount of disease imported into the protected as against the amount imported into the unprotected districts? — Yes, that would be the effect of it. 2228. You have been asked why you did not eliminate these imported cases in your figures ; I suppose, practically, that would he impossible, would it not ; it would involve tracing the his- tory of each particular case, would it not? — Yes, that is practically impossible. If we had the number of men who passed from the unfjrotected districts into the j^rotected districts and the similar number who passed from the protected into the unprotected districts we might estimate the number, but it is very difficult to get that, and I have not been able to get it. 2229. Would you say that under the present conditions it is practically impossible to get at the number of imported cases? — If you could get those facts it would be possible ; but it is practically impossible to get them. 2230. Then it is practically impossible to eliminate the imported cases ? — It is impossible to eliminate them without those facts, and I have not been able to get them. 2231. In comparing the protected with the un- protected districts, did I correctly understand you to say that putting the Acts altogether aside, it Mr. Osborne Morgan — continued, would be, from the state of things which existed before the Acts came into operation, a fair infer- ence that the protected stations would have a larger incidence of disease than the unprotected stations ? — I think so. 2232. Am I right in saying that one reason why those stations were selected for the pui-pose of protection was, that the incidence of disease was greater in those stations than in the others ? —Yes. 2233. I should be glad to ask you a question upon Table No. 6, B., if you will kindly turn to i^. You were asked, I think, by the honourable Member for Glasgow, to explain why the per- centage of secondary or primary sores was so much larger in the protected stations than in the unprotected stations; could you shortly tell me whatyour explanation of that is ? — The explanation of that is this : that secondary symptoms arise, on the average, say, six months after the primary disease has been contracted. The consequence is, that there is a large number of men who con- tract the primary disease at stations not under the Acts, who go to those other stations which are under the Acts, and the secondary disease is there developed ; and as that is an effect which goes on for, say, six months after the men have left the previous station, there is a large number of cases of secondary syphilis imported. With regard to the primary symptoms which the honourable Member for Glasgow is alluding to, they will not be above a fortnight before they appear ; that is what leads to this high per- centage of secondary symjitoms. 2234. Now, I will take you to your diagram ; I observe from looking at it, that which is common ground to us all, that up to the year 1866, that is before the second Act came into operation, there was, for all practical purposes, a steady and almost continuous decline in the cases of primary syphilis ? — Yes. 2235. It was not confined to one station or the other, but it took place in all the districts both subjected and unsubjected ? — Yes. 2236. I think you said that that decline was shared in by the country generally, and that it was not merely the result of sanitary or other mea- sures taken in the army, but that taking the whole length and breadth of England or of the United Kingdom there was within those six years a steady decline in the disease ? — There was a pretty steady decline, with fluctuations. 2237. Is it not true that in this, as in other enthetic diseases, it is impossible to assign any reason why m those six years there should have been a decline ? — No reason has been hitherto assigned. There is merely the reason that the disease seems to rise and fall, just as sraall-i^ox and measles do. 2238. But there is the fact that for six years there was a continuous decline ? — Yes. 2239. The Tables which you have furnished us with are confined to admissions into military hospitals ; but have you any other data from the Registrar General's Beturns or any other source for stating that as regards the general population there was the same decline? — We cannot up to 1865 make sure of the Eegistrar General's Returns, because at that time medical attention SELECT COMMITTEE OX CONTAGIOUS DISEASES ACTS. 109 2 May 1881.] Inspector General Lawsox. [ Continued. Mr. Osborne Morgan — continued, was being directed to the subject; and they were rightly referring to syphilis things which they had previously referred to something else ; but after 1865 the Registrar General's Returns mark out clear periods of fluctuation, periods of maxi- mum, and periods of minimum. 2240. But is it not the fact that even now diseases which really are originally traceable to syphilis are put down to other causes ?^To a very considerable extent : for instance, paralysis of the brain is a very common one. 2241. That is to say, deaths are put down by the Registrar General to paralysis of the brain which might be traced originally to the presence of syphilis of the system ? — Yes, no doubt that is so. 2242. Is there any other disease that you can mention which may be traced to syphilis ? — There may be apojjlesy, or some other causes. 2243. Consumption ? — It is questionable whether consumption is to any extent traceable to syphilis, though disease of the liver or of the kidneys may be. There is a certain portion of disease of the lungs which is connected with syphilis, but what we properly call consumption is only to a very limited extent traceable to syphilis. 2244. Scrofula, I suppose, may be traced to syphilis ? — That is a disjjuted point. 2245. However, I may take it generally, may I not, that there are diseases which might be traced to the j^resence of syphilis in the system which are put down under other heads ? — Un- questionably. 2246. I observe that in 1866 there was a sudden rise in the prevalence of the disease, and it seems to have gone on ; there was a very decided rise in the unprotected districts, and there was a rise, nothing like so great, in the protected districts ; I suppose you could not attribute that fluctuation to any particular cause? — The fluctuation arose in the country generally. At that time there was only a small number of protected stations under the Acts, and they responded to a, certain extent to this rise that aifiscted the country, only they responded to a less extent. 2247. I have your diagram before me, and I see that there is a very slight rise in the pro- tected districts, whereas in the others there is a very considerable rise. Do I rightly understand you to say that as the fall up to 1866 was com- mensurate with the general fall throughout the country, so the rise was also proportionate to the general rise throughout the country? — Quite so. 2248. Do the Registrar General's Returns enable you to state that ? — The Registrar General's Returns enable me to state that. 2249. Now we have got to a time, I suppose, at which the Registrar General's Returns can be relied upon ? — les, they show the fluctuations, though they do not show the full effect. 2250. The Registrar General only returns fatal cases, I suppose ? — The Registrar General only returns fatal cases, and only those that are sent to him. 225 1 . Those fluctuations, which are borne out by the Registrar General's Returns, show the 0.44. i\Ir. Osborne Morgan — continued, fallacy of taking particular years and contrasting them with other years, do they not? — Com- pletely so. 2252. Therefore, your view is, that in order to establish a just comparison, you must not con- fine yourself to one particular year, but you must take three or four or five years, or a period of years ? — Certainly. 2253. Now I come to 1873, which is the date of Lord Cardwell's Order ; Lord Cardwell's Order did not apply, I think, to secondary syphilis ? — No. 2254. It has been said that Lord Cardwell's Order made the figures unreliable, but it would affect stations under the Act, and stations not under the Act, exactly in the same way, would it not ? — Of course ; it would apply to the whole of them. 2255. Therefore, if in the one case it reduced the apparent gravity or prevalence of the disease, it would do so in the other case too ? — Certainly. 2256. So that, in fact, it would be as broad as it was long ? — I think it would be even a little broader than it was long, because the same influ- ence acting on a larger number of people would cause a larger number to neglect reporting them- selves. 2257. Granting that Lord Cardwell's Order has operated as a disturbing factor in the pro- blem, the disturbance would be equal in both stations; or,if any ihing, it would be rathergreater in the unprotected stations than in the protected stations ; would not that be so ? — Quite so. 2258. I think you said that Lord Cardwell's Order did not apply to secondary syphilis ? — It did not. 2269. Might not that in itself account for the larger proportion of secondaries to primaries in both classes of districts after the Order ? — Cer- tainly, that is the explanation. The secondaries come up in the usual number, and there was nothing to prevent their being reported, but the primaries which they succeeded were concealed to a considerable extent ; consequently the pro- portion rose. 2260. With regard to the Act of 1864, that Act was not compulsory, was it ? — As I under- stand it, it merely gave the police power to take a female who they knew was practising prostitu- tion, and was communicating disease, before a magistrate, who adjudged her to submit to treat- ment ; and even then there Avas no power to retain her in hospital until she was thoroughly cured. 2261. Practically that Act was found to be, I will not say entirely inoperative, but so inopera- tive that it was thought necessary to make it very much more stringent ? — Yes. 2262. To what stations did the Act of 1864 extend ? — To very few ; I think to Portsmouth, Plymouth and Chatham. They were all naval ports to which it applied, as well as military ports. 2263. We have been told by one witness that it was impossible in 50 cases out of 100, by exa- mining a woman, to find out whether she was suflfering from syphilitic disease; would your ex- perience bear that out ? — I have had no experience in examining women. 3 2264. What 110 MINUTES Of EVIDENCE TAKEN BEFORE THE 2 May 1881.] Inspector General Lawson. [ Continued- Mr. Osborne Morgan — continued. 2264. "What is the latest period at which a primary sore would be developed ? — A primary sore would be developed sometimes as early as 10 days after coition ; that is to say, a truly syphili- tic sore ; or it miglit be postponed to a month ; but what is called a local non-infecting sore fre- quently will appear after two or three days. 2265. Do you adopt the dualistic theory of the division of sores into infecting and non-infecting sores ? — I am inclined to think that that tallies best with the evidence, but I do not attach any weight whatever to it in this controversy. It is better that we should deal with the figures alto- gether independent of that theory, which is, to a certain extent, not j-et established. 2266. With regard to these figures generally, you have been asked a good many questions, particularly by the honourable Member for Cam- bridge, as to the amount of reliance that can be placed upon them ; you wish them to be taken, as I understand, subject to certain limitations ; that is to say, that there are difierent influences at work in the subjected and the non-subjected stations, and that, of course, you cannot compare stations like London, for instance, or other large towns,with small stations like Athlone orFermoy ; is not that so ? — Yes. 2267. But though there are, as regards par- ticular stations, these difterences, which, of course, aflF'ect \ our conclusions, yet taking the whole 14 subjected stations which are subject to various conditions, and taking, on the other hand, the whole of the stations not under the Acts which are also equally subject to various conditions, you may fairly institute a comparison of one with the other ; is not that so ?- — Certainly, as I have mentioned frequently, all those stations that are not under the Acts are grouped toge- ther, but virtually each station in that group is compared with itself, and with itself only, at a difterent period, and these are simply used to show the varying incidence of the disease. There is no direct comparison between them. 2268. Just as it would not be fair or sate to pick out one year and compare it with another year, so it would not be fair to pick out one single station under the Acts and compare it with another station not under the Acts to which it bore no resemblance ? — Certainly not. 2269. But I understand you that when you take a large number, such as 14 stations, subject to very various conditions as regards population and numbers of troops, and so forth, you can institute a fair comparison between those 14 stations and a hundred other stations also varying in the same respects ; is not that so i — Yes ; in comparing even those we only compare one with another as to one efiTect, but each is compared with itself in the general mass ; for instance, we do not com- pare arbitrarily Aldershot with Portsmouth, but Portsmouth at one period is compared with Ports- mouth at a subsequent period, so that each really compares against itself. Dr. Farquharson. 2270. Dr. Drysdale stated in evidence that he held that those who were responsible for the nomenclature with regard to syphilis ought to be Dr. Farquharson — continued. reprimanded for their scientific inaccuracy ; do you hold that ? — Certainly not. 2271. Is it not the case that the nomenclature of the Army as to syphilis formerly admitted the difference between the two sores ? — It admitted it up to the period of the change of nomenclature by the College of Physicians, which was, I think, in the year 1868. 2272. Then what was the reason that this form of nomenclature was discontinued in the Army ? — It was upon the introduction of the new nomen- clature by the College of Physicians in 1868. 2273. Because it would be inconvenient to have a different class of nomenclature for the Army, and for other scientific considerations ? — Yes. 2274. Mr. Lee wishes to make out that the nomenclature of the College of Physicians is of no authority in dealing with surgical questions, because it was necessarily drawn up by phy- sicians ; was it not the case that the College of Physicians were assisted in drawing up that nomenclature by eminent surgeons ? — Yes. 2275. Therefore their authority in surgical matters is equal to their authority in medical matters? — -Certainly, in that respect. 2276. It is the case we all agree that soft sores will occasionally give rise to constitutional symptoms ? — Yes, a sore which is to all appear- ance soft, and which we cannot distinguish from a soft sore, does lead to constitutional symptoms, and in no inconsiderable number of cases. 2277. And that sore in army nomenclature would be returned probably as a soft sore? — It might or it might not ; but it was open to the person who saw it to so return it if he thought fit. 2278. A soft sore which gives rise to consti- tutional symptoms is in every respect similar to one which is not followed by constitutional symp- toms, is it not? — You cannot distinguish the one from the other. 2279. And as the Army Returns go in weekly, you could not wait to class your sore until you found that it was not followed by constitutional symptoms ? — You could not wait for any length of time. 2280. On the other hand, you often get a sore apparently soft in the first instance, in which the induration comes on late ? — Yes. 2281. And that again would be classed as a soft sore? — Certainly, until the Induration ap- pears. 2282. Then, again, the incubation of the hard sore takes from ten days to three weeks or a month ; that would run us into difficulties again about importation, would it not, and we should have to credit one station with a hard sore which is really caught at the other, if we carried out that so-called scientific nomenclature of the two sorts of sores? — You would be subject to that. 2283. Therefore, taking all these considerations together, it is really impossible to have any abso- lutely scientific nomenclature such as Dr. Drys- dale demands?— It would be impossible practi- cally to carry it out, and if you attempted to carry it out you would be dealing with things which did not represent what you really believed them to be. 2284. And SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS, 111 2 May 1881.] Inspector General Lawson. [ Continued. Dr. Farquharson — oontinued. 2284. And the attempt to show the absolute effect of the Acts on the real infecting disease would be fallacious ? — Certainly. 2285. Do you hold Mr. Lee's opinion that a soft sore is really quite a trifling local matter of little importance ' — By no means. Sometimes it is a very serious matter. 2286. Is it not often painful and disabling. and very injurious ? — It is, and it sometimes runs out and causes very great loss of service, and it pro- duces bubo and so forth. Mr. Oshorne Morgan. 2287. Would a bubo incapacitate a man from service ? — Generally speaking, in the Army it has the effect of putting him into hospital- I think that very few soldiers would be content to do their duty if they got a bubo. In civil life they might. Dr. Farquharson. 2288. Then you cannot get phagedena and sloughing, and local consequences ? — Yes. 2289. Mr. Lee, I think, has no army ex- perience by which he is enabled to give a dog- matic opinion ? — I believe not. 2290. Therefore, in your opinion, a soft sore is well worth checking ? — Certainly. 2291. Even granting that the Acts have been a failure in checking constitutional disease, it would be quite worth while to check these soft sores ? — Distinctly. 2292. It has been asserted that the diminution in the number of cases of syphilis under the Acts has been due to what are called dirt sores being checked by cleanliness ; those dirt sores would not be included iu the army nomenclature as syphilis, would they ? — What we would call dirt sores are not such as would come under the head of primary venereal sores at all. 2293. What would they be called in the no- menclature ? — I do not think I ever saw what you call a dirt sore ; I have seen a sore produced by the secretions of a woman who was sick, not being wiped away, but I never saw a dirt sore. 2294. I think the dirt sore is an invention of Dr. Nevins' ? — I never heard the term before he used it. 2295. I suppose it would be included under the term of balanitis? — Scarcely even that ; that is the effect of diseased secretion. 2296. In your examination by the right honourable Member for Halifax at Questions 1770 and 1771, certain figures were placed before you, and a suggestion was made that you should test their accuracy afterwards ; may I ask you whether you have taken any steps to test the accuracy of the figures ? — Yes, the arithmetical calculation is all right, but it proves nothing ; it has no bearing upon the merits of the question, which was this : that the number under treat- ment for secondary syphilis had diminished at twice as great a rate at the stations under the Acts as at the stations not under them ; and if you were to put back the cases imported to the stations under the Acts, the whole of those would be dissipated ; the thing is a mere chance pro- portion, and it signifies nothing. 2297. So that accepting the figures, you do not accept the deductions? — No. 0.44. Dr. Farquharson — continued. 2298. Referring again to the examination of the right honourable gentleman as to the saving of service, do you accept his method of calculation upon that point ? — No. 2299. Could you give any further explanation upon that point ? — This is merely .showing the smaller number of people in hospital under the Acts at one period than at another period under the same Acts, which is not a saving of service at all ; the saving of service is the saving between the amount of disease that would have prevailed at the stations if no Act had been in force, as com- pared with that actually prevailing under the then conditions, and this does not touch the case at all ; it does not approach it in the right way. 2300. In 3^our examination by the honourable Member for Glasgow, he stated that in your cal- culation of ratio of secondary syphilis, you had begged the question of the duality of venereal sores ; did that question occur to your mind in any way when you were making the calculation? — It never occurred to my mind until I heard it started in this room, and when it did come up it appeared to me to have nothing whatever to do with the facts before us. It is far better that we should regard the facts without reference to that theory, because it is merely introducing what is hypothetical, instead of dealing with the plain facts before us. 2301. You merely took a certain number of primary sores, and a certain number of second- aries, and from that you calculated the ratios without any reference to what has been called the quality of the original sore ? — Without any reference to it whatever. 2302. Now coming to importation, do you be- lieve that the number of cases of primary sores detected by inspection in the force entering a protected station would be very large ? — They are not very large with a regiment actually arriving. During the course of the year there is a very considerable number of those cases, but they generally come from men who have been on furlough, or from small parties of men who have been absent on command duty, as it is called. 2303. I suppose that if men knew that, they were liable to be punished for concealing disease, they would be more likely to report it? — I think so. 2304. The class of disease which would be more likely to be detected on reaching a pro- tected station would be a hard uninfecting sore, which might be overlooked by the men them- selves ? — Yes. 2305. With regard to the ratios which you ad- mitted were a little too high, or a little too low, pro tanto, I suppose that that would not be suffi- cient to affect your general conclusions ? — No, it is very small indeed with regard to primary sores, but with regard to secondaries it is a notable quantity. 2306. There was a question with regard to short service diminishing secondary syphilis in the Army ; do you not think that it is possible that the short service system will increase the number of pi'imaries, because young men are more apt to catch the disease than older men ? — Young men are more apt to catch disease than older men, and are more likely to have the secondary disease. 2307. Therefore if you have more primary O 4 disease. 112 MINUTES OF EVIDENCE TAKEN BEFORE THE 2 May 1881.] Inspector General Lawson. [ Continued. Dr. Farquhnrson — continued, disease, younaturally expect to get more secondary disease ? — Naturally. 2308. And that would more than balance the diminution of secondary disease by the men being discharged before there was time for the disease to deyelope ? — I think so. 2309. One would perhaps balance the other, and perhaps even a little more ? — Yes. 2310. Perhaps a man joining the Army as a young man would get disease at once, and that might be infecting disease ? — It might be either infecting or non-infecting ; he runs the same chance as other people. 2311. You cannot have the infecting disease twice ? — No, it will not develop itself constitu- tionally twice. 2312. We heard about men coming from a pro- tected to an unprotected station spreading disease amongst the women at the unprotected station, and that you called an insignificant factor ; I suppose you meant because, during his residence at the protected station, a man would have less chance of catching the disease ? — He would have less chance of catching disease ; but the soldier is for the most part unmarried, he is a man of a certain age, and I have taken the trouble to take the Eegistrar General's Eeturns and go through the number of single men living in large towns of the military age, that is to say from 20 to 40, and I find that there are at least 20 men of that age living in those towns for every soldier that is in them ; that is so in Manchester, for instance. Now it is well known that those unmarried men are just as free in their association with women as soldiers are, and that they propagate quite as much disease ; soldiers are not the only people that propagate disease. The soldier may come Dr. Faiquharso — continued, in for a little of that which the others have pro- pagated ; but thar is about the ratio, one mili- tary man as against 20 civilians. 2313. But a soldier coming from a protected district has had very little chance of catching the disease himself? — Certainly, his chances of catch- ing disease are represented by the diminished ratio of admissions in the protected districts as against the increased ratio of admissions in the unprotected districts. 2314. Of course he cannot propagate what he has not got ? — No. 2315. We have heard also about the immigration of prostitutes interfering with the calculation ; but that would tell much more against the objec- tions to the Acts than the other way, would it not, because is it not the case that diseased women often come from unprotected to protected districts in order to obtain medical treatment ? — Yes, that has been found to be the case. 2316. And in order to qualify for admission into hospital they act as pi-ostitutes, and of course they must spread disease ? — Yes. 2317. We have also heard about the hospital accommodation not being equally distributed at the two sets of stations ; was not the first object of the Acts to provide hospital accommodation for women ? — At the stations where they were first in force certainly that was so ; and one cf the main objects of the Acts all through has been to provide it at those stations. 2318. And the enforced treatment of the diseased women was only superadded when it was found that the voluntary hospital system was a failure ; was not that so ?— Yes, that was in 1866. SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 113 Mo7iday, 9th May 1881. MEMBERS PRESENT ; Mr. Cavendish Bentinck. Dr. Cameron. Mr. Cobbold. Colonel Digby. Dr. Farquharson. Ml-. William Fowler. Mr. Hopwood. Mr. Massey. Mr. Osborne Morgan. Mr. O'Shaughnessy. Mr. Stansfeld. The Right Honourable W. N. MASSEY, in the Chair. Mr. James Robert Lane, called in ; and Examined. Mr. Osborne Morgan. 2319. I BELIEVE you are a Fellow of the Royal College of Surgeons, are you not ? ■ — ■ Yes. 2320. And surgeon and lecturer on surgery at St. Mary's Hospital? — Yes. 2321. I believe you are also the consulting surgeon to the London Lock Hospital, are you not? — Yes. 2322. During what period did you act as surgeon and assistant surgeon to the Lock Hos- pital ? — I was 25 years surgeon and assistant surgeon. I was resident house surgeon there in the year 1 846, so that altogether my connection with the hospital has been longer than 2.5 years. 2323. Your connection then with the Lock Hospital is of 35 years' standing, is' that so ? — Yes. 2324. I presume you have had a good deal of experience in the working of the Contagious Diseases Acts ?• — -The first Act was passed in 1864, and patients have been sent to the Lock Hospital under the Acts since that time. I was there for about 12 years after that; therefore I have had about 12 years' experienceof theworking of the Contagious Diseases Acts as regards the women. 2325. Had you the charge of the women ?— I had the principal charge of the women. 2326. A good deal of evidence has been given before the Committee as to the existence of two kinds of primary venereal sores ; what opinion do you hold upon that subject ; do you believe in the dual theory, or in the other theory ? ■ — I believe there is only one venereal poison, and that both the infecting and the non-infecting sores are derived from the same virus ; perhaps they may be modifications of the same virus. 2327. But still it is the same disease? — It is one disease, in my opinion. 2328. What is the opinion of the profession generally upon the subject? — The opinion of the profession upon the subject is divided. It may be said to be an open question, and not by any means settled, at all events at present. 2329. Is the theory which you hold advocated by any authorities ? — Mr. Jonathan Hutchinson is one of the principal authorities in this country; 0.44. Mr. Osborne Morgan — continued, he is one who supports this view ; Mr. Savory, I believe, is another ; Sir J ames Paget is another ; and, in the examination in 1865, before the Admiralty Medical Commission, a great number expressed themselves in favour of the one poison theory. Four surgeons from the Lock Hospital, for instance, Mr. Cutler, Mr. Samuel Lane, Mr. Gascoyen, and myself, from the Lock Hospital; !^ir William Ferguson, Sir James Syme, Mr. Solly, Mr. Hilton, and Mr. Erichsen, all well known names. But besides these there were the two Norwegian surgeons, Dr. Boeck and Dr. Bidenkap, who are great authorities on the sub- ject of syphilis, especially in inoculation ; so that, although I do not wish to dogmatise upon it, I say that it is an open question. 2330. You are speaking of opinions given some years ago ; but does that division of opinion still exist in the profession? — It is difficult to say, unless one asks the question specially ; but my idea is that the opinion in favour of unity is increasing, though I would not be too certain about it. 2331. At any rate it is considered an open question ? — I think it is an open question fairly. 2332. Do you consider that this question of the unity, or duality of the disease, is really of much practical importance with reference to these Con- tagious Diseases Acts, and the working of them ? — I think that, from a pathological jioint of view, it is of great importance in the science of disease; but I am quite unable to see that it has any practical bearing on the working of the Con- tagious Diseases Acts, 2333. Will you state why you are of that opinion ? — I may say that JMr. Berkeley Hill, whose name I think has been mentioned here as in favour of the dual theory, has been working with me for the last 10 or 12 years cordially in favour of these Acts, and it never occurred to either of us to think that the question of unity, or duality, had anything whatever to do with it ; and, practically speaking, the treatment of the disease is the same, whatever the opinion of the surgeon may be upon that particular point. It P has 114 MINUTES OF EVIDENCE TAKEN BEFORE THE 9 May 1881.] Mr. Lane. [ Continued. Mr. Osborne Morgan — continued, has no practical bearing on this question in any way that I can understand. 2334. We have been told by the opponents of the Acts that what they call the soft sore is a light trivial disorder, and one to which much importance need not be attached ; is that your view? — I do not at all agree with that opinion, I consider it very important that both classes of sores should be treated, both the hard and the soft, the infecting and the non-infecting, in order to prevent further consequences which may be very serious, 2335. Could you state what the consequences of soft sores would be ? — Yes ; the soft sore may be situated on the outside of the penis, and may be irritated very much and cause great pain and suffering. The sores may be at the orifice of the prepuce, or foreskin, and that is a very pain- ful condition ; it may j^roduce phimosis, which is inability to retract the foreskin, and para- phimosis, which is a very painful condition induced if the tight foreskin is drawn back. Then there are suppurating buboes, which are very disa:bling consequences. 2336. Would the existence of soft sores by themselves, without any constitutional conse- quences, affect the capability of the sufferer fur service ? — Very much so, I should say ; in fact, they are more disabling immediately than the other forms of sore. 2337. We have heard the expression, " dirt sores" used, I think by Dr, Nevins, for soft sores ; is that an expression which you have heard used before? — I never heard the term " dirt sores " until I read it in the evidence given by, I think, Dr. Nevins, and 1 do not know what it means. If it means soft sores, then I under- stand what it means ; but if it means anything else, I do not understand what it means. 2338. Is it a technical expression used by pathologists ? — I never heard it before. I trust it mav not get into general use, because I think it would produce additional confusion. 2339. Is it possible, in your opinion, in the case of a primary sore to detect whether the primary sore will lead to secondary disease or not ? — It is my conviction that it is quite im- possible to tell, from the appearance of a primary sore, whether it will, or will not, be followed b}^ secondary disease. There are certain sores, the well-marked indurated sore, which will pretty surely be so followed ; but, as regards the soft sores, my opinion is, that it is impossible to say in the case of any giveu sore that it will or will not be followed by further consequences. 2340. Then, in your opinion, the presence of a soft sore may indicate that that sore will be followed by secondary constitutional disease ? — A considerable proportion of those soft sores are certainly infecting ; I mean infecting as regards the patient's constitution, not as infecting others. 2341. If that is your opinion, I need hardly ask you whether you consider the classification of all primary sores under one head, which as you know, is the classification adopted by the Army Medical Department, to be a proper classifica- tion ? — I consider it to be the only classification possible, if it is to be made within an early period. It is impossible to tell with certainty whether a sore will be infecting or not, and therefore any Mr. Osliorne Morgan— coniuyaeA. other classification would be quite unscientific, and would lead to numerous errors. 2342. Then as these sores have to be returned at an early period, you would say, I suppose, that there is not only no other scientific, but no other possible classification than that which is adopted ; is that so ? — Precisely. 2343. You are aware, I think, that the prac- tice of the Army Medical Department is to put in a return of the number of primary sores which they detect ; that is done, I believe, at once, is it not ? — It is done, I believe, weekly. 2344. And as it is necessary to make the re- turn weekly, it would be impossible at that stage of the disease, within the week after its appear- ance, to classify it in any other way; is that your meaning ? — It would be quite impossible to do so with any degree of certainty. 2345. I supjDose I may take it, that you con- sider it of importance to prevent the prevalence of soft sores in the military and naval services as far as possible ? — Certainly, very much so. 2346. They are likely to be more immediately disabling, as I understand you, than the hard sores, leading to constitutional disturbances ? — YeS; [ consider so; I have brought with me some drawings of soft sores and their consequences, if the Committee would like to see them ; but they are not pleasing objects to look at. 2347. I think we may take it, that you con- sider that the fact of a man's suffering from soft sores interferes veiy materially with his capacity for service ? — Certainly. 2348. We have had a good deal of evidence as to whether the hard sore is curable by proper treatment, and I put this question to several witnesses, and I have had different answers; giving the most favourable possible treatment of a hard sore, that is to say, assuming that it is treated at the earliest possible period, and in the most scientific and skilful manner, is it possible in that way to prevent the hard sore being fol- lowed by constitutional symptoms ? — I believe it to be possible in a very considerable proportion of cases ; I would not say in all cases. 2349. You mean actually to prevent it? — I mean actually to prevent it, so that no such symptoms occur, as I know in many cases for years and years afterwards, and I assume there- fore that there will be none. 2350. Then, in fact, may I take it, that under proper treatment, it is possible to cure a hard sore in that state ? — I believe so ; I should like to add as regards that, that Dr. Eicord, of Paris, who has had the largest experience of any man living on the subject of syphilis, stated in this country some years ago, that he firmly believed that he could prevent secondary disease if he was able to treat with mercury the primary sore at a sufficiently early period ; he was very confident about that ; I should not like to be quite so con- fident as he was. Mr. Hopwood. 2351. Would you refer us to where that state- ment of his is recorded? — It was in the Journals of the time, and I have quoted it verbatim in a small book which I wrote. I can refer you to that quotation (handing a book to the honourable Member'). 2352. Your SELECT COMMITTEE ON CONTAG OUS DISEASES ACTS. 115 9 May 1881.] Mr. Lane. [ Continued. Mr. Osborne Morgan. 2352. Your own opinion is that, by the em- ployment of mercury, you can kill the poison ? — Yes, you can eliminate it, so that it is entirely got rid of. 2353. I suppose you would say, would you not, that even where it is not possible entirely to eliminate it from the system, it is possible by proper treatment, very greatly to palliate the gravity of the constitutional disease wlien it appears? — I think so. 2354. By treating the hard sore in its primary stage properly, you would be much more likely to reduce the gravity of the secondary disease when it occurs ; would that be so ? — -I think so. 2355. So that of course early treatment, even of hard sore=i, is a matter of great importance ? — I think so. 2356. Both to the patient affected and also with a view to prevent the spreading of the in- fection ? — Yes. 2357. For what period, speaking generally, do the secondary symptoms, wheu they once break out in the system, endure ? — I think one might fairly say from a year to two years. A man seldom gets rid of ths infection entirely in less than a year; but in the great majority of cases, I believe it wears itself out in about two years. 2358. It wears itself out, or I suppose it kills the sufferer ; would you say that if left to itself it wears itself out without treatment ? — I be- lieve it may in a healthy person wear itself out without treatment ; but, of course, it is got rid of much more effectually with treatment. 2359. Are secondary symptoms contagious? — Certainly, very much so, especially any secondary lesions which produce a moist secretion. 2360. They may be communicated, may they not, in various ways? — In a great variety of ways. 2361. You said that the disease was present in the constitution from one to two years ; how long does the contagion generally last during that period ? — I think that the contagion is most intense in the earlier part of the period ; it becomes less so as time goes on, but I believe that the contagion is diminished very much in intensity under treatment, and that, although a patient may not have had the disease thoroughly eradicated, it it is subdued by treatment, it will not be so contagious as at other periods. When a relapse occurs, it will become more contagious again. It is got rid of for a time to a great extent out of his constitution. 2362. I suppose that one might take it that the danger of contagion is commensurate with the gravity of the disease in the patient ; is that so ? —Yes. 2363. Is this indurated sore that you have spoken of often seen in women ? — Not so often or so well marked as in men, but more often, I be- lieve, than is generally supposed. I used rarely to see it in the Lock Hospital amongst the voluntary patients, but I saw it much more often in the patients who were admitted under the Contagious Diseases Acts, because it was found out early; they were admitted early for treat- ment. The indurated sore is very often not in- convenient to the patient himself, and to women 0.44. Mr. Osborne Morgan — continued, especially, and therefore they do not apply for treatment till after it has disappeared alto- gether. 2364. But can it be present without the woman knowing of it ? — Certainly; and very often it is so. 2365. I suppose that would render early exa- mination under the Acts particularly important, because, of course, a woman would not volun- tarily come for examination if she was not aware that she was suffering from disease ? — She would know nothing about it, aud I think that that is one strong reason in favour of a periodical exa- mination, in order that it may be found out before she is aware of it herself. 2366. Is it difficult to discover an indurated sore in the case of a woman? — I think there is no practical difficulty whatever. The great majority of indui'ated sores are situated on the external parts ; that is to say, they are readily seen by separating those parts. If they are not situated externally, they will be seen by the examination which is made by the speculum of the internal parts. The speculum, I may say, as it is being introduced, opens out the folds in the interior to a certain extent, and shows the whole of them to the surgeon's view ; he can see the whole length of the canal, and the neck of the uterus at its upper extremity. He has a double view, be- cause he sees it as he introduces the instrument and as he withdraws it, and it is almost impossible for a skilful examiner to escajje seeing an in- durated sore by such an examination. 2367. One witness, who was examined before us, told us, speaking of himself personally, that in five cases out of 10 of the women whom he examined, he thought that he would be likely to pass a diseased woman as perfectly sound ; should you say that he would be a skilful ex- aminer ? — No one in the habit of frequently examiniu'j women for this disease, would be likely to make such a mistake. 2368. At page 26, Question 495, I asked Mr. Drysdale this : " Then do I understand you to put it in this way : in the case of a woman com- ing to you within the first three or four months of the development of the disease you would have very little difficulty in ascertaining the fact of the disease ? (4.) Usually speaking." Then in the next question, Mr. Fowler asks this : " On the other hand, supposing she came late, you would continually err ? {A.~) I think I should be very likely to make a great mistake if I had not seen her before " ? — That, I think, means secondary disease and not the indurated sore. 2369. At Question No. 1036, Professor Lee was asked this : " I think you have stated, in many cases one half would escape detection ; is that proved, or is that only an expression of your opinion ? " and his answer was: "It is an expression of my experience. I say more than one-half of the cases of real syphilis are commu- nicated by secretions of patients who have syphilis, and do not present any primary lesion which should be characteristic of syphilis." Then at Question 92, Dr. Eouthwas asked this: " Now can you easily, readily, and surely detect the true infection of chancre in the woman?" and his answer was : " In the first place, the p 2 real 116 MINUTES or EVIDENCE TAKEN BEFORE THE 9 May 1881.] Mr. Lane. [ Continued. Mr. Osborne Morgan — continued. real chancre in the woman is often very small. It is painless and hidden in the folds of the vagina, so that it cannot be detected, and there- fore the most close examination of a woman would not lead you to believe that she was af- fected by the disease. I would exemplify that by one circumstance, which will show you how often these things may be overlooked." Then he goes on to give instances. Then at Question 106, the Chairman asked this: •' Does that lead you to the conclusion that the examination of the women by the speculum is generally delusive and useless? {A.) In very many cases, certainly. ( Q.) In what proportion of cases is it delusive ? (A.') That is really a question I could not answer. In acute cases it would be delusive ; but in chronic cases how could I tell, as I have just read that a woman might not communicate the disease." Then at Question 164, Dr. Routh was asked this : " You stated that it was very diffi- cult, if not impossible, to discover the presence of contagious disease in a woman ; I should like to know to what extent you carry that theory ; would you say, for instance, that in one out of two examinations it would lead to no discovery whatever? (J..) Really when you come to that ques- tion of statistics I should find it very difficult, be- cause I have not got the records. (Q.) Of course general answers of that kind are very little use ? — {A.) Really I want to speak the truth. If you will allow me to make a guess at it, I should say that out of 10 women, perhaps, there might be six or seven in whom I could not find any trace of the disease. (Q.) Do you mean to say that out of 10 diseased women you would not find traces of disease upon six or seven ; do you really mean to say that? — {A.) Yes, that I sup- posed to be diseased Avomen, tliat came to me to be examined for the purpose of ascertaining whether they were diseased ; that is the point I put. They might not be diseased at all," (I do not know what he means by that.') "(Q.) No; what I wanted to know is tJiis, and I want to put it clearly, in order that there may be no mistake about it; given 10 diseased women, women really diseased, coming to you, or coming to any other competent medical man, in how many of these women should you say the examination would be purely abortive, that is to say, that the medical man would not be able to ascertain the traces of disease, and would pass her as a healthy woman ; can you give me any idea ? — {A.) I should say about one-half." I will put to you that Question, No. 167, which I put to Dr. Routh? — My answers have been directed purely to the hard sores at present. It is another ques- tion as to whether secondary disease would be over-looked in women. I should like to separate the question of primary from secondary. 2370. You have stated that the indurated sore in a woman can be very readily discovered ? — That is my opinion. 2371. Now I come to the presence of secondary symptoms in women : are they difiicult to dis- cover '.' — I think that they are very unlikely indeed to be overlooked by an examiner who is accustomed to examine women for that pur- pose. 2372. What evidence would there be of the presence of secondary symptoms in the constitu- Mr. Osborne Morgan- — continued, tion of a woman, from which a skilled examiner could detect it ? — There is generally evidence on the genital organs in the shape of mucous patches, mucous tubercles, and this is especially so iu the case of prostitutes. It is rare that they escape from these manifestations ; they are the most frequent manifestations of syphilis in women, and they will be seen by the examination of the genital organs. Sometimes in women who keep themselves clean, they are very slight and super- ficial, and they might be mistaken by an ex- aminer who was not accustomed to them for super- ficial primary sores; butbesides those visible mani- festations on the genital organs, there will usually be indurated glands in the groin ; there will be patches in the mouth and throat, and at the corners of the li23s, and eruptions on the skin, and a falling off of the hair, so that as the examina- tion is directed towards all those points, it is very difiicult indeed for the presence of secondary disease to be overlooked in some form or other. 2373. Are patients with secondary disease, showing no evidence of disease in the organs, sent into the hospital under the Acts ? — Not very frequently, but they are admitted without any manifestations whatever on the genital organs. The house surgeon has recently fur- nished me with some information on this point. In the year 1880, he says that there were 11 cases so admitted, seven cases of secondary erup- tions on tlie trunk and limbs, one with only an inflamed gland in the groin, and three cases of mucous patches on the tonsils, who had no visible sore or discharge, so that patients do get sent to the hospital without any local disease for other secondary manifestations, but most of them have local manifestations of some sort. 2374. Do patients with secondary symptoms often escape detection, and are they often passed as sound after examination ? — I should say, prac- tically speaking, hardly ever. 2375. Then, I suppose you hold the opinion that the cases in which there is no evidence in any part of the body of the presence of secondary symptoms are extremely rare ? — I should say that they are extremely rare, and, if no symptoms can be found the disease will be so much in abey- ance for the time that the patients will hardly be in a condition to communicate contagion. They sliow no sign whatever, local or elsewhere. 2376. I suppose you would say that practically the working of the Acts would not be affected by the fact that there may be, in extraordinary cases, some instances in which the disease is present without any evidence of it ? — -Practically I do not think it will interfere with their action at all. Of course I do not mean to say that no mistake ever takes place. 2377. I will now put to you the question which I put to Dr. Routh : Do you mean to say that out of 10 women suffering from syphilis you would not find traces of disease in six or seven ; and do you agree with Dr. Routh 's answer, which was, that in about one-half of the cases, the medical man would not be able to ascertain the traces of disease, and would pass the woman as a healthy woman ? — Certainly not. 2378. Should you say that a medical examiner who passed one half of the diseased women who SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 117 9 May 1881.] Mr. Lane. [ Continued. Mr. Osborne Morgan — continued, were brought to him for examination, would be a skilful examiner ? — I should say that he was not fit for the duty of examining patients under these Acts, at any rate. 2379. Is a woman equally dangerous through- out the whole period of these one or two years that these secondaries are in her constitution? — I think I have said pretty much what I hare to say about that ; I think that the disease is in abeyance for a time when she is under treatment ; and then, when she is sent out of the hospital with no symptoms at all, either locally, or else- where, she will not communicate disease ; but when a relapse occurs she then again becomes dangerous, and it will again become necessary to send her into hospital. I have a reason for believing that the disease may be in abeyance, and it is this : that it not unfrequently happens that a syphilitic woman has a diseased child. The first child is diseased, the mother is treated, and the child is treated, and they both probably get well. In course of time she has a second child ; that second child may be quite healthy and show no signs of disease at all. She does not fol- low the treatment then, probably, but she has a third child, and the third child may be diseased. I think that makes it clear that the disease may be in such small intensity in the j^erson's blood that she may not be able 1o communicate it, but that it may relapse and increase again ; the syphilitic yeast, as Mr. Hutchinson terms it, may ferment again, and she may become con- tagious ; but she may have an intervening healthy child between two diseased ones. 2380. I suppose that during that healthy period she would not be contagious ? — I think not. She is not contagious to a child who is in her womb for nine mouths at any rate. 2381. Still, upon the relapse taking place, she would become contagious again ; would that be so ? — Generally, when she had a third child who is diseased, she will show signs of disease again. That is what I have seen in several cases. 2382. You are, of course, speaking now of a woman to whom no fresh disease has been com- municated ? — Yes. 2383. Is a child who is born syphilitic often cured of the disease? — Tes, I believe so. 2384. Can it be eradicated altogether? — Yes. 2385. Of course that would only be by skilful treatment ? — By active treatment at an early period. 2386. Otherwise I suppose the child would die? — A great number of the children die of the disease. 2387. Should you say that more children die of syphilitic diseases than are put down in the Registrar General's Keturns as dying from those diseases? — I think it is very likely to be the case, because they would, for obvious reasons, not be returned as syphilitic. 2388. I think we have it in evidence, that many diseases are put down to other causes that really result from the presence of syphilitic poison in the blood ; is that so ?— Certainly, I think so. 2389. Are the morbid secretions of a syphilitic woman contagious? — -Yes; vaginal and interine discharges especially, I believe, may communi- 0.44. Mr. Gshorne Morgan — continued, cate syphilitic disease, even although there is no sore present about the genital organs, primary or secondary. Mr. Stansfeld. 2390. Even though there is no sign of any kind? — Yes, except the discharge. I mean to say unaccompanied by any sore about the genital organs, not unaccompanied by any sign what- ever. I should like that to be clearly under- stood. Mr. Osborne Morgan. 2391. Then where this discharge takes place there is, nevertheless, some external symptom, in addition to the discharge ; is that so ? — There would be pretty certain to be some symptoms of skin eruption, or mucous patches about the mouth, or some evidence of secondary disease to be discovered on close examination. 2392. Some evidence which a skilful and thorough examination would detect? — Yes. 2393. Is the blood of a syphilitic person con- tagious ? — Yes, that has been clearly proved ; but it is not contagious to a very strong degree. It has been found difficult to inoculate with syphilitic blood, where inoculations have been made for the purpose on healthy individuals. That has been done abroad, and there have been many failures. I think about one in four of the attempts has been successful, but it has required great care in the inoculations to insure pro- longed contact for some of the blood with the raw surface in inoculation. 2394. Does the mixture of the blood with other secretions render them specially virulent ? — I never heard that theory mentioned until I read it in the evidence given before this Com- mittee ; but I know of no reason whatever why the mixture should increase the virulence, and it appears to me impossible to prove it, and that it must be, in fact, mere conjecture. The secre- tions are contagious, and the blood is also conta- gious. It is Professor Lee's evidence to which you allude, 8395. We have had a good deal of evidence as to what is called mediate contagion ; do you believe in the possibility of mediate contagion ? — I think it is impossible to deny the possibility of mediate contagion ; but I cannot believe that it is frequent, and I believe that the general opinion of the profession is that it is quite an exception ; that it is a rarity, but that it is a possibility. 2396. I understand you strongly to dissent from the opinion which Dr. liouth exjjressed, that a skilled medical man like himself would fail to discover the presence of disease in five women out of 10? — I quite disagree with that opinion. 2397. And you would go so far as to say that - a medical man who made that statement could scarcely be qualified for the purpose ? — He would not be qualified for examining women under these Acts, certainly. 2398. Is gonorrhoBa easily discoverable in women ? — In the acute form gonorrhosa can hardly be mistaken. There is a yellow discharge ; the parts are red and very much inflamed, and the acrid discharge generally excoriates the outer parts, and the introduction of an instrument p 3 would 118 MINUTKS OF EVIDENCE TAKEN BEFORE THE 9 May 1881.] Mr. Lane. [^Continued. Mr. Osborne Morgan — coutinued. would be extremely painful. There is no doubt about the acute stage of gonorrhoea in women. 2399. We heard it stated, I think, that it was impossible to distinguish gonorrhoea inits less acute form from the morbid discharges of a virtuous woman, is that so ? — Yes; I do not think there is any real distinction between them ; tliey are both discharges produced bj- the same mucous membrane, and there is nothing in their appear- ance to enable you to distinguish the one from the other ; in fact, I think they are essentially the same discharges. 2400. But are they equally contagious ? — It depends upon their character. If they are de- cidedlj' purulent and yellow, they will be con- tagious ; but if they are merelj^ transparent like the white of an egg, or if they are merely of a milky character, they will probably be innocuous. Virtuous women, or at least quasi- virtuous women, undoubtedly do communicate gonorrhoeal disease to men. 2401. What do you mean when you say "quasi-virtuous" women? — Of course they are not really virtuous women. 2402. I am speaking of a perfectly virtuous woman ; is it possible for a man to be diseased by gonorrhoea fi'om contact with a virtuous woman ? — Yes. 2403. But that is very rare, is it not? — There is one thing which I think there is no doubt about : that a woman may have a dischai'ge and may be living with her husband, and he does not contract disease. That has been greatly insisted upon by the French writers, that he is acclima- tised to that discharge. But, if she goes astray, she may communicate disease to another man. ]Mr. Fowler. 2404. I understood you to say that, if a surgeon gave evidence that he could not easily discover disease, he was an incompetent man ? — I said that if he could not discover disease in five cases out of ten, he was so. 240,5. Therefore you say that Professor Lee is an incompetent man ? — I do not think that Pro- fessor Lee said so. Mr. Osborne More/an. 2406. I understand then, practically, that a virtuous woman does not communicate this disease, because, of course, if she has connection with another man besides her husband, she would not be a virtuous woman ? — No. 2407. Then a really virtuous woman could not communicate this disease ? — I do not think that it is absolutely impossible. 2408. But, practically, the thing is so rare that it is not worth consideration? — Quite so. 2409. Can those prostitutes who are examined easily conceal their discharges from the examining surgeon? — It is very difficult, indeed, for them to conceal their discharges. The examination detects it with almost absolute certainty. She may conceal it, or endeavour to conceal it, by using injections to wash away the discharge before she is examined ; but there is this to be said, the lower parts of the vaginal canal are contractile, and the upper part is somewhat dilated and lax. The discharge generally remains Mr. Osborne Morgan — continued, at the upper part, and, although the woman may have used an injection, the use of the speculum will display some discharge remaining at the upper part of the canal, and when the instrument touches the neck of the uterus and presses gently, there will almost always be an oozing of a yellow dischai'ge from that aperture ; and, again, if she has used her injection very effectually, and almost immediately before, if the speculum is introduced, there will almost always be some of the injection left at the upper end of the canal, and that will enable the surgeon to see that she has been en- deavouring to conceal her discharge by using injections. 2410. Taking everything into consideration, may I take it, as your experience, that a woman very rarely does conceal the presence of gonor- rhoea ? — Very rarely indeed, in my opinion. 2411. We have had these three forms of vene- real disease spoken of: soft sores, hard sores, and gonorrhoea ; in what order of severity should you place those various complaints ? — I should place the soft sores and their consequences first, and next gonorhcea and its consequences. 2412. What are the consequences of gonor- rhoea ? — The consequences of gonorrhoea are many. Gonorrhoea may produce inflammation of the parts with phimosis and pai'aphimosis ; it may produce swelled testicle, which is a very painful condition ; or it may extend backwards and produce inflammation of the prostate or of the bladder. Gonorrhoeal inflammation of the bladder is a very serious and troublesome com- plaint, and lasts some time. Then there is gonorrhoeal rheumatism, which is a very trouble- some complaint indeed, and gonorrhoeal ophthal- mia, which, though very severe, is much more rare. Stricture, too, is one of the consequences of gonorrhoea, and that is perhaps one of the most serious surgical diseases that we have. 2413. Would these appear afterwards, or at the time ? — The inflammation of the bladder, or of the prostate, would appear at the time, and so would the swelled testicle; the gonorrhoeal rheu- matism would appear at the time, but as regards stricture, that is an after consequence. 2414. Then I suppose, thirdly, you put the hard sores ? — As immediately disabling, I should put them last. Of course I do not mean to say that syphilis is not the most severe disease alto- gether, in its after consequences especially. 2415. You are speaking of secondary syphUlsj I suppose ? — I am speaking of constitutional syphilis. 2416. Would that be on the ground of its hereditary transmission ? — Partly so, and on account of its serious after consequences to the individual. 2417. But as regards incapacity for work and painful results, you would put the soft sores and theli- consequences first? — I should do so, cer- tainly. The hard sore is a much less painful condition usually. 2418. I believe that you have under your care in the Lock Hospital other patients besides those who were admitted under these Acts? — Patients have always been admitted who apply volun- tarily. 2419. Could you give me any Idea what pro- portion of voluntary patients are admitted into the SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 119 9 May 1881.] Mr. Lane. \_CQntinued. Mr. Osborne Morgan — continued, the Lock Hosjjital ? — At the j)resent moment the proportion of both classes is about equal, I think ; there are about 40 to 50 on each side. 2420. Are all women who come admitted ? — They apply voluntarily, and when there is room they are admitted. 2421. Are you generally full? — We are gene- rally full. 2422. Could you give me any evidence as to the comparative difference and state of disease in the iwo classes of women ; the women who are sent in under the Acts and the women who come in voluntarily ? — The state of disease is very much more severe in the women who apply volun- tarily than in those who are admitted under the Acts. 2423. To what do you attribute that? — Because under the Acts they are discovered early. It is the compulsory periodical examina- tion that makes the difference. The voluntary women do not apply until they are seriously diseased. 2424. Then do I correctly understand you to say tliat, in the treatment of all these diseases, it is everything to get the sufferer under treatment as early as possible ? — I think so, most deci- dedly. 2425. The earlier the stage the better the chance of cure ; would that be so ? — Cer- tainly. 2426. Are you speaking now of all venereal diseases ? — Yes, I may say so of all three. 2427. And, in your opinion, that can only be arrived at by the periodical examination of the women ; is that so ? — I think so, because the women, especially prostitutes, will not apply for admission until they find themselves seriously diseased. 2428. As regards those women who come in voluntarily, do they come in in the early stages of the disease, or are they when they apply to you in such a condition as to make it more dif- ficult to cure them ?— They do not apply as early as they ought ; they do not apply until they are in an advanced stage of the disease, and there- fore they are more difficult to cure. 2429. Until the disease has, in fact, got hold of them ? — Until it has, in fact, got hold of them. 2430. And has assumed either a painful or a grave form ? — Yes, until, as in the case of prostitutes, they are unable to cairy on their vocation any longer. 2431. And then I assume, from what you have said, that the difficulty of treating them and curing them is very greatly increased ? — Yes. 2432. Have you any statistics on that point? — I have here a statement for the last 10 years of the voluntary and other patients in the Lock Hospital, as to their comparative length of stay in hospital for different sorts of disease. You will see that it is very considerably longer in the case of voluntary patients. 2433. Will you put that in?— Yes. {The same was delivered in. ) 2434. Could you state, in general terms, the effect of these statistics ? — Perhaps it would be sufiicient to take the table for one year, 1880. The patients under the Acts for primary syphilis occupied 27 days in treatment ; the voluntary 0.44. Mr. Osborne Morgan— contirmedi. patients 36 days. The secondary syphilis patients occupied 31 days in the one case and 42 in the other. Gonorrhoea patients occupied 15 days in the one case and 29 in the other. The total gives the average number of days as 24 in the one case and 37 in the other. 2435. You speak of the conditition in which these voluntary patients were when they came to the hospital ; do the voluntary patients stay in the hospital until they are cured ; you have no means of detaining them, of course ? — We have no means of detaining them; they can go out when they like ; they do not stay until they are cured. I gave some evidence in 1871 before the Royal Commission on that jJoint. I gave three years, and it was found that in eacla of those three years as nearly as possible 25 jjer cent, went out uncured. 2436. And, of course, in a contagious con- dition? — In a contagious condition. I have here a recent statement for the years 1878, 1879, and 1880, of the number of women who left at their own request uncured, or who were discharged uncured for misconduct. The number of women who left uncured, in 1878, was 92. 2437. Out of how many ? — The total number of voluntary patients admitted was 459, but the per-centage is 20'043. The number discharo-ed for misconduct was 9 ; that would be 1'96 per cent. The total number who left uncured was 101, which would be 22 per cent. In 1879 the number who left uncured was 63, or 16'75 per cent. The number discharged for misconduct was 13, or 3*45 per cent. ; the total number who left uncured was 76, or 20'21 per cent. For the year 1880, mentioning only the total, the num- ber left uncured was 98, or 20-41 per cent. So that the numbers are very uniform for those three years, but they are less than they were 10 years ago. 2438. Have those women who are admitted under the Acts the opportunity of going into the Lock Asylum? — Yes. 2439. Have they all that opportunity ?— They all have that opportunity, and it is urged upon them that they should do so by the chaplain and by the matror, and by others. 2440. Could you give the number of admis- sions to the Lock Asylum of late years ? — In the year 1871, of the Government patients, 23,or 7'69 per cent., went into the Lock Asylum; in 1872 the number was 24, or 7*92 jjer cent ; in 1878 it was 32, or 13-27 per cent. ; in 1879 it was 19, or 7-53 per cent.; in 1880 it was 31, or ITl per cent. 2441. Then a substantial number do go into the asylum ? — A substantial number go into the asylum, but not nearly so large a proportion as amongst the voluntary patients, because the voluntary patients are of a different class. 2442. Do you mean to say that fewer of the patients under the Acts go into the asylum than of the voluntary patients ? — Fewer in proportion ; but a great number of the voluntary patients are married women and women who are not prosti- tutes ; they are a different class. I can tell you, if you like, the number of married women, not prostitutes, who were admitted into the voluntary wards. 2443. Can you give me any information from p 4 your 120 MINUTES OF EVIDENCE TAKEN BEFORE THE 9 May 1881.] Mr. Lane. \_Continued. Mr. Osborne Morgan — continued, your own experience as to the condition of those soldiers' women, as they are called, before the Acts were passed? — I can. Before the Acts were passed we used to receive a good many women from Aldershot. They were sent up in this way ; they had no place of refuge but the Farnham Union. The Farnham Union sub- scribed to the Lock Hospital, in order to be able to send patients there. The women who came from Aldershot through the Farnham Union were the very worst cases of disease I ever saw in my life. The women were in rags, they were covered with vermin, and presented the most frightful cases of sloughing sores and buboes that you could well imagine. Greenwich and Wool- wich used to subscribe in the same way ; their cases were not so bad as those of Aldershot; but they were still very bad indeed. Then when the Acts first came iuto force, various other districts newly put under the Acts sent their patients to the Lock Hospital, because no Go- vernment lock hospitals were then built ; so that I saw the women from a number of districts when they were first placed under the Acts. In all of them the disease was very severe indeed. 2444. And the condition of the women was also very deplorable, was it not? — Very deplor- able ; very bad indeed. 'I here is nothing more remarkable in my experience than the difference in those women after the districts had been placed under the Acts for two or three months ; it worked a complete change in them, in their disease, and also in their general appearance and cleanliness. 2445. Having had, of course, considerable ex- perience for many years of the working of the Acts, what should you say as to the contrast between the condition of the women who are now sent from those protected stations and the condi- tion of those sent to you before the Acts came into operation ? — The cases scut to us now are exceedingly mild as compared with the others. 2446. And you attribute that, I presume, to their being sent to you in the early stage ; in fact, to the operation of the Acts ? — Certainly, especially to the periodical examination. 2447. Hitherto you have spoken mainly of the disease, but with regard to their general condi- tion and appearance, has that changed ? — Very much, indeed ; they are most of them clean and decent in appearance now, and they have certainly very much im]iroved in manner. I should say that their moral condition, if I may so speak, has improved. ' Mr. William Foivler. 2448. Do you say that their "moral condition" has improved? — You may call it a quasi-moral condition. 2449. Very " quasi," I should think?— Yes. Mr. Osborne Morgan. 2450. In your opinion do the Acts tend to drive women a,way from the districts to practice prostitution elsewhere? — I have no positive know- ledge on that point, but I do not think that they do so to any great extent. But this I know, that a great number of diseased women come into the Mr. Osborne Morgan — continued, protected districts for the sake of being sent into hospital for treatment. They come into those districts and qualify themselves to be sent to the hospital by practising prostitution there. Those women are generally seriously diseased. 2451. Could you state the proportion of those women? — In my examination in 1871 I was able to state the proportion of those women for three years, and it was as nearly as possible 15 per cent, who stated, when asked, that they had gone into the district for the sake of being sent to hospital. 2452. In your opinion would the voluntary system, if established on a larger scale, be of much service in extinguishing or repressing venereal disease ? — I do not think it would be of material service in repressing venereal disease genei-ally amongst the public. 2453. May I take it that you come to that opinion upon the ground that frequent examina- tion and early seclusion are necessary, if much sanitary good is to be effected ? — I think they are essential. 2454. And not only that, but also detention for a sufficient period ? — Yes. 2455. What would be the effect if women were admitted voluntarily, but detained until they were cured ? — I think the effect would be to keep a much larger number of them from applying. They are very reluctant to apply novv imtil they become seriously diseased, and have already done a great deal of mischief; and they would be still less ready to apply, if they knew that they were to be kept in compul- sorily. 2456. Then your experience would justify you in saying that it is necessary to have i^eriodical examinations, for the purpose of getting patients admitted at as early a stage as possible ; and in addition to that, you would require comj^ulsory detention until the patient is quite cured ; is that so ? — I am strongly of that opinion, from what I have seen of the voluntary patients not coming in until they are seriously diseased, and a number of them insisting upon going out before they are cured. There is one point as to strangers coming into the districts in order to be sent to hospitals; there have recently been instances of women dismissed from the voluntary wards of the Lock Hospital for misconduct before they were cured. They go down to Woolwich and qualify them- selves there, and are sent back again into the compulsory wards. 2457. Do I correctly understand you to say, that to your own knowledge women do go into the protected districts for the purpose of qualify- ing themselves to be sent to hospitals? — They are asked that question when they come into the hospital, and they say that they did so. Mr. Stansfeld. 2458. You have said that your idea was that the medical opinion in favour of the unity of the venereal poison was on the whole increasing ? — That is my idea. 2459. Have you read Professor Lee's evidence? — Yes. 2460. You are aware that his opinion is pre- cisely the contrary? — I am. 2461. With SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 121 9 May 1881.] Mr. Lane. [ Continued. Mr. Stansfeld — continued. 2461. With reference to the question whether ■ the poison be one or two poisons, there are certain practical distinctions between the hard and soft sores, which you, yourself, have on previous occasions recognised in evidence ? — Yes. 2462. For instance, have you not said that secondary disease, after soft sores, is extremely rare ? — It is not frequent. 2463. But have you not said that it was very rare ? — I do not think I have said that it was very rare. 2464. You were examined before the Venereal Commission in 1865, and I find that at Question No. 3505, you were asked this : " What propor- tion of the soft sores produce secondary disease ? " and your answer was, " I think that secondary disease is an uncommon occurrence after soft sores, but I am convinced that I have repeatedly seen it unmistakeably in sores that I have had an opportunity of watching throughout ; in which there has been no induration whatever present at any time^ and yet they have been followed by secondary symptoms." Do you retain that opinion? — That is 15 years ago. 2465. Do you still retain that opinion ? — Not to that extent. From what I have seen since, I should say that they were much more frequent after non-indurated sores than 1 then thought. 2466. I need not ask you whether you know what is called a " mixed " sore ? — Yes. 2467. In case of secondary disease following upon a soft sore, may there not have been a hard sorft at the same time, the two together consti- tuting what is called a mixed sore ? — I do not believe in the mixed sore at all. 2468. You believe they are two different sores which happen to be present in the same place at the same time ? — No, I do not, because I believe that there is only one disease. 2469. But there are two sores, a soft and a hard sore ; may there not be a soit and a hard sore at the same time, and on the same part of .the person ? — If it is soft it will not be hard. 2470. But may there not be two sores separate and distinct from each other? — Certainly there may be, separate and distinct from each other. 2471. And those two sores, if absolutely con- tiguous, might be called, and sometimes are called, a mixed sore ? — No, I understand by the term " mixed sore," a sore which partakes ot both characters ; that it is infecting, that it will infect the constitution, but that the poison which ■causes the soft sore is mixed with the poison which causes the hard sore, and- there are two poisons present in the same sore. Those who say that there are two poisons hold to the mixed sore, and say that the mixed sore has both con- tagions present in it. I believe in the one poison, and therefore I cannot believe in the mixed sore. 2472. The hard sore is invariably followed, is not, by secondary symptoms? — No. 2473. Unless it is treated ? — Unless it is treated it is almost invarinbly followed by secon- dary symptoms. 2474. And the soft sore is very seldom followed by secondary symptoms ? — The soft sore com- paratively rarely, although not so seldom as I once thought. 2475. Have you, by treatment, prevented 0.44. Mr. Stansfed—contvaweA. secondary effects from soft sores? — It is very difficult to say. 2476. Can you say whether you have, by your treatment, prevented secondary symptoms fol- io wino- upon hard sores ?— Yes, I think 1 can ; at least I know I have treated a hard sore with mercury persistently, and no secondary conse- quences have 03curred. 2477. 'I'hat would be, I presume, since the year 1865, because your evidence was not to that effect in 1865. At Question 3575 you were asked this : " Have you ever, by using the abortive treatmentfor a hard sore, actually stopped the progress of the secondary symptoms;" and your answer is : "I cannot say that I have. In fact, I have never succeeded in effectually de- stroying a hard sore '"' ? — I am glad to have been asked that question, because it refers to quite a different thing. That refers to the cauterization of the sore. I have never succeeded in destroy- ing a hard sore liy cauterization, although I have frequently destroyed the soft sore. That is what is meant by the " abortive treatment," the im- mediate treatment by cauterization, not the con- stitutional treatment by mercury. 2478. Then by treating syphilis evidenced by a hard sore, constitutionally by mercury, you think you have j^revented secondary symptoms ? — Yes, I feel sure of it. 2479. Whether there be one or two venereal poisons, does not your knowledge of the two classes of disease known as soft sores and hard sores, with their consequences, enable you to say that the results are widely different in their character, in their symptoms, and in their conse- quences ? — In what respect ? 2480. You have expressed the opinion that the original poison is the same, whether it lead to a soft, generally called a non-infecting sore, or to a hard sore, and to constitutional symptoms ; but whether that be a correct medical view or not, the two diseases are very different in their char- acter and effects, are they not ? — The progress of a soft sore and of a hard sore is different, and their appearance is different. 2481. And are they not very different in their effects ; have you not just told me that the soft sore is very rarely followed by secondary symp- toms, and that the hard sore is almost always so followed ? — Yes. 2482. Therefore, there is that marked differ- ence between them ? — Yes, there is that differ- ence, that one tends to produce secondaiy disease, and the other does not. 2483. Differing from Professor Lee, you justi- fied the classification of the Army Medical lie- ports by saying that it was quite impossible to tell from the first appearance of a sore, whether it would be truly syphilitic or not ? — Yes, in the early stages. 2484. And you said that for the purpose of the weekly returns, that was therefore the only classi- fication possible ? — I did. 2485. But that justification, if it be one, would surely not apply to the Annual Keturns ? — In the Annual Returns a different classification might be made. 2486. At one time it was proposed, was it not, in the Army, to subdivide the class of primary Q venereal 122 MINUTES OF EVIDENCE TAKEN BEFOKE THE 9 May 1881.] Mr. Lane. \Continutd. Mr. Stansfeld — continued, venereal sores into those wlaicli were ascertained to be really syphilitic and those which were not ? — I am not prepared to say. 2487. Perhaps you will take it from me that that proposal was made, and that it was not carried out? — Certainly. The fact would be ar- rived at, I Imagine, by taking the number of primary sores, as compared with the number of cases of secondary disease occurring in the whole Army dui'ing the year. If there so many pri- mary sores, and so many cases of secondary syphilis throughout the Army, you would then know how many sores were infecting. 2488. You would know it for the whole Army ? —Yes. 2489. But, taking each station by itself, you would be able to effect that classification, if not immediately, in the course of a certain time, would you not ; that is to say, after a certain time if you were the examining surgeon, you would be able to say : " This case is syphilitic, and this is not " ?— If I saw the case for a suf- ficiently long time. 2490. For how long a time ? — You cannot make at all certain under two months or more. The great majority of cases would show secondary disease in two months ; some, however, take as long as six months. 2491. Are you prepared to say that you could not, practically speaking, in 99 cases out of 100 decide imder two months, or more, whether a sore was syphilitic or not? — No, I cannot tell with any certainty until the secondary disease occurs. That is the only absolute sign that the sore is in- fecting. 2492. Then you declare your inability to dis- tinguish between a syphilitic and a non-infecting sore until you have proof positive by the setting in of secondary symptoms ? — I should be unable to distinguish with any certainty. In the majority of cases one would form an opinion, and with the indurated sore that opinion would be very strong. 2493. But would you not form that opinion in the vast majority of cases ? — Not in the case of the non-indurated sore. 2494. I am now speaking of the diseases of men ; it is the diseases of men that you have in your mind at this moment ? — Yes. 2495. Has your practice been amongst men as well as amongst women ? — Certainly, in private practice very largely. 2496. And you would say, with regard to men, that you could not declare under two months, whether a case was syphilitic or not ? — No, I never tell a patient positively that he will not have secondary disease from any sore. 2497. That is a matter of precaution in your mind ; but you, I think, at the same time agree that in the great majority of cases there would be no practical diflficulty in drawing the line at an earlier date? — Very many years ago I used to be led by the prevalent theory and tell patients that they certainly would not have secondary disease after soft sore. I found that I made a considerable number of mistakes, and I never tell a patient so now. 2498. Keferring to the women, in the subjected districts all these women, I take it, at some time, Mr. iS'/aH^/l'/J— continued. and probablj^ at an early period of their career, become syphilised? — Yes, most of them do. 2499. Would you say that they all do ? — No, I would not say all. 2500. There are some women who pursue a career of prostitution in the subjected stations without ever becoming syphilised ? — I think so. I have seen many women come into hospital over and over again with discharges only, without sj^philis ; but the majority, no doubt, do contract syphilis if they continue their career for any length of time. 2501. But are they not likely to contract syphilis at a very early period of their career ? — Likely enough. 2502. Are they not more liable to contagion at the earlier period of their career ? — Yes, 1 think they are. 2503. Therefore, practically speaking, may I not take it that the women who enter a subjected station, either have been syphilised when they enter, or have become so in the course of the first year ? — The majority probably do in the course of the first year. 2504. After a woman has thus been cince syphilised, to what extent is she liable to a new syphilitic infection ? — She is not very liable to a second infection. There are many authorities who say that a second infection never occurs; I do not agree with that, because I have seen many cases where patients have had secondary disease once, and where, after a lapse of years, they have had another infecting sore and another attack of secondaries. I have seen that happen, but I think it is uncommon. I think that the disease may wear itself out so completely that a second in- fection is possible. 2505. But, broadly speaking, a woman once syphilised is protected for a considerable period ? — Yes. 2506. She is protected, that is to say, against syphilis ? — Against a re-infection of constitutional syphilis, 2507. Is she protected against infection of what you have called a non-infecting character ? — She may get a soft sore, undoubtedly ; that is the result of inoculation from a hard sore on a patient suffering from syphilis. 2508. Or she may get it from a person who has a soft sore ? — Yes. 2509. Therefore, a prostitute who has been syphilised is liable to be infected with a soft sore, but is very little liable to be infected with true syphilis ? — Yes. 2510. Does it not follow from that that the large proportion of cases treated under the Acts must be soft sores and not syphilitic cases ? — No doubt a large number of them are soft sores. 2511. But I mean a very great proj)ortion? — Those soft sores are more common than the hard ones, and therefore there would be a larger pro- portion. 2512. "What I mean is this: I understand from you that a prostitute, once syphilised, is practically protected for a considerable number of years ?— From a re- infection with syphilis. 2513. Of course she may come into the hos- pital on account of secondary symptoms, but, so far as the re-infection of a new sore is concerned, the SELECT COMMITTEE OX CONTAGIOUS DISEASES ACTS. 123 9 May 1881.] Mr. Lane. \_Continued. Mr. Stansfdd — continued. the case will be comparatively rare, will it not ? — She may readily set soft sores, but if she is labouring under constitutional disease at the same time, she will be contagious in the sense of communicating syphilis. 2514. I do not doubt that she is liable to in- fection from a soft sore, and that she may have a soft sore ; but I understand you to say that, being once syphilised, she is practically protected from a fresh contagion of real syphilis ? — Yes. 2515. I ask whether it does not follow from that that the great proportion of women treated under the Acts are treated for the disease which is of minor importance ; that is to say, for the soft sore, and not for the hard and truly syphilitic sore ? — A veiy considerable number of the women under the Acts are treated for the hard sore. I have here the number of women ad- mitted into the Lock Hospital, if you would like to hear them. 2516. The exact numbers do not matter for the purposes of this argument ; I will ask you that by-and-bye. You say that a certain number of women iu the subjected districts require treat- ment for the hard sore ? — Yes. 2517. Would those cases of indurated sores be cases of new infection?—! cannot say whether they would be new infection or not. 2518. You told us just now that a woman having once been syphilised is protected, and that she is syphilised almost always early in her career ; in those cases which you have met with in your experience of tlie hard sore in those women, do you think they have been infected for the first time ? — Most probably. 2519. Were they young women? — I cannot say. I have had the returns taken for the last three years ; I have not had the charge of the patients myself for the last three years. 2520. You cannot speak from your jDersonal experience as to that? — Xot as to that fact in the case of those particular women, certainly. 2521. But you have had experience of that kind in previous years ? — Yes. 2522. Did you find that women came from the subjected stations with a hard sore? — Yes. 2523. Were those young women? — I really cannot remember; they were probably of diiferent ages ; most of the women are young. 2524. But I wonder that you cannot remem- ber. I understand you just now to have said that a woman who is once syphilised is protected ; that being the case, did it not occur to you, as a medical practitioner, to say, " How does this woman come here who ought to be protected by having been syphilised " ? The answer would be that she was infected for the first time. In that case she would probably be a young woman, or young to that profession ? — Probably so. 2525. With regard to secondary syphilis, you have said that there is no difficulty in ascertain- ing the presence of secondary syphilis, and I think I gathered from your evidence that, for the purpose of ascertaining the presence of secondary symptoms, it would not be necessary to conduct the personal examination, which is necessary for the discovery of a soft or a hard sore ? — -You mean the local examination. 2526. Yes, the local examination? — Oh, dear 0.44. Mr. Stansfeld — continued, no, because there is almost always evidence of the presence of secondary disease about the geni+al organs. 2527. But I thought I understood you to say that there was always evidence elsewhere than on the genital organs from which you could ascertain the presence of constitutioiial syphilis in its secondary form? — I said that, althougli there might be no evidence about the genital organs, there would be pretty sure to be some evidence elsewhere, if the woman were labouring under secondary disease. 2528. Therefore 1 gather that it is your opinion that constitutional syphilis, in its secondary stage, could be ascertained without this local examination ? — In a great many cases it could. 2529. You have expressed an opinion that mediate contagion cannot be frequent, that it is not a very potent source of disease ? — That is my opinion. 2530. Is that oi^inion founded upon know- ledge ? — It is impossible to have knowledge ixpon the subject. 2531. Why is it impossible to have any know- ledge? — It is impossible to know whether the contagion was mediate or not. 2532. Su2:)posing that you had such a case as this; supposing that you had a certain number of regiments in a subjected station with very varying degrees of disease amongst them, though all alike under the influence of the Contagious Diseases Acts ; and supposing that you were to discover that, in the case of the regiment which was by far the most seriously aflTected, those effects had been produced through mediate con- tagion ; would not that be evidence?— I do not quite understand. 2533. You are aware, are you not, that in some of the subjected stations we have evidence of greater differences in the amount of disease between different regiments all under the Acts than the differences between any of the stations under the Acts, or not under the Acts ? — I am not well enough acquainted with the figures. 2534. Are you aware that we have before us the evidence of Inspector General Luwson to that effect ? — I have heard so. 2535. Should you be surprised if you were told that the cause of the greatest excess of dis ease was mediate contagion? — Yes. 2536. Why would you be surprised if you were told that ? — Because I think it is a very unlikely thing to happen. 2537. We have had very different medical evidence ; will you explain to me why it is un- likely ? — I suppose you understand by mediate contagion that a man must have left some con- tagious material in the parts of the female. 2538. Precisely? — I think that, in the great majority of cases, the discharge, such as it is, would remain about the external parts, and it would not be in any great quantity. I think that a woman will, in most cases, either wash or wipe herself in some way, so as to remove that discharge, and that discharge may get dry and may not readily infect a man. I do not see that anyone can say, with certainty, whether it is frequent, or whether it is not. 2539. We have had very shocking evidence of Q 2 ' the 124 MIXTITES OF EVIDENCE TAKEN BEFORE THE 9 May 1881.] Mr. Lane. [^Continued. Mr. Stansfeld — coiitinuecl. the way in which some of these women will submit themselves to connection with men, and the number of cases per day, or per night, of such connection ; have you any knowledge upon that subject? — I know that the same woman has intercourse with a great number of men. 2540. What number have you heard of? — Women have told me that they have had inter- course with a dozen men in the course of 24 hours. 2541. We have had even stronger evidence than that. Now, if you have circumstances of that character, one woman passino; the night and having connection witli a dozen or twenty men (and that is in evidence before this Committee and before previous Committees and Commis- sions), do you not think that, under those circum- stances, mediate contagion would be a real danger ? — It is a danger no doubt; but a woman does not have connection with one man, and with another man five minutes afterwards. There is almost always an interval of time elapsing, and during that time she will in all probability either wash herself, or wipe herself, and wipe this con- tagious matter away, because, as I said before, it is almost always wiped off and left about the ex- ternal parts of the female. 2542. That of course depends upon the care- fulness of the woman? — Yes. 2543. If she does not resort to these precau- tions mediate contagion may take place ? — It is quite possible. 2544. And you are not prepared, at any rate from your knowledge, to deny that that is a very serious danger ? — I do not consider it a serious danger, because I do not believe it to be so frequent as has been stated. 2545. But you are not prepared, from your knowledge to deny it ; your knowledge does not enable you, does it, to gauge the frequency of mediate contagion? — No, my knowledge does not enable me to say how unfrequent it is, nor can any one's knowledge enable him to state the frequency of it. 2546. Except that one might happen to know the cases, and that knowledge, so far as it went, would have a practical bearing? — Yes, any facts would have a practical bearing. 2547. Coming to the Lock Hospital with which you have been so long connected, you have told us that it has two sides, the voluntary side and the Government side ; is it a certified hospital? — Yes, it is certified under the Acts. 2548. And the Government side, therefore, is a certified hospital, though not in a subjected dis- trict ? — Yes, the London Lock Hospital is certified for the patients now from Woolwich and Green- wich, and Deptford ; they are the only Govern- ment patients that we have now. 2549. You have said that you find disease more severe in the voluntary side than in the Government side ? — Yes.. 2550. Do you mean by " more severe " that there is a greater proportion of real syphilis, or that there are more severe cases of each class of disease ? — I mean that there are more severe cases of each class of disease. 2551. Can you tell me on which side there is that greater per-centage of real syphilis? — The Mr. i!>'to//.«/"<;Zc?— continued, greater proportion of real syphilis is on the voluntary side. 2552. Have you the figures there ?— Yes ; I have the number of indurated sores and secondary syphilis, and suppurating buboes on the two sides for the years 1878, 1879, and 1880. 2553. Is the suppurating bubo really syphi- litic? — It is generally caused by a soft sore; but there may be a suppurating bubo also following a hard sore. I can give you the number for the year 1880: indurated sores, followed by secondar)' syphilis, under the Acts, 7 ; indurated sores, followed by secondary syphilis amongst the voluntary women, 37 ; patients under the Acts with indurated sores not known to be so followed, 4 ; and amongst the voluntary patients indurated sores not known to be so followed, 12. 2554. Btit those figures do not concern the period of your administration ; can you not give us figures during the period of your experience and with your own authority ? — Having left that hospital some years, I cannot. 2555. How many years have you left that hos- pital ? — I think I left in 1876 ; but for the purpose of this examination, I had these facts taken out from the books for the last three years. 2556. But would it not have been possible to take out these facts during your own period of administration, from 1870 to 1876? — It would have been. 2557. We have not your authority for these facts? — You have not my personal authority, but I could not undertake to work out all these figures by my own personal labour, under any circum- stances, either now or formerly. 2558. I will not examine you upon these figures if you have no knowledge of them your- self ? — They are taken from the books by the resi- dent medical ofiicer, Mr. Bishop, who has had the charge of these patients for the last seven years. Dr. Farquharson. 2559. Therefore, for ordinary medical pur- poses, they are of statistical value ? — They are ; I could not at any time have given you these returns frorn my owu personal work ; it would have taken so much time. Mr. Stansfeld. 2560. I can do without these returns for my question. You have said that the diseases amongst the voluntary women are more serious than those on the other side ? — I say so. 2561. Is the voluntaiy side full? — Yes. 2562. Have more women applied than you could admit? — Generally speaking, more apply than can be admitted, or rather I should say that there are more than can be supported by the funds of the hospital. 'I'he hospital has plenty of room in it now, but it cannot afford to keep more than a certain number of Vi'omen. 2563. Are there more applications than admis- sions ? — Yes. 2564. That being the case, how is the selec- tion made amongst those who apply ? — The more severe cases usually are admitted. 2565. On the Government side that is not the case, is it ? — On the Government side we take all that they send to us. 2566. Does SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 125 9 May 1881.] Mr. Laxe. L Continued. Mr. Stansfeld — continued. 2566. Does not that entirely invalidate the comparison between the two sides ; you select the severe cases on the voluntary side, and then you tell me that they are more severe as an evi- dence in favour of the Acts ? — The case is this, that there are none, or a very few, applying for admission on the voluntary side who are not seriously diseased. 2567. But you only take the more seriously diseased; therefore you dismiss the lighter cases? — Yes, but they are none of them light, or very few of them light. 2568. At any rate, they are lighter than those which you take ? — Yes. 2569. You select the most severe cases on the voluntary side, and I ask you whether that does not invalidate the comparison between the two ? — I use the fact to illustrate the advantage of getting them in early. If you get them in early they are not seriously diseased, but if you leave them to apply of their own accord they are se- riously diseased. 2570. If I understood you rightly, you said you used the fact for two purposes ; first of all, to show that the voluntary women were more seriously diseased than the subjected women; and, secondly, to show that the voluntary women would not come into the hospital until the disease was in a compai-atively bad stage ; I ask you how are those facts evidence in favour of your con- clusion when you select the cases ? — I leave them for what the members of the Committee may consider them worth. They are the facts. 2571. The fact remains that v/hen women apply with less serious cases and in a less ad- vanced stage of disease, you refuse those women? — Yes, we refuse the less serious ones, but, as a rule, all those that apply arc serious cases. Mr. Osborne Morgan. 2572. Is it the case that even the rejected voluntary cases are more serious than the Govern- ment cases ? — Yes, decidedly. Mr. Stansfeld. 2573—4. When you reject a case, do you keep a record of the exact particulars of that case ? — I used for many years to have the admission of patients applying voluntarily ; they were ad- mitted once a week, and the most serious ones were admitted, and the less serious ones were sent av;ay. From that knowledge I say that they very rarely applied until they were serious. Even those that were sent away were serious cases. 2575. When you say that they were serious cases, you do not mean that they were in a larger proportion really syphilitic, but that whatever the class to which the disease belonged it was more advanced ? — Yes. 2576. And that is your general impression ; but of course you kept no record of those cases which you did not take in ? — No. 2577. And it remains true that the less serious cases and less advanced cases than those which you received offered themselves ? — Yes, but I say that they were for the most part serious before they came for admission. 0.44. Mr. Stansfeld — continued. 2578. You said that the women would not wait until they were cured, but you gave us some particulars of the time that the treatment took, and I presume that those women remained until they were cured? — No. The tnble which I put in contained the average number of days that the patients remained in hospital ; some of them went out before they were cured. 2579. I thought that those figures which you gave us were figures of the length of time which it took to effect a cure ? — The patient's stay in hospital on the voluntary side is very much longer than the stay on the Government side was under the Acts ; but, if all those on the voluntary side remained until they were cured, the contrast would be still more striking than it is. 2580. But, taking the figures which you gave us as to the length of time which it took to treat the voluntary patients as compared with the Government patients for the three classes of the disease, in those cases have not the voluntary patients waited until they were cured ? — Twenty per cent went out before they were cured. 2581. Twenty per cent, of those very figures? —Yes. 2582. Would that be the case with gonorrhoea and soft sores, or with constitutional syphilis ? — Indiscriminately, with all. 2583. How do you determine whether awoman's cure is effected, if she comes in with secondary symptoms of syphilis ? — When all her secondary symptoms disappear, and you can find nothing, either on the genital organs or no discharge from the uterus, or vagina, and no eruptions or spots anywhere, I conclude that, at any rate, her disease has been brought under for the time, and the disease is in abeyance, and that she is prac- tically not capable of communicating infection for the time. As soon as any relapse occurs, if she is examined fortnightly, she will be sent into hospital again. 2584. You have expressed the opinion that the Acts do not drive women away from the sub- jected stations, but that they come into the sub- jected stations to have the advantage of the Acts ; and I think you said that, as far as that fact is concerned of women coming into the subjected stations to have the advantage of the Acts, 15 per cent, of the women come in that way ? — I said so with regard to the three years that I have mentioned. 2585. As far as that fact is concerned, it shows that the women are willing to go into hospital when they require treatment ? — If they are seriously diseased then they are very glad, in- deed, to go into hospital. 2586. But you think that the Acts do not drive the women away ? — I think that they do not do so to any considerable extent. 2587. Y^'ou are familiar, I daresay, with the Annual Police Returns ? — I cannot say that I am sufiiciently familiar with thein to answer questions upon them. 2588. I have the last Return before me, and I find, taking the whole of the subjected districts, the numbers of those who annually leave the district, not leaving to be married, or to enter Q 3 Homes, 126 MINUTES Oi' EVIDENCE TAKEN BEFORE THE 9 May 1881.] Mr. Lane. [ Continued. Mr. Stansfeld — continued. Homes, or to return to their friends, or dying, that is to say, who leave the district in all pro- bability to continue their profession elsewhere, have, since 1870, varied from 1,500 odd to 900 odd every year ; do you not take those figures as evidence that women are driven out of the subjected districts to avoid the Acts, and carry disease with them elsewhere ; I mean tliat the operation of the Acts upon their minds is such that they leave the districts ? — I believe that it has always been the case, or used to be the case, that about half of the women change every year. 2589. Do you mean that they change their district ? — I mean that about half the women on the books lor the whole year were re-admissions, were first placed under the Acts. 2590. At least half, I believe ?— Yes, but I am not well acquainted with the present returns. 2591. And they take the places of those who have left these districts and gone into other dis- tricts, to a certain extent ? — Yes. 2592. From what motive do you suppose those women have left the districts ; do you not think it likely that they have left the districts to avoid the operation of the Acts? — I think there is a natural love of change amongst them, and that they are very apt to go away with certain regi- ments. Women frequent regiments ; they come in with a regiment, and they will go out with a regiment, very likely, and that will account for a considerable number. 2593. However, wdiatever may be the motive or influence at work ujDon their minds, when they leave a certain district to go into other districts, they carry disease wil.h them ? — They would carry very much less disease than the fresh ones bring- in. 2594. Why will they do so ? — Because they are under the Acts and their disease is dimi- nished. 2595. But have you such a knowledge of these statistics as to be prepared to say that the amount of disease amongst women in the subjected dis- tricts is very much less than iu the non-subjected districts ? — I cannot undertake to speak from these figures, but I had the experience of a num- ber of districts when they were first placed under the Acts, and when they were sent to the Lock Hospital, and the result was, that a large number of beds was occupied from one district when it was first put under the Acts, but that, in the course of three or four months' time, that district did not require half the number of beds, or re- quired a very much smaller number, and that there were not nearly so many women to be found diseased in that district after it had been under the Acts for some time. 2596. A number of women entered the hospi- tal and were cured, and the amount of disease was diminished? — Yes. 2597. Is it not within your knowledge, whether there is, or is not, any similar provision of hospital accommodation for the treatment of these diseases of women in non-subjected sta- tions ? — There is no adequate provision for their treatment. 2598. Is it not your opinion that there ought to be that provision ? — Yes ; if they were under the Acts there would be. Mr. Stansfeld — continued. 2599. Do you think it impossible to have hospitals without the Contagious Diseases Acts ? • — -If the Government think fit to support them, it is very possible to have them ; but I am quite certain, from what I know of voluntary Lock hospitals, that they w'ill never get them sup- ported ; the public vvill not subscribe to them. 2600. You are using the word " voluntary " now in another sense ; you mean, supported by voluntary subscriptions ? — Yes. 2601. You think that those hospitals would not be supported by voluntary subscriptions, but you think that the provision of such accommoda- tion would be of great use ? — I do not think it would be of much use in repressing disease. It would be of great use to the women themselves, and it would be a great charity to them, but it will not be of any great sanitary benefit in repressing disease, becau.se they will not come in soon enough of their own accord, and they will not stay in long enough. 2602. Have you always expressed this opinion? — Yes, since I have had experience of the Acts. 2603. In your examination before the Venereal Commission, I think you expressed a different opinion ; at Question No. 3,662, Mr. Spencer Smith asked you this : " You mean, I presume, that Lock hospitals are absolutely necessary, if the disease is to be diminished," and your answer was : " Yes, I think that the very best way of diminishing the disease would ■ be to establish Lock hospitals, and I believe that much more good may be done by Lock hospitals than by police regulations ; police regulations can only act upon the professional prostitutes, whereas Lock hospitals will be resorted to, not only by the professional prostitute, but also by the non- professional class to which I have alluded;" do you not entertain the same opinion now ? — I do not. That is the opinion vt^hich T expressed when 1 knew nothing about what the Acts could do. It was before they were j)assed. Mr. Osborne Morgan. 2604. That is exactly 16 years ago ? — Yes, these Acts had not been passed then ; but I knew a little about the Act of 1864, which was perfectly futile in its operation, and, therefore, I thought that if that was to be the kind of Act, and these the kind of jiolice regulations, no good would be done. But I had not the least idea that such efiicient Acts as these would be f»assed, and very soon after I had had experience of the working of the Act of 1866 I entirely changed my views on that subject. In fact, that was an im- pression that I had founded upon no particular Icnowledge. Mr. Stansfeld. 2605. In a subjected district you have a cer- tain number of women in any j^articular j^ear upon the register, and you have about half that number hangiug about the neighbourhood, or coming towards the district, to supply the places of one-half in the following year, and you have a certain number of clandestine prostitutes also in the subjected districts ? — Yes. 2606. We have seen that, year by year; on an average about half the number of women in each subjected district are replaced by new comers ? —Yes. 2607. These SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 9 May 1881.] jVIr. Lane. 127 [_C()ntiniipd. Mr. Stansfeld — continued. 2607. These new comers, I take it, are more or less hanging about the district before they come on the register ? — That I cannot say. 2608. You do not tliink so ?— I do not know anything about it. Mr. Osboi'ne Morgan. 2609. Do you know anything about the sub- jected districts personally ? — No, personally I do not. I\]r. Stansfeld. 2610. Does it not appear to you to be manifest that, with this great change in the number of prostitutes from year to year, you must have a continuous sujDply of fresh prostitutes coming into the district, and in course of time getting upon the register? — Yes. 2611. They cannot all get upon the register the first day they come ? — No, 2612. Then is it not necessarily true that there .are a certain number of women in the subjected districts who are not on the register, but who may be fit subjects for the hosj)ital ?— Yes. 2613. Besides those women, there are the clandestine prostitutes ? — Yes. 2614. 'laking the existing hospital accomo- dation in a subjected district, and supposing that you had those hospitals thrown ojDcn for the use of those women, without the periodical ex- amination, and without compulsion, do you not believe that those hospitals would be as full, or fuller, than they are now ? — Very likely they would be full ; but they would not be full until the women were seriously diseased ; I mean that the women would not apply until tliey were seriously diseased, although you might have as many women in the hospitals. 2615. But you are inclined to believe that more women would be in hospital under those conditions than at present ? — No, I doubt that, because there is the reluctance of the women to apply voluntarily ; they would stay out as long as they could. 2616. You doubt it, but you are not prepared to say that it might not be the case ? — It is im- possible to say. 2617. Would not the best test of the efficiency of a system of that kind be the number of women that you kept constantly in hospital? — The number of those constantly in hospital would be the test of the good that was being done. 2618. The object, of course, of any system of this kind is to get the diseased woman into hospi- tal ? — Yes. 2619. And the more of those women that you have in a given district in the hospital, on an average from year to year, the more efficient your proceeding is ? — Yes, if you get them in early. 2620. You may under one system feel more certain of getting the women in early, but that is all you can say, and that is a matter of opinion ; but under another system you might have a greater number of women in hospital and you might have a greater advantage ? — No ; what I say is that the voluntary women will not, as a general rule, come into the hospital until they are so seriously diseased that they cannot carry on their profession any longer ; and then they have done all the mischief nearly of which 0.44, Mr. Stansfeld — continued, they are capable before you get them in. You will get them in, but they will not come soon enough. 2621. But what I want you to address your mind to is this, it is an undoubted advantage to get the woman in at an early stage of the disease, and you doubt whether she would avail herself of the hospital except under compulsion ?— Yes. 2622. That is a matter of opinion ; but is it not clear, on the other side, that if by another system you got a greater proportion of women into the hospital you would have an advantage which might counter-balance the disadvantages of which you speak? — The answer which I just gave is the one that I should repeat ; that they will not come voluntarily until they have done nearly all the mischief that they are capable of doing. These women are too reckless to apply of their own accord, and they are reluctant to seclude themselves in hospitals, especially if they knew that they are to be compulsorily detained. 2623. Ai-e you aware that your opinion is not the opinion of every person connected with in- stitutions of this kind ? — Possibly it may not be ; but it is an opinion which I have formed from a great many yeai's' experience of the two classes of women. I have had 30 years' experience of the voluntary class, and my firm conviction, as regards the voluntary class of prostitutes is, that they will not apply at a sufficiently early period to do much good in suppressing disease. Mr. Osborne Morgan. 2624. They come too late, and they go aAvay too soon ? — They will not come soon enough, and they will not stay long enough. Mr. Stansfeld. 2625. They will not do that if they are left entirely to themselves ; that is your view ? — Exactly. 2626. It does not follow that they will not do it without absolute compulsion ?^I do not see the difference. 2627. Supposing that there was a system without compulsion, and without periodical exa- mination, and kind treatment of the women in hospital, and supposing that that system were made known to them, surely it is in their own interest for the preserv.ation of their health, and for their own pursuit, that they should keep them- selves in health ? — No doubt it is to their own interest. 2628. And the earlier they come the sooner they are likely to be cured ? — Yes, but they are a class of women who will not act for their own interest as a rule. I speak from my own expe- rience of them, of some 30 years, that. they do not come as a fact. It is not because they arc not kindly treated, because they are very kindly treated in the lock hosjDitals. 2629. Has your experience led you to any conclusion as to the • social conditions under which true syphilis is most common; would you expect to find it more common in large centres of jDoiDulation, or in populations which are less dense ? — Certainly syphilis is more common in large centres of population, and I think that is a reason why syphilis is not diminishing at the present Q 4 time 128 MINUTES OF EVIDENCE TAKEN BEFORE THE 9 May 1881.] Mr. Lane. \Continue.d. Mr. Stansfeld — continued, time. The great tendency with all population now is to collect in large towns and to leave the agricultural districts. Mr. Osborne Morgan. 2630. The Census shows that, does it not ?— The Census shows that, no doubt. I think that is a reason why syphilis will not be likely much to diminish. Mr. Stansfeld. 2631. Then you would expect, quite irrespec- tive of the existence or non-existence of the Con- tagious Diseases Acts, to find a greater piopor- tion of syphilis in such places as London, Man- chester, Preston, Dublin, Sheffield, and so on, than in the smaller places where portions of our army are stationed in this country ? — Certainly, the large towns like London, Manchester, and Birmingham show the most syphilis. 2632. And that would be your opinion irre- spective of the presence or absence of the Con- tagious Diseases Acts ? — Yes. 2633. You told us, I think, that more women were reclaimed on the voluntary side of your hospital than on the other side ?— Yes. 2634. To what do you attribute _ that ? — Be- cause there is not so large a proportion of prosti- tutes amongst the women on the voluntary sicle. There are'a considerable number of niarried women who have been diseased by their hus- bands. 2635. What do you call the reclaimmg of those women? — They do not want to be re- claimed. 2636. Then you would not count them among the reclamations; but what you said was that those women were reclaimed upon the voluntary side ? — Yes. 2637. Those married women do not want re- claiming ? — Precisely. 2638. Then how "is it that more women are reclaimed on the voluntary side, proportionately ? — A good many of them are women who are not regular prostitutes ; they are servant girls and dressmakers who have become diseased, and get into the Lock Hospital. They are very glad to o-o into the asylum and be provided for for a certain length of time, and to have the means of o-etting into a respectable mode of life again ; and the women who come into the voluntary side are not such a low class of prostitutes as the others. They are much more seriously diseased, and they have seen what arises out of their mode of life, and they are very much more ready to leave it. 2639. What, in your opinion, has been the effect of the Acts upon the number of women eno-ao-ed in prostitution in given districts ? — To diminish the number, I believe. 2640. You formerly gave some evidence upon that subject, I think, before the Royal Com- mission ? — Yes. Mr. Osborne Morgan. 2641. I think you have uo personal experience of the subjected districts? — I know nothing, per- sonally, of them. Mr. Stansfeld. 2642. You were asked before the Boyal Com- mission, at Question 14710 : " Do you think that these Acts tend to increase the gains of prostitu- tion," and your answer was : " Yes, if they diminish the number of prostitutes in the dis- tricts, as they appear to have done, they will increase the gains." " Do you not think it might be carried to such an extent that prostitution sliould be a considerably more attractive life than an honest livelihood?" — " Yes, it will make pros- titution, so far, a more pi-ofitable and pleasant occupation, but if it make it more attractive it will bring more women into it ; the evil will cure itself. If many more women come into it, the profits will be diminished again." Do you retain those opinions now? — My opinion was, that by diminishing the number of prosti- tutes, those who remained would have Increased gains from prostitution. The questions seemed to lead to the idea that this was an evil, and my answer that you quoted was to the effect that if others were attracted the evil would cure itself, ' because the gains would be diminished and the attraction would cease. 2643. I infer from your former evidence that, from a medical point of view, you think it an evil that there should be a fewer number of .prostitutes ? — No, I am not prepared to say that, if they were carefully examined periodically. 2644. Do you think that, with a careful periodical examination, a given number of women could suffice for a greater number of men? — Yes, and 1 think also that it is better that there should not be so many women and such great facilities for men practising fornication. 264.5. Do you think that the existence of the Acts is likely to have diminished fornication? — In so far as the opportunities are lessened, cer- tainly. 2646. But how are the opportunities lessened? — Because there are fewer women, for one reason, and because they are found not to frequent the streets so nnich ; there is not so much solicitation in these subjected districts as elsewhere. 2647. But you surely do not mean to tell us that there has been any diminution of the oppor- tunities for fornication in the subjected districts, and that a soldier finds it all less easy now to commit fornication than before the passing of the Acts ? — If there are fewer women he would have fewer opjjortunltles. 2648. Surely not ; may it not be that one woman suffices for more men ; but I will not pursue that; I think that you have expressed, upon a former occasion, the opinion that the effect of these diseases has, upon the whole, become mitigated of late yeai-s, quite independent of the Acts? — The chai'acter of the disease, I believe, to be mitigated by the improved treat- ment. I doubt very much whether the quantity of disease has diminished ; the quality of the disease, I think, is less severe than it used to be. 2649. A good deal of disease was made worse by improper treatment ? — I think there is no doubt that that was the case 30, or 40, or 50 years ago. 2650. With regard to the infectious character of a woman under the condition of constitutional syphilis. SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 129 9 May 1881.] Mr. Lane. [ Continued. Mr. Stansfeld — continued, syphilis, would she be likely to convey infection to a man upon a single occasion of connection ? — She might. 2651. Is that frequent? — I believe that secondary disease is the most frequent cause of syphilis ; that it is from the secondary secretions, quite as often as from the primary sores, that disease is communicated. 2652. And it is your opinion that it is com- municated by a single act of connection ? — Certainly. 2653. Do you remember an opinion that you expressed before the Venereal Commission upon that point. At Question 3592, you were asked this : " Should you think it advisable to place women with constitutional syphilis in a lock hosjjital, as well as those with the other form of disease ? — Yes. In order to prevent contagion ? — Yes ; I do not think that a single inter- course with a female with constitutional syphilis would produce constitutional syphilis in a male ; but I think continued cohabitation would do so, not infrequently." I understood you just now to express a different opinion ? — I should modify that opinion very considerably. 2654. To what extent would you modify that opinion ? — To the extent that all secondary secre- tions are contagious, and especially moist secre- tions from secondary affections. 2655. Would you say that a woman with secondary syphilis was as likely to communi- cate the disease to a man with whom she liad a single act of commerce as a woman Avith a soft sore was likely to communicate that disease ? — No, I do not think that she would be as likely, but she would be very likely, as I think the matter from a soft sore is very irritating and very contagious. 2656. A soft sore is more contagious? — Yes. As regards my evidence in the year 1865, I should like to state that, within my recollection in the profession, there was a firm and universal belief that secondary disease was not contao-ious at all. That has been modified by degrees, and the evidence in favour of contagion has been very much increased since I gave evidence in 1865. I spoke less positively then as to the. question of secondary disease than I speak now. Dr. Cameron. 2657. Will you tell us what accommodation there is for the treatment of venereal diseases amongst the female population in London ? — It is very limited indeed ; I could not say what the number of beds may be. 2658. There is the Lock Hospital ; what is the accommodation there ? — It will accommodate from 40 to 50. 2659. I think you said that there are two sides ; what is the total accommodation ? — It will accommodate from 40 to 50 voluntary women. 2660. And have you many women on the Go- vernment side ? — As many as they send. It is an average of about 40 now. 2661. Then, does that fill you up? — No, at one time we had 150 women under the Acts. 2662. How many can you take into the Lock Hospital?— There is room, I should think, for another 80 or 100 women. 0.44. Dr. Cameron — continued. 2663. How many beds have you altogether, or could you put up?— We could put up 100 more. 2664. Then, what accommodation have you ; how many women can you acconamodate in the hospital ? — There is room for 180 at least, but there are no funds to keep them up. 2665. Your funds allow you to keep up how many ? — From 40 to 50. It is a hand-to-mouth business altogether. 2666. What other accommodation is there in London for that class of disease ? — I cannot speak very positively as to that ; but I believe they have a ward at St. Bartholomew's Hospital, and at St. Thomas's Hospital ; but the accom- modation is very limited indeed. I should think that 200 beds in the whole of London would comprise it all ; but I cannot speak positively as to that. 2667. Can you give any information as to the class of disease that they take in prefei-entially ? — They take in syphilitic disease preferentially to gonorrhQ3a certainly. 2668. Then I suppose the accommodation is very much smaller than would be wanted for the accommodation of the diseased women of Lon- don ? — Oh, dear, yes. 2669. With regard to the gonorrhoea cases that are sent to you, do get many cases of gonorrhoea under the Government ? — Yes, a great many vaginal and uterine discharges, with nothing else. 2670. What proportion will they constitute of your Government cases ? — I should think that they would constitute half. 2671. Therefore you would only have about 25 cases of sores and secondaries ? — Yes. I cannot state the exact proportion, and I am speaking rather of some years ago. In my own experience I know that the discharges, with no other symptoms, used to constitute a large pro- portion of the cases. 2672. You mentioned, in connection with your theory as to sj^phiiis, that you believed that the two classes of chancres constituted but one disease ? — I do. 2673. But, in your division of chancres, you spoke of them as hard and soft, infecting and non-infecting; what did you mean by" non- infecting ?— I mean by non-infecting those which do not infect the constitution of the patient. 2674. But, if hard and soft chancres consti- tute one disease, is not the fact of infection, or non-infection of the constitution, a very im- portant difference between them ? — Yes, the question is a very diflScult one. 2675. So much so as to justify their division into two different diseases 7- — I do not believe that there are two different diseases, for these two principal reasons; in the first place, the soft sores, those which are non-indurated throughout, do undoubtedly communicate secondarj' disease; and secondly, that you can inoculate the one form from the other ; you can from an indurated sore inoculate on the same patient, or on a syphilitic patient a sore which shall be precisely the same in its appearance and in its jjrogress as the ordi- nary soft sore. I cannot get over that difficulty as regards the one or the two poisons. 2676. That, of course, as I see you mention R in 130 MINUTES OF EVIDENCE TAKEN BEFORE THE 9 May 1881.] Mr. Lane. [ Coniinued. Dr. Cameron — continued. in your lectures is explicable if you adopt the theory which Dr. Lee explained to the Com- mittee of the mixed chancre ? — Yes. 2677. What is the result of inoculation with the poison of a hard chancre ; do you ever pro- duce soft non-infecting chancres ? — Yes; whether they are non-infecting or not I cannot say, because it is not justifiable to inoculate them on a sound person. 2678. I understand that you would not do it here, but abroad they have often done experi- ments that we should consider hardly justifiable. Do you know from the literature of the subject, whether from the inoculation of the poison of the undoubted infecting chancre, a non-infecting sore has ever been produced ? — I know that it usually produces the reverse ; it usually produces an indurated sore. 2679. You are not aware of any case in which poison from a hard infecting chancre has pro- duced a non-infecting chancre ? — No, not on a virgin subject. 2680. As you mentioned the case of inocula- tion from a soft chancre having produced an in- fecting sore, and as you explained afterwards, there being the theory of mixed chancres which explains that; I simply asked you the converse, with a view of ascertaining whether experiments made in both directions had established the theory of the identity of the disease. There was one point upon which you spoke very strongly about the identity of gonorrhosa with s])on- taneous discharges occurring in women ; am I to understand that you believe gonorrhoea is non- specific? — I do not believe that there is any specific contagion in gonorrhoea ; it is an inflam- mati(m of those parts. 2681. And non-specific? — Non-specific. 2682. That is not the generally entertained opinion, is it ? — It is very largely entertained, and especially abroad. 2683. You spoke about the French writers being of opinion that the husband of a wife with such a discharge might become acclimatised, so to speak, and therefore not subject to infection; have you any information as to the eflTects of spontaneous discharge in producing gonorrhosal sequela; ; if the spontaneous discharge is identical with gonorrhoea, you should have the same re- sults in the subject in the one case as in the other ? — I think that they are generally less irritating if they arise spontaneously than if they arise from sexual intercourse ; and in the case of prostitutes, the discharges are much more con- tagious, from the continual irritation to which the parts are subjected. 2684. But what I wish to ascertain is, how they ground the identity. Of course if a person, not a prostitute, accidentally gets gonorrhoea from infection, the discharge possesses properties which will give rise to well-marked effects ; for instance, gonorrhoeal ophthalmia on the patient herself; do you know of any such results follow- ing from spontaneous discharges ? — No, I do not know of any cases of gonorrhoeal ophthalmia arising from spontaneous discharges, but I should be very sorry to try the experiment. 2685. You have spoken about the inflamma- tion travelling backwards ; and, in the female, Dr. Cameron — continued. gonorrhoea may give rise to ovaritis ? — Yes ; I have not said anything about that. 2686. But it is the fact ?— Yes. 2687. If gonorrhoja is non-specific, the spon- taneous discharge or inflammation would have a similar tendency to spread backwards, and give rise to the same result, would it not ? — Possibly it has, but ovaritis is an exceedingly uncommon affection. 2688. Take any common complication of gonorrhoea ; take for instance rheumatism ; do you know of any case of rheumatism following spontaneous discharges in women ? — I know of no case of gonorrhoeal rheumatism in women. 2689. What do you consider as the sequel and tlie complications of gonorrhoea in the female ? — They are trifling ; she may get from an acute gonorrhoea a bubo. 2690. Do j'ou know of any case of a bubo arising from spontaneous discharges ? — I cannot say that 1 do. 2691. What other complication, or sequelae, would you mention in women ? — There are very frequently superficial excoriations and ulcera- tions about the as uteri. 2692. That is a mechanical result ; you de- scribed very clearly what the sequelae and com- plications of gonorrhoea in men were i — Gonor- rhoea is a very much less serious disease in women. These discharges are very much less serious in women : they do not liave many com- plications, and one reason may be that the dis- charges are chiefly vaginal. The male discharge comes from the urethra, and may travel back- wards to the bladder and prostate. 2693. The identity or non-identity of gonorrhoea and spontaneous discharges is a vei-y important point, is it not, both in its bearing upon the Con- tagious Diseases Acts and upon various medico- legal points ? — Yes. 2694. Do you know any case in which a husband who has become acclimatised, and who consequently v/ould not suffer in the usual way from contact with these secretions, got infected in any way, say in the eye, from a discharge? — No, I do not. 2695. Have you any evidence to support your opinion as to the identity of the ordinary go- norrhoeal and spontaneous discharges, or as to the non-specificity of gonorrhoea ? — I see no evi- dence whatever in favour of its being a specific poison. The same discharge may arise after the passage of a catheter, after theuse of various drugs, such as turpentine or cantharides. A man may have an acute gonorrhoea after that. He may have a swelled testicle from any of those causes, and he may have precisely the same results as those which are usually termed acute gonorrhoea. The same discharge may be produced in his urethra, and has been produced artificially, by injection of canthai'ides and other things experi- mentally. 2696. Is that the opinion of nine medical men out of 10, or of one medical man out of 10 in this country? — I should think so ; I know it is the general opinion abroad. If you read Ricord, he is very strong indeed about it, and most of his disciples too. They do not believe in gonorrhoea at all as a specific disease. 2697. Is SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 131 9 May 1881.] Mr. Lane. [ Continued. Dr. Cameron- — •continiiecl. 2697. Is ihis artificial gonorrhoja in the male ever followed bj those constitutional symptoms which you speak of? — Yes ; I say that the passing of gravel with the urine often gives a man an acute discharge, and may give him a swelled testicle. 2698. But I suppose that you could explain that by other reasons? — I say that it is the same thing, and that there is no distinction between the acute discharge which may arise from the passage of a catheter, or from the passage of gravel with the urine, and the discharge' from an acute go- norrhoea caught from connection with a woman. 2699. Then the fact of a woman having an infectious discharge, I suppose would not be any reason to lead you to believe that she was a pros- titute ? — Oh, dear, no. 2700. You talked a good deal about the infec- tious nature of secondary discharges, and so on ; what form of infection would you expect from them ? — I should expect that syphilis might be contracted from them. 2701. J)o you mean constitutional syphilis, or do you mean a local sore? — T say that all the con- stitutional lesions of syphilis, especially those producing a moist discharge, will communicate disease to others. 2702. But what form of disease would it be? — Most probably an indurated sore. 2703. Which you would class as primary, I suppose? — I should call it primary, or in its initial stage. She would give an indurated primary sore, which would be followed by secondary disease afterwards. 2704. Then would you ever have constitu- tional syphilis produced by infection from these secondary discharges directly, without any pri- mary symptoms in the first place? — No, I believe not. 2705. Is that a belief which is generally entertained ? — Yes ; and in all the experiments which have been made, an indurated sore, or tubercle, has been the result of inoculations with secondary syphilis. 2706. In the case of hereditary syphilis, do you consider that there is any primary local sore in the first place ? — Hereditary syphilis is quite a different question. I think there is no doubt whatever that a diseased father may beget a diseased child, and that child will communicate disease to the mother during her pregnancy. The mother will get that disease from the child without the intervention of any primary sore. 2707. There have been a number of cases reported of vaccinal syphilis inoculated in vacci- nation ; you have talked about Mr. Hutchinson; he had one remai-kable case ; those cases were carefully examined, and there was no primary sore, if I recollect aright, apparent at the point of inoculation, was there ? — Yes, they showed indurated soreS, or tubercles, at the point of inoculation, and afterwards secondary disease. 2708. Have you studied any of the French cases ; there have been a number of cases re- corded by M. Dupaul ? — I have read a good deal of the French literature on the subject. 2709. Is that universally the case ? — Yes, I belie-ve it is, according to my reading. The vaccination sore heals, and is forgotten ; and at the end of a month or six weeks, induration 0.44. Dr. Cameron — continued, appears at the inoculated point, and soon after- wards secondary disease comes on. 2710. What I wished to ascertain was whether, the infection from those secondary discharges uniformly reverts to what you may call a primary form of the disease? — Where it has been com- municated experimentally, I believe the primary form has always been reverted to. 2711. Do you know of any case in which any gonorrhojal disease of a child, ophthalmia for instance, has occurred in the child of a virtuous woman suffering any discharge ? — Purulent oph- thalmia certainly has occurred ; the mother's having vaginal discharges is a common cause of purulent ophthalmia. 2712. With the ordinary characteristics of gonorrhoeal ophthalmia ? — I think you would find it impossible to draw ihe line between pu- rulent ophthalmia and what is called gonorrhoeal ophthalmia ; it is a mere question of acuteness. Mr. Hupwood, 2713. But for a long time it was denied that syphilis could be communicated by inoculation, and in the cause of vaccination, was it not ? — Yes, it was denied for a long time. 2714. And it is now settled beyond doubt in the minds of the profession that it can be, and has been, so communicated ? — Yes, beyond a doubt. 2715. Would that have any bearing upon the inference to be drawn from the question put to you by the Judge Advocate General, that children die from syphilis where the cause of death is put down as other diseases ; they die from syphilis ; it may be from vaccination, may it not ; that affects the number, does it not? — To a very trifling extent, if any. 2716. You answered the question, that you believe that many children die from svphilis, who are put down as having died from other diseases ? — Yes. 2717. Then do you draw from that the in- ference that there is a large amount of syphilis in the civil population ? — Yes. 2718. And when you find that syphilis may be communicated by another material agency, does that affect the question of the normal existence of syphilitic disease in the civil population ? — Anything which communicates syphilis to the civil population will increase all these effects, and must necessarily do so. 2719. Where have you derived your experience of these Acts ; has it been solely in your capacity as surgeon to the Lock Hospital ? — I have no knowledge of the working of the Acts amongst the soldiers. 2720. Your official duties at all events, in re- gard to the administration of the Acts, have been confined to the Lock Hospital, have they not ? — Yes. 2721. You have never acted as examining sur- geon under the Acts ? — No, I have not at the original examination. 2722. In every case that has come to you, you have had the advantage of a previous examination by some one else ? — Yes, but no intimation of what disease w.as found. 2723. But still the patient was sent to you as E 2 diseased. 132 MINUTES OF EVIDENCE TAKEN BEFORE THE 9 May 1881.] Mr. Lane. [ Continued. Mr. Hojjwood — continued. diseased, and pronounced so by what you deemed to be a fkiriy competent authority? — Yes. Mr. Osborne Morgan. 2724. Of course you are only speaking of Grovernment patients now ? — Yes. Mr. Hopwood. 2725. In speakinLi; in criticism of any gentle- men who have given an opinion as to the difficulty of finding disease, they had the disadvantage of being the first to investigate it, and you had the advantage of being supplied with the information of a surgeon who had previously examined the case ? — Yes. 2726. If one gentleman says that it is very difificult to find it out, he is speaking of his un- aided exertions, whereas you are speaking having had the advantage of previous examination by a surgeon ? — Yes. 2727. With regard to this open question be- tween the dualist and the unicist theory you quoted, I think, two Norwegian physicians ; are you aware that one of those is quoted in support of an opposite opinion to what you ascribe to him ?— I quoted hr. Boeck and Dr. Bidenkap. 2728. Has not Dr. Boeck given the contrary opinion? — Oh, dear, no. 2729. Neither of them ? — No. 2730. Which is the gentleman who was cited to us the other day who had prosecuted an enor- mous number of inoculations ? — Those who have practised inoculations most are those two whom I mention. They have practiced it on an enor- mous scale, because they pursued the treatment only by inoculation. 2731. Do you say that both those gentlemen are of opinion that there is only one form of the disease?— They are very strongly of that opinion, and you would convince yourself of that by look- ing at their evidence before the Commission of 1865. I know it from personal communication with both of them, because I had a great deal of communication with them when they were here. 2732. Do I rightly understand you to say that no importance is to be attaclied to that question as to the working of these Acts? — I do not see what bearing that question has. 2733. Does it not appear that if a number of primary soft sores are sufficient to result in con- stitutional disease if you cure a number of those soft sores it makes very nuich for the Acts ? — That is one of the advantages of the Acts. 2734. If you assume then that these soft sores include the enthetic or constitutional disease it makes for you ? — Yes. 2735. if that is denied and questioned, surely the settlement of that point is very important for the Acts ? — I think it equally important to sup- press both kinds of disease. 2736. Is it equally difficult to suppress both kinds of disease !—l should say that it was. 2737- Does it require the same elaborate ma- chinery to suppress both kinds of disease ? — I should think so. 2738. Then you do not agi'ee that a great number of the soft sores are cases which yield very readily to treatment? — Not very readily; they run a course of about a month. Mr. Hopwood — continued. 2739. But many of them present no complica- tion to the surgeon ? — There are many which do not present any complication, but there is a very large proportion which jn'esent the various com- plications which I have mentioned. 2740. Yon took some exception to the term " dirt sore " ; we did not understand that to be used as a scientific term, but as a nickname for the sort of disease. Is it not the fact that a large number of these soit sores result from filth, or from the personal habits, want of cleanliness, or want of ablution ? — No, not in the case of soft sores of that kind. 2741. Is there some other sore besides soft sores and indurated sores that you do understand by that term ? — I think that a person who is dirty may get sores anywhere, in the folds of the groin, or anywhere else. 2742. But I mean soft venereal sores. Do I rightly understand you to say that you think that the Armyllegulations which Mr. Sidney Herbert introduced had no effect at all upon this question of disease .' — -I think that cleanliness is of great service in preventing disease being coutracted, because the poisonous matter which may be lodged on a person's skin is washed away, but if he leaves it there for a longer time it may penetrate. But what I understand by a soft sore is a sore which secretes a specific poisonous matter, and which may be inoculated on other persons or the same person through a series ad injiidtum. 2743. Perhaps you will take it from me that what was meant by dirt sores was a portion of sores that might be avoided by cleanliness ? — There may be excoriations from dirt, certainly ; but they would not be likely to be mistaken by an experienced surgeon for what we understand by a soft sore. 2744. I assure you that these gentlemen did not mistake it in that sense at all. I think it was your opinion, upon a former occasion, that the disease was propagated by women in spite of fortnightly examination? — It must be, to a certain extent. 2745. How far would you carry the frequency of the examination to be safe? — I think that, practically, you can hardly make it more fre- quent than fortnightly. 2746. It is to be admitted then that, under the present system, disease is propagated between the times of examination ? — Of course it is. Dr. Farquharson, 2747. You have given a decided opinion in favour of one virus ; can you give any opinion that would be intelligible to a non-medical audi- ence, as to the way in which some sores infect the constitution and others do not ; why do some sores become hard and others remain soft ? — I cannot give any definite reason. 2748. Has there not been a great increase of opinion lately amongst members of the medical profession and members of the medical com- munity iu favour of the unity of the syphilitic virus ? — It is my impression that the opinion in favour of unity is growing. 2749; And that is probably so, because it is only within the last few years that we have had such undoubted evidence of soft sores being fol- lowed by constitutional infection? — Probably so. 2750. That SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 13S 9 May 1881.] Mr. Lane. [ Continued. Dr. FarquhursoiL — continued. 2750. That would probably account for your own change of opinion in the mattftr? — Yes. 2751. Is your own change of opinion due in any way to your having more extended expe- rience of soft sores in women and finding that tliey very frequently were followed by constitu- tional symptoms? — That was one reason why I always believed in unity, that you often got secondary disease in women from non-indurated sores. 2752. Do you think that a soft sore, which is followed by secondary symptoms, is in any way to be distinguished from a soft sore which is not followed by secondary symptoms ? — I know of no means of distinction. 2753. Mr. Lee, I think, stated that a sore which was described by him as a soft sore could never be followed by a secondary symptom, but you do not hold that opinion ? — No, I do not. 2754. Mr. Lee produced a diagram of an in- oculation that he had made on the urm of a gentleman ; would you consider that at all com- jDarable to a soft sore on the genital oi-gans ? — An inoculated sore on the arm would be pro- perly taken care of and covered up, and not sub- ject to any irritation ; but a soft sore on the outside of a man's penis, or at the point of his fore skin, is continually getting rubbed and irri- tated, and that is a different matter altogether. 2755. I think that this inoculation made by Mr. Lee was made on the outside of the arm away from the probability of bubo ; that would tend to make it less irritating, would it not ? — Yes. 2756. A great point has been made by one or two witnesses, more especially of the fact that there has been a general diminution in the quan- tity of soft sores and non-infecting sores through- out the country, and one of the witnesses brought forward some evidence from the Lock Hospital at Paris, to show that soft sores were becoming very much more common ; is it not probable that that is one of the waves of which Dr. Lawson has spoken ? — I believe that there have been great fluctuations in Paris during the last 10 or 15 years as to the proportion of soft and hard sores. That has been shown by M. Mauriac ; but I under- stand that another surgeon, M. Horteloup, has shown that in the year J 879 sofc sores were in- creasing again, and that whereas the hard sores had the preponderance in numbers before then; in 1879 the soft sores preponderated to a very considerable extent, almost double ; the numbers being 749 against 331. 2757. So that the decrease of soft sores two or three years ago was really due to one of those periodical waves which Lispector General Lawson has described? — I suppose so. 2758. I think you say that it is possible to pre- vent secondaries following primaries. Dr. Lee and Dr. Routh stated very much the same, that an experienced eye would see some .slight evi- dence of infection, and that a patient would get a little thin and out of health ; do you hold that opinion, or do you consider that you can entirely obviate the secondaries by treatment? — I believe that you can entirely obviate secondaries by treatment. 2759. Do you believe that indurated hard sores must inevitably be followed by secondaries? — Not inevitably, even without treatment ; but 0.44. Dr. Farquharson — continued. in the great majority of cases they would be. The Norwegian surgeon. Dr. Boeck, who had an immense experience in syphilis, and who never used mercury at all, told me that he knew of cases, not a large number, in which indurated sores not treated by mercury were not followed by secondary disease. I always treat the indu- rated sores myself by mercurj', and therefore I cannot say what would happen if they were left to themselves and whether some of them might not escape secondary disease. 2760. You agree with the opinion so often ex- pressed, that hard sores are less common in women than in men ? — I agree that they are less common and less well marked, but I am not at all so strongly of that opinion as I was, because I have the returns of the number of indurated sores seen in the Lock Hospital within the last few years, which shows that in both classes of patients there are a considerable number of such sores. I handed in a paper to that eifect. 2761. I suppose that one reason why hard sores would be less frequent in women than in men would be that women have so often had syphilis before ? — Possibly. 2762. Supposing that you have a woman who has had syphilis already, and a hard sore is com- municated to her, it appeal's upon the person as a soft sore ? — Most likely. 2763. Would that soft sore, communicated to a man, give him the infecting variety of sore or a soft sore? — I think it would probably give him an infecting sore, because that woman will often have syphilis in her constitution. 2764. So that the fact that women have a small number of hard sores does not in any way show that they do not communicate a large num- ber of infecting sores to men ? — No. 2765. We have heard a good deal about the difficulty of detecting a hard sore in a woman, and I asked Mr. Lee whether he might not often be assisted by the presence of enlarged glands in the groin; and he said that very often those sore appeared so high up near the os uteri, that they would not in any way aiFect the inquinal glands, and cause hardness ; do you consider that that is probable? — According to my experience it is the rarest possible thing to find a distinct indurated sore, or a distinct soft sore, either on the os uteri, or high up in the vagina. 2766. So that in almost every instance yoil have the existence of enlarged glands in the groin to assist you in detecting a hard sore ? — Yes. 2767. We have heard Mr. Lee's opinions re- garding the probability of hard sores or any sores being detected. I think it was overlooked at the time in answer to a question which I put to him at Question 1040. " Would you think that one-half escape detection under that mode of examination? {A.) If a patient were tho- roughly examined all over, I think she would not escape detection." — Was that upon the question of the discovery of secondary disease in wo- men ? 2768. No; I think it was merely that in the case of any sore, the examination was so imperfectly conducted that half the number of sores would escape detection ; but he says : " If a patient were thoroughly examined all over, I think she would not escape detection"? — I understand E 3 him 134 MINUTES OF EVIDENCE TAKEN BEFORE THE 9 May 1881.] Mr. Lane. [ Continued. Dr. Farquharson — continued, him to mean that although nothing was found about her private parts, yet when she was exam- ined all over, you might find something in other parts of her body whicli would lead you to know that she had secondary disease. 2769. Therefore Mr. Lee's real opinion is, that if the patient is properly examined no case of secondary syphilis ought to escape detection ? — I think he said so himself. Mr. Osborne More/an. 2770. That is clearly your opinion ? — That is my opinion. Dr. Farquharson. 2771. Tlien you both agree that if a patient is projjerly examined it is not likely that syphilitic disease will escape detection ? — That is my opinion, and that, I understand, to be Mr. Lee's opinion if she was examined all over, but not if the examination was purely local. 2772. In your experience it is not merely a local examination, but the patient is looked all over carefully? — Yes. 2773. Though you are not an examining sur- geon, you have had a large experience in ex- amining women? — Yes. 2774. We have heard a good deal about mixed chancres; is there any pathological proof that such a thing can exist, or is it merely what we may call pathological theory ? — I know of no proof whatever; but I think that there are better explanations. A soft sore may become indurated at any period of its course, and it would be called a mixed sore. 2775. Then do you consider that the mixed chancre is merely a jDathological theory invented to meet certain difBculties ? — That is my opinion, and that is the opinion of a very good authority in Paris, M. Clerc, who believes in unity, and he says as I myself said, I believe, before him, that if it had not been for the duality theory, mixed chancres would never have been heard of. 2776. And of course those who like you, believe in unity, cannot believe that there is such a thing as a mixed chancre ? — No, I do not believe in it. 2777. In fact, is it not against pathology to hold that two morbid processes can go on at the same time on the same portion of the body? — Yes. 2778. We have heard a good deal about me- diate contagion ; is that in any way proved by experiment or otherwise ? — It has been proved by experiment, but not on a very large scale. Cul- lerier, in Paris, many years ago, performed some experiments in that direction, and they seemed to prove that mediate contagion was possible. What he did was to put venereal matter in the inside of the female parts, and leave it there for a certain time, and then examine the woman again, and take some of the matter and inoculate it, and he found that it was inoculable. 2779. In The case of hard sores in wliich the secretion is very scanty, it would be extremely unlikely that such a thing could happen ? — Much less likely. 2780. With regard to those cases that hap- pened at Aldershot in which there was sucb an extraordinary access of disease in one particular regiment, I do not think there was any proof Dr. Farquharson — continued. adduced at any time that that had been caused - by mediate contagion ? — Not that I am aware of. 2781. Could it not happen in this way : that perhaps a woman had come in from the outside, and before she was detected to be diseased she mio-ht have caused an enormous quantity of dis- ease by consorting with those men in the regi- ment ; in fact, I think it was proved that women had been taken to the men's rooms at night and lived there ; could not one diseased woman come into a station like that and very rapidly disease the whole regiment ?— -She might veiy soon dis- ease a large nimiber. 2782. Supposing that a woman told you tliat slie had had connection with 20 men in a night, would you think it necessary to believe it be- cause she said so? — No. 2783. Do you think that there is any difference in the severity of the true syj^hilis ; do you think that it is becoming less severe than it formerly was ? — I think that individual cases are less severe than they formerly were on account of the improved treatment ; that is to say, we do not see the serious mutilations now amongst the bones and in the throat which used to be seen. I do not think that syphilis is less frequent, and I do not think that it is less dangerous in the way of hereditaiy transmission ; but I believe it is doing quite as much mischief in that and other directions, although in individual cases it may be less severe. 2784. Have we not a large mass of evidence to show that syphilis will affect almost all the in- ternal organs in a very serious way ? — Cer- tainly. 2785. Do you think that thatis because we have recognised these things, or because they are more common than they used to be ? — I think it is only of late years that the importance of the study of syphilis in the internal organs has been recog- nised, and the physicians have been working very hard on that subject, and they have shown be- yond all doubt that sypliilis in the interniJ organs is by no means infrequent, that many persons die from sypliilis in the internal organs, and did for- merly ; but formerly the disease was not set down to syphilis. In the case of lung disease, for instance, it is known that syphilitic deposits take place in the lungs, and persons may die of symptoms resembling consumption, where the deposit is not that of tubercular consumption, but a syphilitic deposit. Mr. Osborne Morgan. 2786. And are not those cases now very often put down to consumption ? — I dare say many of them would be. Dr. Farquharson. 2787. Therefore, although the non-infecting sore may be less severe in consequence of the im- proved method of treatment, there is no evidence to show that an infecting sore is less severe in its consequences ?■ — No, as to its remoter conse- quences especially. 2788. Have you any opinion to give about the increase of clandestine prostitution since the Acts were introduced? — I have no knowledge as to the increase of clandestine prostitution. 2789. Witb regard to the voluntary lock hospitals, SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 135 9 May 1881.] Mr. Lane. [ Continued. Dr. Farquharson — continued. hospitals, Mr. Lee states in Hs evidence, in answer to Question 1127, that tlie women would diagnose their own cases and go into the hos- pitals ; do you think that that is a very likely thing to happen ? — I know that practically they do not go in until they are seriously diseased. There is not the least doubt that many women are diseased for a considerable time without knowing it at all, and nothing can touch them except frequent examination ; and the woman may be quite innocent as far as knowingly com- muiricating the disease is concerned; she may not know that she has it. 2790. A hard sore being painless might, of course, be often overlooked by the woman her- self? — Yes, and so may the soft sore, if it is situated internally, and does not give her much pain. 2791. Mr. Lee also stated that he did not think that any real good could come from forcible de- tention ; would not forcible detention be quite as efficient, from a medical point of view, as any other kind of detention ? — Certainly, if you allow her to go out before she was cured in a state to communicate disease she will communicate dis- ease. 2792. We have heard a good deal about the women being driven out of the district for fear of their being brought under the Acts ; that does not look as if the voluntary hospital system was a great success if they are so anxious to leave the district ? — Yes, that is so. 2793. Various reasons were given ; I suppose that the women naturally object to be disturbed in the exercise of their profession, and tliey run away, perhaps, because they are disturbed, and they wish to go, perhaps, where they can pursue their occupation undisturbed ? — Probably. 2794. Have you any evidence to show that those women, who leave a protected district, ne- cessarily go elsewhere to exercise their profession ? — They may leave the district intending to leave their profession. 2795. May they not marry, or be reclaimed? — Yes, and many do so. They may be disgusted with the life, and go away and leave it. 2796. There is no evidence to show that the. women who leave a protected district ne- cessarily go and carry on their profession else- where 'i — Not that I know of. 2797. The honourable Member for Glasgow asked j'ou a question about the inoculation of the hard sore producing soft sore ; but if you inocu- lated a hard sore in a subject who had already had syphilis you would get a soft sore, would you not ? — Yes, that has been proved to demonstra- tion over and over again. 2798.. As to the so-called dirt sore, is thei'e any proof at all that dirt can produce a sore which can in any way be mistaken for the non-infecting form of syphilis ? — No, or at any rate the mistake would be corrected very speedily by keeping the sore clean. I say that dirt will not produce a sore which has a specific poison which can be inoculated on the same person, or on any other person, and which will communicate a direct and specific contagion. Dirt will produce sore places, but dht will not produce soft chancres. 0.44. Mr. Osborne Marc/an. 2799. Dirt will not produce an infectious or communicable sore ? — No, dirt could not. A very dirty person will have very acrid discharges from a sore place which might irritate any one else very much. 2800. But such a sore coitld not contain a specific poison which could be communicated to anyone else ? — It could not. Dr. Farijukarson. 2801. Do you think that a sore produced by dirt would be in any degree mistaken for a sore produced by contagion? — No, I should say not: or at any rate the difference would be very soon apparent. The dirt sore would be well in a day or two if it was kept clean, and the other would last a month or longer. 2802. There have been some questions asked about the difference between the sequelas, or as to the possibility of gonorrhasal sequoias following a gonorrha3a produced by leucorrhoea ; but I un- derstood you to say that there is nothing specific about a gonorrhceal sequelae, but that it is merely the result of the purulent discharge from the urethra ? — Yes. 2803. Therefore you might as well have gonorrhasa produced by leucorrhoea as by gonor- rhoeal discharge ? — Yes, you might certainly get it from the passage of an instrument, or from the passage of gravel along the male urethra ; you may get swelled testicle and you may get attacks of rheumatism. I have seen It over and over again. 2804. And the gonorrhoeal discharge would only differ from that produced by leucorrhoea in degree ? — Only in degree of acutencss. Colonel Dighy. 2805. From what part do the women who come to your hospital under the Contagious Dis- eases Acts come ? — At present from Greenwich and Woolwich, and Deptford, and Charlton, and the surrounding districts only. 2806. I think you said that you had some difficulty as to funds for the hospital ? — On the voluntary side. The Government ])a.y for the others. 2807. You also stated, I think, that you had a great deal of difficulty in keeping the women who were in the voluntary side in hospital, because they frequently take their discharge before they are perfectly cured ? — They will do so ; 20 per cent, do so. I have put in some papers showing that. Ten years ago it was 25 per cent, so that they stay rather better now than they did then. 2808. Is there any means that you know of of persuading them to remain? — 1 am told that they remain now better than they used to do, because there Is a very judicious nurse looking after them. It depends a good deal upon that ; but still 20 per cent, now do leave in a state in which they can communicate disease. 2809. Would it have any effect on the number of women who voluntarily submit to the system if they signed a form on admission to the hospital, agreeing to remain there until they were perfectly cured? — I think it would have the efi'ect of making a great many of them stay R 4 away 136 MINUTES OF EVIDENCE TAKEN BEFOUE THE 9 May 1881.] Mr. Lane. \_Coiitinued. Colonel Dirjhy — continued, away. They stay away as it is until they get very seriously diseased. Mr. Cavendish Beutinck. 2810. It has been urged by the opponents of these Acts, that a great deal of the diminution of disease is due to the improved arrangements for the comfort and cleanliness of the soldiers, and especially in the matter of ablution ; do you concur in that opinion ? — I daresay that it has had some effect in that direction ; but it is also said that that effect has been produced only on the soft or non-infecting sore. There is no reason whatever, that I can see, why it should not dimi- nish both forms of sores. Cleanliness is quite as useful in the one case as in the other. 2811. When Mr. Lee was examined, I took the liberty of addressing to him some rather par- ticular questions vipon that point ; I asked him whether, if ablution was really to prevent disease, it ought not to take place almost instantaneously or very shortly after the connection? — Certainly, it ought to take place very quickly. 2812. I was not able to get a very direct answer from Mr. Lee, and therefore I will ad- dress the same question to you, if you will be kind enough to answer it. I asked him whether ablution is effectual unless the poison is washed off very soon, and his answer was, " I do not know how soon " ? — Neither do I. 2813. Then I asked him, at Question 1174, " I understand, from medical opinion, that unless the ablution is done speedily no good effects result " ? His answer to that was this : " True syphilis is very often imbibed through the skin, and for that to take place I expect a considerable amount of time would be required." Then I said : " We are now dealing with soft sores ; I understand, and it has been alleged by other witnesses, and also by yourself, that the intro- duction of Lord Herbert's Orders and the habits of greater cleanliness in the Army have prevented infection from soft sore ; do you think that ab- lution is of any use at all unless it comes very soon after infection? (^4.) I should say de- cidedly ; hut how long it would take I am sure I could not say ; of course it is much more likely to be effective the sooner it is done." Do you consider that the ablution ought to take place very speedily, to have any effect? — It ought to take place very speedily. I cannot say any more than Mr. Lee how soon ; some persons have very much tougher skins than others, and it would be a longer time penetrating; so that one could hardly specify any given time. If there is an abrasion of the parts the ablution must be immediate, or it would be of no use at all. 2814. But do you think that these improved arrangements in the Army, these wasliing estab- lishments and lavatories, and other things that they have in the barracks, are any considerable protection against disease ?— I think they are a considerable protection against disease ; but I do not admit that they are exclusively protective against soft sores. I should say that they were most protective against the other kind of sores, because in the other kind the matter is less irri- tating and will take longer to penetrate. Mr. Cavendish Bentinck — continued. 2815. On the whole, do you think that those improved arrangements have had any material effect in the diminution of disease ? — -I should think that they must have had some effect. Mr. Osborne Morgan. 2816. Of course they would have an equal effect upon the pi'otected and the unprotected stations? — They would have an equal effect in both sets of stations, and equally, I should like to insist, upon both forms of sore. 2817. You said, in answer to the Right honour- able Gentleman the Member for Halifax, that you have had certain statistics from your hospital l^repared ; will you state the result of those sta- tistics ? — There was one return showing the num- ber of indurated sores on both sides in the years 1878, 1879, and 1880. 2818. Will you state what the numbers were in the year 1878? — The number of patients with in- durated sores, followed by secondary syj)hilis, was 48 on the voluntary side, and, on the other side, the number of patients with indurated. sores, followed by secondary syphilis, was six. The number of indurated sores not known to be so followed was, on the voluntary side 18, and on the Government side 15 ; suppurating buboes, associated with syphilis, eight on the voluntary side and three on the other side ; suppurating buboes, not asso- ciated with syphilis, that is to say, with soft sores, 22 on the voluntary side and nine on the otlier side ; soft sores, followed by secondary syphilis, four on the one side and 16 on the other. Chairmaji. 2819. Will you give the numbers in 1879?— The number of voluntary women with indurated sores, followed by secondary syphilis, was 39 ; and on the other side 10. The number of women with indurated sores not known to be followed, was 13 on one side and 12 on the other. The number of cases of suppurating buboes associated with syphilis was three as against one ; and the number of cases of suppurating buboes not asso- ciated with syphilis, was 23 against eight ; soft sores followed by secondary syphilis, eight on the one side, and 12 on the other. 2820. Now, will you give the figures for 1880 ? — Indurated sores followed by secondary syphilis, 37 against seven ; indurated sores not known to be so followed, 13 against four ; suppurating buboes associated with syphilis, 10 against four ; suppurating buboes not so associated, 22 against 19 ; soft sores followed by secondary syphilis, nine against 12 ; both tables seem to show very clearly tliat indurated sores are not so uncom- mon in women as was formerly supposed, and also that soft sores are not unfrequently followed by secondary disease, Mr. Osborne Morgan. 2821. You did not draw up these figures your- self, I think ?— No, I did not. 2822. AVho drew them up ? — The resident medical officer, Mr, Bishop, whose name is signed to them ; he has been there for seven years, and he has taken a good deal of interest in the statis- tics SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 137 9 May 1881.] Mr. Lane. \_ConUnued. Mr. Oshorne Morgan — continued. tics of the matter, and he thoroughly understands the whole question, 2823, In your opinion, he is qualified to speak upon the subject, and to draw up the returns ? — Thoroughly qualified, in fact, any report which I gave in my former evidence, was drawn up in precisely the same way ; I did not do it personally, 2824, You would consider his name a sufficient guarantee of the authenticity of the return ? — Certainly. 2825. When a patient is sent to the hospital on the Government side, all that you know about her, I suppose, is that she is diseased. The honourable and learned Member spoke to you about your having the advantage of being pre- pared by the previous examination ; you do not get any history of the case when it is sent you, do you? — No, we take our own history ; we find it all out for ourselves. 2826. And, of course, in the case of the women who come voluntarily, you have not even that Mr. Osborne Morgan — continued, advantage ; you have no sort of examination beforehand ? — Those we examine for ourselves. 2827. In fact, you rely upon your own exami- nation ? — Yes. Mr. Cavendish Bentinch. 2828. Those cases come in recommended by the subscribers, do they not ? — Yes, but many of them are admitted without a subscriber's order. 2829. Then will a subscriber's case have the joreference then? — Yes. I would say that we do not have to examine the patients under the Acts before they come in, but we have to examine them before they go out, and we have to sign a certificate that they are free from contagious disease. Mr. Osborne Morgan. 2830. I suppose somebody sees them when they come in? — The resident medical officer is always there, and sees them in the first instance, and examines them, and takes their history. 0.44. 138 MINUTES OP EVIDENCE TAKEN BEFORE THE Monday, I6th May 1881. MEMBERS PRESENT Mr. Cavendish Bentinck. Mr. Cobbold. Viscount Crichton. Colonel Digby. Dr. Farquharson. Mr. William Fowler. Mr. Hopwood. Mr. Massey. Mr. Osborne Morgan. Mr. Stansfeld. Colonel Tottenham. Sir Henry Wolff. The Right Honourable W. N. MASSEY, in the Chair. Mr. John Birkbeck Netins, m.d., re-called ; and further Examined. Mr. Stansfeld. 2831. You have read, I presume, the last evi- dence given by Surgeon General Lawson ? — I have. 2832. And amongst other answers of his you have read, have you not, bis criticisms on your Table, No. 2, in the Appendix to the Report of 1880, page 47 ?— I have. 2833. Mr. Lawson could not find any figures in it correct ; have you any explanation to give as to that evidence of Mr. Lawson's upon your Table No. 2? — The heading of the table is "from 1867 to 1877," which last figure is a mistake, and should be " 1873." If that mistake is corrected the figures will come out correct. But a further correction will be necessary. The object of this table was to show the influence of the Acts, and some of the stations now under the Acts were not under them for the whole period of seven years. Some were only under them for sis yeai's, and therefore the ratio is taken for six years ; others were only under them for five years, and the ratio for five years is taken ; and others were only under them for four years, and the ratio for four years is taken. When these corrections are made, the table comes out correct. 2834. That is to say, taking the average of ratios, you divided the totals by the number of years during which the Acts had been in opera- tion at each station ? — I did. 2835. And that is your explanation of the table ? — That is my explanation of the errors in the figures. 2836. There was a diagram of yours, which I think is to be found at page 54 of the Report of 1880 ?— It is at page 54. 2837. That diagram also was criticised by Mr. Lawson, who put in a diagram of his own. I see that in answer to Question No. 1387 ; " Have you any observations to offer upon this diagram ?" he said, " Dr. Nevins embodied that in a diagram, a copy of which is in his evidence"? — I really do not know what difference there is of importance between Mr. Lawson's diagram and mine. I am perfectly ready to accept his diagram. The diagram which I handed in to the Committee was this one {producing a diagravi). Mr. Stansfeld— continued. 2838. In that answer of Mr. Lawson's what he says is this : " This diagram " (of Dr. Nevins') " is one which anybody who is not very familiar with the manipulation of diagrams would be easily deceived by ; it has got a very great vertical scale and a very small horizontal one, and there are no means of tracing the influence from year to year readily upon it. To meet that diflSculty, I have prepared a diagram myself, embodying the facts that he has given, and some further facts which are of importance in the question." Will you show us the diagram which has been printed upon our notes, and have you any explanation to offer us with regard to that vertical scale to which Mr. Lawson refers? — This {holding up a diagram') is the diagram as it is published in the Report. It was published upon this scale in order that it might come into a single page along with the other ])ages, which it could not do if the years were made much broader. Mr. Lawson's table occu^oies three pages instead of one. I believe that there is no difference whatever in reality between them. 2839. The objection, as I understand it, to this diagram, as printed by the printers to the House of Commons, is that the vertical lines are longer than the horizontal lines ; you have a line for each year, and each year is not represented by a square, but by an oblong figure, of which the vertical line side is the longest ? —Yes. 2840. So that it makes a more striking curve ? — It makes a more striking curve. 2841. Is not this accident, as I should call it, a typograj)hical accident ; or has the printer accuratelj' coj^ied the larger form which you held up before the Committee ? — He certainly has not copied the larger form. This is the large form which I held up to the Committee. In this case I have squared it, and carried it on, so as to show how exceedingly small the fall would be year after year when the ratio has become smaller. This {producing a amaller diagram) was the diagram which 1 handed in to the Committee, and it has been copied on a smaller scale for the con- venience of printing. The black line shows the actual fall of the disease ; the red line shows the fall, putting it upon an equal scale all the way through ; SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 139 16 May 1881.] Mr. NevinSj m.d. [ Continued. Mr. Stansfeld — continuecl. through ; and, of course, as the number becomes smaller, the proportionate fall would become smaller year by year. Mr. William Fotvler. 2842. What do you base the red line upon ? — The fall from ISeo'to 1866 was without the Acts, and I have taken this fall and carried it forward. 2843. At what you suppose it would have been if there had been no Acts ? — At what it would have been if there had been no Acts. 2844. Assuming the old fall to have con- tinued ? — Quite so. jMr. Stansfeld. 2845. You have no objection to take Dr. Law- son's diagram instead of your own ? — Not the slightest. 2846. It has one advantage, has it not; it has another line, a dotted line ? — It has. 2847. What does that dotted line show ? — The dotted line shows the unsubjected stations. 2843. All the unsubjected stations? — I think it shows them all. Mr. William Fowler. 2849. But it says that the large dotted line is for 14 stations? — It is for 14; this line is for all the stations {pohiting to the diagram). The introduction of that line to a certain extent, as it appears to me, confused the original object that I had in view, and I did not adopt it ; but I am perfectly ready to adopt Mr. Lawson's diagram. Mr. Stansfeld. 2850. The additional line shows the diflFerence between the progress of the disease in all the subjected stations, as compared with the selected unsubjected stations ? — Yes. 2851. The total of the non-subjected stations shows a line more favourable to your views than that of the selected ? — It does. Mr. William Fowler. 2852. Would it not be very easy to print your diagram in the same way as this is done ? — There would be no difficulty at all in doing that. I had no idea that any objection would be taken to it. I had no object in printing it in one way rather than in another. Mr. Sta7isfeld. 2853. One great question which has been dis- cussed in the evidence before us appears to be this : whether, at the time the Contagious Dis- eases Acts were first brought into operation, there ought to have been, looking back, a reason for a continuance of the improvement in the amount of disease in those stations which had shown itself in previous years ; what is your opinion as to that? — Aly opinion is that that fall ought to have been continued, and might reasonably have been expected to continue. 2854. Is your answer that the rate of improve- ment in these stations before the Acts would have been specifically continued, or that some imjirove- ment would have continued ? — That the improve- ment would have been substantially maintained. 2855. Would you give us some reasons for that belief? — The reason that I have for it is, that 0.44. Mr. Stansfeld — continued, the improvements which were introduced into barracks, and the improvements of every descrip- tion which were introduced under the influence of Lord Herbert's Commission were carried on with even greater energy after the Acts were put into forde than they were before, and that they were carried on more largely at the stations which were under the Acts than at the stations which were not under them. 2856. Without going (unless it is required) into a long detail, having read the Army Medical Reports from year to year, can you summarise to us the results of those reports ; first in the period previous to the Act of 1866, and then in the subsequent period ? — Yes, in these sheets I have taken out every reference that the Army Reports contained to the intro- duction of sanitary and other improvements from 1859 to 1878; and the result of the whole is that, before the Acts, that is up to the year 1866, improvements of an important character are recorded in the Army Reports as having been carried out 35 times in the subjected sta- tions, and 20 times in the 14 unsubjected sta- tions. 2857. In the 14 unsubjected stations or in all of them? — In the 14. I also find that improve- ments have been recommended, but not carried out, six times in the subjected stations, and that improvements have been recommended, but not carried out, 10 times in the unsubjected stations. That is the condition of things before the Acts. Since the Acts, improvements of an important character are reported 48 times in the subjected stations, and 23 times in the 14 unsubj ected station s. That is the result of every reference which I have been able to find in the Army Medical Reports year by year of impi-ovements carried out in the respective stations. 2858. Then, Itakeitthatthegenei'al impression produced upon your mind, about which you have no doubt, from reading of the Army Medical Re- ports, is this : that these improvements, con- sequent upon the recommendations of Lord Her- bert's Committee, were by no means exhausted in the year 1866, but went on with almost in- creased vigour from that date ? — Certainly, they were not exhausted, but went on with increased vigour in the proportion of 35 to 48. 2859. Without going into the exact propor- tion, they went on with increasing vigour, and you would, I understand, have expected that if the Contagious Diseases Act had not been passed, the improvement in health which they eifected up to 1866 would have been more or less continued after that date ? — That was my ex- pectation. 2860. Your view is this, that if there had been no Acts, some improvement (without defining exactly what improvement) in the conditions of health, in regard to venereal diseases, would have continued in the subjected stations after 1866 ? — That is my impression from reading the Army Reports. 2861. I further gather from you that it is your impression that these improvements were made with greater vigour and to greater effect in the subjected than in the unsubjected stations, on the whole ? — That is my impression. I am s 2 able 140 MINUTES OP EVIDENCE TAKEN BEFORE THE 16 May 1881.] Mr. Nevins, m.d. [ Continued. Mr. Stansfeld — continued. able to supply the details if ttie Committee should wish for them. 2862. Can you give us any official evidence of opinion which would at all support the view which you have just now expressed ; have you any quotation from the Army Report of 1866 which you would wish to give us? — In the Army Report for 1866 it is said : " The pay, position, and comfort of the soldiers within the last few years have been so vastly improved in every re- spect that we may therefore expect the quality, as well as the number, of recruits to improve." That is the evidence which I have been able to find in the Army Reports, referring to the ex- pectation of continued improvement under the improved condition of the army. Mr. Cavendish Bentinck. 2863. Is that all the extract?— That is all that I have extracted. Mr. Stansfeld. 2864. Is it your general impression that these sanitary improvements to which we have been referring are more likely to have been carried out, and have been carried out, with greater success in the large stations which are the subjected stations, than in the smaller stations in the middle of larger civil populations ? — That is my impression; and the Report for 18.59, I think, speaks about the improvements being carried out in the large and important barracks. The improvements are not specified in the Report of 1859, but there is a general remark that they were " chiefly carried out in barracks of magni- tude and importance." 2865. Are you prepared to give us some con- secutive statement of the causes to which you would be disposed to ascribe the fall in venereal diseases, both prior and subsequent to the Acts ? — The causes to which I should be disposed to attribute this improvement, are some of them specified before the Royal Commission, and others are mentioned In the Army Reports from time to time. The principal improvements have been additional opportunities for education and instruc- tion; encouragement to pursue or learn trades, which is often commented upon in the Army Reports ; the establishment of libraries and read- ing rooms which are constantly referred to in the Army Reports ; the payment of sailors without delay on their return home, instead of keeping them idling about for days in Portsmouth or elsewhere, waiting for payment ; bringing sailors back only to ports where there are sailors' homes in which their wages are paid, instead of bringing ships to any place indifferently ; the establishment of sailors' homes; the establishment of savings' banks; the transmission of part of their wages to the men after their return home, instead of paying it all in a lump sum to the sailor on his return to port; assisting the men to return to their homes in every possible manner; the establishment of canteens within the barracks, which is constantly referred to in the Army Reports ; the establish- ment of fives courts and other sources cf amuse- ment, and especially gymnasia, which are very frequently referred to in the Army Reports ; the shorter period of enlistment and encouragement Mr. Stansfeld — continued, of the best men to enlist again ; the provision of the means of cleanliness and decency, which are almost constantly referred to in the Army Reports ; the improvement of the quarters for married sol- diers referred to over and over again ; the esta- blishment of training ships for boys intended for the Navy; improved police regulationsin the large towns, and general strictness in their administra- tion ; and general care for the character of the men, instead of practically some indifference about it. Those are the causes that have been in active operation since 1859. 2866. Can you refer us to any official opinions upon the improvement in the character of the men in the Array or Navy of late years ? — At page 579 of the Evidence taken before the Me- dical Commission of 1867, Admiral Sir F. Grey, who was being examined with regard to the subject of the policy and the general tendency of the operations, says : " I would add this, that our whole object has been to raise the character of our seamen, particularly that of the petty officers, and I should be very sorry, indeed, to take any step which I thought would have the effect of destroying their self respect by a practice which I think would be very prejudicial to the character of our men." That is with reference to making a compulsory examination of our men as to vene- real disease. 2S67. This was in 1865; and you would quote that as evidence that already, in 1865, steps of various kinds had been successfully taken to raise the character of the seamen and petty officers?— That is my evidence, and in 1866 the Army Report refers to the subject in the same terms. 2868. Can you refer the Committee to an answer on the same subject by Dr. Balfour before the Royal Commission of 1871 ? — In answer to Question 16164, Dr. Balfour said this upon the question of the compulsory examination of the men : " There is another point connected with the recruiting which ought not to be lost sight of, that we liave been endeavouring now, for a good many years, to get a better class of men to enlist, whom we have been trying to get into the service." 2869. What you quote there is for the purpose of showing that in Dr. Balfour's opinion, at that time, endeavours had been made in various ways to raise the character of the men who were re- cruited for the army ? — -That is my object in quoting it. 2870. You have referred to a number of special means which have been adopted from time to time to raise the character and improve the con- dition of soldiers and sailors; you could also give us, could you not, details extracted from the Army Medical Reports of all those sanitary im- provements which have been effected at the various stations ? — I could. I have them all here. 2871. It has been put very strongly before the Committee that, if you take the two sets of sta- tions which are generally compared, there is in- contestable proof of the efficacy of the Act in reducing what are called primary sores ; what would you wish to say further upon that subject? — Upon that subject my evidence would be a re- petition of the evidence which I previously gave. SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 141 16 May 18S1.] Mr. Neyins. m.d. [ Continued. Mr. Stansfeld — continued, gave, that the fall before the Acts in the number of primary sores was at a more rapid rate than the fall has been since. 2872. You would not give us that as a con- clusive answer, I take it, by itself, would you ; would you not agree with me that though it would be right to expect some continuous fall after the enactment of these Acts, it would be too much to say that you were entitled to expect a continuance of exactly the same rate of fall ? — I am not prepared to say that we should expect exactly the same rate of fall ; but I do not see why we should have a diminished rate of fall, with an increased amount of improvements ap- plied to the army. I should expect rather an increased rate of fall to result from these im- provements. 2873. If you compare those two sets of stations, you will see that in the subjected stations the fall in primary sores has been greater since the Acts than in the unsubjected stations? — Yes, much greater. 2874. What would you say as to that fact ? — I would say that I should expect the fall in the unsubjected stations to be very different after the Acts from what it was in the subjected stations, because the fall was so different before the Acts; and for this purpose I will call attention again to this diagram, which shows an almost unbroken steady fall of disease in the subjected stations before the Acts. I should expect, therefore, that there would be a progressive fall of disease ; but in the unsubjected stations I would call your attention to this diagram, which shows, in the first place, the fall is less in the unsubjected stations, and you will see that here, instead of there being a continuous fall, there is a large fluctuation. For two years there was a fall; for two years there was a rise, and then there was a fiill again for two years. This is a very fluctuating fall in the unsubjected stations before 1866, before there were any Acts ; I should ex- pect, that being the case, that there would be a fluctuating fall afterwards, and that the character of the stations would remain unaffected ; and here we see how it has fluctuated continually ever since the Acts. It fluctuated before the Acts, and it has fluctuated continually since the Acts. On theother hand, in the subjected stations the fall was almost unbroken ; before the Acts there was no rise what- ever; after the Acts there was for a single year a rise, and since then the fall has been again a con- tinuous fall; but not by any means so regular as it was before the Acts. Y"ou will observe that there was a much greater fiuctuation after the Acts than there was before ; in the one case the fall before the Acts is almost continuous and uniform ; in the other there is a much more fluctuating fall after the Acts. I should expect then that the fall would continue to be fluctuating in the sta- tions not under the Acts as it was before the Acts. 2875. Your answer 1 understand, therefore, to be this : that in your opinion' these two groups of stations, the subjected and the unsubjected, have different characters, and you find this differ- ence of character in the fact that both before and after the Acts they differed in the ratio and pro- gress of disease ? — That is so. 0.44. Mr. Stansfeld — continued 2876. Do you find that tlie character of the siationsremains practically apparently unaffected by the introduction of the Acts into one set of stations ? — In one sense it remains unaffected. The large fluctuations continue in the unsubjected stations, and the progressive fall continues in the subjected stations. 2877. And you would say, referring to the figures and to these diagrams, that with regard to the progress of venereal disease before and after the Acts, there was a continuous decline in the protected stations, and in the unsubjected stations there was a great fluctuation and less decline ? — Decidedly, both before and after the Acts. 2878. So that you object to a comparison be- tween those two sets of stations, as if they were otherwise the same stations under equal con- ditions and of a like character?— I object to the comparison of the two seta of stations which differ so completely in their character, to beyin with. 2879. Sir William Muir and the Army Medical Department from year to year contrast these two sets of stations as if they were fairly entitled to be weighed one against the other, do they not? — I think the most recent reference to the subject that I remember is in the Army Report for 1873. At page 13 it says : " It is believed that the two groups of stations are fairly comparable, and that by a contrast of the results obtained at each, since the application of the Acts, their efficacy may be tested." This is only the last that I hapjDen to have noticed. Over and over again, in previous years, the same comparison is made, and the fall in one set of stations as compared with the fall in the other is taken as a legitimate test of the effi- cacy of the Acts. The assumption of the Army Reports is, that the two sets of stations are com- parable with each other. 2880. Have you Inspector General Lawson's last evidence before you ? — 1 have. 2881. I think he guarded himself against being supposed to make any similar contrast between those two sets of stations?— I think Mr. Lawson said that he never had compared the two sets (if stations one with another. 2882. Would you turn to his answers to Ques- tions 2148 and 2156 ?— Question 2148 is, "Do you give up the comparison of the two sets of stations?" and his answer is, "I never have com- pared them directly ; on the contrary, I have constantly stated what I now state, that the use of those stations is to find the alteration in the incidence of the disease in the country." Then he is asked, at Question 2156, " Then, taking the the whole thing, you do not admit that the two sets of stations are under equal conditions for the ptirposes of the Act?" and his answer is, '• I do not compare them directly one with the other for the purpose of the Act." 2883. Therefore your opinion is rather that of Mr. Lawson than that of Sir William Muir? — My opinion is that they cannot be compared for the purposes of the Act. 2884. You have shown us that the character of the two sets of stations as to the progress of disease is distinctly different, and that each is of the same character both before and after the Acts, but with differences ; could you point out what renders the contrast and comparison between S 3 those 142 MINUTES OF EVIDENCE TAKEN BEFORE THE 16 Mul/ 1881.] Mr. Nevins, si. p. \_Coniinued. Mr. Stansfeld — continued, those statements as grouped togetliei- in your mind « priori an unsound comparison l — In the first place, the subjected stations have extraordiuary precautions taken in ihem that are not taken in the unsubjected stations. 2885. Before we come to the question of the precautions, will you first take the character of the places themselves ? — The character of the places is that the subjected stations are all lai'ge garrisons, ranging from 2,000 to 12,000 or 15,000 men, and that they are situated in places where the influence of the army and navy is entirely supreme. The unsubjected stations, on the con- trary, are suiall stations with from 500 men to bai-ely 1,000, and they are situated in the midst of large manufacturing towns, or other places, as a rule, where the military are a mere drop in in the bucket, and are scarcely to be considered. Mr. Osborne Morgan. 2886. Are you speaking now of the 14 selected stations, or of all the unsubjected stations ? — My remark would apply efjually to all the unsubjected stations. 2887. To the whole of the unsubjected sta- tions ? — I do not know where the 100 are ; but wherever the 100 are, they are small bodies of men. 1 think evidence was given lately that sometimes there are only a dozen or 20 men con- stituting a station. As a rule, the unsubjected stations are stations with under 500 men, and the selected ones Tary from 500 to 1,000. I think you will find, if you turn to the actual strength, that there is scarcely an unsubjected station that is in number above 1,000. 2888. Are you speaking of Dublin? — Of course Dublin and London ai-e excluded ; Dublin has 4,000 or 5,000, and London has 5,000. I am speaking of the bulk of them. I thought your question applied to the general character of the unsubjected stations. Mr. Stansfeld. 2889. Taking the comparison between camps and manufacturing towns, is there any sense in your opinion in such a compai'ison ? — It appears to me totally impossible to compare them ; and, the difference between them is alluded to in the Ami}' Reports, where it is said that the camps are so much more favourably situated for inspec- tion for health purposes than the large towns, that you would exjiect more favourable results in ihe camps than iu the large towns. 2890. Taking such cities asLondon and Dublin, and comparing them with such small cathedral cities as Canterbury and Winchester, is there anything scientific in that comparison ? — It seems to me that there is no possibility of comparing them. 2891. Therefore, in the original character of these various places, there are, in your opinion, elements of difference which render the com- parison between them an unsound comparison? — I think there is no common ground upon which they can be compared. 2892. Are there any smaller stations whicli are fairly comparable ? — There ai'e only two stations which appear to me to be comparable, taking their general circumstances, and those are Hounslow and Windsor. They are both not Mr. Stansfeld — continued. f\ir from London ; they are both about the same strengtli ; and the ratio of disease is less in Hounslow, which is not under the Acts, than in Windsor which is under the Acts. They are the only two stations which admit of anything like a fixir comparison. Jlr. William Foiclcr. 2893. Windsor is now included in London, is it not?— It was included in London until 1866. Mr. Stansfdd. 2894. Can you refer us to any official confir- mation of the uniformity of the cnurse of disease in one set of stations as compared witli its fluc- tuating character in the otlicv? — Iu the Army Report for 18G5, page 281, Dr. Balfour alludes to the amount of disease. Speaking of the amount of disease in the Camp at Aldershot, he says: "A camp like that at Aldershot affords facilities for effectually working the Act such as do not exist in large garrison towns. The camp is circumscribed, and it is easier to exercise sur- veillance over unfortunate women." Sheerness was a subject of examination before the Com- mittee of the House of Lords ; that is also one of the subjected towns, and the chairman asked the witness: " Can you give us the reason why, in Sheerness, the Act has been so much more successful than in other places?" and the answer is : " Sheerness is isolated so very completely ; this is the solution of the success of the Act in Sheerness.'' Then further on, Mr. Romaine was asked this : " You mentioned that, at Sheerness, the complete success rested entirely upon the hospital accommodation, as I understood you ; are there no other circumstances at Sheerness which render it more easy to w^ork the Act there' than in other places?" and his answer was: " The population, I think, is less fluctuating at Sheerness; it will be mure difficult at a place like Liverpool to carry out the Act, because you have every day new ships arriving from foreign parts. There are no other arrivals at Sheerness from the sea, except ships under Her Majesty's control, or only small coasting vessels. It is quite a nulitary port." The distinction between the two sets of stations is the point which they dwelt upon there. \_Note. — Witness did not, at the moment, ap- prehend this question, and replied by mistake by giving additional official comments on the difference between camps, &c., and the unsub- jected stations. Had he at the time recognised that the question related to " fluctuations," his answer would have been as follows : — " Dr. Balfour commented upon this difference (fluctuations) in his Report 'on the operation of the Contagious Diseases Acts ' in the Army Report for 1868, p. 255, where he says : 'Itmay be stated generally that prior to the introduction of the Act there had been at all these stations (the large subjected ones) a progressive decrease in the amount of this class of diseases. At the stations to which the Act has not been applied, with two or three exceptions, a similar progres- sive fall has been going on, but with less regu- larity, a result perhaps of the smaller numbers giving rise to greater fluctuations.' The fallacy liable SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 143 16 May 1881. J Mr. Nevins, m.d. \^Conlinued. Mr. Stansjeld — continued, liable to arise from these ' smaller numbers,' is assigned in the Army Report for 1860, p. 6, as the reason for classing the army stations into ' groups,' such as ' camps,' &c. That Report says, ' The number of men at many of the stations is so small, that it would be obviously incorrect to draw conclusions. With a view to obtain data less liable to objection, we have classed a number of the stations together in the following groups, ' camps,' 'seaports,' ' manufacturing towns,' &c.''] 2895. With regard to the large cities of Lon- don and Dublin, which you would regard as quite exceptional, to what extent do you consider it to be unreasonable to compare them with any of the subjected stations ? — I think that the temp- tations and the conditions of every sort in those two places, are ouch as to put them entirely out of comparison with everything else ; and, in the Army Reports, for every other ^^urpose except the Acts, Dublin and London are put in ranks by themselves. In the Army Reports, the sani- tary condition of London is in every year put by itself, and the sanitary condition of Dublin is put by itself for every other purpose, except the Acts. 2896. Do you know where the barracks in Dublin are situated ? — The Army Reports for two years say that two of the largest barracks are in the lowest and most degraded parts of Dublin ; and in Manchester the report is the same. 2897. Can yon tell us from the Army Reports anything about the condition of the barracks at Manchester ? — At Manchester the report is also that the barracks are situated in an extremely low part of the town, where they are so built up that there is scarcely anything to prevent their being overlooked, and that it is in a very un- favourable position indeed. The Army Report for 1860, at page 233, says: " The Hulrae Bar- racks " (that is the large ^Manchester barracks) "closely enveloped by the dwellings of a poor and squalid portion of the inhabitants ; light and ventilation obstructed by the adjoining buildings." Then in 1866, six years afterwards, at page 26, the Army Report says : " When these improve- ments are effected, the hospital will then be tolerably commodious and well ventilated for an old hospital in Manchester." That is the utmost that the Army Report says : " When these im- provements are effected," and there is no report of the improvements having been carried out. 2898. You have told us that, taking the unsub- jected stations as a whole, they show a different and more fluctuating character in the progress of disease than is shown in the subjected stations; have you any diagram vs^hich would show us those conditions, taking station by station ? — It is strongly shown in this- diagram {producing a dia- gram). The stations on the left hand side of the diagram are the subjected stations ; and the stations on the right hand side are the unsubjected stations. The character of that diagram is that there is a fairly uniform fall or progress of disease in the subjected stations both before and after the Act. That thick black mark shows when the Act was introduced. On the other hand, in the unsub- jected stations from first to last, there has been a remarkable fluctuation. 2899. Therefore, the remarks which you made 0.44. Mr. Stansfeld — continued, about the two groups of stations and the fluctua- ting character of the disease in the one as com- pared with the other, apply also to the stations, taking them one by one ?— Yes, to the individual stations. 2900. How are you disposed to account in your own mind, for these great fluctuations in the unsubjected stations ? — The great fluctuations do not occur in London and Dublin, where the fluc- tuations are comparatively small. That fluctua- tion arises from the influence produced by a new- regiment going into a small place. Mr. Lawson, in his evidence, told you that some regiment under his control, had a ratio of 500 to 1,000 diseased, that is to say, every other man was diseased. If such a regiment as that went into a place like Manchester, where there are less than 1,000 men, it would at once raise the ratio to a very high standard. He told you that in Aldershot, he found a regiment with a ratio of disease of only 23 per 1,000 ; if that regiment succeeded the other regiment that had 500, the ratio at Manchester would at once fall ; and if that again was followed by the regiment which he found in Aldershot in which the ratio was 124 per 1,000, that would at once raise the ratio again. In Manchester the fluctuations are very extraordinary indeed, as you will see in the diagram which illustrates the fluctuations perhaps better than anything else. 2901. Then, what I understand from you is this, that the normal rate of disease in any par- ticular station may partly depend upon the cha- racter of the stations ; but the extreme fluctua- tion in that rate you woidd expect to depend upon what we may call the importations and ex- portations of disease into and from that station ? — The extreme fluctuations dejoend entirely upon the importation and exportation of a bad or a good regiment. 2902. You would expect that to be the case ? — I should. 2903. Because, if you have a station with very few men, if you change the whole of those men, or the greater part of them, and introduce, on the one hand, a diseased, or, on the other hand, a healthy regiment, you would very much more largely affect the ratio of disease in that station than if the same operation were carried out in a station containing a force equal to many regi- ments? — That is the case, and this is seen in the small stations which are under the Acts. This other diagram shows the small stations that are under the Acts, and it shows the extraordinary fluctuation in them. Maidstone has less than 500 men, on the average, and its fluctuations are some- thing enormous. 2904. I understand from you that, if you take the subjected stations as a whole, the large sta- tions may be said to swamp the small ones, and the general effect produced in the diagram, or in figures, is a steady and continuous downward progress of disease ; but that, if yotx take them station by station, the small sitbjected stations show similar fluctuations in disease to the small unsubjected stations ? — They do. 2905. Most of the unsubjected stations, ex- cept London and Dublin, being small military stations ? — Yes. s 4 2906. And 144 MINUTES OF EVIDENCE TAKEN BEFORE THE 16 May 1881. Mr. Nevins, m.d. [ Continued. Mr. Stansfeld — continued. 2906. And in this case, I take it, that the same explanation suggests itself to your mind, viz., that these fluctuations are occasioned by changes of the force, and by the importation or the exportation of disease ? — Yes. 2907. Coming again to the more radical dif- ference, in your mind, between these two classes of stations, have you any further confirmatory evidence of an oflScial character in support of that general view of their difference which you would like to cite ; will you take Mr. Lawson's Table, for instance, of the constantly sick from primary disease in the two classes of stations ? — The result is the same, that the fluctuations of the constantly sick are greater in the unsubjected stations and much less in the subjected sta- tions. The fall in the number of the constantly sick was much greater before the Acts in the stations which were ultimately subjected than in those which were never subjected. 2908. In 1860, in the subjected stations, the constantly sick from primary disease were 10"47, and in 1866 they had come down to 6'94 ; does that accord with your memory? — -Yes, ihat it had fallen from 10 to 6 ; but, in the unsubjected stations it had only fallen from 8'48 to 6-62. The difference in per-centage is that there was a fall of something like 34 per cent, in the sub- jected stations before the Acts, and a fall of some- thing like 22 percent, in the unsubjected stations. 2909. Besides the differences to which you have referred, are there any other important differences in the conditions now aifecting those two gi'oups of stations respectively, to which you would like to refer as having an influence upon the progress of venereal disease ? — The circumstance that has been put before this Com- mittee of the examination of men going into the subjected stations in order to prevent the spread of disease, and the neglect of any such precau- tion in the unsubjected stations, appears to me to be a very important diff^eience indeed, and there is a further difference (but that is, more or less, part of the Acts) that I should refer to, that in the subjected stations there is more than amj)le hospital accommodation, the beds are never full, but with the exception of London, Cork, and Dublin, I do not remember an unsub- jected station that has a Lock Hospital, and the accommodation is infinitely too small in all those places. Mr. Lane's evidence was that in Lon- don it was so small that they were obliged to pick only the worst cases. London is the Lock Hospital for Government purposes, not for Lon- don, but for stations out of London. Mr. Osborne Morgan. 2910. Surely no Government case is refused in the London Lock Hospital ? — For the unsub- jected portion. 291 1. Your knowledge of the subject is derived from Mr. Lane's evidence ?— It is derived from his evidence that the accommodation for Govern- ment patiejits is more than sufficient everywhere, but that the accommodation for patients that are not Government patients is extremely limited ; and London (where there is a Lock Hospital for TiOndon not supported by the Government), and Cork, and Dublin, are the only three stations not Mr. Oshorne Morgan — continued, under the Acts where there is a Lock Hospital. All the remaining 100 stations have no Lock Hospital except Liverpool, where there are a few soldiers. It has a Lock Hospital, not supported by Government. Mr. Stansfeld. 2912. We will take the London Lock Hospital; I understand that no Government patients who are sent there are refused ? — Never. 2913. But they are not Londoners, are they? — They are not Londoners. 2914. They come from Woolwich and Green- wich?— Thev do. 2915. And, therefore, the existence of that Lock Hospital does not affect the amount of disease amongst Government women in London ? — Not at all ; there are no Government women, so called, in London. 2916. If you take the voluntary side there, the Lock Hospital treats diseased London women ? — '^I'he voluntary side takes diseased London women. 2917. I understand your proposition to be this, that in London, and other unsubjected stations, there is no suflScient Lock Hospital accommoda- tion, and therefore there is untreated and un- cured disease ? — I hat is my position. 2918. And tliat is an element of danger to the soldier if he is stationed in those places ? — Yes. 2919. And that is an unfair difference between the subjected stations and the unsubjected sta- tions ? — I think so. 2920. Therefore we have first of all one differ- ence which is not only sreat, but unfau-, that in one group of stations the soldiers are examined upon entering to ascertain that they are not diseased ; and, in the other, they are allowed to enter diseased, and to spread disease ? — Yes, that is one unfair difference. 2921. The next is, that in these subjected sta- tions there is ample and more than ample hospital accommodation, and there is very insufficient hospital accommodation, if there is any, in the unsubjected stations ? — That is another difference. 2922. Have you any information to give the Committee about the diseased women who are driven out of the subjected districts into the un- subjected districts? — I think that that is another very unfair difference between the two gi'oups of stations. Women at the rate of from 900 to l,d00 per year leave the subjected stations and go somewhere ; they are soldiers' women. It has been given in evidence that the soldiers' women very often accompany the regiments. Dr. Barr gave it in evidence that he has known several cases in which women at A Idershot, finding them- selves diseased, have gone to Ijondou to escape the examination ; and have remained in London spreading disease until they were so bad, not being able to get hospital treatment, that they have come back to Aldershot to go into hospital. And this large yearly migration of 900 to 1,500 women, many of them no doubt diseased, going into the unsubjected stations where they cannot get hos- pital ti'eatment, appears to me an extremely unfair element against the unsubjected stations. 2923. [las the migration of prostitutes, diseased or not, from the subjected stations largely in- creased since the Acts ? — Very largely. 2924. You SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 145 16 May 1881.] Mr. Nevins, m.d. [^Continued. Mr. Stansfeld — continued. 2924. You find that from what figures ? — From Captain Harris's reports, published year by year. 2925. Can you refer me to those figures ? — For the year 1865, the year before the Act, 67 women left tlie district ; in the year of the Act, before it was put into operation, 181 left; in 1870, the first year of periodical examinations, 1,558 women left. The Acts were not univer- sally introduced until 1870. That number con- tinued falling a little until last year, 1880, when 927 left the district ; that is one-fourth of the total number. 2926. Therefore we have these two great facts, have we not : that in consequence of the arrange- ments of the military authorities for the examina- tion of soldiers going into subjected districts that they may not spread disease, and for their non- examination when they leave subjected for non- subjected districts, there is a greater importation of disease by soldiers from the subjected to the unsubjected districts, than the reverse ? — We have. 2927. No soldier can import disease in his own person, and communicate it to women going from an unsubjected to a subjected station ? — He is immediately put into hospital. 2928. And that danger to the women who con- sort with the man, and therefore to the other soldiers, is absolutely stopped by the arrange- ments of the military authorities? — It is. 2929. It has not pleased these authorities to adopt similar arrangements, has it, in the unsub- jected districts ? — It is stated in the evidence that it is not done in the unsubjected stations. 2930. It is clear, therefore, that the importa- tion of disease by men takes place from the sub- jected to the unsubjected disti'icts? — That is the case. 2931. I presume that you are also clear in your opinion that the same thing, to a certain extent, is true as to women? — Diseased women go into the unsubjected stations to escape the examinations. 2932. And they follow the diseased regiments? — They follow the troops. 2933. When they go from an unsubjected to a subjected station those women are presumably locked up if they are diseased ? — Yes, as soon as they come into the subjected station. 2934. They can fireely escape from tlie sub- jected stations and carry their disease into those that are unsubjected ? — There is no hindrance to their going. 2935. And, in your mind, these unfavourable and unfair conditions produce those enormous fluctuations in disease in the unsubjected stations, for which, otherwise, you would be unable to account? — That is my explanation of it. 2936. As to the mere fact of a greater and more continuous fall in primary disease in the subjected stations, that you do not dispute? — 1 do not dispute that at all. 2937. But I presume that you are not prepared to admit that that is a greater and more con- tinuous fall in primary syphilis ? — I do not con- sider it to be a fall in primary syphilis, because I do not find that there is a corresponding fall in secondary syphilis. 0.44. Mr. Stansfeld — continued. 2938. Without going back into the details of that purely medical question, is all that you admit that there is a greater and more continuous fall of primary venereal sores of a non-syphilitic character ? — Yes, of a non-syphilitic character. 2939. Coming to secondary syphilis, secondary syphilis does not sho(V a similaiy continuous re- duction, does it ? — It does not. 2940. Will you refer to Mr. Lawson's Table, 6 B., Appendix, No. 81 ? — I have it before me. 2941. What does that show as to secondary syphilis ? — It shows that in stations which even- tually came under the Acts the per-centage of secondary to primary sores was 34-1 in the six years before the Acts ; that during the six 5'ears, whilst the Acts were being gradually introduced, the per-C€ntage had risen to 37' 6 ; and that during the last six years of the table the per-cenlage has risen to 56. More than every other case is now a case of secondaries. At all the stations which were never under the Acts the per-centage before there was any Act was 29'S ; this rose to 31'2 ; that is to say, it rose 14 per cent.; and, during the last six years, the per-centage has risen to 42-4. The rise has been in the non-subjected stations from 29'8 to 42-4 ; in the subjected stations the rise has been from 34*1 to 56. 2942. You have probably made similar calcu- lations to those ; can you illustrate this view further by some of your calculations ? — Without going into details, I may say that I have taken Mr. Lawson's period of six years, which is given here ; I have taken a period which I am nut sure whether he suggested, but it is a matter of no consequence, 1 have taken periods of three years, and periods of four years ; and the result is, of course, not identically the same, but substantially the same, showing a gradual increase of secondary per-centage in the subjected stations. I have also taken what I call natural periods, the period before the Acts, which was six years, the period of the gradual introduction of the Acts, which was three years, and the period of the full operation of the Acts, before there was concealment of disease, which was four years. Mr. Osborne Morgan. 2943. That would not apply to secondaxy disease ; Lord Cardwell's Order did not apply to secondary disease ? — I say that I have taken these periods of six years without the Acts, three years during the gradual introduction of the Acts, and then the remaining period ; and I find the result is substantially the same, that whatever mode of computation is taken, and whatever periods are taken, there is a gradual and progressive increase of secondary as comjaared with primary disease. Mr. Stansfeld. 2944. And there is a greater proportion in the subjected districts? — The result is always against the subjected districts. 2945. These calculations you have, if required, at the disposal of the Committee ? — If required I have them here, and will put them before the Committee. 2946. The same proposition would be true, would it not, if you were to take, not the ad- T missions. 146 MINUTES OF EVIDENCE TAKEN BEFORE THE 16 May 1881.] Mr. Nevins, m.d. [ Continued. Mr. Stansfeld — continued. missions, but. the constantly sick? — To the con- stantly sick the same principle applies, and generally speaking the same result ; but I have not the figures in my recollection to give them to the Committee ; I can supply the figures if they are desired. 2947. I do not want to go unnecessarily into conflicting figures in the Government returns ; there they are and must stand for what they are worth ; but is there anything that you desire specially to say to us upon the conflicting figures of the ratios of secondary to primary disease in the old and newer tables which have been laid before the Committee ?■ — The proportion of se- condary disease is widely different in the new tables, which have been before this Committee, Mr. Shaw Lefevre's Tables, from what they were in all the. evidence that had been given previously ; they are largely in excess of the previous tables, but that large excess is almost entirely before the Acts were put into complete operation, that is to say, before 1870. 2948. The new figures show a larger ratio of secondary syphilis in the earlier years before the Acts ?— They do. 2949. What is the effect of these new figures upon the year 1866 ? — That the ratio of the year 1866 is very much raised. 2950. Can you give us the ratio of sy- philis in 1866, according to Mr. Lawson? — At Question No. 599, Mr. Lawson's answer is that he takes Sir William Muir's figures of 24-77. 2951. And therefore his figures and Sir William Muir's figures for 1866 are a ratio of 24"77 of secondary syjihilis per 1,000 men? — They are. 2952. In the new table, what is the ratio? — The ratio instead of 24-77 is 27-66. 2953. Can you explain to us the cause of the difference between those figures ? — The explana- tion appears to be that in all the old ratios which have been given for so many years, the number of men who were in the Home Army for the entire year were computed, and are stated in the Appendix to every Army Report ; but, in the new tables, about-one tenth additional number of men are included, who are in the Army at home for only a portion of the year, that portion being a totally uncertain portion ; it may be a few weeks, or it may be a few months, it may be at the beginning of the year, or at the end of the year ; but it is a totally uncertain number of men, and for a totally indefinite period of time. 2954. Therefore, in your opinion, the old tables are upon a sounder basis than the new ones ? — I think on a much sounder basis, and they appear to be the only reliable tables in the matter. 2955. The addition of one-tenth of the men, or more, at the stations during the year, has pro- duced very remarkable results, as we have seen, in the proportion of disease ? — It has been fol- lowed by that remarkable result. 2956. Are those figures for the whole Home Army ? — They are for the Home Army. 2957. Taking the year 1866, if you take nine-tenths of the British Army, those who Mr. Stansfdd — continued, were permanently in barracks, do you find the ratio of secondary syphilis to be 24-77 ? — You add one tenth for the number com- ing home from foreign stations, and so on, being, it may be, a very short part of the year in barracks, and you raise that proportion from 24-77 to 27-66. 2958. Does not that great rise show that this one-tenth must have had a very extravagant amount of secondary disease amongst them to have so largely affected the result as regards the whole force? — There appears to have been a very disproportionate amount of secondary disease. 2959. In how many years does the introduc- tion of this new element of the one-tenth of men not in barracks for the whole year alter the ratio of secondary disease? — It alters the relation in 15 of the 19 years. 2960. Can you tell me to what extent it has operated ; within what percentages?— I will hand in a paper containing the information {see Ap- pendix). 2961. Have you anything that you desire to say about the comparative duration in hospital, and the comparative severity of cases of secon- dary syphilis in the two groups of stations ? — The general result of my inquiry is, that the average duration of secondary cases is less in the unsubjected stations than in the subjected stations since 1870. I have here a table which I should ask to be allowed to put in, showing that. In I860, the average duration of secondary cases in the subjected stations was 27-56 days, and in the unsubjected stations it was 30-84 days; in 1861, the average duration in the subjected sta- tions was 26-01 days, and in the unsubjected stations 3 I'll days ; in 1862, in the subjected stations 25'90 days, and In the unsubjected sta- tions 35 days ; in 1863, in the subjected stations 28-19 days, and In the unsubjected stations 28-88 days; in 1864, in the subjected stations 29-32 days, and in the unsubjected stations 29-89 days; In 1865, In the subjected stations 27-70 days, and In the unsubjected station 2G-66 days; in 1866, in the subjected stations 25-34 days, and In the unsubjected stations 2853 days; In 1867, in the subjected stations 25-22 days, and in the unsub- jected stations 24-67 days; in 1868, In the sub- jected stations 26-15 days, and In the unsubjected stations 26'71 days; In 1869, in the subjected stations 28-44 days, and in the unsubjected sta- tions 29-08 days; In 1870, In the subjected sta- tions 28-22 days, and in the unsubjected stations 27-27 days ; in 1871, in the subjected stations 29*37 days, and in the unsubjected stations 27 days; in 1872, In the subjected stations 28'99 days, and in the unsubjected stations 28-20 days; In 1873, in the subjected stations 30-51 days, and in the unsubjected stations 26-98 days ; in 1874, in the subjected stations 29-57 days, and in the unsubjected stations 26-63 days ; in 1875, in the subjected stations 29 -26 days,and in the unsubjected stations 27 days; in 1876, in the subjected sta- tions 30-61 days, and in the unsubjected stations 27-89 days ; in 1877, in the subjected stations 30-99 days, and in the unsubjected stations 24-85 days ; In 1878, in the subjected stations 27-18 days, and in the unsubjected stations 24'60 SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 147 16 May 1881.] Mr. Nevins, m.d. \Continued. Mr. Stansfeld — continued, days. The greatest difference is in the year 1877, where there was a difference of above sis days duration, and the smallest difference has been in 1872, when there was a difference of '8. It has ranged from less than one day to above six days' duration since 1870. 2962. You have told us already that the i-atios and the figures of secondary syphilis have been fluctuating, both in the subjected and in the un- subjected stations? — They have fluctuated largely in both sets of stations. 2963. Entirely differing in the character of their progress from the conditions of primary venereal sores in the subjected stations ? — They are entirely different; there is no comparison whatever between them. 2964. Taking the constantly sick, if you have Sir William Muir's Table before you would not that illustrate what you have said ? — I have here Sir William Muir's Tables, which gives the ratio per thousand constantly sick 2965. Does that show extreme changes? — If I take them at random they will run thus: 2-57, 3-85, 4-76, 4-55, 1-71, 2-8l, 1-58, M5, 2'94. 1-82, 1-15, 1-45, 2-22, 1-36, 2-02, 3-22, 2-21, 2-26, 1-29. 2966. We have that Table of Sir William Muir's before us, and what you desire to say about it is this, as I understand : that, alike in the subjected stations and in the unsubjected stations, there is extreme fluctuation in the course of secondary disease ? — There is extreme fluctuation in the course of secondary, disease. • 2967- With reference to the question of the necessity of the compulsory detention of venereal patients in hospital, you have given very special attention and study to that question, have you not? — I have. 2968. I thiuk you already told us, at your previous examination, that -you had obtained a considerable amount of evidence relating to the compulsory detention of venereal patients in workhouse hospitals and infirmaries? — In my evidence previously, I was only able to inform the Committee that the general run of workhouse medical ofScers were in favour of compulsory detention for an unlimited period. Since then I have been able to analyse the whole of the returns completely, and, with scarcely an excep- tion, I think they all say that the patients can easily be induced to remain m the hospital as long as they think necessary without the employment of compulsory detention. I wrote to 160 medical officers, speaking in round numbers, to every large workhouse, and sent a request that I might be furnished with the information, as I was about to give evidence before this Committee, and I received answers from nearly half of them. 2969. What information did you ask for ?— The questions that I put were these : " Is com- pulsory detention of venereal patients enforced in the workhouse hospital under your charge ? Is it applied to men and women alike or only to women supposed to be common prostitutes ? Was difficulty experienced in enforcing the patients to stay until cured ? Has it been practically impossible to enforce the compulsory detention, and have you had practically to rely upon per- suasion and influence, and abandon compulsion ? 0.44. Mr. Stansfeld — continued. Have you been able to persuade the venereal patients to remain in hospital as long as you thought necessary ? Is it desirable, in your opinion, that the power of unlimited detention in hospital of venereal patients should be conferred upon the medical officers of every workhouse hospital ? {See Mr. Bond's evidence before this Committee, Question 3103.) Would the know- ledge that this compulsory power was possessed prevent venereal patients from applying for ad- mission into hospital in the early stages of dis- ease ? {See Dr. Barr's evidence before this Committee, Question 1872.)" 2970. As I understand, the general result of the answers which you received was, that no practical difficulty is found in inducing patients to remain until they are cured 1 — Room cleared. The Committee deliberated. Witness again called in, and examination resumed. Dr. Farquharson. 2971. Could you give us any general impres- sion as to what have been the different sanitary measures and improvements carried out at the various stations to which you refer? — I think that the best answer that 1 can give is to read them. In 1860, in Aldershot, more cubic space was dwelt upon ; " baths and ablutions only par- tial as yet, but greatly improved ; games and gymnastics much encouraged ; gymnasium con- structed, and the canteens good." The following year extraordinary care was taken to prevent sanitary evils ; the next year the gymnasium is reported on favourably. In 1864 recreation rooms were added. In 1865 improved married quarters were added, and in 1866 a hospital for soldiers' wives ; those were the improvements before the Acts. Then these were the improvements after the Acts : in 1867 serviceable basins for ablution were required for the camp at Aldershot, and also increased accommodationfor married men. The following year an extension of the ablution ar- rangements in Aldershot ; the following year extension of married quarters in Aldershot ; the following year a further extension of married quarters in Aldershot; the ne.'ct year still further urgency about the necessity for improved mar- ried quarters in Aldershot. Then in 1875 and 1876 I do not find any mention of Aldershot; but in 1877 improved ablution arrangements in Aldershot. Mr. Osborne Morgan. 2972. All in Aldershot?— All in Aldershot. Then, if I take Shorncliffe, in 1860 improved huts were recommended, and ablution and bath accommodation available at any time, and an ample supply of water ; games and exercises ; fives court ordered to be found ; canteens good. The following year hygienic arrangements regu- larly carried out; fives court and three cricket grounds were provided. The following year im- proved married quarters. The following year " Shorncliffe cannot be too highly commended for these improvements ; it has been much used as a eanitoriuih for the Army of late years." Then, after the Acts, I do not find Shorncliffe T 2 much 148 MINUTES OF EVIDENCE TAKEN BEFORE THE 16 May 1881.] Mr. Nevins, m.d. [ Continued. Mr. Osborne More/an — continued, much alluded to, but iu 1872 gymnasia had been brought into use. Now I will take some of the unsubjected stations and compare them in the same way. At Hounslow, which is not under the Acts, in 1860 latrines were improved, ablu- tionary accommodation was improved, and baths provided. The following year ablutions reported good ; new huts were provided in 1862, and I find no further reference to Hounslow. In Preston in 1860, not under the Acts, bath ac- commodation was provided, gymnastics and amusements were said to be requisite, but I find no further allusion to Preston. In Sheffield there were " no baths ; it may be inferred that the deficiency has not been overlooked," but I find no mention of their being provided on a future occasion. At Pembroke Dock the bath and ablution accommodation is spoken of as sufficient." At Athlone in 1860, " convenience for ablution, so far favourable as having been reported sufficient." There was no mention of it for three years. In 1864 " New canteen most successful, recreation and reading rooms added, and very beneficial," and no further allusion to Athlone. It shows that every year something has been done in the large stations, but only from time to time, and on a limited scale at the small ones. Dr. Farquliarson. 2973. But at the unsubjected stations we had much the same thing, had we not, in large bar- racks like London and Manchester ? — In London it is very little alluded to ; it is surprising how seldom it is alluded to in the Army Returns. In Manchester, in 1860, the liulme barracks were said to be '' closely enveloped by the dwellings of a poor and squalid portion of the in- habitants. Light and ventilation obstructed by adjoining buildings." The Salford barracks, which are the other barracks iu Manchester, Avere said, in 1860, " less trenched upon by buildings ; lavatory conveniences extended, and baths hot and cold." I find no further reference to Manchester till 1866, five years afterwards. " When these improvements are effected the hospital will be tolerably commodious and well ventilated for an old hospital." That is all the reference that I fiud to Manchester previously to the Acts, and after the Acts I find that service- able basins for ablution were recommended for Salford barracks in 1868, and I do not find it mentioned again in the Army Reports until 187C. In this paper I have extracted every reference that I find to every sanitary improvement in the Army Reports for every station for every year. Then I do not find, until 1876, that any refer- ence is made again to Manchester. Gymnasium is made compulsory in Devonport, and is com- pleted in Salford. The Hulme barracks are not mentioned. That is all the reference that I find to Manchester. 2974. Take London, of which I have some experience ? — I am able to say very little about London, because it says, in i860, and the pre- ceding years : " Improvements recommended or carried out on a scale not recorded." London is so exceptional that the individual recommenda- tions are not mentioned here, but I have not made extracts for London ; they were not numerous. Dr. Farquliarson — continued. 2975. We have had some questions about the difficulty of comparing the two sets of stations ; the subjected stations are all large garrisons ; would it not be possible that, in a garrison town, there may be less temptation to incur disease than in a large town, there being less amusement for the soldier and more inducement for him to associate with common women ? — I think that, in the first instance, it was so, and the large stations were worse off for disease than die small stations. The very first reports show that. But all these improvements were carried on at a much more rapid rate in the large stations than in the small cues, and the improvement was rapid in propor- tion. They were worse, no doubt, to begin with. 2976. We have heard of the women being driven out of the subjected stations; there is no proof, is there, where those women actually go to ? — I have no pi'oof of it, but they are camp followers, and it has been stated in evidence both here and in other Committees, that they do follow regiments. I am not connected with the army, and I cannot speak to that point from personal knowledge. 2977. But they follow the regiments from one subjected station to another, do they not? — No doubt they do. Mr. Berkeley Hill gave evi- dence before the Committee of the House of Lords as to their following regiments from Ply- mouth to Aldershot. That is a particular case that I happen to remember, because he found so much disease imported, either from Plymouth to Aldershot, or from Aldershot to Plymouth, when the men were examined on arriving at the bar- racks, that he brought it before the notice of the Committee of the House of Lords. Dr. Barr says that he knows that they go to St. John's Wood, in London, until they are so diseased that they come back to Aldershot to be taken into the hospital. I have no evidence on the question ; I do not know where they go; I merely think it is probable that they follow the regiments, and as regiments are sent to unprotected stations the women go with them. 2978. But that theoretical importation might be balanced by the importation from unsubjected stations to subjected stations, in order to follow the hospital treatment ; that of course would go against the subjected stations ? — I think that the evidence that has been given is, that the women who are old hands, are known at once by the special police, and they at once go to the brothels and take them up. The women are not, as far as I can gather from the evidence, practising prostitution more than a day or two before they are found and put in hospital ; they come back for the express piu'pose of going into the hospital ; they must go somewhere, and they go into the brothels, and the brothel keeper is liable to be fined if they are found diseased. 4979. But they cannot be taken to the hospital unless they are found practising their profession in the town ? — I cannot tell what may be done. The voluntary submission holds good for 12 months. It is not necessary to prove that a woman is actually practising prostitution ; she is in a bi'othel, and that is sufficient. 2980. But the probability is that she has been practising prostitution ? — Quite so. 2981. Therefore, SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS, 149 16 May 1881.] Mr. Neyins, m.d. \_Continued. Dr. Farquharson — continued. 2981. Therefoi-e, when she comes to town for the purpose of treatment, she must have dissemi- nated disease largely amongst the men ? — I can- not tell that, because the evidence from the police is that tJiey do not let the women be on the streets diseased. They know at once when a new woman comes in ; they have not seen the woman before, and they take her up. I do not believe that they are many days in the subjected stations, but I have no proof to that effect. 2982. In one day they might spread a lot of disease, might they not?— Yes, Dr. Barr says that the women in the subjected stations will take 20 men in a day, or more. That is one of the results of the protected stations, though. Mr. Gsborne Morgan. 2983. May I ask you whether you have any experience of Army practice ? — None whatever. 2984. Have you any personal acquaintance with these subjected stations ? — NonCj except that I have been, as everybody has been, in Plymouth and Portsmouth. 2985. You have not made any professional ex- amination ; you have not visited the Lock Hospitals there, have you ? — I. have only visited one, and I was refused admission there. 2986. But you have not, as a matter of fact, inspected any ? — As a matter of fact, I have not had the chance. I went to Chatham, and I was refused admission there. 2987. As 1 understand you, the evidence you have given to-day, and your former evidence, is derived from, what we lawyers should call, secondary sources, that is to say, the Army Reports, and the evidence, and the returns which you have read ? — It is entirely so. 2988. I think you admitted the accuracy of a diagram which was put in by Inspector General Lawson? — Yes. 2989. I have been looking at that diagram very carefully, and I do not think it quite bears out what you stated with regard to the much greater fall in primary disease before the Acts in the subjected as compared with the unsubjected stations ; it seems to me that the fall before the Acts is pretty nearly similar in the 14 subjected stations, and the 14 unsubjected stations, and in all the unsubjected districts? — There is no ques- tion that, between the beginning and the end, the fall is not materially different ; but there was a rise in the middle of the period of two years in the unsubjected stations. 2990. But still, taking that diagram to be ac- curate, you would not dispute that, with trifling exceptions, the fall before the Acts in the 14 subjected stations, and in all the unsubjected stations, is pretty nearly similar ? — There is very great similarity ; 1 do not dispute that. 2991. On the other hand, after the introduc- tion of the Acts the fall has been very steady and regular in the 14 subjected stations, while in the unsubjected stations, both the 14 selected unsubjected stations, and all the unsubjected stations, the incidence of the disease has been very fluctuating ? — Very fluctuating. 2992. You were asked a good many questions about the different influences which had been brought to bear upon the subjected and unsub- 0.44. Mr. Osborne Morgan — continued, jeeted stations, and the inference which you drew from that difference was that it was uot fair to compare the one with the other ; is not that your view? — That is my inference. 2993. Do you really mean to say that, taking them all-in-all, you consider that there are a more moral class of men at the subjected stations than at the unsubjected stations ? — I do not know that I am prepared to enter upou that question. I think they have less temptations at subjected stations, and more to fill up their time, and take them off from debaucherj^ 2994. You would say, then, that men living at subjected stations are exposed to less temptation than the men living at unsubjected stations ?— I would say that they are more favourably situated ; that is my impression. 2995. Would you go so far as to admit that the effect of the Acts is to remove temptation from the soldier ? — No, I do not say that the Acts have anything to do with it. 2996. But as a matter of fact, you do say that, for some reason or other, the soldiers who are quartered at the subjected stations are relieved from temptation? — I think they are more favour- ably situated, and I have given the reasons which I think make them more favourably situated. 2997. Let us take them one by one. First of all, let us take what I may call the sanitary con- ditions ; you mentioned that the sanitary condi- tions were more favourable at the subjected than at the unsubjected stations? — Yes. 2998. I noticed that when you came to be examined by my honourable friend, the Member for Aberdeenshire, as to the sanitary improve- ments which have taken place in the subjected disti'icts, your statements were confined to Alder- shot ? — I said Aldershot and Shorncliffe, and I will take any other stations that you like. I have all the 14 stations, and I will take any one of tbem you please. 2999. Can you give me any notion why sani- tary improvements should have been introduced into the subjected stations, as and not into the un- subjected stations? — I do not like to give the reason that I confess is in my own mind. The ' Government was desirous of securing a success for this legislation ; it had been introduced as a measure for the benefit of the Army, and, natu- rally, the desire was that the Army should be benefited. 3000. Then, do you go so far as to say that the Government, in order to make it appear that the Acts were working beneficially, introduced sani- tary improvements in the subjected districts, which they did not introduce in the unsubjected districts ? — I do not desire to impute any dis- honesty whatever in the matter ; but, as a matter of fact, these large subjected stations had the largest number of soldiers in them, and, therefore, it would present itself to anybody's mind that the great improvements should first be carried out in the places where there was the greatest number of men to be influenced. Then, as a matter of fact, we have been told that the Acts were a great ex- periment, and that everything must be done that there might be no interference with the success of that experiment., 3001. Where did you get that information? — T 3 Mr. 150 MINUTES OF EVIDENCE TAKEN BEFORE THE 16 May 1881.] Mr. Nevins, M.D. \_Continued. Mr. Oshor7ie Morgan— coxiimxieA. Mr. Lawson gave that in his first day's evidence in 1879. 3002. He never said that they had tried sani- tary improvements in the stations under the Acts which they did not try in the unsubjected sta- tions ? — It was with reference to the examination of men. He was asked why the examinations were made in the subjected stations and not in the unsubjected stations, and he said that there was a great experiment going on with the Acts, and that it was desirable that nothing should interfere with it. 3003. Would it not follow almost as a matter of course that if sanitary improvements were found to answer in the subjected stations they would be equally good for and therefore would be introduced into the unsubjected stations? — I think that they would be equally valuable if they were carried to an equal extent. 3004. Can you conceive the Government, or any official of the Government, deliberately choosing to neglect sanitary precautions in un- subjected districts, in order that the Acts might appear to work more beneficially? — I am not a Member of Parliament, but I know the diflnculty there is in passing an Estimate sometimes, and if they have to choose between getting the money for a great station, or a little station, they would improve the big station first. 3005. 1 ask is it your suggestion that, in order to make it appear that the Acts were work- ing beneficially, sanitary improvements were adopted in the subjected stations and not in the others ? — No, that is not what I say ; I say it is not in order to make it appear so, but because, naturally, they would select the big stations first. 3006. You say that they naturally would select the large and important stations as the theatre for their sanitary improvements ? — Yes. 3007. Might not that observation apply to the large stations all over the country? — But the large stations are only London and Dublin. 3008. Tliere is Belfast, I think ? — There are 1,000 men at Belfast ; Belfast is one of the ' smallest stations. 3009. There is Manchester? — Manchester has 1,000 men and very often less. 3010. Then there is Preston? — Preston has generally less than 1,000. 3011. There is Limerick ?— Limerick has less than 1,000, generally speaking; if you look through that list you will find that there is scarcely one which has an average strength of IjOOO, except London and Dublin. 3012. Why should not these sanitary improve- ments be adopted in Dublin, which is a veiy large place? — I cannot tell why. As a matter of fact they are not reported so often, and they are not carried out there so rapidly. 3013. Then you bring against the Government this charge ; that it has adopted in the protected stations certain sanitary precautions which it has not adopted in the unprotected stations ? — As a matter of fact it has done so, but I impute no motive whatever. 3014. As a matter of fact, you say that for some reason or other, sanitary improvements which must be equally useful, I suppose, in the sub- Mr. Osborne Morgan — continued. jected stations and in the unsubjected stations, have been introduced into the subjected stations, and not into the unsubjected stations? — More rapidly in the subjected stations; I have men- tioned the inti'oduction of them. 3015. Have not most of these sanitary im- provements, or appliances, or whatever you call them, been introduced at Aldershot? — Yes. 3016. Then what you say would apply to Aldershot, and not so much to the 13 other sub- jected stations? — If it is your pleasure I will read you the report as to Plymouth, which is another one ; I merely took Aldershot because Aldershot comes first in alphabetical order. "Plymouth, 1860; latrines vastly improved; baths and ablutions good and satisfactory ; fives courts and cricket grounds under the patronage and encouragement of the ofScers ; general bar- rack improvements recommended ; bath accom- modation in course of being provided ; amuse- ments are not wanting in Plymouth." That is all in one single year. 3017. Do you know Manchester? — Yes, I know Manchester. 3018. Have not exactly the same things been done in Manchester ? —But this is now 1881. In Manchester the report for 1860 was that the barracks were in such a bad condition that when certain improvements were done then it might be tolerable. 3019. Since 1866 have there not been very many of the improvements that you speak of in- troduced into Manchester ? — I have read you the references to it that I have found in the Army reports. 3020. Still you cannot answer that question from your own knowledge ? — No, I cannot answer it from my own knowledge; I cannot go to the 28 stations and go about in them. 3021. You spoke of fives courts and gymna- siums ; do you think that the institution of those fives courts would diminish venereal disease ? — Speaking as a medical man from a very long ex- perience, there is not a question in my mind that the more muscular exertion you give to a man in proportion to his strength, the less (I will not use the word " steam," because it is a vulgar word) desire he has for profligacy. I have knoivn many cases in which men have been practically cured of an almost uncontrollable desire for sensuality simply by going through a course of gymnastics at the gymnasiums. 3022. Would not the ordinary professional drill, or military exercise which a soldier goes through, have the same effect? — I am not an army man, but I have always understood that the drill is an exceedingly monotonous and irk- some thing to both officers and men. The gym- nasium exercises are amusement and recreation. Drill is a duty and a business, and is monotonous, and the other is not. Sir Henry Wolff. 3023. The drill would equally exhaust men by the physical exertion, would it not? — They do not carry either the one or the other to the stage of exhaustion. I have had no experience of drill, but I have had experience of gymnasia, and therefore I speak of them with confidence. 3024. As SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 151 16 May 1881.] Mr. Nevins, m.d. [ Continued. Mr. Osborne Morgan. 3024. As a matter of fact, are there not fives courts attaclied to every station, whether sub- jected or unsubjected ? — No, there were not, because I have read to you the rate at which they were introduced. 3025. Are there not cricket grounds attached to all stations ? — I do not know what there are in 1881, but I have read to you the references in the reports. 3026. Can you state from your own knowledge, or from any other information, that there is any difference in the modes of rational employment and rational amusement provided in the subjected stations, and in the unsubjected stations ? — I have no means of knowing, except the Army Reports. 3027. You spoke about the different mode adopted in paying sailors, and of disembarking sailors only in ports where there are sailors' houses ; can you inform me how that treatment of sailors could in any way affect the sanitary condition of soldiers ? — In Portsmouth there are about as many sailors in shijis of war, and as much navy strength as there is army strength. If you have 3,000 profligate sailors knocking about the streets, you will have more risk to the soldiers than if there were no sailors. 3028. I am told that there are fives courts in most barracks, even in small stations, and that there have been for 30 years past ; you could not, from your own knowledge, contradict that, I suppose ? — Oh no. 3029. You spoke of it as being impossible to compare the 14 protected stations with the 14 selected unprotected stations, except that I think you instanced the two stations of Hounslow and Windsor. I must say, looking through this ■ return, I should have thought that 3-ou coixld have compared Cork and Belfast, for instance, the one being protected and the other not? — Cork, on the average, has about 2,000 troops in it, and Belfast has only a small number. Belfast is a large manufacturing town, and Cork is a cathedral city, and it is very different in circum- stances. 3030. Do you know both Cork and Belfast ? — I know Cork pretty well ; I do not know Belfast, but it is a large manufacturing town. It is possible that Cork and Belfast may be com- parable, hut I looked carefully through them to see what did admit of comparison. 3031. I understand your answers to all these questions to be given with the reservation that you have not any personal acquaintance with the stations? — I have no personal acquaintance with the army. 3032. Or with the subjected stations? — Or with the subjected stations. 3033. You spoke of there being no sufficient hospital accommodation for prostitutes suffering from venereal diseases, except in the subjected stations ? — ^I did. 3034. Upon what do you found that ? — Before I gave my evidence to the Committee in 1880, I sent out circulars to every hospital, making up as many as 20 beds in England, Ireland, and Scotland ; and I have received nearly 900 reports from those hospitals in return, and from those 900 reports I find that Liverpool has a Lock 0.44. Mr. Osborne Morgan — continued. Hospital, Glasgow has a Lock Hospital, and Cork has a Lock Hospital ; London has a Lock Hospital to the limited extent that has been brought before your notice ; and I believe I am correct in saying that there is not another town in England, Ireland, or Scotland, that has a Lock hospital. 3035. You speak of London having a Lock Hospital ; are you aware that patients are treated for venereal diseases in St. Thomas' Hos- pital ? — I am not sure whether primary cases are treated there, but I know that in London some of the hospitals, Bartholomew's and Guy's, for instance, are pre-eminently hospitals in which venereal cases are admitted, and always have been. I am not certain about St. Thomas', though it may be so, but the accommodation is very limited. 3036. Mr. Lane, In answer to Question 2562, is asked whether, in his hospital, more women applied than he could admit, and he says : " Generally speaking more apply than can be admitted, or, rather I should say, that there are more than can be supported by the funds of the hos23ital." I ask you whether you have any other evidence, except that answer of Mr. Lane's, to show that the accommodation at the Lock Hospital is insufficient? — I have not evidence that I could quote to you, chapter and verse, but I have evidence thut I have been in posses- sion of for years, that the hospital accommoda- tion in London is very deficient for slight cases. I do not like to say that there is no doubt about it, but I believe that there is no question that the Lock Hospital accommodation in London is very deficient. 3037. But you have no data that you could give us for it? — I could not give chapter and verse, but it is a matter which, speaking as a medical man, I have not the slightest doubt about. 3038. Are there not these workhouse infir- maries open throughout the country to women where they may receive special treatment? — They are open, but I was for 20 years connected with a workhouse hospital, and therefore I know that the feeling amongst the relieving officers and guardians is, that they throw obstacles, as a rule, in the way of venereal patients coming in. There is no disease and no case in which a patient has so much difficulty in getting admitted as a venereal case, as a rule. In the Liverpool workhouse, which is a very large one indeed, there are lock wards, and they are always well filled. There entrance is encouraged. 3039. That is rather a serious charge to bring against workhouse officials ; do you mean to say that they deliberately reject people who are suffering severely from venereal diseases ? — I do not hesitate to say that there is more difficulty in a venereal patient getting in. In the first place, such patients are, generally speaking, rather an objectionable class of paupers, and in every way, both guardians and relieving officers, have a feeling against them. 3040. Have you, in the course of your ex- perience, come across a single case of a woman, a prostitute, if you like, who was suffering from a serious venereal complaint, who had not been T 4 admitted 152 Minutes of evidence taken before the 16 May 1881.] Mr. Nevins, m.d. [ Continued. Mr. Osborne Morgan — continued, admitted into a workhouse hospital ? — I cannot say that I have. 3040*. You spoke of a large emigration from the subjected to the unsubjected stations, and you handed in figures which showed that there was at one time a large migration ? — Yes. 3041. I prefer to call it a migration from the subjected districts, because I think you stated, in answer to my honourable friend, that you could not tell whether many of those women who left one subjected district did not go to another subjected district; was not that so ? — It was so ; I have no proof where they go to. 3042. You have no means of finding out where they go ? — I have no data that I can quote you chapter and verse for. 3043. All that you know is that a certain number do leave the subjected districts, going either to the unsubjected districts or to other subjected districts (in which case they would be re- registered afresh), or possibly leaving the country ? — The only evidence that I can quote is Dr. Barr's evidence, that he knows cases of pros- titutes leaving Aldershot and going to London. 3044. But all that the Returns show is that those women disappear ? — That is all. 3045. And they may, of coui-se, go to a sub- jected or to an unsubjected station, or give up the occupation altogether ? — I do not know where they go. If they go into a subjected district they would appear still as being upon the register, be- cause that column takes all the women that are upon the register in every one of the fourteen stations ; it gives the women that have left the subjected districts. The 900 have not left one subjected station to go to another, but they have left the subjected stations altogether. 3046. But do you mean to say that, supposing a woman left Aldershot, and a month afterwards she arrived in Cork and was registered there, she Mr. Osborne Morgan — continued, would be treated as having left a subjected station? — I do not know ; I do not know how Captain Harris keeps his books. 3047. I observe, and I suppose you would agree with me, that the number of these emi- grants, if ] may use the expression, has consider- ably decreased of late years? — I am not sure whether I could say that, because I was calcu- lating roughly, and without having calculated it carefully 1 j;an it uj^ in my mind, and for many years it seems to me that about one-fourth of the prostitutes leave the district annually. 3048. It fell, I think, from 1,500 to 900?— That is so. It was only at the rate of 1,500 for about two years, and then it came down to 1,000, and it has been from 1,000 to 900 ever since. 3049. You put in the number, did you not? — I gave you Captain Harris's Report. 3050. I think you stated, in reply to my right honourable learned friend, that what we call Mr. Shaw Lefevre's Return, embraced men belonging to corps, which had not been in the country for a whole year, and that it included others who had been a whole year in the country? — Yes. 3051. And the inference that you drew from that was that the ratios were too high ? — Yes, or at any rate that the ratios are not trustworthy. 3052. Are you not aware that, in the case of a regiment which has bean in the country for only a part of a year, all the admissions are, in this Return, reduced to what they would have been if a proportionally smaller force had been under observation for a whole year ? — I am not aware of that. It was not in the Table, and it was not stated in the evidence that was given before this Committee. I know nothing about what these Tables are, except by the statements on the face of them. 3053. You simply go upon the returns ? — That is all ; I am not able to answer the question. Inspector General Lawson, re-called : and further Examined. Mr. Osborne Morgan. 3054. Will you state how these fractional periods are dealt with ? —In our statistical opera- tions, dealing with the fractional periods, we reduce them to what they would be for a force for a whole year. The year is the unit of time, and the 1 ,000 is the unit of number ; so that, in the case of a regiment of 1,000 men having been under observation for three months only, instead of taking 1,000 men, and adding that to the strength, you divide the 1,000 by 4 and only put 250 to the strength. That is the coui'se which is always pursued in these statistical operations. There are only three months' admissions for the three months, and of course you take one-fourth of the strength for that. Mr. Stansfeld. 3055. Do I correctly understand that not only generally, but in this particular case, you are pi'epared to say that the men have only been reckoned with reference to the portion of the year which they have spent in the station at which they are '.' — Certainly, that is the universal course. Mr. Stansfeld — continued. 3056. But do you speak from knowledge of your own in saying that this is true with refer- ence to this particular return? — It is true with regard to every return of the kind. It is a re- cognised statistical principle, and I have no reason to suppose that they pursued a diflferent course in that particular case from what they have pursued in any previous case. 3057. That is the rule, and therefore you as- sume that that rule has been observed ? — That is the rule universally observed in making up these returns. 3058. Then, supposing that a certain force comes into a district for only one-fourth of the year, you assume that in this return they will be put at one fourth cf their number for a whole yearf — Certainty. 3059. What rule would be applied to the statistics of disease with regard to those men ? — They would have the admissions for one-fourth of the year only. These are assumed to be the admissions for a whole year upon one-fourth of the strength. 3060. I think SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 153 16 May 1881.] Inspector General Lawson. [ Continued. Mr. Hopwood. 3060. I think that the Return which you pro- duced, you vouched for as having been made by yourself? — I produced the table, and got the details from the Army Medical Department. 3061. Then you prepare the table from what is furnished to you from the Dej3artment? — Yes. 3062. How do you account for the increase of the figures in this table in favour of the Acts, as compared with the figures furnished as William Muir's figures ? — Would you be good enough to point out the instance that you allude to, and I shall be able to give you the particulars. 3063. You have heard what Dr. Nevins says about that ; he accounts for the difi^erence be- tween the figures in your Returns, as compared with Sir William Muir's as regards the value of the Acts, by the importation of these figures which we are now discussing? — If you will be good enough to let me know the specific figures I shall be able to speak positively. 3064. That I cannot do ; but have you the materials from which you compiled these tables ? — Certainly. 3065. Can you give us an instance of troops being imported for a portion of the year and the strength being reduced, in order to meet the fact of their being there only for a short time ? — I cannot give you an absolute instance, because it is a thing that is so thoroughly understood that no one ever doubts it. 3066. You must excuse me for saying that 1 want some evidence of that, if you have got it. Can you give me an instance of any body of troops being brought in that would cause such a Mr. Hopicood — continued, disturbance in the figures as Dr. Nevins has re- ferred to ; can you show us that due allowance has been made for that in calculating the ratio of the strength of the troops ? — I have no doubt that I could find cases if you give me time. 3067. On this particular return? — If you will specify the return, I will immediately get you the information. 3068. You know the return which we are re- ferring to ? — If you will let me know exactly which Return it is, I will follow it up. 3069. We are referring to the return which you have produced, which professes to give a large increase of the numbers in favour of the Acts, as compared with Su- William Muir's figures in the Army Medical Report ? — There are two returns before the Committee, and one of those returns I expressly stated was handed in, not by nie, but through Mr. Lefevre. 3070- I mean the same return that the Right honourable Member has just asked you about, and you had no difficulty in understanding what he meant? — He asked me with regard to p, specific return, but if you will specify the Re- turn, I will go into it. 3071. Can you give me any instance from the figures from which you derive that table where you have made the proper allowance in regard to the importation of troops for a fraction of a year into a district ? — These returns, as I tell you, are not made by me but by the Army Medical Depart- ment ; but I shall be able to get that from the Army Medical Department if you wish it ; it is a regular part of statistical operations. Mr. John Birkbeck IS^evins, m.d., re-called ; and further Examined. Mr. Osborne Morgan. 3072. It is your opinion, as I understand, that venereal disease has diminished in the subjected stations, not in consequence of the Acts, but because men play cricket and fives more ? — I admit that primary venereal sores have dimi- nished. 3073. And you attribute that, not to the ope- ration of the Acts, but to the fact that the soldiers play cricket and fives more, and have more amusements? — Yes, and they are a better class of men altogether. 3074. Are they a more moral class of men? — They are a more moral class of men ; and a higher class of men are enlisted now ; that is what Dr. Balfour says, and it is what we have had in evi- dence from the Army Medical Reports, that they are trying to get a better class of men into the army. 3075. You admit, I think, that the amount of primary sores has diminished more in the sub- jected than in the unsubjected stations ? — It has. 3076. Following that out, would you say that you think that it is not in consequence of the Acts, but in consequence of the fact that the men are more moral at the subjected stations, and that they play more at cricket and at fives ? — They have better chances of keeping free from disease quite independent of the Acts. 3077. And those chances consist in induce- ments to i)lay cricket and fives, and matters of 0.44. Mr. Osborne Morgan — continued, that sort ? — All those agencies that operate in the subjected districts. Mr. Cavendish Bentinch. 3078. Do you really think that the institution of fives courts makes any diff'erence in the dimi- nution of this disease ?— I do, and I have said so. 3079. You say that the muscular exertion diminishes sexual desire ? — Yes. 3080. How many men in a regiment do you think can play at fives ? — I cannot tell. 3081. You know what a fives court is, I sup- pose, do you not ? — Yes. 3082. How many men do you think can play in the course of a day ? — A fives court is only one of the things ; there is a gymnasium, and all the other tilings going on at the same tune. 3083. Have you seen those things yourself in the barracks ?^No ; I may tell you at once that I know nothing about the barracks. 3084. Then you do not know what proportion of a regiment can be employed in playing at fives at one time ? — I do not. 3085. While on the one hand there are these muscular exertions and lliese muscular employ- ments, which you say diminish disease, on the other hand the soldiers have vastly more sedentary occupation, have they not, in reading-rooms, and such like ? — They have ; but they may be just as well sitting in a reading-room as in a public- U house. 154 MINUTES OF EVIDENCE TAKEN BEFOEE THE 16 Mai/ 1881.] Mr. Nevins, m.d. \_Co7itinued. Mr. Cavendish Bentinck — continued. house. In Chatham I know that, at the back of some public-houses, there is accommodation for debauchery ; but at the back of a library or readinpc-room there is not accommodation. 3086. But would not the sedentaiy occupations that they have neutralise altogether the etfect of the muscular occupations that they have ? — Certainly not. 3087. Do you mean to tell me that a man would not be as likely to desire to have sexual connection with a woman after sitting in a read- ing-room, or in a place of amusement of that sort, as he would after sitting in a public-house ? — No, because he v;-ould not have been drinking in the one place, as he would have been in the other. 3088. Do you mean to tell me, as a man of the world, as I suppose you are, that a man only requires sexual connection after drinking ; do you maintain that it is only in conse(juence of drink that the soldier wishes to have sexual inter- course ? — I think drinking helps it very much. 3089. Do you mean to tell me that it is neces- sary to have drinking in a public-house in order that a soldier should desire sexual connection ? — I do say that it helps it very much. 3090. Is it so, or not? — It is not absolutely necessary. 3091. Is it necessary at all? — I do not say that ; but I have known many a man who, when a little in drink, goes with a woman, who does not think of doing it if he is not a little in drink. 3092. Is not a large proportion of the soldiers who desire sexual connection men who are not under the intluence of drink at the time ? — No doubt many of them are not drunk at the time. 3093. Then, practically, the drink has nothing to do with it? — No, I do not acknowledge that at all. 3094. Has it anything to do with it in a large proportion of cases ? — In a large proportion of cases 1 say that it has a great deal to do with it. 3095. In your opinion ? — In my ojiinion. 3096. But you do not know it as a matter of fact ? — I know from my experience for the last 40 years that some of the worst cases have oc- curred when a man has been half seas over. 3097. Do you mean to say that, if you had a regiment of total abstainers, you would not have a vast number of men who had sexual intercourse with women? — I do, without hesitation, say that you would not have nearly so many. 3098. But you would have a large nvnnber ? — I do not know ; probably the best men get astray in that way ; but 1 say that there would not be nearly so many. 3099. You Avould have some ? — You would have some, but I will not admit that you would have a large number. Mr. Osborne Morgan. 3100. Surely there are as great opportunities for drinking at the subjected stations as there are at the unsubjected stations? — No doubt; but a man at Aldershot can have thorough good exercise at the gymnasium if he chooses ; he goes to the canteen in the barracks, and then he goes to the library and reads his newspaper ; and after he has gone through those different stages. Mr. Osborne Morgan — continued, very likely he does not care to go out of the bar- racks to get into bad company ; but sujjposing that he had had no gymnasium, and no library, he probably would have gone to a low public- house outside the barracks, and in that low public-house, as you know perfectly well, women are kept expressly for the soldiers. Mr. Cavendish Bentinck. 3101. Do you know of your own knowledge that there are public-houses where women are kept for the soldiers ? — I do not know of any at Aldershot, but I know of some at Chatham ; and I have been told by men who have been quar- tered at Aldershot, if that is sufficient, that it is so thei'e also. 3102. Do you not know that those people caa be prosecuted who keep women in public-houses? — No; they cannot be prosecuted for keeping women. Mr. Osborne Morgan. 3103. Do you know of your own knowledge that there are in the unsubjected stations greater temptations to drink than there are in the sub- jected stations ? — I think there are ; it is a matter of opinion ; but I think there are greater tempta- tions altogether in a large town. If I can be- lieve the evidence of soldiers whom I should believe upon every other question, I have had pointed out to me in Chatham that public-house, and that j^ublic-house, and that public-house, and told that there was a place of reception at the back of those public-houses for this express purpose. 3104. Chatham is a subjected station, is it not? — It is a subjected station. Captain Harris's Reports for the last eight years, year after year, have shown the same two public-houses used as brothels. Mr. Cavendish Bentinck. 3105. Plowever, you do not know this of your own knowledge, do you ? — I have never been in one of them, so that I do not know it of my own knowledge. 3106. There is a very important point which has been raised about ablution, and as I have addressed questions upon the point to medical witnesses, I wish to repeat them to you. It has been said that facilities for ablution in lavatories and elsewhere have had a considerable effect in diminishing disease; do you think that they have had sucli an effect ?^I think they must have, because I know so many cases in my own expe- rience in which the want of ablution has been the cause of the men coming under my hands. 3107. At what period of time after connection with a woman ought ablution to be performed to be efficacious? — I cannot tell you. 3108. We have had it given in evidence by Professor Lee, and also by Mr. Lane, that ablu- tion is really, in most cases, of no avail unless it comes immediately after connection ; do you a'gree in that opinion ? — I think it should be soon after, no doubt. 3109. Therefore, considering the classof women from whom the soldiers contract disease, in such cases these lavatories would be of no avail ? — I do not SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 155 16 May 1881.] Mr. Nevins, m.d. [ Continued. Air. Cavendish Bentinck — continued, not say so. Those lavatories are erected under the urgent advice of medical officers, and if they did not think that they were important they would not, year after year, urge their exten- sion in all the large stations as they have done. 3110. But you have just told us that those women from whom the soldiers catch disease are in the public-houses ; are there lavatories in the public-houses ? — The public-houses are not far from the baiTacks. 3111. 'I hen you think that after a soldier has gone to the public-house and taken his fill of drink, and had connection with a woman, he im- mediately goes back to the barracks and performs an act of ablution ? — You are asking me a ques- tion that I cannot answer. 3112. If ablution is to have any effect, we have been told that it must be within a veiy short time after the impure coitus ; therefore, in order that this ablution may be effective, the soldier after having connection with a woman must immediately perform an act of ablution ? — I have no doubt that many of them dp. Mr. Stansfeld. 3113. And ablution was recommended by the medical authorities on that ground, was it not ? — It was. ^Ir. Cavendish Bentinck. 3114. Do you think that a considerable number of soldiers do that? — I have no doubt they do. 3115. In your former examination, you were asked by myself at Question 642 on a point ■which was referred to by my right honourable friend. I asked you whether you were per- sonally acquainted with the mode of administra- tion in the hospitals, and you having said that you were not fiimiliar with the hospitals, I asked you at Question 642 : " Do you not think that it would be an advantage if you were to do so ?"' to which your reply was : ''I was refused, so point blank admission to the Chatham hospital, that I confess I am chary about applying." Have you applied since ? — No. 3116. Do you not remember the invitation that I held out to you ? — I know you asked Colonel Alexander if he would get me admission ; but I have not been in London, or in any sub- jected stations since ; and Colonel Alexander, after all, was doubtful whether he could get me authority. 3117. That is 14 months ago ? — Yes, I know; but I have not been at a subjected station since then, nor have I been in London since then until to-day. 3118. Therefore, you are quite as inexperienced in the management of these hospitals as you were before ? — Quite. 3119. You do not know anything about the way in which these hospitals are administered ? — Nothing more than I did then. 3120. Do you remain of the same opinion as you expressed on the 9th of March 1880, when, in answerto Questions 592 and593, you said thatgreat good had resulted from the reduction of disease ? — Unquestionably, great good has resulted from the reduction of disease. 0.44 . Mr. Stansfeld. 3121. The Judge Advocate General invited you to admit that you had charged the Govern- ment in your answers to my questions with deliberately abstaining from making improve- ments in the condition of the. soldiers in the unsubjected districts, in order to bolster up the Acts ; that, I take it, was not in the slightest degree the nature of your evidence ? — I con- tradicted it most flatly. I do not intend to impute anj-thing of the sort. 3122. Whatl understood your evidence to be was, that the improvements which followed upon the Report of Lord Herbert's Commission, were naturally and most easily carried out sooner in the larger than in the smaller stations ? — Most naturally so. 3123. And that that operated to the advan- tage of the subjected stations ? — Yes, and that it was quite natural that they should ajijaly them to the large stations first. 3124. The Judge Advocate General also endeavoured to make you say that you attributed the reduction in primary sores in the subjected as compared with the unsubjected districts en- tirely to cricket grounds and tennis grounds, and trifles of that kind ; did you not also refer me to some very much more serious causes of differ- ence ; for instance, the examination of the men in one class of districts and not in the other; to the existence of hospitals for the treatment of venereal disease in one class of districts and not in the other ; and to the migration of diseased women from the protected to the unprotected stations ? — Undoubtedly. 3125. Having reference to these differences and to the fact that by a distinct Government order soldiers are examined who go into a sub- jected station to ascertain whether they are diseased and to prevent the spreading of the disease, but that, as deliberately, they are not examined in the non-subjected districts ; I would ask you whether that, in your opinion, gives a fair chance of comparison between those two groups of sta- tions ? — I think it gives a very unfair chance ; but I do not wish to impute any dishonourable motives. . 3126. We were told by Mr. Lawson that the object of that order was to give a great experi- ment a fair chance, that is to say, surely to give a great experiment the best chance ? — Yes. 3127. A fair chance would be to treat the the two groups equally ? — Yes. 3128. And therefore, although you do not wish to impute motives, you would say that without any dishonest motives a course has been adopted which is entirely unjustifiable on the ground of fairness, and which has produced re- sults upon which no sound conclusions can be built? — I think so. I do not like to impute motives ; but I think it has been a most unfair proceeding as regards the comparison of the two sets of stations. 3129. With regard to the ratio of secondary to primary disease, and the later returns in which one-tenth more of the men are taken into account who are only in stations for a certain time, Mr. Lawson has explained that if a certain number of men are in a station for only a quarter u 2 of 156 MINUTES OF EVIDENCE TAKEN BEFORE THE 16 Blay 1881.] Mr. Nevins, m.d. r Continued. Mr. Stansfeld — continued. of a year they are booked as only one-fourth of that number of men for a whole year ? — Yes. 3130. That of course is a fair method of cal- culation ? — Yes. 3131. But if that be so is not this true; that the very great differences which, taking those men into account, have appeared in the projoortion of secondary syphilis, show that those importations must have been importations of men very largely tainted with that disease ? — I think it is a clear inference. 3132. So, as very much indeed to disturb the statistical balance which otherwise would have been arrived at? — Yes. 3133. The Judge Advocate General pointed Mr. Stansfeld — continued. out to you that the number of women who have annually left the subjected districts were reduced since the Acts were brought into complete opera- tion, and those figures are contained in Captain Harris's return ; is the proportion of those who leave, to the number of those who remain on the register at the end of the year, at all reduced? — Practically, it is one-fourth all the way through. 3134. But before the Acts get into complete operation, before the screw is put upon those women to drive them out, do you find that the proportion of those who leave to those who remain is a smaller proportion? — Very much smaller. SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. lo7 Mondaj/, 30th May 1881. MEMBERS PRESENT : Mr. Cavendish Bentiuck. General Burnaby. Mr. Burt. Dr. Cameron. Mr. CobbolcL Colonel Digby- Dr. Farquharson. Mr. William Fowler. Mr. Hopwood. Mr. Massey. Mr. Osborne Morgan, Mr. O'Shaughnessy. Mr. Stansfeld. Sir Henry WolfF. The Right Honourable W. N. MASSEY, in the Chair. Inspector Silas Rendel Anniss, called in; and Examined. Mr. Osborne Morgan, 3135. Do you belong to the Devonport divi- sion of the Metropolitan Police ? — Yes. 3136. Will you state what is your position in the force? — I am the Inspector. 3137. What are your duties? — To carry out the Contagious Diseases Act in the Devonport and Plymouth district. 3138. Are your duties confined to that dis- trict? — To the Plymouth and Devonport district, ■which includes a radius of 10 miles from Ply- mouth, as also Dartmouth. 3139. May I ask how many years' experience you have had in that district ? — The whole time the Acts have been in operation, viz., 16 years. 3140. That is, since 1864?— From the 1st of April 1865. 3141. Had you any experience of it before the Acts? — I knew the district 12 years before the Act of 1864 was put into operation. 3142. Officially ? — Yes, as a police officer. 3143. And since the Acts, I understand that you have been actively engaged in superintend- ing the execution of the Acts, is that so ? — Yes ; for 16 years on the 1st of April last. - 3144. Can you inform the Committee how many common women there were in your dis- trict before the first Act was put in operation, that is to say, in the beginning of the year 1865 ? — At the end of the year 1864 there were 2,020. 3145. Do you know that of your own know- ledge ? — Yes. Mr. Hopwood. 3146. How do you know that? — By visiting all the brothels, and seeing the prostitutes found there. Mr. Osborne Morgan. 3147. Have you any notes by which you could refresh your memory ? — Yes. I had directions to make the inquiries in 1863 ; I then went through all the brothels, and the number of w'O- men 1 found as prostitutes was 1,960. 0.44. Mr. Osborne Morgan — continued. 3148. That was in December 1863? — Yes. In December 1864, after the Act of 1864 was passed, I received instructions that the Act would be put into operation, and that I was to ascertain the number of common women. I then went through the houses somewhat more care- fully than before, and found the numbers then to be 2,020. 3149. Then I understand you to say that those numbers were arrived at after an inspec- tion of the houses in the course of your duty as police inspector ; was that so ? — Yes ; I had been visiting the houses of ill fame for about three years, accompanied by two serjeants and a police constable, for the apprehension of strag- glers and deserters from the Royal Navy. 3150. Will you inform me what the size of your district was at that time ? — It consisted of the three towns, Plymouth, Devonport, and Stonehouse, also Torpoint, but there were very few prostitutes there. 3151. Has the size of your district been ia- creased or reduced ? — The size has been consi- derably increased by the Act of 1864. 3152. To what extent ?— The villages within 10 miles of Plymouth, that is to say, Plympton, Ivy Bridge, Oreston, Turnchapel, Saltash, and Dartmouth ; Dartmouth is 50 miles off, but is part of the district. 3153. Could you give me any idea of the rela- tion which the population of the present disti-ict bears to the population of the district of 1864? — In the year 1864 the population was consi- dered to be about 150,000. Taking in the vil- lages and outlying districts, it would now be about 180,000. 3154. Then, in fact, the population has in- creased ?— Yes ; Plymouth has increased of itself something like 9,000, and Dartmouth and the villages are over 20,000, 3155. Have you any figures that would sh-ow the increase or reduction in the nimiber of common women ? — If you would allow me, I U 3 would 158 MINUTES OF EVIDENCE TAKEN BEFORE THE 30 May 1881.] Inspector Anniss. [Continued. Mr. Osborne Morgan — continued. would say that after the Act of 1864 had been in operation for nine months, that is to say, in December 1865, for my own guidance I took the name, age, and address of every common woman in the district. (Up to that time we had been dealing with a very small number of those known to be diseased.) The number on the 31st December 1865 was 1,770. 3156. Coming now to the year 1866, what were the numbers in that year ? — I have the numbers every year, with their ages, from 1865. On the 31st December 1S66 the number in the district was 1,238 ; in 1867, 1,010 ; in 1871, 503; and in 1880, 431; and 411 on the 25th May 1881. - 3157. Tiien I understand you to say that the total number of common women in j'our district, which has been, as you say, considerably increased, has fallen in 16 years from 2,020 to 411 ; is that so "r — That is so. 3158. Do you know how many brothels there were in your district before the existence of the Acts? — The number of brothels on the 31st of January 1865 was 356 ; in 1867, 246 ; in 1869, 131 ; in 1873, 130;' Dartmouth and the villages were included in 1870 ; in 1873 the number was 106 ; in 1875, 92 ; in 1877, 86 ; in 1879, 85; in 1880, 81; and on the 25th instant, 70. At Christmas last, by the assistance of the local authorities, we prosecuted four brothel keepers, which has caused a reduction of 11 brothels within the last five months. 3159. Then I understand you to say that the number of brolhels in your district has fallen in the course of 16 years from 356 -to 70 ? — Yes. There were really 400 when I went through the brothels first before the Acts came into operation. "WTien I took names and ages of all prostitutes in the district in the year 1865 there were 356 brothels, and now the number is 70. Mr. Stansfdd. 3160. What is the number in the last pub- lished return? — Eighty-one. 3161. Does that mean at the end of the year 1880?— Yes. Mr. Osborne Morgan. 3162. Then, in fact, in the course of those 16 years the number of hrothels has practically been reduced to little more than one-sixth ; is not that so ? — Yes ; less than one-fifth. 3 J 63. Now I will ask you to state how you account for the reduction in the number of common women and of brothels ? — By conti- nually taking the young females who find their way into the brothels, sending some to their friends, others to hospitals, and homes. The brothels became empty, and one by one closed. 3164. But I presume that you would connect that in some way with the operation of the Acts, would you not ? — I consider it has been done en- tirely by the operation of the Contagious Dis- eases Acts. Before the Acts were put into ope- ration, I was for several years visiting those brothels with no effect as regards their reduc- tion. Mr. Osborne Morgan — continued. 3165. You stated that you visited the brothels as part of your police duty before the Acts commenced ? — Yes. 3166. Had the visits which you made before the Acts came into execution any eftect in re- ducing the number of common women or brothels? — Not the slightest ; in fact they continued to increase. 3167. I think you speak from the experience of four years before the Acts ? — Yes, I was for four years practically visiting those brothels, be- fore the Act of 1864 was passed. - 3168. You visited the brothels for four years before the Acts came into operation, but not having then the poweis which were afterwards given to you by the Acts, you were unable to reduce the nmnljer of either the brothels or the common women ; was that so ? — They were not reduced in any way ; but increased. 3169. What, judging by your experience, is your opinion of the operation of the Acts in re- ducing the number of common women and the number of brothels?— They tend to reduce them to a very considerable extent, and must do so wherever they are put into operation. 3170. Is there any other cause to which you can attribute this striking reduction both in the number of common women and of brothels ? — No, 1 know of none. Many things have been sug- gested, but, practically, that there really has been no other cause. The duties have been performed in the district by the local police, just as they were before with regard to such houses. 3171. Then I understand you to attribute the I'eduction in both cases to the operation of the Acts ; is that so ? — Yes. 3172. As regards the prevention of juvenile prostitution, can you tell me what number of juvenile prostitutes, by which I mean girls under 17 years of age, there were in the district at the time when the Acts came into operation ; what is your definition of a juvenile prostitute? — I should call a juvenile prostitute a girl under 20, that is my definition. 3173. Can you state the number of young prostitutes under 20 in your district at the time when the Acts came into operation ? — Yes. The number on the 1st of January 1866, or rather on the 31st of December 1865, when I took the ages was 1,060 ; the Act had then been in opera- tion nine months. 3174. Will you give the numbers and the ages?- — Fifteen years of age and under, 212; 16 years of age and under 18, 434; 18 years of age and under 20, 414 ; making a total of 1,060. 3175. There were 1,060 prostitutes under the age of 20 in your district on the 31st of December 1865 ?— Yes ; on the 1st of January 1866. 3176. Now, can you give me the number and ages of juvenile prostitutes under 20 in the year 1869? — In 1869 there were 37, 15 years of age and under; 107, 16 years of age and under 18 ; and 176, 18 years of age and under 20 ; making a total of 320. That is on the 1st January 1869, when the jDcriodical examinations were com- menced, which is my reason for fixing that date. In January 1872 there were none under 15 years of age; 10 from 16 to 18 years of age; and SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 159 30 May 1881.] Inspector Anniss. [ Continued. Mr. Osborne Morgan — continued, and 41 18 years of age and under 20 ; making a total of 5 1 . Mr. Stansfeld. 3177. Those figures do not agree with the figures of Captain Harris's return ? — I think they do. Captain Harris's return is made to the end of the year, and those on the 1st of January. 3178. Are not these figures to the end of the year? — The return for 1866 is to the end of thu year 1865. In 1872 the total number is 51, and in 1881, the 1st of January, there were two only, 16 years of age and under 18. 3179. How many were there under 15 ? — None ; 32 under 20 years of age, that is to say, 18 and under 20 ; making a total of 34 under 20, on 1st of January 1881. 3180. In Captain Harris's return there are 23 ? — Probably you are only taking one column I have given the numbers between the ages of 18 and 20 ; that would be two ; they are 9 at 18, and 23 at 19, total 32. I did it for brevity. Mr. Osborne Morgan. 3181. Then, in the course of 15 years, the number of juvenile prostitutes has been reduced from 1,060 to 34; is that so? — That is so. 3182. That is to say, it is exactly one-thirtieth in December 1880 of what it was in December 1865 ; is not that so? — Nearly so. 3183. I should be glad to know to what you attribute this reduction ? — Entirely to the opera- tion of the Contagious Diseases Acts. 3184. By what process have the Acts reduced, or enabled you to reduce, the number of juvenile prostitutes? — 1st. The power to remove those found diseased to hospital. 2nd. The constables employed under these Acts see those girls at once when they get into brothels, and, if they are very young, the first thing is to communi- cate with their friends, or if they are orphans, as a good many of them are, it is suggested that they should go to some one of the homes, and they are helped to do so. That is the first process. 3185. You get them before they are hardened, before they become accustomed to the life? — Quite so. Farther, juvenile prostitutes, girls under 20, if left alone, as prostitutes, are decoys for others. The first thing they do, if left alone, is to find some one of their own age to accom- pany them ; therefore by taking such girls out of the brothels, you suppress very many evils. 3186. Therefore you not only stop the prosti- tution in the case of tliose girls whom you find out, but you prevent them from acting as decoys for others ? — Yes, that is so. 3187. Can you give any instances within your experience of girls who have been saved from an immoral life in. that way? — Yes, of very large numbers ; an instance occurred the day before I came away. A girl came in from Cornwall, and was placed in service in Plymouth ; her mistress turned her away at night, and she was found in a brothel. She declared she had not slept with any man, although she was seen with a man in the house. It was suggested to her that she could go to a place where there is a bed pro- 0.44. Mr. Osborne Morgan — continued, vided, and she did, and she is now in the Hamp- ton Home. Mr. Stansfeld. 3188. Was she an innocent girl? — She said that ; but it is somewhat questionable. She is only 16 years of age. Mr. Osborne Morgan. 3189. She was going to a house of ill fame ? — She was in the house, and in a bed-room with a man. Mr. Stansfeld. 3190. You did not say so? — 1 said she was in a brothel. 3191. You did not say that she was in a bed- room with a man? — She was at No. 9, Fore- street, Stonehouse, and her parents have been informed where she is now, and are very thank- ful. Mr. Cobbold. 3192. She had been turned out late at night by her mistress? — That is so. Her mistress was asked the reason why, and she gave her a bad character. Another case, which occurred a few days ago. The tiither is a labourer in Her Ma- jesty's'Dockyard at Devonport, and has only one daughter, who is 19 years of age ; she left home one Sunday and having stopped out late, was afraid or ashamed to go home, she was found in a brothel. At first she gave a false name; but afterwards gave me her right name, and the pa- rents were communicated with, and her mother went to the brothel, and took her daughter home with her. Mr. Osborne 3Iorgan. 3193. Have you any other instances that you can give the Committee ? — Yes ; the week before that there was a girl who came from Cornwall and was found in a brothel in Fore-street, Stone- house. She* said the woman there had tried to induce her to do what was wrong. She was placed in lodgings, and a lady, who takes a very active interest in these matters, aided by the editor of the "Western Morning News," f amd her a situation. 3194. Is it not the case that girls, in fits of tempei', sometimes run away from home, or just as in the case that you put, are turned adrift by their mistresses, and fall into the hands of these brothel-keepers, and in that way go wrong? — Yes, it is so ; and before the Acts were put into operation brothel-keepers would look out for such girls, and keep them out of the way for a time until they got hardened. Now, every female who finds her way into a brothel has to be seen within 24 hours, and I expect it to be done within 12. 3195. The result of that, as I understand you to say, is, that if they are not actually reclaimed, at any rate they are put in the way of reclama- tion ? — Yes, they are helped to the right paths. I will give another case, which is also in the Hampton Home, and which occurred only a little time ago. The girl had neither father nor mother; an oriDhan, 16 years of age. She was found in a house of ill fame, and sent to the xj 4 Grreenside IGO MINUTES OF EVIDENCE TAKEN BEFORE THE 30 May 1881.] Inspector Anniss. \_Continued. Mr. Oshorne Morgan — continued. Greenside Refuge, where we leave them in the hands of the ladies for instruction, &c. 3196. There are some girls, I suppose, who are restored to their friends ; was there not some case of the daughter of a master mariner at Plymouth who went back to her friends ? — Yes, some little time ago ; a gentleman, the master of a large vessel, who has two daughters, one of whom is only 16, ran away from home. She gave a false name. 3197. Has she been restored to her friends? — Yes, the mother came to me, as a large number of parents do, to ask for assistance, and a man was sent to show her where the girl was, and she was taken home. 3198. Did you find her, and restore her to her parents r — Yes. That circumstance reminds me of something else, if you would allow me to mention it. At the same time as we found this girls, two other, who have most respectable friends, were both restored in the same way ; three in one day. 3199. Do I correctly understand you to say, that parents often apply to you for information and assistance in recovering girls who have run away fi-om home, or who have left service, or who have been turned away from service ? — Yes, it is so well known in the district that we sometimes get two or three inquiries in the day, whilst sometimes Ave go a week or 10 days without any. I had three such inquiries the week before I came away ; last week. 3200. And in how many cases are you able to trace the girls ? — If they are in the district, we are sure to find them. In most cases they are found before the applications are made. 3201. But for the fact of the Acts being in operation would it be possible, or would it be so easy, to trace the whereabouts of those girls ? — No. Parents often go to brothels to look for their daughters, and are not able to find them. That reminds me of a case in which a mother came to me respecting her daughter. The parents are highly respectable people in Devon- port. The daughter was 15 years old. When the mother came to me I was leaving Plymouth by train for Dartmouth, and told her at once where I thought she would find the girl. She said, " No, Mr. Anniss, I have been there, but they say my child is not there." I sent a man with the father, and they denied that the girl was there. That was in the morning. When I came back at nine o'clock p.m., the father and mother were waiting in very great distress, and I had the greatest difficulty to prevent the mother from going to the brothel. I went with the father, and, after two hours, found the girl, who had been secreted in a room close by. That was a very notorious house, and had given me a great deal of trouble. I had been trying to get it indicted for some time. I got into one of the bed-rooms, where I heard some rustling in a cupboard, and I sat down, refusing to leave the room until the cupboard door was opened. I stayed thei'e for two hours. The girl whom I was looking for was foimd in an adjoining house ; the old brothel-keeper having sent for her ; and a second one was found shut tip in the cup- board. 3202. Then do I rightly understand that those Mr. Oshorne Morgan — continued, girls are frequently secreted, and that, but for the powers which the vVcts give you, their friends would not get at them ? — They, the brothel-keepers, would not allow their friends to see tliem, was it not for the Contagious Diseases Acts Police. 3203. These brothel keepers secrete the girls in the house, and, but for the powers given you by the Acls, it would be impossible to institute an effective and complete search in the houses ? — We have to find all females who are leading immoral lives, and it is a matter of discipline that we see all such ; and, if any of the brothel- keepers jDersist in disallowing the police to see them, we take the necessary steps to close such brothels. That is if they attempt to secrete or harbour girls of tender age in their houses. Mr; William Fowler. 3204. You have no power under the Act to do that, have you ? — We have no power of entry besides the ordinary powers. I have given the facts as they stand. Knowing that the brothel- keeper referred to was determined to do what we found her doing that night, I at once set myself in comtnunication with the magistrates, and the house was indicted. That old bawd cleared out of Plymouth, and came up and opened a brothel at St. John's Wood, London, where she carried on, as she said, "a very roaring trade," not interfered with by the Contagious Diseases Acts Police. Mr. Osborne Morgan. 3205. As a matter of fact, before "the Acts were in operation, were you in the habit of searching those brothels and, if you did so, did you do so OS effectually as you have done since'? — We do not use the word " search ;" but if I found there were stragglers or deserters fre- quenting bi-othels, I felt it my duty to go there and apprehend such stragglers or deserters, the same as if they were in the streets, and by the same rule we see those common women that are in such brothels. 3206. As a matter of fact, I think you said that your figures show that your entry into those houses had not been attended with the same suc- cessful results before and after the Act ? — They had no effect at all before the passing of the Acts, because at that time we took no notice of females ; we simply went there for the appre- hension of the men who were away from their duties, Mr. Hopwood. 3207. If you took no notice of them, how was it that you knew the number that existed at that time ? — [ had an order to ascertain the number of brothels and prostitutes in the district. 3208. You have given us a return ending 19th December 1863 ; was that the time? — Yes, I had to make a return of the number of brothels and common prostitutes in the district, and that return I sent in on the 31st December 1863. Mr. Oshorne Morgan. 3'209. So that, in fact, you made that return in pursuance of a duty that was imposed upon you ? — Yes. 3210. But SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 161 30 May 1881.] Inspector Anniss. [ Continued. Mr. William Fowler. 3210. But, if I understand you aright, you made those investigations not under the Con- tagious Diseases Acts at all ? — Not the slightest. 3211. You had the same power by law as re- gards searching those brothels, both before the Acts were passed and afterwards ? — Yes, but as a matter of discipline the procedure is dif- ferent. 3212. You had the same power before the Acts, as regards that matter, as you had after ? — We acted in the same way in our duties ; that is to say, wherever we found men har- boured in brothels as absentees, we entered such brothels, and people who harboured such absentees from the Navy were prosecuted. Mr. Osborne Morgan. 3213. You said just now, in answer to me, that if a girl became a prostitute you would know it within 21 hours ; by what process would you discover it? — The district is divided into six sub-districts, and each constable has to visit every brothel, at least twice a day, to ascertain the names of any females therefrom the previous day, and to report the circumstances to me. 3214. Since when has that pi'actice com- menced ? — Immediately we had a number of beds in the hospital sufficient to take all the diseased cases in, viz., since 1868. Before that we were not so careful in this respect, but for 12 years that has been done regularly and care- fully. 3215. It has been stated tliat the Acts increase clandestine prostitution; is that your opinion? — I have heard it stated, but the thing is incon- sistent. Even if we did not interfere with these young girls, clandestine prostitutes when we find them, the very fact of its being known that constables visit all brothels would have quite the opposite effect. The number of clandestine pros- titutes has decreased nearly ten-fold. The number now is about 40, and there were cer- tainlv nearly 400 when we started, I think I know it better than anyone else, in the district. 3216. I understand you to say, that the Acis, so far from increasing clandestine prostitution, has diminished it ; is that so ? — Clearly. 3217. You state that the number of clandes- tine prostitutes has been reduced from 300 to 40 ? — I say, about that, and I know well how it is done, 3218. In what way, if at all, would the Acts tend to reduce the number of clandestine prosti- tutes ? — First, the fact of those people who are inclined to such a life, knowing that they will be at once found out, and if they continue the life, be registered as common prostitutes. 3219. You think that the fear of -being brought under the Acts ojDerates as a deterrent in the ■case of clandestine prostitutes 1 — Yes. In the next place, such cases as I quoted to you just now ; those people have their associates, and, as we say, sometimes, " birds of a feather flock together," and they go at once and tell their companions, and if they do not tell them all they know, they say, " You had better take warning, or you will be found out, as we have been." 3220. Do the police endeavour to warn those clandestine prostitutes against pursuing their 0.44. Mr. Osborne Morgan — continued, course of life, and tell them that if they continue to pursue it, they will bring themselves within the Acts, and does that operate as a deterrent ? — Yes. In practice, every femalefound in a brothel, or house of ill fame, is at once told the character of the house (not but what they, as a rule, know it), and is informed if she persists in remaining there, she will have to subject herself lo the re- strictions of the Acts. They are also told that if they have not the means to return to their friends it will be found for them ; and if they are very young, mere children of 14 or 15, they are requested to leave at once. 3221. Are they sent to homes? — In a very large number of cases. In others their parents, if they are in the district, are communicated with. In each case, of one who belongs to the district, her parents are told. 3222. Then, in fact, the operation is three- fold ; in the first place they are deterred by the fear of being brought under the Act, if they are leading an immoral life ; then they are exhorted to return to their homes; and, thirdly, their parents and friends are informed of their doings, and put in the way of reclaiming them ; is that so ? — That is so. Xo female is brought under the Acts in the district that I have charge of before she has had an opportunity of discon- tinuing the immoral life she has commenced. 3223. Then she is brought under the Acts, not only after she has commenced her course of life, but after she has had an opportunity, if she chooses, of leaving it; is that so? — That is the practice. Everyone is told that, if she has made a mistake and desires to discontinue her mode of life, she will have a helping hand to do it. With regard to clandestine prostitution, a person-, who called herself a lady, certainly of very respect- able famil}', who had lived in Torquay, about 35 miles from Plymouth, came and took a house near the Hoe, Plymouth, really for the purpose of meeting one or two friends. She was found in a biothel in Raleigh-street. Plymouth, and was at once reminded where she was. She said, " Well, I have done the same thing in. Torquay, and have never been interfered with, why should I be interfered with in Ply- mouth ? " Mr. Stansfeld, 3224. She had done what in Torquay? — Been in the habit of cohabiting with men. I saw her, myself, and told her that if she at- tempted to do it in Plymouth, she would be con- sidered a common prostitute. She thanked me for the caution, packed up her furniture, and went back to Torquay. Mr. Osborne Morgan. 3225. What became of her ? — I do not know. She belonged to a very good family. 3226. Could you give me any other instances ? — There would be numerous instances of mar- ried women, whose husbands were at sea, who are getting their half- pay. 3227. There are girls, I suppose, who are upon the border land, between levity and immo- rality, and you get them at that particular state when they are not hardened, and you are able X partly 162 MINUTES OF EVIDENCE TAKEN BBFOKE THE 30 May 1881.] Inspector Anniss. [ Continued. Mr. Osborne Morgan— coni'mued. partly by exhortation and partly by determents, to prevent their becoming prostitutes? — Yes, a very large number. Mr. Stansfeld. 3228. When you say Plymouth, do you mean the three towns ? — I do ; I speak of the dis- trict. Mr. Oiborne Morgan. 3229. Would there be much clandestine pros- titution that would escape your observation altogether?— No, not much; there are many reasons to prevent such. 3230. Why would it not escape you? — The men are continually about ; every brothel is visited twice in the 24 hours, at various times, and other houses where they are likely to go; houses of accommodation. Then there is a large number of common women all over the district; they have their eyes o])eu, and although the police do not act upon anything they say, there is very httle chance of a woman going on long •without being found out. Chairman. 3231. You never interfere with women who are living privately with men ? — No ; any woman kept by one gentleman is recognised, as far as we are concerned, as if she was married. We do not interfere with a woman living with one man, no matter of what class they may be. Mr. Osborne Morgan. 3232. If a woman lived with a man is his wife, without being his wife, you would not in- terfere ? — No, not unless she found her way into a brothel with other men. 3233. May I ask by whom these acts are carried out under your superintendence ; I think their e?;ecution is entrusted to the Metropolitan Police, is it not ? — Yes. 3234. The local police have nothing to do with them "* — Nothing. We have one serjeant and six constables in the Plymouth and Devon- port district. 3235. Are they men of intelligence ; I stip- pose they are picked men? — We take all the care possible, and do our best to pick the men for steadiness and sobriety, and they are all married men. 3236. Are you aware of any complaints being- made as to the improper or harsh execution of the acts, or of virtuous women being taken up under them ? — I have heard a good deal about it, but if the acts are carried out fairly it is impossible as re- gards the Plymouth and Devonport district, and I say it unhesitatingly, there is not the slightest chance of a virtuous woman being interfered with, whatever may be the opinion of people who do not know. If any gentleman will come and see the working for one month, he will see that, in practice, a mistake is impossible. 3237. As a matter of fact, has any virtuous woman or quasi-virtuous woman been interfered -with? — Certainly not. 3238. It has been stated that the Acts lead to immorality amongst young people of both sexes. Mr. Osborne Morgan — continued, boys and girls, in the districts which are sub- jected to them ; you were in this district- four years before the Act came into operation; da you know anything personally about the state of the morality of the district before that time, particularly as regards young people? — Yes ; I knew it well. It was a very different state of things from what it is now. There were many houses then in the district where young lads and girls met together without let or hindrance for. immoral purposes before the Acts were jrat into operation, which have been entirely stamped out. Mr, Stansfeld: 3239. Do you mean that there were houses specially appropriated to the reception, practi- cally, of children ? — That really was so. Mr. William Fowler. 3240. Why were they not stopped by the police ? — The police do not interfere inside a house unless they are called in. We must not expect too much, I am afraid, from the police. If there is noise or disorder, the police are called in and they see what is going on inside of that house and take action thereon. Mr. Osborne Morgan, 3241. At that time the metropolitan body of the police, of which you are the head, did not exist, did they?— Yes, for the apprehension of stragglers and deserters, and we visited those houses, but then we had nothing to do with those children. 3242. The Acts not having been passed there were no police appointed and told off to carry the Acts into execution ? — No. 3243. Therefore it was left to the operation of the ordinarjf law, just as it would be in Torquay or any other place not under the Acts ? — Quite so. 3244. I asked you whether you coidd give me any general idea of the state of morality in your district before the Acts were in operation, par- ticularly as regards the condition of young people of both sexes '. — It certainly was bad, as those figures show.. Before we had been carry- ing out the Acts for three months it was at once discovered that the greater part of the disease was amongst juvenile prostitutes, and my atten- tion was called to that, and therefore I looked about to find a remedy, and at once set to work to visit all those places, which were Avell-known to me to be frequented by youths for a Ions; time before I commenced these duties. 3245. What state of things did_ you find there ? — They were houses set apart where boys and girls met and had their debauch just at their will. 3246. At what age?— Varying from 12 to IS years of age. You would find, for instance, one house frequented by butcher boys and drovers, another by sailor and drummer boys, &c. 3247- Did girls live in those houses ? — Yes, in some of them, but in others they only resorted to them at given times. I have found as many as 15 or 20 in some of those houses. 3248. Were they all young girls?— They would SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 163 30 May 1881.] Inspector Anniss. \_Contiiiued. Mr. Osborne Morgan — continued, would be young girls. Those houses could not exist ; the very fact of our visits to them would shut them up. It was not part of my duty, but I did not scruple to speak to the parents or friends of such children as were found in such dens of vice. Mr. William Fowler. 3249. Why did you not do that before ? — My attention was not called directlj^ to those girls ; but, when I found that they were frequent- ing such places and spreading disease, I thought it my duty to take action in the matter. 3250. 'J'hen the only thing that the Act did was to call j'our attention to it ? — It brought it •direcily under my observation. Mr. Oihorne Morgan. 3251. That Act gave you the power to place those women on the register ? — If they continued to lead immoral lives, that is to say, if they did not take warning. 3252. Therefoie, in fact, as I understand, the real virtue of the Act, if I may use the expres- sion, was, that it gave you a power by which yon were able to trace any of those women, and find out wliethcr they were leading an immoral life, and if they refused, al'ter due warning, to abandon that life, it gave you the power to put them upon the register? — It not only gave the power, but the duty. Whatever their age may be, if they persist in conducting themselves as common prostitutes, if they do not submit to the restric- tions of the Acts, voluntarily, I have to make a report, and they are summoned before the magis- trates. 3253. Whether for good, or evil, that was the power which the Acts gave you ? — Yes. These children in 1865 and 1866 were found in the most deplorable state as regards disease, filth, and squalor. I remember a case where I had to purchase articles of clothing to cover a coloured girl. There were two of them diseased ; one only 13 years old. Such cases then were numerous. 325 1. You have already given evidence as to the great decrease in the number of juvenile prostitutes ; I suppose, therefore, I may take it, that you are of opinion that the Acts have operated very largely to prevent immorality amongst young people of both sexes ? — Yes, it is found in practice that the Acts operate very largely in that direction. For instance, when we started, nearly every brothel-keeper had one of those young girls as a servant, wluch meant being trained to prostitution. 3255. Is it not a very common thing to get young girls into service in brothels, and then to train them for prostitution? — It was really a matter of fact that some of those brothel-keepers had two, but the majority of them one, and nobody interfered. People would put their daughters there, and be very angry when I in- terfered with it. I have a return of the number of children as servants, and brothel-keepers, and prostitutes, in the district for each year. Mr. Stansfeld. 3256. Are we to understand that you prevent 0.44. Mr. Stansfeld — continued, those brothel-keepers having these young ser- vants ? — It is really so ; that is what I wish to convey. If I find brothel-keepers attempting to have these girls as servants I take steps to prevent it. I spoke of brothel-keepers being prosecuted the other day ; it was entirely in consequence of some of these miserable creatures persisting in having young girls in their houses. Mr. Osborne Morgan. 3257. We cannot but be struck by the very great diminution, in juvenile prostitution parti- cularly, which has taken place since the Acts were passed ; will you explain a little more fully in what way the existence of the Acts has tended to reduce that practice? — It has operated in various ways ; first, the parents of girls, who live in the neighbourhood are acquainted Avith the fact that their children are frequenting such houses ; secondly, children are daily removed from such houses, others are prevented from entering, &c., &c. 3258. Could that take place if the Acts were not in operation ? — Not unless we had some law diff^ereut to what we have now. There is no law in existence, that I know of, that would really operate. 3259. Are you acquainted with any of the towns where these regulations are not in opera- tion ? — Yes. 3260. In the case of Torquay, which you have mentioned, would there exist any means by which the fact of a young girl's leading a life of prostitution could be discovered by her parents, and by which they could find out where she was ? — It would not be known. A girl could go to Torquay, or any other town, and hide herself away almost as long as she liked. 3261. But she cannot do that in subjected districts? — No, certainly not. 3262. Then I understand you to put it in this way, that in the present state of the law in the non-subjected districts, there do not exist those facilities which you have in subjected districts, for discovering the whereabouts of girls who have fallen, or who are on the point of falling, and for restoring them to their friends? — That is so. You have just reminded me of a case. There were two young uirls at Plymouth, they were both in service, and they got into a house of ill-fame, and at once the brothel-keepei's said : '"' The police will be about, and we shall have to tell them that you ai-e here ;" and they said, " Then we will leave," and they left, and went off to Torquay. They were there for a month, and then found their way back to Plymouth. In the meantime their friends had communicated with me, and the same night they came back they were taken home. 3263. And they were not found in Torquay ? — No, they were not found in Torquay. That is a case which occurred in the autumn of last year. 3264. For a month they were in Torquay and they could not be traced ; but the very night that they came back to Plymouth they were traced? — They were. 3265. A good many questions have been asked of other witnesses about the spread of contagious X 2 disease 164 MINUTES OF EVIDENCE TAKEN BEFORE THE 30 Maij 1881.] Inspector Anniss. [ Continued. Mr. Osborne Morgan — continued, diseases in the army and navy in the Plymouth district; I will not ask you any ijuestions about that, although I believe you are prepared to answer questions on that point ; but are you aware that these Acts prevent common women from recklessly spreading venereal disease amongst the civil population? — Necessarily so. It is very patent. 1 may say at once that the first 200 women that I brought up for examina- tion in Devonport were all practising prostitu- tion, and they were all found to be diseased. That was when we commenced these duties. Mr. Hopwood. 3266. But at that time the Act only enabled you to arrest them if they were diseased? — Those women were really practising prostitution, and would still do it, if they were not called upon to go the hospital. We have instances every day. There is one fact which I look upon as a very unfortunate one, that every prostitute found diseased is allowed to go to hospital by herself, to place herself in the hospital. The first evil consequence of that is she, as a rule, goes away and gets drunk before going to hospital ; and the next consequence, which is veiy much more serious to the ser\ice is, that she goes off, picks up a man where she is not known, and sleeps with him. She has the certificate in her pocket, knows that she is affected with syphilis, and yet she goes and sleeps with a man deliberately. Mr. Osborne Morgan. 3267. That is under the present law? — Yes, that is a defect, and I hold it to be a very grave one. 3268. Can you tell me whether the Acts have reduced venereal disease amongst the civil popu- lation of the district ? — Yes, clearly so. 3269. Can you give any proofs of that? — I have various proofs ; for instance, when I com- menceil my duties first, I used to have a hgst of men calling on me to give information that they had got disease from this, that, and the other woman. Now, I rarely get such complaints. I have also kept a return of the number of paupers treated in the various workhouses of the district, Avhicli clearly shows, I thirk, the state of disease in the district, at any rate amongst the lower classes. 3270. That would be a fair index, I suppose, to the incidence of disease in the civil popula- tion ? — I think it would. It is for the Plymouth, Devonport, and Stonehoiise district; there are three workhouses. In Devonport, iu the three years directly before the Acts were put in operation, the years 1862, 1863, and 1864, the total number of cases of venereal disease was 214; 51 males and 163 females. In Stonehouse Workhouse there were 51 cases, all females. In Plymouth Workhouse ther-e were 96 males and 455 females. That gives a total number of cases of 147 males and 669 females, or a gross total of 816 for the three years. I have them for every period of three years until the three years 1877, 1878, and 1879. In Devon- port Workhouse there were, for those three yeai-s, four males and four females. In Stone- house Workhouse there were no males and two Mr. Osburne Morgan — continued. females. In Plymoi\th YVorkhouse there were 15 males and 18 females. That gives a total of 19 males and 24 females, or a gross total of 43 as compared with 826. 3271. Where does that return come from? — Those figures are obtained from the medical men of the various workhouses every year, and then compiled into that shape. 3272. Are they sent to you? — It is collected every year. Those cases in the workhouses now, as regards the females, include pregnant women. The males would show more correctly the amount of disease in the district. ' 3273. 1 suppose that, as regards the health of the women, the Acts are a great benefit, are they not? — Clearly. I heard a ladv say the other day, that she thought they were too favourable for them ; that there ought to be some punish- ment attached to such of them who continued year after year, in the way of placing them in homes, for a given time even against their will. Mr. Stansfdd. 3274. That what was too good? — The Act'5. Mr. Osborne Morgan. 3275. I should like to know what the sanitary efi^ect of these Acts is, in your opinion, indepen- dently of the reduction of venereal disease ; have they any further operation in checking other diseases? — Yes, to a very considerable extent. The bi-othels are really hotbeds of every kind of disease, not merely of venereal. 3276. Is it not a fact that small-pox and other Infectious diseases of that kind, very often originate in brothels and are communicated ' — Yes, they used to exist to a very serious extent, and yet be taken little or no notice of But now such cases are at once known, and iso- lated. If I find a case of small-pox, measles, or fever, in one of those brothels, I at once say, " You must isolate that case, or send it away," otherwise I adopt the means of keeping men of the service away from such houses. 3277. You ascertain the fact of the disease first and then isolate it? — Yes. Mr. Hopwood. 3278. Under what section do you do that? — It is really a regulation to prevent such diseases being spread, and which I feel as part of my duty. Mr. Osborne Morgan. 3279. Is it part of your duty to do that under the Public Health Act? — We have a number of ships in Plymouth, and those ships go all over the world. If men go away in one of those ships with small-pox, they may infect a large number of men of such ships ; in fact, we have had instances of it. What I always do is this : if the brothel-keepers do not take steps at onc& to isolate such cases, I ask for assistance to place that house out of bounds, to prevent the men of the service from entering, and then the houses are cleansed. 3280. I understand you to say that the inspec- tion of these brothels enables you to discover cases of infectious disease, not being of a venereal character, and to isolate them ? — That is so ; such cases are of frequent occurrence. 3281. Do SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 165 30 May 1881.] Inspector Anniss. \^Continued. Mr. Osborne Morgan — continued. 3281. Do you consider that in that respect the Acts have been a benefit to the population? — Yesj they have been a very great benefit in that respect. 3282. You say that from your personal know- ledge ? — Yes, 1 speak of that as a matter of fact. I have had a number of cases where I have been compelled to have the houses placed out of bounds. 3283. Going to another subject, as regards public decency, what effect upon the state of the streets say, has the existence or the operation of the Acts had to your knowledge? — The Acts have cleared the streets of a host of half-starved young creatures, and in that respect have been most salutary. 3284. First of all, comparing the state of the streets in your district now with the state before 1865, have you observed any change ? — Every- thing is changed. Those girls being wiped away, the streets are in quite a different state, for the better. 3285. Is there as much solicitation now as there was formerly ?— No ; I was coming to that. Solicitation is an offence, although we do not act directly on it. Women who come in in large numbers from the outlying districts, from Exeter, Torquay, &c., who do not know the restrictions, and are found soliciting in the streets, the first time they are seen at the waiting-rooms, are told that it is an offence, and that it must not be prac- tised ; and one informs the other, so that soli- citation is almost a thing of the past. ]Mr. Hopioood. 3286. That is not under the Acts? — Not pro- vided for by the Acts ; but supposing I am passing through Plymouth at midnight, and a prostitute from Exeter is soliciting in the streets, and to- morrow she comes under my notice at the waiting- room, I at once remind her that solicitations in the streets is an offence, and hence the improve- ment spoken of. Mr. Osborne Mon/an. 3287. The honourable Member reminds you that that is not owing to the power which the Acts give you ? — It is a matter of discipline. 3288. You would put it in this way, that it is the power which you have behind you, under the Acts, which enables you to bring this deterrent to bear upon them ?^ Yes; every woman that leads an immoral life can be called by name. They are not spoken to in the stteets, but there are oppor- tunities of speaking to them, and then they are reminded that it must not happen; and, if they make use of foul language, the same thing occurs. It is a matter of discipline. 3289. Do I understand, as regards the state of the public streets, as regards solicitation in the public streets, and as regards bad language, there has been a very marked improvement since 1865 ? — Yes, there has been a very marked improve- ment, certainly. There is no doubt about that. 3290. How have those effects been produced? ■ — In the first place a large number of these females have been wiped away, as before stated. 3291. That is to say, that the number of pros- 0.44. Mr. Osborne Morgan — continued. titutes, and the number of brothels, have been most materially decreased ? — Yes. I do not think I mentioned it, but it is a matter of fact that those poor creatures, before the Acts came into operation, not only lived on prostitution, but partly on theft ; there was a very consider- able amount of thieving carried on. Now they are all well known, and if they commii theft are sure to be found out, and it is prevented. Then they had a number of what we call crimps hanging about after them ; that is a thing of the past, it does not exist at the present time. 3292. Is that in consequence of the operations of the Contagious Diseases Acts? — Entirely; I do not know any other Act which has effected it at all. All I know is that the number has gone down from over 100 to just one or two, and I know also how it has been done. 3293. I understood you to say that, as regards the women who are left, they are more decent in their behaviour? — Yes, outwardly the}' are more decent ; there is no doubt about it. 3294. And they also become more honest, and do not live by theft? — Certainly. 3295. Do you find at all, that the behaviour and the language of the common women, at their own residences, are improved ? — Yes, there is a very great difference, in every respect. They are still prostitutes, and the houses are still brothels ; but at the same time no one can go through without finding an entire change. In the first place now, every woman has a room to herself ; that certainly was not the case when we commenced. Then, in the next place, as I have already stated, they are known by name, and they would at once be admonished if they made use of improper language. ]\Ir. Slansfeld. 3296. Do you require that every woman should have a room to herself? — I have not the power to request it, but it is a matter of discipline. If I find brothel-keepers allow two women and two men to go into one room, I stop it. We often used to find two men and two women in the same bedroom, but it is not so now. 3296*. You mean that every woman has a room to herself now, at the time that she is en- tertaining a man.'' — With very few exceptions, a woman has her own room now, which she calls her room. There are exceptions, but they are few. Mr. Osburae Morgan. 3297. I suppose that those brothels are very much made use of for the purpose of seduction, are they not ? — Yes, they are open to every kind of vice. Some years ago, when we commenced first, there were several houses known as night houses. No prostitutes lived in them, but any one, if they had the money to pay for the accom- modation, could get it and remain as long as they liked without interference. 3298. I understand you to say, that that class of houses has been very much diminished? — Yes, we have two of them now, and they give a good deal of trouble. There are only two now instead of 50 formerly ; and they are being con- tinually visited by the Contagious Disease Acts Police. X 3 3299. I suppose 166 30 May 1881.] MINUTES OF EVIDENCE TAKEN BEFORE THE Inspector Anniss. \_Continved. Mr. Osborne Morgan — continued. 3299. I suppose, from the facilities for seduc- tion being diminished in that way, you would infer that seduction itself has decsreased?— Yes, I have nnt the slightest doubt that it has decreased very much ; I get instances of it. 3300. Could you support what you state by any particular instances ? — I know gentlemen have complained, " We cannot get a place in Plymouth to go to." Mr. William Fowler. 3301. Under what law do you suppress them ? — If 1 find a brothel is being conducted in that way, that is, taking in young girls and married women, and prevented the police from cautioning them, I place a man in such a position as to shut them up. 3302. Under the ordinary law ? — Under a regulation for such cases. Mr. Osborne Morgan. 3303. As I understand you, the arm which the Contagious Diseases Acts gives you, is the power of putting a woman on the register ? — Yes. 3301. You have the power of putting a woman on the register, and, if she is diseased, of detain- ing her; and that arm which the law gives you has enabled you, in fact, to decrease very ma- terially the number of prostitutes ?— Entirely. It is my duty to see that the names of the women who are leading an immoral life are on the register. 3305. I suppose, that if you decrease the number of prostitutes, you would naturally de- crease the number of brothels ? — Yes, it neces- sarily follows. 3306. I observe that, in the figures that you gave, the two things bear the same relation to each other ? — They would necessarily. 3307. Can you tell me how many women have been removed from your register annually ? — About 300. 3308. Would you also state the way in which they have been dealt with ? — The number of women who left the district during the year 1865 was 38: 11 were married; 15 entered homes ; and 4 died. In the year 1872, 44 left the district ; 25 were married ; 88 were sent to homes: 170 were restored to their friends; and six died. Mr. StansfiUl. 3309. You did not give us the number that were restored to their friends in the year 1865 ? — Seventy-three were restored to their friends in 1865. In 1880, 38 left the district; 37 were married ; 74 entered homes ; 145 were restored to their friends ; and three died. I see the largest number that died in one year was in the year 1869, 18. 3310. And in the year 1874, 12 died?— Yes. Mr. Osborne Morgan. 3311. Then do I rightly understand you to say that the Acts have operated beneficially in two ways ; first of all, by deterring women from entering upon a career of i^rostitution ; and. Mr. Osborne Morgan — continued, secondly, by enabling them to be reclaimed after they have entered upon it? — Yes, certainly so. 3312. Supposing that the Acts were repealed, would there be any agency now in existence, as the law now stands, which would be equally effe'itive for either of those two purposes? — Certainly not. 3313. Can you suggest any other remedy as regards either of these distinct matters, viz., the prevention of prostitution and the cure of prosti- tution ? — One can suggest, many means by making Iuavs, but with the present law I know of none. 3314. You remember, I suppose, the time when these Acts first came into operation ; was that opposition to them, which has since sprung up, in existence during the first three or four years that they were in ojDeration ? — No, we had no opposition for about the first four years, in fact the Acts were not known, except by the police who were carrying them out, and the magistrates of the district. 3315. I believe that you are prepared to state, are you not, that there are a number of gentle- men in your district (I think you have given me a list of the names, some 21 in number, clergy and magistrates and jDrofessional men) who are strongly in favour of the Acts, and who are willing to give evidence in their favour? — Yes; you might get as many as you like amongst gentlemen who know the district. 3316. Keeping j'ourself entirely to what is within your knowledge, what do you say as to the feeling with regard to the Acts when they were first put into operation? — They were really unkno-wn up to that time, and for three or four years, except by the jjolice and the magistrates. 3317. You have spoken of the difference be- tween the protected and the unprotected parts of Devon and Cornwall ; you have some knowledge, have you not, of the unprotected parts ? — Yes, I know the two counties of Devon and Cornwall very w ell. We have the means of asceri;)ining as to the state of disease by the way in which the women come into the district. 3318. Perhaps you will be kind enough to state what facts you have, bearing upon the com- parative freedom from venereal disease, of the two districts ? — I have a return beai'ing upon that directly, but it comes to the same thing year by year; if anything, I am afraid it is rather increasing. In the Devonport district, last year, there were 88 prostitutes who came into the dis- trict diseased, and there were 26 others who were found free from disease; that is to say, 114 fallen women came into the district, and of those 114, 88 were found to be diseased on being examined. The number of women who belonged to the dis- trict proper, as we call it, were 173, and there were 45 of those found diseased, and 128 not. The per-centage of disease amongst prostitutes who come into the disbfict is 77 "19, and the per- centage amongst the prostitutes belonging to the district is 26-01. This Return is precisely the same as has been compiled in London and mine. I have it here from all the districts, and the per-centage is 66-1 from the unprotected districts, and 29 from the protected districts. I am now- speaking of those women who are examined for the first time ; not of the general examination. 3819. Then SELECT COMMITTEE ON UONTAGIOUS DISEASES ACTS. 167 30 May 1881.] Inspector Anniss. [ Continued. Mr. Osbur>ie Morgan — continued. 3319. Then, do I rightly understand you to say, that the incidence of venereal disease in tlie case of women coming from an unsubjected dis- trict, as compared with the incidence of disease in the case of those who are examined for tlie first time in the subjected district, is considerably more than two to one ? — Yes, it is nearly three to one. 3320. I believe you spoke of some defects in the existing Acts, and of some suggestions which you had for their amendment ; do you believe that in some respects the existing Acts are defective ? — Yes ; one defect is that the woman is not taken direct to the hospital. 3321. Are there any other defects, in your opinion ? — Yes; the Acts should deal with young children, that is to say, houses of ill fame exist, and are known to exist, and they should not be allowed to have children of either sex ; it should be an offence, I hold, for any brothel to have a child of either sex in it. Mr. Stansfeld. 3322. What age would you fix?— I shoLdd like it to be 20, but 17 would meet the difSculty. Mr. Hopivood. 3323. Do you know that there is an Act of Parliament to that effect, the Industrial Schools Act, which was passed last Session ? — I do not think that would meet the case. Mr. Stansfeld. 3324. In your view it would be an improve- ment in the law to make it an offence to allow girls under a certain age to be in brothels? — Yes ; I would not let them be in any house where lodgings are provided for common prostitutes for immoral purposes. I would like to see it made an offence for any one to admit a child of either sex under 17 into such a place. Mr. Osborne Morgan. 3325. There are some returns which you wish to hand in ; will you hand them in ? — Yes. I have a return showing the number of brothels and the number of persons, men, women, and children residing in each, for every year from the time the Acts were put into operation. 3326. You are responsible for the accuracy of these returns ? — Yes. ( The Returns icere handed in.) Dr. Cameron. 3327. The number of brothels in the district before the commencement of the Act, amounted to about 400 in round numbers, did it not? — It did. 3328. And at the date of your last information how many were there ?— When I left Plymouth on the 25th inst. there were 70. 3329. As the E-ight honourable gentleman who examined you last remarked, they have been reduced, roughly speaking, to about one-sixth ? — Yes. 3330. What is the population of your district? — It would be now, taking all the villages, nearly 180,000. 3331. You are aware that in Glasgow there are no Contagious Diseases Acts ? — 1 am. 0.44. Dr. Cameron — continued. 3332. Should you be surprised to learn that there, in a population many times greater than that of your district, there are only 38 brothels ? — I am not surprised to hear that, it is in print ; but I should be surprised to find that it was a fact. 3333. Would you be surprised to know that that is the evidence given by the chief constable of Glasgow?— I should not be surprised to hear it ; I presume it is the fact. Of course I accept that. 3334. The chief constable of Glasgow, in the evidence from which I am quoting before the Committee, which some years ago sat upon the Sale of Intoxicating Liquors on Sunday (Ireland) Bill, mentioned that in 1849 there were in Glas- gow 211 brothels; in 1874 there were 204; and at the date of his evidence in 1877, the number had been reduced to 38 ; and he explained this reduction as having occurred through the powers which licensing laws and local Acts gave him? — I do not know Glasgow at all, and therefore I cannot speak of it. 3335. You consider the reduction of brothels a great improvement? — I do, clearly. 3336. Then should you not consider that the state of Glasgovv in respect of brothels, shows a vast improvement over the state of Plymouth? — The difference as stated would be in favour of Glasgow. 3337. The actual state of things being 70 brothels to 180,000 inhabitants in Plymouth, against 38 brothels to 500,000 inhabitants in Glasgow ; which shows the best ? — Clearly Glas- gow. 3338. And there are no Contagious Diseases Acts there ? — No. Mr. Hopicood. 3339. Are you still an inspector, or have you been promoted? — I am still an inspector. 3340. And an inspector for these districts that you are telling us of? — l''es. 3341. You were previously stationed at these places as one of the water police, as it is called, were you not? — No ; I was a detective belonging to the detective branch, but for a time had charge of the water police. 3342. What we understand to be the water police is a detathment of the Metropolitan Police Force sent down to have charge of Her Majesty's Dockyards and Victualling Yards, and so on, under the Act of Parliament? — No, that is not so. The Devonport Dockyard was a division, consisting of 150 men ; there is a sub-division of water police, consisting of about 15 or 16, in- spector, sergeants, and constables ; there is a sub-division of police to cari'y out the Con- tagious Diseases Acts, as also for the Victualling Yard, and so on. 3343. At all events, all those whom you have spoken of are metropolitan police ? — Yes. 3344. And they have jurisdiction gver Her Majesty's dockyards, except that the Contagious Diseases Acts give a certain jiortion of their body powers outside the dockyards ? — That is 80. 3345. What is the consideration for which a man undertakes this duty of watching over the X 4 prostitutes 168 MINUTES OK EVIDENCE TAKEN BEFORE THE 30 May 1881.] Inspector Anniss. ^Continued. Mr. Hopwood — continued, prostitutes of the district? — The constables se- lected for these duties are old constables. 3346. I asked what was the consideration paid to them for this work ? — Each man gets 5 5. a ■sveek to provide himself with lodgings. 3347. But they must all be down there for the purpose of the Admiralty district, must they not? — Yes. 3348. Then this is 5 s. afterwards, in considera- tion of their doing this duty, is it not ? — Yes, these are special duties, and the men get 5 s. per week. 3349. I understand you to say that, before these Acts came iuto operation, you had a large acquaintauce with the prostitutes of the district ? — Yes, 1 knew where they were to be found. 3350. And you explained that, as I under- stand it, you went occasionally with two sergeants to arrest deserters? — 1 did not say occasionally ; that was my duty. 3351. Your daily duty was to visit every brothel in the place ? — 1 would like to be thoroughly understood. I had charge of the detective police as well as those men who were employed afloat for the detection of any of Her Majesty's stores that might be purloined, and also to apprehend any men that might be absent, or were disorderly in the streets. 3352. 1 understood you to say that that afforded the opportunity of telling us how many prosti- tutes there were in the place ? — No, that did not ; I had no conception of the number of prostitutes in the place before I had the order to ascertain ; it was when I had the order to do that that I became thoroughly ucquainted with the num- bers. 3353. You say that you had not the slightest conception of the number, although you were in the habit of daily visiting the brothels ? — Yes. It was not my business then. 3354. Then you could not tell us whether, be- fore you began to count, there were thousands, or whether there were hundreds?-— I could have given you, in round numbers, as good an account as anyone could, but 1 could not have said what the number actually was. 3355. What was the round number that you were conscious of before you began to count ? — • I did not know before I ascertained, and then I found the number which I have given. 3356. How did you ascertain the number ; you say that you took the name, address, and age of every woman ? — That was in 1865. 3357. May I ask under what right you did that ? — It was a right of duty ; I had a duty to do, and 1 carrried it out to the best of my ability. 3358. Supposing a woman objected to tell you, what then ? — Then I had to leave it. In 1864 there were about 200 that I did not get the names of; but, in 1865, there were a considera- ble number that had been talked with, and I had very little trouble to get the names of these w^omen than. 3359. How did you spot a woman to be a prostitute before you put these insulting ques- tions to her ? — I do not think it was an insulting question ; I should not ask a woman whether she was a prostitute ; I should ask where her room Mr. Hopwood- — continued, was, and I should know that the house was a brothel, and shape my questions accordingly. 3360. Did they all answer you willingly ? — Yes, fairly so. 3361. Did they know you to be a f)oliceman? — Yes, very clearly. 3362. That was a good reason for their answer- ing you willingly ? — Yes, it would be one very good reason. 3363. The police have ways of making their authority felt without the law, have they not ? — Yes, I hold that we cannot make laws for every- thing. 3364. Y"ou have told us already that they have ways of stationing men at brothels, and so on ? — Yes. 3365. Then you could make it inconvenient to anybody who refused to give you the informa- tion ? — Yes, clearly. 3366. Then you accosted and spoke to, you say, 1,960 in December 1863 ?— Yes, that was the number. 3367. Before you had any warrant, or power, to do anything of the kind ? — I had no warrant, but found the moral power. 3368. What is your district now ? — Plymouth, Devonport, and Stonehouse, and all the villages within 10 miles. 3369. Do you not extend your jurisdiction to 15 miles sometimes? — -No, 10 miles is the distance. Ivy bridge is mentioned in the Act of Parliament, and then Dartmouth is also men- tioned in the Act of Parliament, which is 50 miles away, and I have one man there. We have no other villages which troiible us at all, and therefore ray duties are very simple as regards distances. 3370. By not troubling you at all, you mean that you do not know that there is anything going on that calls for your attention ? — I should know it if there was. 3371. How would you know it if you do not go there and see ? — Take Saltash, with about 2,500 inhabitants, that is in the district, .and St. Germans, a little further on, is not. If any- thing was going wrong at St. Germans the men would hear of it when visiting Saltash. 3372. I do not want to know anything about St. Germans ? — I thought you were speaking of the villages outside the district. 3373. Do you mean to say that you do not go to the villages which are inside the Acts, because they give you no trouble ? — Every village under the Acts is visited. 3374. Then how could you understand me as meaning to refer to villages outside the Acts ? — I thought you mentioned villages outside the Acts. 3375. What right have you there ? — None. 3376. You say, as I understand, that you had 150,000 inhabitants in 1864 to look after, and you have now 180,000 ; how many men have you under you ? — Six constables and a ser- geant. 3377. What was your mode of action when you began ; did you begin by inquiring into the history of the different women of the district ? — Y^ou are, I presume, speaking of after the Acts were passed. 3378. Yes, SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 169 30 Maxj 1881.] Inspector Anniss. [ Continued. Mr. Hopwood — continued. 3378. Yes, after the Acts were passed? — We had a limited number of beds in the Royal Albert Hospital ; only 30 ; I felt it my duty, although I had no instructions, to visit the hospitals, and ascertain what men were there suffering from venereal disease, and I got a very long list, I am sorry to say. 3379. I was asking you about the women. Did you make it your business to ascertain who were the women of the place, and their history ? — I did not go into that at first. 3380. Have you done so lately ? — Yes, for the last 10 or 12 years. 3381. Any strangers that appear in the place you immediately look after? — Yes, and ascertain, as far as possible, their history. 3382. Do you watch them ? — We find them in brothels. 3383. I asked you whether you watched them ? — No, we do not ; is is not a matter of watching. 3384. Do you mean to say that you do not look after them ? — Yes, we do look after them. 3385. You look after them, but you do not watch them ? — Yes, we look after them, and do not watch them. 3386. Does it depend upon a woman's dress, or upon her appearance ? — It would depend entirely upon whether she was a common pros- titute. 3387. How do you know a common prostitute ? — I hold that a common prostitute is a woman who cohabits with diiFerent men ; that is to say, one who goes into a brothel indiscriminately vrith men. 3388. I was asking you about strangers coming into the streets ; do you make it your business to look after them ? — If a person is found in the streets soliciting, late at night, we tnke care to find out where she goes, and if she is found in a brothel she is spoken to, or found about to enter a brothel. 3389. Do you mean to say that you always wait until a woman is charged with solicitino- before you inquire ? — Until a woman is found in a house of ill fame, or soliciting for prostitution, we do not interfere with her. 3390. Do you not watch any stranger that comes into the place? — No; if a common woman comes into the town she has to find a lodfino-s, and we know such houses and look for them there, and then speak to them. Mr. Osborne Morgan. 3391. Do you watch them going into houses of ill fame ? — Yes. Mr. Hopxvood. 3392. If a lady came in from Torquay, for in- stance, do you mean to say that you do not watch her ? — Certainly not. 3393. You do not look at her; I suppose if you passed her in the streets you would turn your eyes away ? — We do not look after ladies, but prostitutes only. 3394. How do you know a prostitute by her appearance from a lady ?— 1 do not know that we should always, but if we find a woman in a brothel with a man, unless she shows very clearly that she has only just got there, we 0.44. Mr. Hopwood — continued. consider her a prostitute, even if she call herself a lady. 3395. Did you understand me as speaking about a brothel ; I asked you as to their appear- ance ; how do you know a prostitute by her ap- pearance from a lady ?— If I did not know that a woman was a prostitute I should take no notice at all of her. I take no notice of persons except they are prostitutes. 3396. And you declare that no one has ever interfered with a respectable woman in Devon- port ? — I do ; I say that unhesitatingly. 3397. Do you think that you have a right to speak to a woman in the streets, and ask her where she lives ? — No, and I do not do it nor allow it to be done. 3398. And you never have done ? — No. 3399. It never has been done ? — It never has been done ; the men are not allowed to speak to a woman in the street unless they find her going into a brothel. If a woman is in the street, and she is found going into a brothel, the constable at once reminds her that she is going into a house of ill fame, and if she persists he gets her address. 3400. Have you any right to do it ? — I do it as a moral right, a matter of duty. 3401. Have you ever found somebody who was not a prostitute who was guilty of some in- discretion in this way ? — Y''es, a good many, 3402. Were they, as far as the world supposed, respectable people ? — Y'es, very. 3403. And all their history you knew ? — Yes, or some of it. 3404. In those cases I suppose you took upon yourself to warn them of the ill consequences ? — Yes. 3405. Did you do that on the score of religion, or of the Acts?— I do it " on the score " of duty. 3406. Then, if a woman should be so unfor- tunate as to have an indiscreet affection for some- body, you know it and learn it ? — Y^es, it is very likely to come under my knowledge. 3407. And your subordinates all know it ? — Yes. _ 3408. And they could make it public at any time to the ruin of those people? — It would not be well for a man if he diet it ; he would not have a chance to make a second case known, and we have never had such a case. 3409. It is in the breast of the ordinary police- man, as well as the inspector, whether they do so or not?-- Yes. They are men of nearly 20 years' service, and the man has his living to think of ; at any rate I can only say that we have never had a case. 3410. And you never have been charged with a case ? — No, never, not with exposing a case ; that is what you asked me. 3411. Y'ou say you have never had a case of complaint of any molestation or interference ? — I had a complaint against myself, and a very serious one to me it was. 3412. Y^ou were asked by the Judge Advocate if you had had any complaints made, and you said none whatever ? — Against the constables. 3413. There was one against yourself? — Yes, a very serious one. 3414. That was a lady who, right or wrong, charged you with stopping her and asking her questions under this Act ? — Not a lady. y 3415. I believe 170 MINUTES OF ETIDEIfCE Tj\KEN BEFOKE THE 30 May 1881.1 Inspector Anniss. [ Continued. Mr. Hopivood — contiDued. 341.5. I believe it was heard by tbe magis- trates, was it not? — Yes. 3416. And you were acquitted by the magis- trates ? — Yes; and the magistrates expressed their approval of my mode of carrying out the Act before I left the court, as they hare often done at other times. Mr. Osborne More/an. 3417. Was the charge dismissed? — Yes. Mr. Hopicood. 3418. The lady swore it? — The female. 3419. And I think she pointed you out in the chapel at which you were a regular attendant ? — She said she had done that. I shall be very glad to answer any question on that case. 3420. I believe two of your officers showed that you were not far from the spot, but not at the spot ? — That is not so. It so happened that I met a magistrate of the borough the same night and at "the same time. But it was well known that the case was got up for the purpose ; there is no doubt about it. 3421. As I understand you, you have brought your district to the felicity of having only 70 brothels in this present year?— Yes, that is the number at the present time. 3422. The population has increased, or at least the population of the district has increased, 30,000?— Yes, the district has been extended. 3423. Do you mean to say that the district has become so much more moral on .the part of the men ? — I should think it would be. 3424. Do you mean that they go to chapel or to church — No, I do not ; I have not gone into that. But where there is less solicitation amongst young men, and lads in their teens, temptation being kept out of their way, there is less immo- lalitj-. If they are solicited in the streets they are liable to give way to the temptation ; whereas if they are not solicited there is much less mischief done. At Dartmouth, a little town by itself, in 1870, we had 16 prostitutes; the police said there were 30, but we found 16. At the present time we have only one in the place ; and I saw a medical man of very long standing the last time I was there, and he said tliere was neither disease nor prostitution in the town. 3425. Then you mean to say that the use of these women has been discontinued in the dis- trict ? — Yes, to a considerable extent. 3426. Does that apply to the soldiers and sailors coming ; have you had about the same proportion of soldiers and sailors that you had before? — I think there is something like 1,000, on an average, more than there were before the Acts were put in operation. 3427. And your proof that thei'e is no clandes- tine prostitution is that you have watched the brothels ? — It is because they must come under our notice, if they are in the district. 3428. The brothels ? — No, the women who would be clandestine prostitutes if they were not prevented by fear. 3429. Are there no other houses for them to go to ; houses of friends, houses in back streets, that are not brothels? — Friends would hardly Mr. Hopwood — continued, allow them to come there for immoral purposes ; they would be false friends if they did ; cer- tainly. 3430. On the grounds of morality, I supjjose ? — Certainly. 3431. That is your main reason; that there are 70 brothels and you watch them all ? — I did not say that ; I said we took care to visit them all twice a day at least. 3432. Will you tell me what power you have to visit the brothels unless they allow you to do so ? — They have tried to disallow us ; but we are not beaten, and if they do not allow us we take care to shut them up. 3433. How do you do that ; do you do it by appealing to the local police ? — We do not appeal to the local police ; I am afraid the local police are very much more helpless than we are in this matter. I mentioned four cases just now where they would persist in harbouring young girls. I then went to the Plymouth Board of Guardians, and we got two householders to indict them to lay an information, and I produced evidence and convicted them. That has been the cause of reducing the number of brothels by 1 1. Mr. William Fowler. 3434. Not under these Acts, though ? — I gave evidence myself against them, as also my men, because they had become very notorious. 3435. I suppose you could shut up any brothel in the same way, could 3'ou not ? — I am not sure ; but when they become obnoxious by making prostitutes we take notice of them ; as long as young girls of tender age are not harboured, or disease is not fostered, I do not interfere. 3436. Then the brothels are under the protec- tion of the police ? — I do not think that by any means. 3437. Could j-ou not stop them by planting two officers near the door to see who went in and who went out ? — No, the number would be very large for such a process. 3438. Could you not take them in detail? — That is what we have done. 3439. Why have you not gone on with it ? — I think we have done fairly well in that respect. 3440. You think 70 is a fair number? — I should not say tliat. 3441. Vt'ould you put them all down ? — I am not sure that that would be practicable just now. 3442. Then, in fact, your men protect these houses, do they not? — No, certainly not ; any- thing but that. 3443. You see that they are well ordered ; you call upon them, and see that they are decent; and as long as they ai'e, you do not disturb them? — We see that they do not foster disease nor har- bour juveniles for prostitution ; we go as far as we think we can, legitimately. 3444. I thought there were no juveniles for prostitution now ? — Yes ; but by wiping them one by one out, week by week, we have none. I will give an instance. 1 found a girl of 14 years old during the present year in a place where she was being literally trained to prostitution ; she is now in a Home for the homeless, at Plymouth. 3445. You told us of inquiries which you said had SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 171 30 Mmj JS81.J Inspector Anniss. [ Continued. Mr. William Fowler — continued, had been made of you by parents and relatives ; are you not well aware that the local police are also inquii'ed of by the parents as to missing children 1 — Yes, and they send them on to me. 3446. Your police do? — No, the local police send them. 3447. Are not you aware that the same thing happens in London? — Cleai-ly, every day. 3448. It is a common incident of the police- man's duty, is it not ? — Clearly ; but it is a very great question whether they can be found as we can find them. We know every place and find them at once. I am afraid that in large centres they are not always found where the Acts are not in operation. 3449. Then, as I understand, you do know now that you have no power to address a woman in the streets, to stop her, to question her, or even to accost her in any way ? — I know that, as a matter of practice, that has never been allowed in the Plymouth district. I suggested, from the very first, that it would be a dangerous practice, and it has never been tolerated. 3450. Do you claim the right to go into houses ? — Yes, where they are brothels. 3451. But into other houses ? — Certainly not. 3452. Never? — Certainly not. 3453. But you claim the right to go into brotbels ? — Yes. 3454. By what law? — They, the brothel keepers, live outside the law, and I contend that so long as they live outside the law we have a right to go in. 3455. I should like to advise them? — They have tried to kick us out, but we have managed to beat them. 3456. You will try once too often, perhaps. You have had great success in Devonport, have you not ? — We have plenty to do. 3457. But comparing Devonport with the other places returned, have you not had wonderful success above them all ? — I have not studied the other districts much. 3458. Do you mean to say that yout attention has not been called to the fact that your number for the reduction of prostitutes is greater than that of any other place ? — No, I do not think that is so. Still I think we have been suc- cessful. 3459. Have the local people objected to your statistics at all at any time ? — Yes. 3460. The mayor and some other people ? — Not the mayor. 3461. Not the present mayor? — No, nor yet the then mayor. 3462. Has no mayor objected to the number which you gave, to the late Home Secretary, Lord Aberdare ? — No, I think not. 3463. Do you say that he did not? — He did not. There was an inquiry, and I assured the gentleman, who was well acquainted with Ply- mouth, that my figures were right, and that theirs were wrong, and that they neither knew where the prostitutes were, nor their number. I had the name and age of every one. 3464. As I understand you, the women who come into the district are diseased? — A very large proportion of them are ; 77 per cent., as you saw. 0.44. Mr. William Fowler — continued. 3465. In fact, we have heard that they come into the district to get cured? — Yes, some of them do ; but very many of them, I am sorry to say, come ui for prostitution. It is a very un- fortunate fact, that these women go into brothels for jirostitution, notwithstanding they are dis- eased. I have a young girl of 16 years of age, who came into the district a fortnight ago from Kirgsbridge ; and she admitted that she had been diseased for four months ; she is now in the Albert Hospital. Mr. Osborne Morgan. 3466. Is Kingsbridge outside the district ? — It is ; and the girl referred to is quite a child. Mr. Hopwood. 3467. Will you tell us who keeps the register in the first instance ; does each officer have a temporary register ? — Yes, or pocket-book. 3468. And he has the names of all he suspects? — -No ; he has nothing to do with it before a woman is on the register. He has a pocket register of all common women contained in the sub-district which he has to look after, but not of clandestine prostitutes. 3469. Those are the women already on the register ? — Yes. 3470. Let us take the first stage. There is a woman, as you say, whom you find in a brothel upon one occasion ; your first course, you say, is to expostulate with her? — Yes. 3471. Supposing she says, "Mind your own business," what do you do then? — That is my business, and I tell her so. 3472. Supjjosing that she persists in it, what then ? — I tell her that there is a law she has to submit to, that is, to attend for the examination. If she is wilUng to do that by voluntary submis- sion, I tell her the hour and place to attend ; if she says, " No," I make a report to the Commis- sioner, and ask for authority to summon her, and she is told that. 3473. You say that your evidence of prostitu- tion is finding a woman on one occasion in a brothel ? — The evidence would be of various kinds. That would be one. 3474. You told me that if you found a woman in a brothel you expostulated with her, and I suggested that she might say to you, " Mind your own business;" what do you do next? — If 1 find she is cohabiting with men 3475. I did not put that question to you ; I will take the instance of those unfortunale people, of whom you say you have known many, who commit private indiscretions ; why do you not go on with any of those cases? — If a woman says, " I am in a brothel, and I shall do as I like," I take care to find out all particulars about her. 3476. I am asking you, in regard to those cases of private indiscretion, as to which you said you had information of a large number, and I ask why you do not take one of those cases and go on with it, and put it under the Acts ? — Because, if a woman is seen in a brothel, or con- ducting herself immorally, and she discontinues from that time, no further notice is taken of her. If she leaves the brothel at once, and discon- Y 2 tinues 172 MINUTES OF EVIDENCE TAKEN BEFORE THE 30 May 1881.] Inspector Anniss. {Continued. Mr. Hopwood — continued, tinues it from that time, she is not interfered ■with; if she remains, she is dealt with accord- ingly. Dr. Farquharson. 3477. I think yon stated that the constables were specially selected for this duty ; may I ask what is the principle of selection ? — In the first place they must be married men ; in the next place they must be well known to have no reports against them, and to be temperate in their habits ; they must be men mthout anything against their character, and of at least 10 or 12 years' police service. 3478. Then, I suppose any instances of harsh conduct on their part would naturally be reported to you as inspector ? — I should know it at once. 3479. Have any such reports ever been made to you ? — No ; I unhesitatingly say that we have not had a case of hardship in the district; not one substantiated. 3480. The women do not ever complain to you of the harsh method in which the duties of the constables are conducted? — No. 3481. We have heard something about the mode of taking evidence as to women under the Acts, but I presume that you would only venture to have any suspicion of a woman if she appeared under suspicious circumstances ? — We take no notice of a woman unless we find her conducting herself as a common prostitute ; that is to say, she is either soliciting in the streets as a stranger in the town, or she is found going to a brothel. 3482. In fact, there is no possibility of any one being apprehended or taken up under these Acts simply on sus2jicion ? — It is quite impos- sible ; whilst it has been talked of, it is simply from not understanding how the duties are car- ried out. 3483. I suppose wc are not to refer again to the case of this lady who apparently made a charge against you, but I should like to have it quite clear that the case was thoroughly investi- gated by the magistrates, and you were acquitted? — Yes ; I should like to say that I was at least two miles from where she said I was that night. It so happened that I was on the Plymouth Hoe, and I met with a certain magistrate there. I did not remember the circumstance before he called my attention to it, tliat he met me there the same night, not before he mentioned it. 3484. Do you think it probable that if the number of brothels were diminished from any cause in any town in which the Acts were not in operation, say in Glasgow, clandestine prosti- tution would increase or not ? — There is a very difi^erent state of things, 1 presume, in Glasgow to that in Plymouth, but still 1 do not know Glasgow. 3485. Supposing that brothels were reduced In a town which was not under the Acts by simple police interference, would you consider that clandestine prostitution would increase or not ? — It would increase without a doubt. 3486. From what reason ? — There are always people who will carry on such a trade in a clan- destine way if they can get money by it; and the police do not look after it as we do ; we look after it as a matter of duty ; the ordinary police Dr. Farquharson — continued, do not in the same sense. When the police, 10 years ago, professed to say that there were 500 prostitutes in a certain district, I said it was not so ; I said there were not 300 ; they said there were 500 ; and, on inquiry, they only found 180. 3487. In the towns under the Acts the women do not care to be clandestine prostitutes on ac- count of the fear of being brought under the Acts ? — The Acts have a very deterrent effect. 3488. So that there is an essential difference between the diminution of brothels in a town which is under the Acts and in a town which is not under the Acts ? — Yes, most clearlj' so. 3489. Could you give us any definition of the term common prostitutes? — I call any woman who cohabits with different men, indiscriminately, a common prostitute. 3490. In what way can you prove that? — - Their being in brothels with men. There should be police evidence to that effect, that she is coha- biting with different men, or being in a brothel with men, or in some other place in the act of prostitution. 3491. If a woman is found once in a brothel I think I understand you to say that she is not necessarily brought under the Acts, but that she is cautioned? — In my districtshe is never brought under the Acts until she has had an opportunity of returning to her friends or of discontinuing such a life, aud she is helped to go to her friends if she has any. 3492. That is to say, a single appearance of a woman in a brothel is not sufficient to bring her under the Acts ? — I think it would be if we found women there sleeping with men, but we take it as a matter of duty to give them an oppor- tunity of retracing their steps. 3493. Then if a woman says that she declines to go on any further, and that she will give up the practice of prostitution, you give her an opportunity of doing so ? — -Yes. 3494. You do not take her at once to the police station and examine her ? — No. 3495. We have heard something of persons who were afterwards proved not to be prostitutes who have been brought up before police magis- trates ; but I presume thax those people were all found under suspicious circumstances ? — We have never had such a case, and we are not likely to. 3496. Is there any possibility of any innocent person simply walking along the streets being taken up on suspicion and registered as a pros- titute ? — It is monstrous ; it is impossible. A man would be dismissed from the service at once if he attempted such a thing ; but he could not succeed. 3497. With regard to the actual machinery and taking first the point of the medical ex- amination, what is the practice ? — I never take a woman before the magistrates unless I have evidence to show that the woman has had an opportunity not only of retracing her steps, but also of getting back to her friends; and I have two witnesses at least, two policemen, to show that she is a common prostitute. I never trust to any evidence except police evidence ; I would not think of calling anybody else. I had a case in which a woman came from Falmouth ; she was found in a brothel in Devonport, and she said the man who was with her was her husband (that is an SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 173 30 Marj 1881.] Inspector Anniss. \_Continued. Dr. Farquharson — continued, an ordinary remark) ; but the constable knew better, and he said, " Yours is a i^retty husband to take you into a brothel." Two nights after- wads she was found in a brothel in Bath-street, Plymouth, in quite another part of the district, with another man. I called to see her, and said, "This is the second time." She said she was not the same woman, and I said, " Very well, you were found at Devonport the other day, and you said that man was your husband ; they can't both be husbands, and now there are two things open for you to do : you will either attend for examination to-morrow, or else I shall take you before the magistrates ;" and the woman attended the next day for examination. 3497.* You hold that your opportunities and machinery enable you to have communication with the parents very much more effectually than the police in London, or in any other non- subjected place? — Yes. 3498. You hear of these cases earlier, and you have better opportunities of finding them out ? — Yes, and we do find them at once. There is another case which I would mention. A girl was found in a brotliel on Tuesday of last week ; she at first gave a false name, but on my seeing her the next morning, I found that she was the daughter of a man in the dockyard, and, according to the ordinary course of pi'ocedure, I told a con- stable to call and acquaint the mother where her daughter was. The mother, uot more than one hour after that, called at my oflSce, and I sent a man to show her where her daughter was, and she was sent home. Mr. Osborne Morgan. 3499. Do I rightly understand you that it is always the case that a woman has the chance of being restored to a virtuous life before she is put upon the register ? — In every case, unless there is information, or belief, that the woman is diseased, and then, if she has had warning be- fore, and she is found a second time, she is com- pelled to come under examination. In the case of the woman that was found in Bath-street, she was found a second time, and she was compelled to submit herself to examination. Dr. Farquharson. 3500. You told us that, since the Acts have been in operation, women have rooms to them- selves ; was that the case before ? — No, certainly not. I have hundreds of times found two men and two women in one bed. It is painful to relate, but fact nevertheless. 3501. We have had some reference to what I may venture to call the recent Acts of police regulation in Glasgow ; have you any personal knowledge of the police regulations in Glasgow with regard to prostitution ? — I have none. 3502. Have you ever heard auytliing about the increase of claudestine prostitution in Glas- gow as following those police regulations ? — Yes, I have, but that would be only hearsay. Chairman. 3503. Have you ever visited Glasgow ? — Yes, a good many years ago ; but I met a gentleman 0.44. Chairman — continued. the other day who came from there, asking for information. Mr. Osborne Morgan. 3504. Have you not got a return showing the number of prostitutes admitted to the lock wards of the Eoyal Albert Hospital, and discharged ? — I have. Dr. Cameron. 3505. Can you give any information as to the amount of lock hospital accommodation that there was previous to the Acts ? — Before the Acts were put into operation, the number of beds was 25 ; but there was scarcely one-half of them occupied. When I first commenced, many of them were empty. I have here a return show- ing the number of women who have discontinued their immoral practices, year by year, on their discharge from hospital, as also the cases of disease admitted. 3506. Have you any other particulars bearing upon that subject ? — Yes, I have various returns with me. Mr. William Fowler. 3507. You spoke about clandestine prostitu- tion, and I understood you to say that there was no known number, and that it was only a guess about the number ; of course you have no regis- ter? — There is no register. I did not use the word " guess," because we take all the care that we possibly can ; it is more than a guess. 3508. But there might be a great many that you do not know about ? — I think not. 3509. That is a matter of opinion ? — I hold it very strongly nevertheless, and consider it more than an opinion. 3510. On the other hand, you said you were quite sure that in a place like Glasgow, where there were only ordinary police, there must be an increase of clandestine prostitution? — There is no doubt about that. 3511. How do you know that the police in Glasgow would not look after them? — I said that 1 did not know Glasgow. 3512. However, you say that in Devonport there is not a great increase, but a diminution ? — A very great diminution. 3513. iTour opinion is, that where there is a proper police supervision, you may decrease clan- destine prostitution? — Yes, to a very great extent. 3514. Could not that be done without the Contagious Diseases Acts ? — Yes, with suitable laws, but not with the present law. 3515. If you had a law, for instance, enabling you to look after the prostitutes carefully, with- out reference to the question of disease ? — Yes, if properly looked after. 3516. Have you ever heard anything about the condition of Paris, with regard to this ques- tion ? — I have heard and read a good deal of it, but I do not know it personally. 3517. In reference to the diminution of brothels, I did not quite understand how you proceeded when you ivanted to put down a brothel? — There are many different ways. 3518. They are all ways that have nothing to do with the Contagious Diseases Acts ? — I T 3 should 174 MINUTES OF EVIDENCE TAKEN BEFORE THE 30 May 1881.] Inspector Anniss. [ Continued. Mr. William Fowler. should not interfere unless I thought they had to do witli the Contagious Diseases Acts. 3519. But you interfere under the old law; the Contagious Diseases Acts bring the facts to your knowledge, and then you put the old law arising under the London Police or local Acts in force ? — That is not always the case : sometimes we have to use a law of our own. 3520. At any rate, you do not go under the Contagious Diseases Act ? — We do ; we prose- cute tliem if they harbour diseased prostitutes. 3521. That is a very special case; but as a rule you go under the idea that the brothel is improperly conducted, and therefore you abo- lish it ? — I did not use that term. 3522. But that is what your evidence comes to ; that they harbour juvenile prostitutes, or something of that kind?— Yes, but I hold that every brothel is improperly conducted. 3523. I quite agree with you ; you allow 70 brothels to remain, which you think is about the right number? — No, I beg your pardon; I have said distinctly that, as to the number,- 1 would not allow myself to be a judge. 3524. Still you have allowed 70 to remain, notwiti) standing the number of years that you have been at work ; and the others have been abolished by degrees, and that you think is to a considerable extent through fear of you or of your direct action ? — Yes, I think that. 3525. That has been by ordinary police, or local law, or without law, as the case may be ; therefore that has been by the information which you have received under those Acts, and not by the powers which the Acts have given you ? — It has been done by the machinery of the Acts, and therefore I hold that it is by the power of the Acts. 3520. I think you will admit that there is no power whatever of putting, down a brothel under the Act of Parliament? — Yes, the power neces- sarily follows. 3527. You said that you put men to watch the places, and so on ; that I presume would come under your powers, because you can watch a whole town if you like anywhere you please for this purpose ; but there is no such power as the power of j)utting down brothels in the Con- tagious Diseases Acts ; you have to proceed in other ways? — The Acts were passed to prevent the spread of venereal diseases, and all these things follow in their train. Mr. Osborne Morgan. 3528. You are bound, under the 15th section of the Act, to ascertain that a woman is a common prostitute before you bring her before the ma- gistrates ? — That is so. 3529. And in order to ascertain that she is a common prostitute you are bound to take the steps necessary to ascertain that ? — Yes. Mr. William Fowhr. 3530. Your action against the brothels is an action arising out of a law apart from these Acts ; but the information that you obtain through these Acts, enables you to lake that action ? — Yes ; I have a case before me, one of many. A man who was a brothel-keeper in Stonehouse, a pensioner from the Royal Navy, Mr. William Fowler — continued, persisted in kicking the police out, and carrying on a brothel. He gave me a great deal of trouble, but under the Contagious Diseases Acts his brothel was closed. 3531. How? — I waited my time ; found that he had harboured a diseased prostitute ; brought him before the magistrates, when he was con- victed, and his license as a beerhouse keeper was taken away, and his pension stopped. 3532. He was stopped by the Licensing Act, but not by the Contagious Diseases Act, although you got the information through the Contagious Diseases Act? — He was convicted for harbour- ing a diseased prostitute in his house, under the Contagious Diseases Acts. 3533. But that would not have closed his house of itself, unless you went to the magis- trates under the Licensing Act, so that it is the old police law which is brought to bear upon the brothels? — Yes, in letter; but in fact by the Contagious Diseases Acts. 3534. Is it not an offence against the law alto- gether for a beerhouse keeper to have a brothel ? —Yes. 3535. How many of these brothels are beer- houses ? — We have none. The local police did their very utmost to convict this man. They tried to shut him up for years, but failed, and it was left to me to do, and after a long time done. 3536. How did you get your information in that case? — I had information from many sources, but got direct information from a man in the hos- pital with syphilis. He said that a certain woman had been the cause of it, and that he had slept in this house, and he gave the names of other men that slept there also. Some of our friends, who were opposing us at that time, thought to beat us, and sent this woman away. However, I found out where she was, and brought her back, sent her to the hospital, and convicted this man. We had cautioned him for years, but he would persist in carrying on his trade in defiance . Mr. Stansfeld. 3537. You have handed in your returns, one of which is a return showing the number of cases of disease admitted into the lock wards of the Royal Albert Hospital and discharged there- from. I do not know whether any question was put to you upon this return, or with what object you put it in? — I brought it with me amongst a large number of returns, in order to show that a certain number of these women, after being discharged as cured, had really given up their old practices, 3538. There are certain columns here : first of all there is a column of the number of cases ad- mitted to the lock wards of the Albert Hospital ; then we have the number of those who returned to prostitution ; and then the number of those who did not return to prostitution after their dis- charge ; now, how do you ascertain the fact that this number of women did not return to prostitu- tion after their discharge ? — 1 have a register, and every woman, as she is admitted to the hospital, is entered, and as she is dischar2;ed therefrom, she is again entered, as being discharged, and there are columns in the register to show that. If she returns to prostitution, she is brought back asrain SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 175 30 Mmj 1881.] Inspector Anniss. [ Continued. Mr. Stamfeld — continued, again for examination, and if not her name is removed. 3539. Then all that this column means is, that she did not return to prostitution in your dis- trict ? — That she discontinues jjrostitution. 3540. I find that the total cases admitted to the lock wards in a certain time were 10,691, and of those, 10,529 left the hospital free from disease and returned to the practice of prostitu- tion in your three towns ? 3541. And only 1,486 did not return to the practice of prostitution within this time ? — Yes ; I think that is a goodly number. 3542. Have the goodness not to express opinions, but to state facts ; the number of cases admitted is 10,691, and those who returned to prostitution are 10,529 ; what is the difference between the two numbers? — One hundred and si.\ty-two. But here there is an error. 3543. Then I find from your first column that there were 10,691 cases admitted, and of those, 10,529 returned to the practice of prostitution in Devonport, leaving a balance of 162 ; nevertheless you make out that 1,486 did not return to the practice of prostitution in your towns ; can you reconcile those figures ? — They are right, I know. 3544. They cannot be right ; you had better look at these figures? — {After looking at the figures) 1,486 ; I think the number is right. 3545. The women discharged as free from dis- ease, and who did not return to prostitution after their discharge, you now make 1,459 instead of 1,486 ?-The number is 1,486. 3546. I will take that number, 1,459, and I must repeat my questions to you ; the number of cases admitted were 10,691 ? — Yes. 3547. The number of women who were dis- charged free from disease, and who, to your knowledge, returned to prostitution in Devon- port was 10,529 ; the difference between those is 162, is it not ? — The number of cases in which women are found to have returned to prostitution is 9,151. 3548. You have only a balance of 162 left ; how do you make out the 1,459 ? — It is evident that there is an error. I quite see that you are right and the numbers wrong. I know that the number 1,486 is right. 3549. I will leave you to correct that by-and- bye, but subject to your correction of those figures, where there is a clear inaccuracy, I want to put to you another question ; all that you know of those 1,459 women is that they did not return to the practice of prostitution in Devon- port? — No, that is not all. A very large num- ber of them, at least moi-e than 90 per cent., would be known to be sent to homes direct from the hospital or to their friends. 3550. They may be sent to homes, but they do not stay indefinitely in those homes ? — No. 3551. Are you able to speak as to all the future history of every prostitute who passes through the Albert Hospital? — No. 3552. And you cannot undertake to say what happens to her after she leaves the Albert Hospital ? — Not in raany cases. 3553. You have a column in these returns containing the number of those who go to their friends ; what do you mean by going to their 0.44. Mr. Stansfeld — continued, friends? — I mean those who return to their hus- bands or fa;thers, or other friends. 3554. But many of them have friends ? — I am sorry to say a large number have not. 3555. I am afraid that they have friends who are not good friends, but I take it that all that " returning to their friends " means is, that thay have not come again on your register, but that they have gone back again to their belongings, good, bad, or indifferent? — It is not so. It is those that we know have given up prostitution. 3556. "Will yen undertake to say that those women who are in the column headed " Keturned to Friends," have given up prostitution ? — Yes. 3557. What is your evidence in those cases ? — I should know them one by one. 3558. You would know them if they returned to prostitution in Devonport, but not else- where ? — Such a woman would be shown as " Left the District." 3559. Then I understand that under the head- ing " Eeturned to Friends," are included only those women who return to their friends within the district, and therefore whose future conduct you know? — Yes, and those sent to friends else- where. 3560. That would explain the meaning of that column; but under the column headed "Left the District," you put the names of those who disappear from your sight ? — Yes. 3561. And what becomes of them in the future you do not know ? — "We do, in many cases ; but still, having left the district, and being off the register, we leave them. In many cases we find that they have returned to their friends after- wards. 3562. But you do not undertake to watch the future career of those women whom you enter as having left the district ? — Clearly not. 3563. In this case you undertake to say that 1,459 of these women did not return to prostitu- tion after their discharge ? — One thousand four hundred and eighty-six is the number, I find from my register, who were not brought back again for registration after leaving the hospital. 3564. But you have just told me that if they left the district you do not undertake to follow them ? — That is so, but I show those who have entered homes, or have been restored to their friends. 3565. You have just said that, under the column " Eestored to their Friends," you enter only those who are restored to their friends within your district ? — No, that would not fol- low. , If we send a girl into North Devon, Penzance, Liverpool, Torquay, or Exeter, as we do very many, we show them as " Restored to Friends." 3566. Would they be included in this return of women who did not return to prostitution ? —Yes. 3567. How do you know that, after leaving these homes at a distance from Devonport, they did not return to prostitution? — It is known if they come back. 3568. And yet you insert them under a column with this heading, " Free from Disease, and did not return to Prostitution after their Discharge "? —Yes. 3569. Therefore you insert under that heading T 4 the 176 MINUTES OF EVIDENCE TAKEN BEFORE THE 30 Mai/ 1881.] Inspector Anniss. J_ Continued. Mr. Stansfdd — continued, the names of women of whose future you know nothing? — It is a woman who does not return to prostitution, and therefore her name is removed from my register as a prostitute. 3570. You have just admitted to me that this column contains the names of women who have left Devonport, and you assume that they have not returned to prostitution? — I would not assume anything. They have not returned to prostitution in the district, and further, they have been sent to their friends. 3571. That was my first Interpretation, and you objected to that interpretation ; am I to understand you therefore as meaning this : that this is the number of women who having been discharged as free from disease did not return to prostitution after their discharge within your district ? — They are known at the time to have ceased prostitution. 3572. Then we must alter the heading of that column, and make it that they did not return after their discharge to prostitution within the district ?— Yes, and were not known to have returned to prostitution. Mr. Colbold. 3573. Would you consider those as reclaimed? — If we send a girl into a home, or to her friends at a distance, we lose sight of her. Mr. Stansfeld. 3574. With that limitation we get the number of 1,459 out of 10,691, of whom we will say the greater portion have not returned to prostitu- tion within your district? — Yes, 1,486. 3575. So that you get a proportion, of say, 12 per cent. ? — I would like it to be understood that one column shows cases, and the other women. We are dealing with sending cases to hospital. One woman may be there a great number of times, so that you have the number of cases to hospital. The number of women are very much smaller. Mr. Oshorne Morgan. 3576. Am I right in saying that the 10,691 represents the number of cases, and the 1,486 represents individuals 1- — That is quite so. M]-. Stansfeld. 3577. I now understand that these columns which are in juxta-position, you have not been comparing like with like ; in the first two columns you have the number of cases, and in the last column you have the number of indi- viduals ? — Yes, one shows individual women, and the other cases. 3578. Therefore when we find such proportions between the number free from disease who re- turned to prostitution, and those free from disease who did not return to prostitution, that is not a fair comparison that you are giving us ? — No ; one is cases of disease and the other is women. 3579. But that makes the return very unintel- ligible, and of very little value to this Com- mittee ? — I should be very glad to correct it in any way the Committee would wish. 3580. Can you give me, even roughly, an idea of the number of women represented by the total Mr. Stansfeld — continued, of 10,691 cases ? — Yes, I can, by referring to my register. This register is to the 25th of Febru- ary of the present year, and shows that the number of individual women we have dealt with is 5,338. That is the number of individual women who have been brought under the Acts. 3581. Between what dates? — From the 1st of April 1865 to the 25th of February of the present year. 3582. That is practically the period of your return ? — Yes, 3583. Your total is 5,338 ?— Yes; and I think about one-third of those women were never in. hospital, so that you would have to strike out about one-third of that number, 5,338. A good many of those women during the last five or six years, I am very glad to say, have never gone into hospital at all. 3584. Are those women who you say never go into the hospital merely on the register ? — Yes. 3585. They are not women who have been on the register many years? — Some of them are, but others may have only just been brought on the register. 3586. Therefore the women who come in from unprotected districts on the register now in very increasing proportions, do not go to the hospital at all ? — That is not so. My return which I put in just now, shows that a large per-centage of those in our own district are not diseased, while those from outside the district are. 3587. Are those .women, who you are happy to say do not want the hospital at all, women who have been a long time upon the register, or women who have recently come upon the register ? — Women who have been on the register for va- rious periods, but not in the hospital at all. 3588. Therefore what I understand from you is this, that within recent years you have an in- creasing number of women coming in from out- side, and being for the first time on the books, who never require the use of the hospital at all ? — That is not so. I did not say that. I .=aid that 77 per cent, of the women who come into the district are diseased, and therefore there are 23 per cent, who are not diseased, and who would not go into the hospital on their first examina- tion. I think the per-centage in the district would be 26 diseased, and 74 not diseased. That is on the first examination. 3589. Will you tell me what is the meaning of the statement that you made a short time ago, that you were very happy to say that of late years a great many women come in who do not want to go into the hospital ?^ — I did not say " come in ; " you misunderstood me. I said that I was very glad to say that a large number of the women coming on the register now, and for some years past, have not to go into the hospital at all ; they are not diseased. What I mean is, that they are removed from the register before they are diseased at all ; but they are women of the district as a rule. 3590. Do you mean that they are not diseased when they are first put upon the register, or that they never require to go into hospital during their practice of prostitution? — They are not diseased when they are first placed on the register, neither are they aifected with disease after- wards. 3591. Where SELECT COMMITTEE ON CONTAGIOUS DISEASES ACTS. 177 30 Marj 1881.] Inspector Anniss. \_CoHtinued. Mr. Stansfeld — continued. .3591. Where do those women come from ? — Xearly all would be from the district. 3592. Your answer is that those come from the district ? — Yes, that is so. 3593. And you say that that reduces the num- ber of cases admitted to the lock wards, from 5.338, to what? — I should think that the number of individual women who have gone into hospital would be about 3,000, speaking from memory. 3594. Three thousand out of 5,338 ?—Yes, about. 3595. Do you mean that in this period 2,000 out of 5,338 have practised prostitution, and have never been in the hospital at all? — I should think neai'ly that number. 3596. For what length of time would they practise prostitution ? — Many of them would be only examined once. 3597. You say that you would reduce the figure of 5,338 to 3,000, because you say that out of 5,338 women, you believe that from 1865 to 1881 not above 3,000 passed through the hos- pital? — That would be about tlie number. 3598. And of those 2,000 that did not pass through the hospital, how many jjractised pros- titution for a short time, and then left ? — -A large number of them would discontinue their immoral practices after being examined once, 3599. What proportion ? — I should think that of those not iu hospital 60 per cent, would be off the books after the first or second exami- nation. 3600. Take the other 40 per cent. ; how long would they practice their profession in your dis- trict? — Various periods. I will get you the number. T should think we have about 20 now Avho have been on the books for the last six or seven years, perhaps, and who have never been in the hospital at all. 3601. That is 20 out of 400 odd ?— I think we should find quite that number, 3602. You have expressed very strong opi- nions as to the effects of reclamation ; and 1 do not know whether you have stated it to-day, but on a former occasion you expressed the opinion that 90 per cent, of those who are re- moved from the register are reclaimed ? — Yes, and I have worked that out, and find that my figures would come pretty well the same from that time to the present. I find that about 10 per cent, of those women removed from the re- gister returned to prostitution ; Avhat we call re- registered cases ; it is less than 10 per cent. 3603. Then I take it that you mean that i3ro- portion of 90 per cent are those who disappear entirely from the register ? — Yes, those who were not brought back again a second time. 3604. Within your knowledge? — Yes; they must be within my knowledge if they came back. 360t. And of those you think 90 per cent, are reclaimed ? — Yes, they do not come back for re- registration. 3606. You are aware that that opinion has been controverted ? — I know it was disputed. 3607. It is your opinion '.' — Xo, it is not an opinion ; my books show it ; it is not a matter of opinion. Every woman that comes back again is entered as a re-registered woman. 3608. But I must again remind you that your 0.44. Mr. !Stansfeld — continued, experience is confined to Devonport ? — I am speaking of Devonport entirely. 3609. Therefore, when you say that 90 per cent, of those who leave your register altogether are reclaimed, it means that they do not'come upon your register again? — Yes, that is quite so. I have a return showing the number of women examined once, and those who were only- examined twice whilst on the register. It is very rough, but I shall be very pleased to hand it to you {handing a return to the Riis^ht honour- able Member'). 3610. Here is another return of yours showing the result of the first medical examination of common women who came from an unprotected district ; ^vhere do they come to ; to Devonport? — The Devonport district is included ; but that return is for all the district. 3611. This return shows the result of the first medical examination of the common women who came from unprotected districts to a protected district ?— Yes. 3612. As compared with those who came from districts under the Acts, and who were registered and re-registered during the 3'ear 1880? — Yes. 3613. What is the distinction between those registered and those re-registered? — Those re- registered are the cases that you were just speak- ing of, of women returning to prostitution. For instance, 100 women leave the Eoyal Albert Hospital, and discontinue their immoral j^ractices; 10 of that number return to prostitution, and are then called re- registered women. 3614. But this is a return of the first examina- tion of the women coming into one district from another? — From , unprotected places. In our district, would be the two counties of Devon and (.'ornwall. We get a case once and again from Bristol ; but, as a rule, they are from the two counties of Devon and Cornwall. 3615. But I do not see the meaning of the woi-d " re-registered," because above the column I only find " registered " ; what is the difference between those registered and those re-registered? — One is a woman who has been on the register before, and is called a re-registercd woman; the other is one registered for the first time. 3616. Supposing that she comes from a pro- tected district? — Then she would be included in that return as registered or re-registered, and if she came from an unprotected district, the same. If a woman from Exeter is found dis- eased, and on her discharge from hospital is sent to the Bovey Home, and she came back again diseased, I should enter her as " a re-regis- tered woman," supposing her name to have been removed from the register. 3617. We are dealing with this return of women who come from unprotected to protected districts ; how can they have been registered in the unprotected districts ? — No ; a woman comes in from Exeter and is put on the register as '' Jane Jones," from an unprotected district. 3618. But under what circumstances would you call Jane Jones a registered woman ? — On her being placed on the register. 3619. If I understand you rightly, the num- ber in this return represents not only the women coming in from the unprotected districts, and who are registered, but those who, after they are Z protected 178 MINUTES OF EVIDENCE TAKEN BEFORE THE ZO May 1881.] Inspector Anniss. [ Continued, Mr, 5'ifa?2«feZ£^— continued, protected in your district, are re-registered ? — If a woman came into Plymoutli and was regis- tered, and remained in the district but ceased prostitution, and was removed from the register, but after a time relapsed into prostitution, she would be shown as belonging to the district on being re-registered ; but if she went to Exeter, got diseased, as very many do, and came bacli again, I should show her as coming from an unprotected district. Mr. Oshornc Morgan. 3620. The test whether she was re-registered would be whether she had been registered in your particular district before ? — Yes. Mr. Stansfeld. 3621. This is a return of the women who are registered and re-registered within certain dis- tricts, but if they are re-registered in protected districts, then those cases of disease arise in the protected districts? — It matters not whether a woman is diseased or not ; if she came in from outside the district, she is shown in that column. If she is of the district, she is shown in the column provided for that purpose. 3622. Those figures are not the figures of women coming into a protected from an un- protected district, but they are the figures of women registered and unregistered ; when they are registered the first time, it is to be assumed that they import the disease ?— If they are diseased they do so. 3623. But if they are registered they do not Import the disease? — Yes, I have just given you an instance. If a woman on discharge from hospital goes to Torquay, as they do, and gets diseased and has to come back again, of course she imports that disease a second time. If she comes back free, she is entered as free. 3624. I will put to you a case which will express my meaning ; a woman comes from Torquay into Devonport, and when she comes in she is registered and found to be free from disease ; she leaves the district and gets off the register, and for one reason or another (it may be that she says she is going home to her friends) I suppose that she does not leave the district; she is re-registered ; she cannot be re-registered without having been first on the register, and then off? — She has been off, and therefore is re- registered . 3625. Then she comes in from an unprotected district and she gets on the register, and then she gets off and you re-register her, and you debit her against an unprotected district? — You have quoted the first as being from outside. "What would you do in the second case ? 3626. I do not know where she has been in the meantime; do you? — I thought you were suggesting that. 3627. AH that I say is, that I understand that she has been off the register, and I understand that this return includes the names and numbers of women jjut on the register in a protected dis- trict, having originally come from an unpro- tected district, having ceased to be on the recister, and then having come on it again ? — If a woman has come into Plymouth diseased. Mr. Stansfeld — continued, she is shown as coming inio the district diseased. Then, in two or three months, she is removed from the register, having left the disti'ict or gone to her friends. She comes back again to the district three months hence, and is re-regis- tered and re-numbered. If she is then free, she would appear in two places ; in the first column as diseased free, in the second as free. 3628. Therefore, she would appear twice? — She would appear twice, if she is re-registered. 3629. Therefore these, in fact, are numbers of cases, rather than of individual women? — These are the women registered and re-regis- tered. 3630. I do not find at the head of any of the columns the word " registered " ? — It is under- stood. 3631. You have also given us a return show- ing the number of paupers treated for venereal disease for certain years, from 1862 to 1879, in- clusive ; from whom did you get this return ? — From the medical man of each workhouse. 3632. From the poor law medical officers ? — Yes. 3633. Does that include out-patients, or only in-patients ? — It is entirely in-patients ; I do not think that they have any out-patients for venereal disease. 3634. But you do not know that they have not? — I think I should know if they had ; I never heard of any. 3635. I think you had better not say so, I am rather familiar with Poor Law administra- tion ; will you undertake to say of your own knowledge, that they have no out-venereal patients? — JNly answer is, I do not know of any. 3636. In these cases, let us look at the totals ; we will take the three years, from 1862 to 1864, in which there is a total of 82"6, and in the years 1865, 1866, 1867, before you come to the Acts, you have 273, and then you begin with 167 im- mediately in 1868 ; the largest reduction takes place before the Acts, does it not ? — No, that is not so. 3637. We found a little mistake, you know, in your figures before ? — Yes, and I shall be very glad to correct it ; the return we are now on goes back three years before the Act was put into operation. 3638. When were the present Acts put into operation at Devonport? — On the 1st of April 1865. 3639. The present Acts were only enacted in 1856 ?— There was the Act of 1864. 3640. We are dealing with the Act of 1866, was there any register under the Act of 1864? — Yes. 3641. Was there any register under the Act of 1864? — Yes, there was a compulsory register. 3642. Was that a register of all prostitutes? — No, only of those dealt with as diseased. 3643. The present register is a register of all prostitutes under the Act of 1866, and that re- gister was only set up in Devonport in 1868 ? — That is not so ; this register contains the name of every woman that was placed on the register in 1865. 3644. The earliest Act at present in force is the Act of 1866?— Yes, the Act of 1864 was repealed by that Act. 3645. The SELECT COMMITTEK ON CONTASIOUS DISEASES ACTS. 179 30 May 1881.] Inspector Anniss. \_Coutinued. Mr. Stansfeld — continued. 3645.' The Act of 1864 was a Tcry different Act, was it not?— Yes, it was. 3646. The earliest Act is the Act of 1866, and it is under the Act of 1866, is it not, that you have the power of registry, and of compulsory periodical examination ? — Yes. 3647. The register was set up in Devonport in 1866, you told us that ? — I do not think I told you that; we commenced on the 1st of April 1865; got into our work gradually from 1865 to 1867 or 1868. 3648. When did you set up your register ? — My register commenced on the 1st of April 1865. Mr. Osborne Morgan. 3649. The Acts came into operation on the last day of December 1867, did they not? — No, the Act of 1866 came into operation on the 1st of October 1866. Mr. Stansfeld. 3650. The register was practically established in Devonport in 1868 ; if you dispute that we will establish it otherwise ? — I do dispute it. As far as the accommodation admitted, our register was in full force from the 1st of April 1S65. 3651. You only brought the register partially and gradually into operation, because you could not use the register for the purpose of sending the women into hospital? — Because we had not sufficient room there. 3652. I find a return of Captain Harris's which was presented to the Royal Commission, under which he gives a list of the districts, and the date at which operations commenced, and the date at which the register was first taken into use ; aud I find that in Devonport the register was first taken into use in January 1869 ; do you contradict that statement of Captain Harris's ? — They are both correct; Captain Harris is quite correct, and so am I. 3653. Captain Harris tells us that the register was first taken into use on the 1st of January 1869, in Devonport? — That is the register of periodical medical examinations. 3654. Do not be in a hurry in contradicting me ; there is only one register, is there ? — Yes, 1 have two with me. 3655. The register is a register of the names of all the women liable to examination ; it is not a register of the actual examinations? — It is both. 3656. What is this register to which Captain Harris refers ? — ^That is when the periodical medical examinations were first commenced, viz., in 1869. 3657. My question is, what is this register to which he refers ? — That is a register of all common women who were to be examined from that time, periodically, once a fortnight. 3658. It is a register of all persons found to be common prostitutes, and therefore liable under the Act of 1866 to examination and to treatment? — Yes, that is so. 3659. And that register was first taken into use at Devonport in January 1869? — Yes; that was simply a new register, and from that date 0.44. Mr. Stansfeld — continued. periodical examinations were carried out once a fortnight. 3660. But in this return of yours I find that by 1870 we were dropping down from a total of 167 of these pauper venereal patients to 46, and that there has been no reduction at all since 1871 ; the first three years you had 46, and then you had 49, and then 43, which is practically no reduction at all. The great reduction is from 826 in 1862-63-64 to 273 in 1865-66-67 ; that is during the period before you had a system of compulsory examination and a register ; can you deny that? — No; but I maintain notwithstanding that, the reduction is entu-ely due to the Con- , tagious Diseases Acts. 3661. But you cannot deny what I say ? — No ; all I say is, that the reduction is entirely due to the Contagious Diseases Acts operations. 3662. You say that this is entirely due to the Contagious Diseases Act; it is naturally so in one respect, because I take it that the Poor Law authorities are not anxious to have this class of patients ? — No, certainly not, 3663. And when in a particular district or locality provision is made, paid for out of the taxes of the State instead of out of the rates of the locality, for the care of those patients, tlie local authorities prefer that they should go to those places which are supported by the taxes ? — Yes. 3664. That would be the way in which you would say that the Contagious Diseases Acts account for that diminution ? — No, you will see that there are a large number of males, and no males are treated in the lock wards of our hos- pital ; it will show, I think, clearly the state of disease in the district. 3665. Taking this district of Devonport, Stone- house, and Plymouth, and 10 miles round, is that a district entirely coterminous with the Poor Law Union ? — There are other workhouses. For in- stance, we have one at Tor Point and one at Plympton St. Mary, but not much troubled with venereal diseases. 3666. But do those figures refer to an area coterminous with the area of your district? — No, not quite. 3667. Then that is one element of uncer- tainty in the comparison ; you say, taking a dis- trict which does not compare with your district, that you find an immense reduction in the number of pauper venereal patients in the workhouses? — These are the workliouses to be affected. 3668. I point out to you that that reduction occurred in far greater proportion before the provision of lock hospital accommodation ; do you deny that proposition ? — That would not be correct. The women were compulsorily exa- mined, and sent to the hospital in 1865. The Act of 1864 was equally compulsory. 3669. We know j^erfectly well the distinc- tion between the Acts of 1864 and 1856; it is true that the women were taken compulsorily, but they were only taken when they were reasonably suspected of being diseased ; but you do not understand that this Committee is exa- mining into the operation of the existing Acts, and not discussing the Act of 1864 ; before Z 2 . the 180 MINUTES OF EVIDENCE TAKEN BEFORE THE 30 May 1881.] Inspector Anniss. \_Conlinued. Mr. Stansfeld — continued, the existing Acts I find that the number of pauper venereal patients in those workhouses di-opped from 147 to 47, and since then it has dropped fr