( 4 ) It will be observed that the attendance has not been nearly so good as it was in 1876.
The Medical Officer at Toungoo has failed to give any information on this point for 1877.
Excluding this station, the average attendance in 1876 was 88 . 83 per cent., against 71 per
cent. in 1877, which is a great falling-off. Rangoon and Bassein are chiefly accountable for
this defection. The numbers on the register at Bassein, however, are so small that they do
not effect the general total number. At Rangoon, the falling-off in the number attending
the examination is not accounted for by the Medical Officer ; but the Town Magistrate, I
notice, attributes it to the weekly examination ordered by me in May last. These weekly
examinations were ordered in consequence of the Medical Officer reporting to me that disease
was much more prevalent amongst the women than usual, and this was proved to be the
case by the very large number of women found diseased and admitted into hospital. The
Town Magistrate considers the weekly examination causes discontent and that the oftener
they are held, the greater will be the difficulty in forcing registrations ; but surely it is de--
sirable that a woman should only be allowed to go about spreading disease broadcast for
a week, than a fortnight, even at the risk of causing her some discontent. If her trade
renders her amenable to the law, it is the duty of the Magistrate to enforce that law,
and protect the public. These weekly examinations were discontinued by my orders,
after August, when it was reported to me that the number and severity of the cases had
considerably decreased ; but I shall not hesitate to order them to be resumed if I see
necessity for doing so.
Weekly examinations are held at all the hospitals throughout the year, except at Bas-
sein, Moulmein, and Rangoon ; and it is at these very stations where the attendance is
worst. No complaints are made, at the stations where weekly examinations are held,
of discontent among the prostitutes, or of any inconvenience ; and I am of opinion every
registered prostitute should be examined at least once a week. In all, 2,240 cases were
reported to the Magistrates for non-attendance at the periodical examinations. Of this
number, no less than 2,037 were at Rangoon, according to the Medical Officer's report ; but
he does not shew how many were punished. This officer's figures, however, are not very
reliable as before stated, and it is difficult at times to comprehend his meaning. It will
be observed, he states in paragraph 7 of his report that 758 were found diseased, out of
8,171 examined ; in the next para. he gives the total admissions into hospital at 950.
IX.—The arrangements for examining and treating the women of the city and cantonment.
The arrangements at all the hospitals are satisfactory, and leave little to be desired.
X.—How far disease has increased or decreased among the women ; to what extent it has become less virulent ;
its nature as compared with that among men.
There has been a diminution in the number of women admitted into hospital at every
station except Rangoon, where there was an enormous increase, no less than 950 (that, I
presume, being the correct number, and not 758, as stated in the previous paragraph) being
admitted during the year, against 518 in 1876. The average number of women on the
register was 443, so that every woman was admitted into hospital more than twice in the
year. It is a noticeable fact, too, that of the 950 admissions, 600 were cases of primary
syphilis. The admissions into hospital, however, depend very much on the views held by
different Medical Officers of what is, and what is not, infectious disease, and the care with
which they make their examinations. Some, among whom I notice is the Civil Surgeon
of Akyab, hold that all discharges in a prostitute are not infectious, and that all ulcers on
her genitals need not necessarily cause a syphilitic sore on the male ; others, like Mr.
Foster, of Bassein, hold that any ulceration or discharge in a prostitute may cause disease
in a male ; and it is probable that the present Medical Officer of the Rangoon Lock Hospital
holds similar views, though he does not state so ; but it would account in a great measure
for the large increase of admissions in 1877, especially for the increase in the number of
cases of primary syphilis—at any rate, it will be seen that the admissions into hospitals
depend very much on the views held by Medical Officers, and the care with which they
perform their duty. As four of the Medical Officers have not shewn the extent to which
diseases prevailed in their Civil Dispensaries and Jails, the most important of which is
Rangoon, not much information is to be gleaned from the reports of the remaining four.
There was a considerable increase of disease seen in the Akyab and Prome Dispensaries,
and a diminution at Thayetmyo and Henzada. In the case of Jails, I do not think any
accurate deduction can be drawn, as I presume the Jail population is derived as much, or
more, from rural or from urban districts, and cohabit with women who never come under
the influence of the Lock Hospital at all.
The attendance at a Dispensary, on the other hand, depends so much on the popularity
of the Medical Officer in charge, that it will not do to conclude disease has diminished in
the male population because there are few patients.
I believe, too, that numbers of men who contract syphilis or gonorrhœa prefer the
native method of treatment by mercury, which they understand pretty well ; and that they
only apply at the Dispensary when they fail to cure themselves, and the disease is in its
advanced stages. The deductions to be drawn, therefore, from the number of males appear-
ing in the public hospitals for treatment, are not, I consider, reliable or important.