The excessive consumption of alcohol was an important factor leading to the rise in venereal disease. The Contagious Diseases Ordinance of 1870 required prostitutes to go for compulsory examinations by a visiting surgeon. Those diagnosed with gonorrhoea and syphilis would be sent to the hospital for medical treatment. The karayuki-san were some of the first to recognise the need for protection against such diseases and came forward voluntarily for regular medical examinations.