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the patient having given a false name or address or both, and although a few of the clinics think that
such letters have been useful, the majority are clearly of opinion that, on the whole, the system of
following-up letters is a failure, and may even have a prejudicial effect on the attendance of the patients.
It would appear, therefore, that the most effective steps which can be taken to reduce the large percentage
of failures to complete treatment are—(a) for the medical officer of the clinic to do
everything he possibly can during his interview with the patient to impress upon him the seriousness of
the disease and the absolute necessity for regular attendance until discharged; (b) to study, as far as
possible, in every way, the convenience of the patients in regard to facilities for attendance by avoiding
overcrowding, long periods of waiting, and inadequate attention during examination and treatment;
and (c) by the use of prominent notices in the waiting rooms; leaflets to the patients, etc., indicating
the serious nature of the venereal disease.
These measures are of particular importance during the period when the patient, his symptoms
and discomfort having abated, has ceased to feel in himself the necessity of regularly attending the clinic.
It is at this time that powerful influences, such as loss of work or pleasure, begin to operate against
regularity. It cannot be repeated too emphatically therefore that the battle for the public health has
not been won until a patient has been rendered non-infective.
The lady almoner and the nursing staff can be of great assistance to the medical officer of the
clinic in securing the regular attendance of women patients.
Attendance at more than one venereal disease clinic.—On several occasions during the last few
years it has been ascertained that a patient may be in attendance at more than one venereal disease clinic.
On one occasion a patient was found in the out-patient department of a venereal disease clinic who was
actually at the same time an in-patient in the venereal disease ward of another hospital. Upon enquiry,
it was found that this patient was allowed out on two afternoons per week, and that he utilised his
time to put in attendances at another clinic. Further enquiry revealed the fact that this was by no
means an uncommon practice among the in-patients of this hospital. The seriousness of such a practice
is not confined merely to the question of whether there are any grounds for complaint, such as were
made by the patient in this case, viz., that "he was not satisfied that he was getting proper treatment."
The obvious danger to be borne in mind is one which arises where Salvarsan substitutes are being used.
In this connection it may also be mentioned that it is a well-known practice for patients suffering
from venereal disease to move about from one clinic to another without completing the course of treatment
at any one clinic. For obvious reasons it is difficult to get hold of these patients in order to
ascertain their reasons. In other cases where we have been able to get any information, the patients
usually give some quite trivial reasons, such as, not liking "the new doctor," or "new nurse," or that
"the injections hurt." The reasons are no doubt trivial in most cases, but there are often others,
referred to elsewhere, such as overcrowding, resulting in long periods of waiting. Whatever the cause,
however, of this practice, the lack of knowledge as to previous treatment is a serious handicap to the
medical officer of the clinic, and may be a misfortune in more ways than one to the patient. It is fully
realised that whatever steps are taken, even the most drastic, there will always be a certain number
of patients who will drift from one clinic to another, and perhaps attend two at the same time, just as
everyone knows of patients amongst their own friends who will do exactly the same thing with their own
private doctors, consulting and general. These facts, however, do not absolve us from doing everything
in our power to warn venereal disease patients of the dangers they are incurring by such practices, and
therefore it is recommended that the walls of the waiting rooms in venereal disease clinics should be well
posted with warning notices in regard to these matters.
Statistical returns.—In very many cases the system of keeping records for statistical purposes
is distinctly bad, and the records unreliable in consequence. The annual return required by the
Ministry of Health contains information mainly as to the turnover of patients, their attendance, and
their final disposal. It is in regard to the last section that the returns are unreliable, since we found
in so many instances that medical officers had not interested themselves at all in the matter. They
had left the decision as to whether a patient had ceased attendance before completion of treatment, or
after satisfaction of tests of cure, to a clerk, who, obviously, could not be competent to judge the question.
In a number of instances it was found that medical officers were totally ignorant of what it was
they were asked to decide upon for the purposes of the annual return, and many have not even troubled
to read, much less understand, its headings. While everyone is desirous not to load up medical officers
with an unnecessary amount of clerical labour, returns are obviously necessary, and they require decisions
as to results of treatment which, if they are to be reliable, must be made by medical officers and not
by clerks. It does not therefore seem to be too much to require that medical officers should periodically
go over the case records and indicate, by some symbol, on each of those relating to patients who have
ceased attendance, under which category the patient should be classed. The rest can be done by a
clerk.
Supply of free Salvarsan substitutes.—Under the regulations made by the late Local Government
Board in 1916, it will be remembered that the councils of the counties and county boroughs in
England and Wales and the Common Council of the City of London, were required to supply medical
practitioners with Salvarsan or its substitutes for the treatment of venereal disease. At a later date
the Board issued further regulations defining the conditions upon which medical practitioners were
entitled to receive Salvarsan or its substitutes from the local authorities. From these regulations it
will be seen that it was necessary for the medical practitioner to be "approved." It will also
be remembered that the Council was fortunate in being able to make arrangements with the hospitals,
where venereal disease clinics were situated, to act on their behalf as distributing agencies for
this purpose. Mention should also be made of the fact that the Medical staff of Poor Law infirmaries