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XX

The subject of still-births is referred to in this report because of the well-known fact that a considerable
percentage of still-births is due to syphilis. The percentage is put at 25 per cent. by some
authorities, and in the case of illegitimate births, at double that figure. Comparatively little attention
has been paid in London to the importance of still-births in relation to syphilis, but, having regard to
the truly remarkable results which have been achieved by the treatment of the pregnant syphilitic
mother, the time has surely come for much greater activity in this direction.
The Metropolitan Asylums Board and the Guardians of the City of London have carried on at
Thavies Inn, since September, 1917, a hospital, equipped with 20 beds, for the treatment, as in-patients,
of pregnant women suffering from venereal disease. All the patients come from various Metropolitan
Poor Law authorities. Similar facilities are provided on a small scale under the Council's scheme at
the Lock Hospital; the Royal Free Hospital and Hostel; Highbury Quadrant Hostel; and the hostel
at 93, Grove Lane. Further accommodation of a similar character is needed, but the most urgent
development should be in the direction of linking up the work of the maternity and child welfare centres,
and the practices of midwives with the venereal disease clinics. There can be no doubt that many
cases of still-birth take place where no attempt is made to ascertain whether syphilis is present. For
this purpose the examination of the placenta (after-birth) and placental blood is one of the most valuable
steps which can be taken, but without the co-operation of the midwife it is certain that this will be
almost impossible. On the other hand, the co-operation of the midwife having been secured, it would
become a comparatively easy matter, not only to conduct this examination in all suspicious cases, but
also to secure the attendance of the mother at the clinic for treatment, if necessary.
The Council, through the Education Committee, has for some years past periodically provided
courses of instruction for practising midwives. As a rule, venereal disease forms the subject of at least
one of these lectures, and we are of opinion, that by the medium of these courses of instruction, and
the great influence wielded amongst practising midwives by the Council's inspectors of midwives, it
would be possible to secure the examination of many of the suspicious specimens at the laboratories
of the venereal disease clinics, and we recommend that steps should be taken as soon as possible for
this purpose, and for the securing, through the agency of midwives, the attendance of infected mothers
for treatment.
V.
Poor Law Infirmaries.
Boards of guardians are entitled upon application to the Ministry of Health to obtain, under
certain conditions, approval of their infirmaries as "treatment centres" under the Venereal Diseases
Regulations, 1916. In London seven such infirmaries have been approved, with a total bed accommodation
for this purpose of over 200 beds. Several of these infirmaries have been visited and conferences
have been held with their medical superintendents with regard to the class of patients dealt with, the
methods of treatment, etc., etc. Hiving regard, however, to the fact that such institutions do not
come within the purview of the scheme, it was decided to make no observation thereon, but merely to
place on record an appreciation of the courtesy of the medical superintendents in allowing their wards
to be visited in order that some idea might be gained of the work carried on therein.
VI.
Publicity.
In the circular by the medical officer of the late Local Government Board, which accompanied
the Board's regulations, dated 12th July, 1916, the local authorities for carrying out these regulations
were charged with the duty of:—
(а) Informing all practitioners, within the administrative area, as to the facilities provided
for laboratory diagnosis, for consultations respecting patients and treatment of patients at
the clinics, and as to the method of utilising these facilities;
(b) Making arrangements for informing midwives, the police, poor law authorities, prison
doctors and chaplains, probation officers, clergymen, rescue workers, and all voluntary agencies
concerned in the diminution of venereal diseases of the arrangements at the clinics with a
view to securing co-operation in encouraging the attendance of patients.
The Local Government Board circular also stated that any Council may make provision for
giving instructional lectures and for the publication of information on questions of venereal diseases
as the Council may think necessary or desirable.