View report page

iii
ments which should be made, and as to the method by which the expenditure should be shared between
them. Stress was also laid on the necessity for securing in any scheme the co-operation of general
practitioners, and for affording facilities to enable practitioners to participate in the work of the
hospitals.
The Local Government Board thought that, though there should be no refusal of treatment to
any patients at the hospitals, medical officers of such institutions might properly suggest to patients
who could obtain satisfactory treatment from their own doctors, and could afford to pay, that they
should do so. Lastly, conditions were laid down under which Salvarsan, or its substitutes, should be
-supplied to medical practitioners, including district medical officers and medical officers of Poor Law
institutions.
It should be carefully noted that at this date (June, 1916) the measures required to be undertaken
were limited to those necessary for securing adequate facilities for diagnosis and treatment.
At an early stage in the deliberations upon the steps to be taken in London, it became evident that
great advantage would accrue if the local authorities adjoining the County of London would co-operate
with the Council in the utilisation of the facilities afforded by the great general and special hospitals
of London. Conferences on the subject were accordingly arranged between representatives of the
counties of London, Bucks, Essex, Hertford, Kent, Middlesex, and Surrey, and the county boroughs
of Croydon, and East and West Ham. The final conferences which were held at the Local Government
Board had the additional advantages of the advice and assistance of the officers of the Board, and,
ultimately, the following decisions, among others, were arrived at:—
(1) That any scheme provided for London would be utilised by many patients from the
surrounding areas, and that it would be equitable for the councils of these areas to contribute
towards the cost of the scheme.
(2) That it was desirable to leave the preliminary negotiations with hospitals in London
to the London County Council and that it should be made clear to the authorities of these
hospitals that the facilities provided would be required for patients not only from London,
but also from the surrounding areas.
(3) That the payments made to hospitals for the first year's working of the scheme should
be divided into three parts for the following services:—(i.) the work of the treatment centre,
including the supply of Salvarsan or approved substitutes for patients treated at the centre
and any pathological examinations of specimens from these patients; (ii.) the pathological
examination of specimens sent to the hospitals by medical practitioners in the areas included
in the scheme ; and (iii.) the supply of Salvarsan or approved substitutes to such practitioners.
(4) That for the purpose of framing estimates and making advance payments to the
hospitals, the sum required for the advance payments should be apportioned between the
councils on some agreed basis, but that at the end of the year the total payments to the hospital
should be apportioned between the councils according to user.
(5) That the Local Government Board should undertake to settle the payments to be
made by the councils according to user.
These principles were approved by all the participating authorities, and negotiations were opened
with the governing bodies of the principal London hospitals on behalf of the local authorities concerned.
All the hospital authorities which were approached expressed their willingness to undertake the
work, and to enter into agreements with the local authorities in the scheme. The services which it was
proposed should be undertaken by the hospitals were :—
(1) The appointment of a committee of the staff to draft a scheme for carrying out the
special work at the hospital for the diagnosis and treatment of venereal disease, and to organise
and superintend these arrangements within the hospital.
(2) The appointment of a competent staff.
(3) The provision of necessary beds for patients.
(4) The treatment of out-patients at evening sessions and other suitable times.
(5) The supply of Salvarsan or its authorised substitutes to medical practitioners on an
approved list to be supplied by the local authorities concerned.
(6) The supply to practitioners of any apparatus necessary for taking samples of blood,
etc., and the furnishing of the necessary reports on such specimens to such practitioners.
(7) The supply of statistical information of work done in the treatment centre and
laboratory.
(8) The provision of free instruction for practitioners and medical students.
(9) Opportunity for practitioners to act as clinical assistants at approved rates of remuneration.
(10) The employment where possible of women doctors in clinics for women patients.
(11) The issue of printed instructions for the guidance of patients and practitioners.
It should be noted that, while no limitation was placed upon the right of the hospital to treat cases
of venereal disease at any stage, the local authorities concerned definitely limited their financial liability
to cases in the early and at all communicable stages. The financial arrangements made with the hospitals
undertaking the work were very simple. It was generally recognised by all parties to the agreement
that, for the first year or two, it would be impossible to forecast with even approximate accuracy the
probable number of patients who would take advantage of the facilities provided, more especially in
those hospitals where no special provision of any kind had hitherto been made for the diagnosis and
treatment of these diseases. Furthermore the Great War was bound tc have all kinds of disturbing
61004 2