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V
(2) Concentration of all medical and pathological work ; distribution of drugs ; teaching,
etc., under one roof.
(3) Limitation of Council's financial aid to cases in the early and communicable stages,
i.e., exclusion of such cases as locomotor ataxia and general paralysis of the insane.
(4) Payment by block grant to the hospitals and by each participating authority according
to user.
(5) Propaganda work distributed between councils of participating authorities and the
National Council for Combating Venereal Disease, according to whether the bodies concerned
are official in character or not.

During the year 1917 the scheme was carried out under very great difficulties. These were
mainly due to the ever-increasing demands made upon the personnel of the medical profession by the
Great War. Notwithstanding, these immense difficulties, however, every hospital carried out its schedule
of advertised clinics; in the course of the twelve months, no fewer than 15,000 new patients attended,
(see Appendix A), and many practitioners availed themselves of the facilities provided in the laboratories
for the free examination of pathological specimens from patients suffering, or suspected to be suffering,
from venereal disease. During the fyear quite a large number of other hospitals and laboratories
expressed their willingness to provide facilities for the diagnosis and treatment of venereal disease,
but after most careful enquiry it was decided to include only three more institutions in the scheme,
viz.: the Metropolitan Hospital; the Hospital for Diseases of the Skin, Blackfriars ; and St. John's
Hospital, Lewisham.
These hospitals were included in the scheme for the year 1918, on the same conditions in all
respects as those which had been at work throughout 1917. Considerable efforts were also made to
provide some special hospital in-patient, as well as out-patient, treatment for pregnant women
suffering from venereal disease, but owing to the acute shortage of both medical and nursing staff at
the lying-in hospitals, the proposal had to be abandoned. On the other hand, the importance of
endeavouring to link up certain sociological factors with the diagnosis and treatment at venereal disease
clinics was recognised for the first time. From time to time attention had been drawn to the fact that
many patients were in attendance, more or less irregularly, at the clinics, who were living under conditions
which either made efficient treatment impossible or rendered the patient liable to convey infection
to another person. Common examples of these were domestic servants, shop girls, waitresses,
cooks, and scullery maids in public restaurants, etc. It was also ascertained that in many instances
women patients, whilst under treatment, were still walking the streets as prostitutes. In some of these
cases there is no doubt that the girls were devoid of any other adequate means of subsistence, and would
gladly have taken advantage of any offer of board and lodging which would have saved them from the
necessity of adopting or continuing a life of prostitution. Numerous other examples could be cited of
women and girls in attendance at venereal disease clinics for whom, for a great variety of reasons, it was
very desirable to make hostel provision for at least part of the time whilst they were under treatment. It
might be asked why they were not taken into the hospitals as in-patients. Such a course could easily
have been adopted under the scheme, but there were many obvious objections. In the first place, the
demand upon hospital beds is always of such an acute character that only cases which could not otherwise
be satisfactorily treated should occupy such beds. Secondly, the occupation of a hospital bed for
several weeks or months by such a patient would be a very unnecessarily expensive method of dealing
with the case. Thirdly, a properly constituted hostel, conducted more or less on the lines of a
residential club for girls, under the control of a wise, sympathetic, and understanding matron, who
would be a mother in the best sense of the word to the girls while under her care, was much more
likely to prove to be a satisfactory method of dealing with the varied types of girls seen at the venereal
disease clinics. Moreover, it was considered that, whilst the girls were in residence in such hostels, they
could undergo a certain amount of necessary treatment daily, their regular attendance at the venereal
diseases clinic could be ensured, and they could usefully be employed in housework, needlework, etc.;
taken out for healthy exercise; and last, but by no means least, moral and spiritual help could be
extended in such a manner as to be of great assistance to them in many ways which need not be entered
into in detail at this juncture.
It may be added that, for obvious reasons, the daily cost of a bed at such a hostel is less than
half that of a hospital bed, and experience has shown that the girls after leaving it as residents,
frequently make such a friend and confidant of the matron that they often visit her afterwards for
advice and help, and come to regard the hostel as a kind of club. Reference should also be made to the
fact that in many instances it has been possible to place a girl when she leaves the hostel, in a good
situation with a respectable and trustworthy environment, and thus to give her another chance of
making good.