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A treatment centre which properly fulfils the purpose of the venereal disease scheme should
(a) attract for treatment the maximum number of infected persons within its sphere of influence.
Obviously it would be useless to set up a clinic, however well equipped with treatment appliances, and
however distinguished its staff, if, for some reason, such as the length of time spent in waiting for
treatment, undesirable exposure of the person to which patients were subjected, inconvenience of hours
at which sessions were held, and so forth, the clinic was not popular.
(6) The premises should be so arranged that, conformably with (a) the staff can work with a
minimum waste of time and energy. Thus, if a medical officer has to wait whilst a patient prepares
himself for examination, or has frequently to walk comparatively long distances to carry out his different
functions, it is impossible for him to see as many patients efficiently in a given time as if the premises
were arranged to preclude the necessity of his time and energy being wasted over these manoeuvres.
The arrangements should include provision for intermediate treatment of gonorrhoea in both sexes by
nurses and orderlies. This should be available all hours of the day, in order that patients may not be
deterred from daily attendance by loss of work.
(c) The medical and surgical equipment should be the most convenient possible, and be at once
available where required. This implies that equipment should be grouped in sections (1) for taking of
specimens, (2) for special examination and treatment of gonorrhoea, and (3) for special treatment of
syphilis. A useful plan is to equip separate instrument tables on castors so that they can be moved
quickly from one place to the other as required. The alternative plan of requiring the patient to go to
some special room or cubicle where the equipment is stationed is not so convenient if adhered to alone,
and, in practice, it is better to duplicate the equipment for some purposes, such as the special examination
of gonorrhoea, keeping one set fixed and the other movable.
(d) The staff should be co-ordinated under one head, who should be responsible for the ideal of
treatment carried out by those under him and for the conduct of the clinic generally. He should be
responsible also for assigning to members of the staff their due proportion of work and should see that
this work is of a proper nature. Thus, in a well-organised clinic a medical officer does not perform
duties which can equally well be carried out by a clerk or an orderly, though this does not imply that a
medical officer should never touch a pen, or that he should never irrigate a patient himself. On the
other hand, it does imply that an orderly, however skilled, should not pass urethral instruments.
(e) The hours at which sessions are held should be determined by the convenience of the patients,
since venereal diseases do not necessarily incapacitate from work, and the financial loss incurred by
attendance during work hours is a powerful incentive to discontinuance. Some patients can attend in
the evenings only, and some during the day, so that, during the week, some sessions should ordinarily
be held in the evening and some during the day. The number of hours during which medical officers
attend for the examination and treatment of patients, or the number of medical officers appointed,
should be sufficient to permit of each patient receiving the attention which is adequate to render him
non-infectious in the shortest space of time. It is a self-evident fact, which is, however, frequently
forgotten, that a medical officer could see many hundreds of patients in a comparatively few hours and
thus register a huge total of attendances, but the value of such work to the public health would be nil.
Merely to glance at a large array of patients week after week, with the mere injunction to most of them
to " carry on," is not applying that skill for which the medical officer was appointed. Indeed payment
for such work is a waste of public money. As mentioned under (b), the clinic should be open for intermediate
treatment all day, and until late in the evening.
(/) The conduct of the venereal disease clinic should be governed by the principle that it was
established to render venereal patients permanently non-infectious, and that in every instance where
it fails to accomplish this object, it fails entirely to achieve the purpose for which it was established.
To alleviate symptoms, leaving the patient a carrier of infection, is, indeed, worse than useless to the
general public, since the patient is the sooner enabled to follow those practices which lead to conveyance
of his infection to others.
III.
Facilities for Diagnosis and Treatment in the London Clinics in 1920.
Premises.—With only a very few exceptions, the venereal disease clinics operating under the
London scheme are located in the out-patient departments of the various hospitals. This arrangement
frequently interferes with the efficiency of the clinic for various reasons, the chief of which are that
(a) the premises are available only at certain hours on certain days during the week, and it is impossible
to arrange for intermediate treatment of both sexes to be carried out at all hours. This is an important
defect, since patients frequently cannot attend every day at the hours when the clinic is open, and the
success of treatment depends very largely on its daily application. Further the restriction of the hours
during which the rooms are available leads to congestion of patients during those hours, and not only
is it impossible for the staff to give them the individual attention which is necessary, but patients have
to suffer the discomfort and inconvenience of waiting long periods for treatment. If the rooms were
available all of every day, it would be possible for the staff to arrange for patients requiring lengthy
examination to attend at some time when the clinic was not crowded. Experience in those clinics
where the rooms are available at any hour has shown that, since this detailed examination is not required
very frequently, many patients can be persuaded to attend specially for it. The importance of a
detailed examination of each case of gonorrhoea at regular intervals, with the formulation of a definite
plan of treatment to be carried out for some weeks to come, cannot be over-estimated ; clearly it is