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far superior to the cursory examination, with haphazardly chosen treatment, which the staff is compelled
to adopt when the clinic is open during restricted hours, and is " crowded out" with patients
who must be " got through somehow."
(6) The rooms of the average out-patient department are not arranged conveniently for the work
of a venereal disease clinic. The nature of venereal disease makes it necessary to examine in privacy,
otherwise the patient is discouraged from attending. The preparation for the private examination
takes time, and must be done in private, so that the patient must be put into a separate room or cubicle.
Sometimes the examination is only a short one, but must still be made privately and the disrobing and
robing which precede and follow it take practically as long as for the complete examination. To work
quickly it is necessary that the medical officer should have at his disposal a number of rooms or cubicles
into which he can put patients, who can then prepare for the examination in their own time. If
sufficient of these rooms or cubicles in which patients can be examined and treated are not available,
the medical officer has, perforce, either to wait whilst some of the patients prepare, or has to let the
examination of a number go by whilst one patient, or perhaps two, are getting ready. Usually, the
result is a compromise, and, whilst one patient prepares in a special room, a dozen are put off with a
repeated prescription until some future date. It may be asked why patients receiving free treatment
should be humoured in regard to privacy of examination. Why should they not subordinate their
ideas of modesty to the convenience of the clinic and expose themselves regardless of the presence of
a number of other patients looking over a screen ? The answer is that they may submit to this exposure
so long as their discomfort or fear of consequences impels them, but as soon as their symptoms have
disappeared (and that is long before they have become non-infective) they begin to weigh up the discomfort
of attendance against what is to them the slight need of attendance, and the result is that they
discontinue long before they have been rendered non-infective. The case is totally different from that
of the ordinary out-patient, since, in the latter, if the physician or surgeon has achieved some measure
of relief he has accomplished some good, and it is the patient's look-out if he does not choose to attend
again. In the case of the venereal out-patient, no good whatever has been attained until the patient
has been rendered non-infective, and it is not merely a matter of individual, but of national importance
if the patient chooses to cease attendance, consequently reasonable privacy must be secured and this,
owing to the large number of patients, in such a manner as will not waste one moment of the medical
officer's time. In most of the clinics inspected there are one, or perhaps two, private rooms for special
examination, and the general interviewing takes place in a larger, common room. Usually one medical
officer interviews and a second conducts special examinations. If there is only one medical officer, he
interrupts his routine " running through " the patients from time to time to conduct a special examination.
In this case, either one of the attendant staff is kept waiting about doing nothing in particular,
or the attendant in the common room has to " switch off " to a different train of duties. If there is
another medical officer, he and his attendant are kept waiting whilst the patient prepares for examination.
In either case considerable time is wasted. If privacy is sacrificed, something approaching the
state of affairs discovered in one hospital results. Here, in a single room, some patients were waiting,
others were having instruments passed, others undergoing prostatic massage, and still others were
irrigating, all within view of one another. Truly efficient from the point of view of time-saving, but
truly discouraging to any but the most callous patient. In some hospitals the medical officer has to
walk a considerable distance to another room in which to conduct any special examination he wishes
to make; not a great matter, perhaps, if the patients were few in number, but they are usually more
than the staff could efficiently attend under the best circumstances. In connection with the arrangements
resulting from the sharing of the ordinary out-patient department by the venereal disease clinic
mention must be made of the indifferent irrigation arrangements which usually result. These are of
a temporary nature, since all traces of the apparatus must be removed after each session. Time is
wasted in setting up and dismantling the apparatus, and they are never arranged in such a manner that
the orderly can serve them quickly and efficiently. In other cases the apparatus is hidden away in an
isolated room or a basement, far from the view of the medical officer, and not only is there no skilled
supervision, but either an attendant has to be employed whole-time in the supervision of one or two
irrigators, a great waste of man-power, or he has to attend to the irrigation when his other duties will
allow him, with the result that patients have to wait long periods before being attended to. It is unlikely
that patients will continue attendance for long under such conditions.
Most of the adverse circumstances which have been commented upon above are undoubtedly associated
with the difficulties arising out of the considerable capital expenditure which would be involved
in the provision of properly designed premises. In these circumstances, it is unfortunate that no
arrangements have been made for the provision of capital grants in the case of venereal disease schemes.
In consequence of these difficulties the internal arrangements of most of the London clinics make for
inefficiency or waste of man-power or both. Assuming that maximum efficiency is the goal, and
there may be no other under the public health venereal disease scheme, more men are required
for the conduct of the average London clinic than would be necessary if the premises were
designed for the special needs of venereal disease work. It is hardly necessary to remark that the
capitalised value of the salary of a single male attendant would go far towards the provision
of entirely new and up-to-date premises. In a number of hospitals it is not possible to provide
new premises because no space is available, but in others this does not hold, and it would
probably be a more economical plan to erect new premises specially designed for venereal
disease work wherever possible, encouraging the growth of venereal disease clinics here, and even
to close down some which, conformably with the ideal of efficient treatment, cannot be run
economically. In the case of one clinic—St. Thomas's Hospital—completely new premises have been
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