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right of the plan, and the orderly working at the bench in the centre of the clinic supplies solution, nozzle
and, if required, assistance for the irrigation ordered. Each cubicle is fitted with hot and cold water,
so that, for most types of irrigation, the orderly need bring to the cubicle only the concentrated solution
and the nozzle.
It will be seen that the main principles of the clinic are that:—
(i.) The staff works on internal lines and has ready access to every part of the clinic. Thus
anyone standing at the end of the central bench can see the greater part of the clinic, and the
staff is almost entirely within view. Also the distance to be walked by any member of the
staff is comparatively small, and his passage is unimpeded by any door.
(ii.) The patients are examined and treated in reasonable privacy without thereby interfering
with the working of the clinic. This and other advantages are secured by making the
patients use the corridors on the outside and never permitting them to enter the central,
working space. It is easy, also, with this arrangement to give demonstrations to students,
since the patient lies on the counter and most of the class stand in the central space.
It may be added that, although the average male attendances per day are now over 200, the
small waiting room is never more than half full and only approaches that state when patients are
congregating for anti-syphilitic injections. This is because the clinic is open all day, and it is possible
to relieve the normal evening congestion by getting many patients to attend for special examinations
during slack hours.
The female clinic is worked on much the same principles as the male. New patients interview
a lady almoner, who obtains social particulars which are often of great value. Thus girls in distress
may be provided for in the hostel or elsewhere, and often also the lady almoner is able to get the patient
to send husband and children for treatment, so that one case becomes the means of securing for treatment
a number of infected members of the community who might otherwise escape notice. In the
main part of the clinic are five examination cubicles, each fitted with an examination chair and other
appliances on the complete equipment principle observed in the case of the male cubicles. At the
back of each cubicle is a small dressing space screened off by a curtain. The patients enter the cubicles
from the corridor, as in the case of the male clinic, and the cubicles all open on to a working space which
is sacred to the staff on the same principle as in the male clinic. In addition to the rooms mentioned,
are a doctor's room, nurses' room, sterilising room, lavatories and W.C.s.
Experience of the clinic arranged as described above has proved that the principle is correct.
The work proceeds without rush, and patients are not kept waiting unduly long, while time is given for
the individual examination and treatment which are essential to the efficient management of venereal
diseases.
The laboratory attached to the male department makes the clinic a complete unit. It would be
difficult to over-estimate the advantages derived from the proximity of the laboratory, which it must
be remembered, however, is not employed for routine microscopical examinations. These are carried
out in the clinic itself.
Days and hours of clinics.—The total number of clinics in London is 28, and the total number
of sessions (morning, afternoon, and evening) provided at 27 of these clinics is well over 200 per week,
of which more than one-half begin at or after 5 p.m. The remaining clinic, viz., St. Thomas's Hospital,
is open for treatment from 8 a.m. to 10 p.m. daily (except Sundays). If credit be taken for the work
done at this clinic at the rate of say, four sessions daily, the total number of sessions in all the hospitals
included in the London scheme would closely approximate to 250 per week. It is noteworthy that
only 17 of the 27 clinics are open on Saturdays, and only one of the 17 provides an evening session
on this day. There are no clinics available for any form of treatment on Sundays.
The question as to whether the days and hours of the clinics are conveniently arranged for the
various classes of patients, and sufficiently numerous for the demands made upon them at present,
naturally required very careful consideration, and many enquiries were made in a variety of directions
upon this subject. With regard to the provision made for diagnosis and treatment, it would appear
that the facilities available on Saturdays for these purposes are inadequate and that considerable extra
provision should be made on this day as soon as possible. The provision of clinics on Sundays for
diagnosis and treatment of new cases is not advocated at present, but a recommendation is made later
as to the use of the clinics on Sundays, which it is believed will be found to be of great practical value.
There is unquestionably definite evidence that certain of the clinics suffer from overcrowding,
and that the large number of patients in attendance per session must tend to inefficient treatment.
The medical officer of a venereal clinic is in just the same position as any other medical officer
of the staff of a hospital, in that, however competent he or she may be, a high standard of efficiency
of work can be attained, and, above all other things, maintained, only if his time, thought
and skill, are concentrated upon a limited number of patients. The moment he succumbs to the temptation
of working beyond his capacity is the moment when the efficiency of the work of the clinic begins
steadily to deteriorate. It is impossible to over-estimate the importance of a high standard of efficiency
in connection with the treatment of venereal disease. Too much stress cannot be laid upon the
extent to which the efficiency of the work of the clinic is dependent, not only on the professional
ability of the medical officer in charge of the work, but also upon such factors as well designed and
conveniently arranged premises, adequate assistance (medical, nursing, and male orderlies), good
organisation, and a steady dribble of patients spread over the several hours of a session rather than an
overwhelming rush within a shorter period of time. It would seem somewhat trivial to lay so much
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