View report page

xiii
emphasis upon such elementary principles were it not that detailed enquiry into the work of the
venereal disease clinics in London has shown over and over again (as in the survey of tuberculosis
dispensaries), the immense difference which well-designed premises, good organisation, and the determination
to maintain a high standard of efficiency makes in the success of the work, and how gravely
efficiency suffers by the attendance at each session of an excessive number of patients. The very
nature of the diseases dealt with in these clinics must be the justification for dwelling so emphatically
upon the absolute necessity of nothing less than 100 per cent. efficiency. Anything less is in truth not
only largely wasted effort and wasted money, but, most important of all, the loss of perhaps the best
opportunity for the prevention of the spread of venereal disease.
Apart from its harmful effects upon the efficiency of the work, overcrowding also has other serious
disadvantages. Thus complaints have not infrequently been made that large numbers necessarily
entail long periods of waiting for some at least of the patients, and it is believed that this is a considerable
factor in preventing patients from attending regularly, especially if their attendance involves
in addition a long journey. Moreover, it is stated that, especially amongst women patients, an
aggregation of large numbers of waiting patients is often associated with a lack of discipline and decorum
in the waiting room, resulting in foul language, filthy stories, and other forms of offensive conduct which
are resented so greatly by many patients that they discontinue their attendance. For these and many
other reasons, it is clear that every possible effort should at once be made to prevent the overcrowding,
which is already obvious in certain of the venereal disease clinics. There are several methods which might
be suggested for overcoming these difficulties. (1) Increase in the number of clinics. (2) Increase in
the number of sessions. (3) Increase in the number of hours daily when treatment is available.
The last method is the one which has been adopted at St. Thomas's Hospital, and is undoubtedly the
best of all for meeting the difficulties indicated above and certain other matters in need of improvement
which will be referred to later.
The throwing open of the clinic to all those who choose to avail themselves of the facilities at
any hour of the day, say, e.g., from 8 a.m. to 10 p.m., has the following advantages:—
(1) It enables the patients to attend at the times most convenient to themselves.
(2) It affords the medical staff of the clinic every opportunity for systematic examination
and carefully considered treatment of all the patients—the essential factors of a high standard
of efficiency.
(3) It avoids overcrowding and at once does away with all complaints in regard to long
periods of waiting, offensive remarks and conduct of certain classes of patients who must
inevitably frequent venereal disease clinics.
On the other hand, it is fully recognised that all the venereal disease clinics in London cannot
at once provide "all day" facilities for treatment, etc. In certain instances, indeed it would be true
to say that the additional expenditure involved in the provision of such facilities would not be justifiable
at present. But substantial increase in the number of hours per week during which the clinics are
open would be justifiable, and the provision of the facilities for a longer period daily would greatly
increase the efficiency of treatment and, at the same time, largely do away with certain of the disadvantages
already referred to. The other alternative would be to increase the number of sessions per
week at each of the clinics without increasing the number of hours per session during which the clinics
are open. The decision as to which of these methods would be the most effective for meeting the particular
circumstances and conditions of each clinic, is clearly a matter for consideration and consultation
with the hospital staff of each venereal disease clinic. It is perhaps worthy of note at this point that in
London the minimum number of sessions per clinic per week recognised by the Ministry of Health
and the Council for approval is three, and it is certainly an open question whether the minimum should
not be raised immediately to one session daily of not less than three hours' duration, according to the
special circumstances of each clinic. In this connection it will be convenient to draw attention to the
fact that the facilities available at the clinics for intermediate treatment, although much improved
within recent months, are still very far from satisfactory. It may be taken as an axiom that no venereal
disease clinic can be considered to be efficient unless facilities are provided for daily irrigations of males
and for such intermediate treatment for females as can properly be applied by nurses. There is no
need to dilate upon the immense value of such facilities, as they are so well known and so fully realised
by everyone who has any large experience of the treatment of venereal disease.
It should be borne in mind that the supervision of intermediate treatment can largely be left in
the hands of trained male orderlies and female nurses and that the attendance of medical staff for a
large number of hours daily for this purpose only is not necessary. It is desirable, however, to emphasise
again the importance of securing well trained male orderlies and female nurses for this work.
In connection with the discussion of the facilities available at the various clinics for diagnosis
and treatment, it was pointed out above that none of the clinics are open for this purpose
on Sundays. An exception should be made in the case of intermediate treatment. As already shown,
provision for this purpose is a factor of great importance in successful treatment, and the value of
the work done in the venereal disease clinics would be greatly increased if facilities for this purpose were
provided on Sundays during certain definite hours.
In some clinics it is found convenient to set aside certain sessions weekly for the administration
by injection of Salvarsan substitutes and other forms of special treatment, and again in a still more
limited number of instances, certain sessions or portions of sessions are devoted to the examination of
special cases, e.g., cases of chronic gonorrhœa. There is no objection to such arrangements.
On the contrary, under present circumstances it may be a practice to be commended, but