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where the growth of the work of a clinic is such as to demand such special arrangements there
probably exist simultaneously other circumstances indicating that the work of the clinic has reached
what might be termed its " breaking point," and that the best way to deal with these is in the manner
already indicated above, i.e., by opening it daily for a longer number of hours or by increasing the number
of fixed sessions per week, and by attending to various other matters concerned with the maintenance
of a high standard of efficiency, such as adequate and competent medical nursing, and male orderly
staff, properly designed premises and good organisation.
Before concluding this section, reference must be made to the practice which exists in a number
of clinics of seeing cases of venereal disease at the same time, and during the same hours as patients
suffering from other diseases, such as diseases of the skin, genito-urinary cases, gynaecological cases, etc.
It is claimed for this practice that, by not restricting the work of the session to cases suffering, or
suspected to be suffering, from venereal disease, the attendance is secured of a number of patients
suffering from venereal disease who would otherwise neglect to apply for treatment; there is,
in fact, an element of "camouflage," which has a real practical value. There are no grounds at present
to dissent from this view, which is strongly held by some, but the important question is whether such
venereal disease patients do in fact receive adequate treatment in clinics of this description.
In certain cases it is believed that patients do not receive adequate treatment under these
circumstances, and would recommend that this practice should be allowed only where there is satisfactory
evidence that the physician or surgeon in charge of the composite department is competent to
give such adequate treatment, and that he or she shall be specially approved for this purpose. There
is no desire to interfere in any way with the physician or surgeon who wishes to retain cases
of venereal disease for treatment under his or her care, whatever the nature of the particular department
may be, but, as a rule, where grants in aid out of public funds are made to hospitals for the
specific purpose of treating cases of venereal disease, only such patients should be paid for as are referred
to and taken over by the clinic specially set up for this purpose.
The staff.—Before proceeding to the consideration of what is probably one of the most important,
if not the most important, factor in the efficiency of the venereal disease clinic, it would be well to bear
in mind that the circumstances under which the scheme for the diagnosis and treatment of
venereal disease was launched were such as to militate seriously against the opportunity of securing
highly competent as well as adequate staff, whether medical or nursing, male or female. In the middle
of 1916, and for more than two years thereafter, we were engaged in the Great War, and it is only
necessary to mention this fact to enable everyone to appreciate the immense difficulties which had to
be overcome in securing competent and adequate staff for the 22 clinics which came into operation on
1st January, 1917. These difficulties became even greater throughout that year, and in 1918. In
many instances medical and nursing staff engaged in carrying out the work of the clinic were called away
to war service, often at a very short notice, and the constantly increasing difficulty in maintaining the
clinics in operation, not only owing to the lack of staff, but also to the consistent growth of the work from
the day of opening onwards, needs only to be mentioned in order to be fully appreciated. It should
also be remembered that, prior to the year 1917, only a very limited number of the London hospitals
had ever undertaken the provision of an organised department for the diagnosis and treatment of
venereal disease. It will be easy, therefore, to realise that those who were responsible for the provision
of an efficient scheme were faced, not only at its inception, but also for a long time thereafter, with a
combination of adverse circumstances which might well have wrecked such a vast undertaking at any time
between 1st January, 1917, and 31st December, 1918. In the early part of 1919, some slight relief to the
strain became perceptible by the gradual demobilisation of various members of hospital staff who had
joined the Royal Army Medical Corps for war service, some of whom had special knowledge and experience
of the treatment of venereal disease. In addition to these, a certain number of demobilised medical
practitioners who had gained considerable experience of venereal disease during war service came
forward and desired to take part in the work of the clinics. On the other hand, the circumstances of
demobilisation, for various reasons which need not be detailed here, threw a large additional amount
of work upon the clinics, and the number of new patients and the attendances of new and old patients
showed a great increase throughout the year as compared with 1917 and 1918. So far as it has been
possible to form an estimate, the growth in the attendances of new and old patients will also show a
considerable increase in the year 1920, as compared with the year 1919. Bearing these facts in mind,
the question we have to put to ourselves to-day is this: Can it be said that satisfactory provision is
made for medical, nursing, and male orderly staff at the London venereal clinics at the end of the year
1920 ? After giving most careful consideration to all the facts resulting from the special enquiries
made during this year, one cannot but come to the conclusion that the position, more particularly in
regard to the medical staff, is not by any means satisfactory, and this is all the more to be regretted,
because, in the case of the County of London, one ought not to be forced to this conclusion. The
grounds for these conclusions are as follows:—
In the first place, there has been an unfortunate tendency on the part of some of the
hospitals to regard the position of medical officer or officers in charge of the venereal diseases
clinic as the rightful possession of one or more members of the honorary staff, without any regard to
the dominant consideration that ability to do the work properly and to be able to give up
the necessary time to the work, should be the foremost considerations. In one instance, for example,
the practice of the hospital is to change the staff of the clinic annually. It is clear that in such a case
the clinic cannot possibly attain a high degree of efficiency, and such an arrangement should not be
permitted to continue. In other instances, the practice is to appoint one member of the honorary staff