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as the chief medical officer of the clinic, and to appoint certain junior and insufficiently experienced
medical officers as assistants. One practical effect of this arrangement is found not infrequently to
be that the head of the clinic attends only as an exceptional event, and then only for a short period of
time, and the real work of the clinic devolves upon an assistant who is not sufficiently competent to
undertake the full responsibility of the work. It is true that these cases only obtain in a minority of
the hospitals, and that in the majority the standard of the staff engaged in the work is, on the whole,
a high one. Indeed, in a few. instances, the men undertaking the work and actually seeing it through
are of international standing and reputation. But the fact remains that there is considerable
scope for the introduction of a much higher standard of competence in some of the clinics,
and, above all, men and women who, in addition to possessing the ability to do the work, are
also able and willing to give up the necessary time. The time has undoubtedly now come not only to
call for the appointment of men and women whose skill, knowledge and experience in the diagnosis
and treatment of venereal disease is beyond all question, but also to insist that those appointed should
be able and willing to devote the time and attention which is really necessary for the efficient performance
of the work of the clinic. It is believed that it will be found necessary, except perhaps in a few special
instances, to make a definite departure from the established tradition and practice of many of the
London hospitals, and, instead of regarding the venereal diseases as sub-departments of dermatology,
genito-urinary surgery, and gynaecology, to appreciate the fact that the time has come when these
diseases must be regarded as the province of a specialist department to be known as the venereal diseases
department. The work must be carried on in a portion of the hospital which must be just as carefully
designed for its special needs as the throat department, the eye department, the radiological department,
or, indeed, any other specialist department of the hospital. Moreover, the staff, whether medical,
nursing or male orderly, must be specially trained for the work of the department, and the medical
officer in charge must be given the same rights and privileges and status on the. staff of the
hospital as the honorary physicians and surgeons and heads of specialist departments. Until
these steps are taken, the work of venereal disease clinics in the several London hospitals will
continue to suffer. It should also be remembered that the present conditions react unfairly upon the
nursing and orderly staff in the same way as they do upon the medical staff, and for similar reasons.
These are considerations which must also be taken seriously into account in determining the policy to
be adopted. In this connection, it is only right to point out that the work is paid for out of public funds,
and, therefore, public authorities, responsible as they are to the taxpayer and ratepayer for the proper
use of grants in aid, are fully entitled to take into consideration any factors which may militate against
securing the high standard of efficiency which is rightly and justly expected from the hospitals undertaking
the work, and which, indeed, must be secured in any measures taken for dealing with diseases
of such grave national importance.
The provision of teaching facilities.—Each hospital included in the scheme is bound by the terms
of the agreement to provide facilities for the instruction of medical practitioners and medical students
free of charge. The actual provision made varies from very little, if any, in some of the clinics, to a
considerable organisation for the purpose in a few of them. Naturally the latter are usually hospitals
with medical schools attached. There is no doubt that broadly speaking the medical practitioner and
the medical student take very little advantage of the facilities available, despite the fact that some of
the clinics have made special efforts from time to time to attract their attendance. The usual explanation
given is that neither the medical practitioner nor the student have time to devote to the purpose.
It is frequently stated that both practitioners and students turned up occasionally, perhaps
two or three times, and then disappeared. The practitioners are too busy and the medical student
complains that the medical curriculum is already so overloaded, he cannot "take on" venereal disease,
beyond making a passing acquaintance with some of its manifestations and treatment as he threads his
way through a maze of departments to his "Final" examination. In these circumstances, it is very
doubtful whether any. useful purpose can be served at present by stimulating the staff of venereal
disease clinics to provide any greater facilities for the busy practitioner or the medical student.
There would appear to be greater prospects of doing permanently useful work by concentrating upon
those medical men and women who are willing and anxious to work in the clinics for limited periods of
time, either as "paid clinical assistants," or postgraduate students, and therefore, although no difficulty
should be placed in the way of either the busy general practitioner or the medical student, attending
the venereal disease clinics when he can, the best course to adopt is to cater for those who will give up
some weeks or months to the continuous study of the diagnosis and treatment of venereal disease.
Payment of the staff (medical) of the clinic.—Attention has been drawn from time to time to
the somewhat chaotic conditions which prevail with regard to payment of the medical staff
of venereal disease clinics, whether at the treatment centre or the laboratory. The remuneration
of the staff is found to vary from nil up to four guineas per session, where payment
is per session, or a salary of £600 to £800 per annum as a whole time medical officer at St. Thomas's
Hospital (with right to private practice, so long as this does not interfere with hospital clinic duties).
The London County Council and the other local authorities participating in the scheme decided
at the inception of the scheme to make their payments to the hospitals by block grant annually, and
not to interfere in any way with the discretion of the board of the hospital in regard to the payment
of the staff undertaking the work, although it should be clearly understood that, in calculating the amount
of the grant in aid to each hospital, it was assumed that some payment would be made to the medical
as well as other staff, unless, as in certain definite cases, it was intimated beforehand that the medical
staff would not accept payment. It should also be stated that, in a few instances where requested, the