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56
Inevitably, the bulk of the burden of treatment has fallen on the Metropolis and
the Council, by agreement, arranged with voluntary hospitals to provide free diagnosis
and treatment, pathological services and drugs for clinics and general practitioners,
teaching facilities and assistance to necessitous patients by payment of fares. Clinics
at seventeen voluntary hospitals in London were thus supported by grants from the
County Councils and in addition the Council itself maintained two clinics. Aid was
also given to hostels for unmarried mothers suffering from the disease. About 80%
of the grants were contributed by London and the remainder by the Home Counties.
The Council also arranged for extensive health and sex education by lectures, by the
free distribution of literature, and by advertisements and notices concerning health
and venereal diseases. Throughout the thirty-two years the clinic staffs did work
which was beyond praise in combating the spread of these diseases. Most of the
hospitals suffered heavy damage by air raids, yet the clinic work went on without
a break in face of great difficulties.
It is with much regret that this link between the Council and the hospitals is
severed but it is hoped that close co-operation may be continued in future in
preventive work and persuading patients to accept and complete treatment.
As stated in the Annual Report for 1947, Defence Regulation 33B expired on
31st December, 1947, but the Council has continued to undertake the tracing of
contacts of patients with a view to persuading them to undergo treatment voluntarily.
This forms part of the Council's work under Section 28 of the National Health
Service Act, 1946, and male and female welfare officers are available for this purpose
and for following-up patients who are defaulting from clinics.
An enquiry made into the extent of preventive and social work carried out at
sixteen of the clinics in London shows that generally there is among them a similarity
in working, the little variation between them being chiefly due to the amount of time
which the staff have available to give to patients.
The procedure in general use for case holding is for the almoner or director to
send a letter which is sometimes followed by reminders if there is no response from
the patient. Visiting is resorted to by some clinics but not by all, and it appears
that the larger full-time clinics, having more adequate staff, are able to give greater
attention to case holding than are the smaller hospitals. Ten clinics were able to
do their own case holding and six were not. For tracing contacts the majority of
clinics rely on the issue of contact slips which are handed to patients. Almoners at
a few clinics have made some attempt to approach contacts direct but generally with
negligible results. Only two clinics were able to do all the contact tracing desired
and 14 were not. The almoner's work is practically confined to female patients,
there being no comparable organisation on the male side.
Four clinics have sought the assistance of the Council's welfare officer in
persuading male defaulters to return for treatment but these requests were concerned
with only twelve patients, several of whom had lodging-house addresses and enquiries
met with little success. A few requests were also received for assistance by the
Council's officers in tracing female contacts and defaulters.
No reliable statistics are available of the results of the issue of contact slips.
The V.D. clinics cannot be compared with other departments of a hospital.
The relationship between doctor and patient is most important; the patient is often
super-sensitive and resents the least interference or inquisitiveness. In no other
work is it so essential for staff to have an unbiassed attitude and sympathetic understanding.
Tactful handling is the best way to achieve good case holding. In London
clinics the medical staff generally try to find time to undertake some propaganda
conversation with patients and, in the case of married patients, make special efforts
to bring in the spouse. There is, however, probably little time for eliciting information
for contact tracing which needs the exercise of much skill and a special line of approach
to be successful and yet retain the goodwill of the patient. In female clinics there is