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and with the co-operation of the Civil Defence Department, been at the disposal of the London
County Council Divisional Medical Officer in Area 5 for the use as an anti-poliomye litis clinic.
During the year 1,404 persons received initial vaccination as compared with 6,441 in 1960.
CITY OF LONDON CANCER DIAGNOSTIC CLINIC AT ST. BARTHOLOMEW'S HOSPITAL
An account of the first two years' work in the Clinic by Mr. Brian Measday, M.B. Lond.,
F.R.C.S.E., M.R.C.O.G., Resident Assistant Physician Accoucheur, St. Bartholomew's Hospital,
London, E.C.I, is reproduced below by courtesy of Mr. Measday and of the St. Bartholomew's
Hospital Authorities.
A WELL-WOMEN'S CLINIC 1
Brian Measday
M.B. Lond., F.R.C.S.E., M.R.C.O.G.
RESIDENT ASSISTANT PHYSICIAN ACCOUCHEUR,
ST. BARTHOLOMEW'S HOSPITAL, LONDON, E.C.I
The value of exfoliative cytology in the early diagnosis
of cervical carcinoma is now recognised. Unfortunately,
the evolution of a service to exploit this diagnostic weapon
is expensive and slow. Relatively few centres or hospitals
in Great Britain are able to offer a service which is so timeconsuming,
and which requires technicians specially
trained to read the slides. Thus the prospect of " screening
" of the population—as envisaged, and to some extent
practised, in the U.S.A.—seems distant in this country.
Routine examination to assure positive health is rather
foreign to us, and, even if practicable, it would not be
wholly uncriticised. On the other hand, prophylactic
dental and antenatal care, now so well established in the
structure of the health services and of such obvious
benefit to the community, were in a similar position in
their early days. The value of cytological investigation is
now so well known that the necessity for starting a cytology
service must be faced.
Cytological surveys of large numbers of women are
often carried out in the U.S.A. by medical and nursing
aides and by trained technicians. Therefore coincidental
gynaecological lesions which would not be picked up by
a smear may presumably pass unrecognised. Thus
benign lesions in women without symptoms who attend
for cytological screening may remain unreported. The
cure of such lesions will be a secondary reward of any
cytology clinic where an appraisal of the patient can be
made by a clinician. With this ideal in mind, I am making
this preliminary report of the first two years' work in the
City of London Cancer Diagnosis Clinic at St. Bartholomew's
Hospital.
The clinics began in January, 1960, and have been
entrusted to a senior registrar or registrar from the
department of gynaecology. Cytological smears have been
made, and also the clinical condition of the patient and
her genital tract has been reviewed. A cytological pathologist
has been employed part-time.
This report is not concerned with the value of exfoliative
cytology in diagnosis. Indeed, it covers only 678
cases and, numerically, is insignificant. It does, however,
give some idea of the gross benign lesions seen in a clinic
where such smears are taken. As the overall incidence of
such lesions has been in the region of 30%, a detailed
analysis seems worth while. A well-women's clinic is
not necessarily attended by well women.
THE ROUTINE
Patients attend the clinic after telephoning for an appointment;
this they do in response to a leaflet which has been
distributed in the rest rooms of business houses and companies
in the City. This notice invites any woman over thirty-five,
who works or lives within the City boundaries, to attend a
clinic where, by means of a simple test, her positive health in
respect of cancer of the genital tract can be assured.
At the clinic, patients are invited to give their reasons for
attending; this is to distinguish those with symptoms from
those attending solely because it is a good idea. The menstrual
history is briefly reviewed, and marital status and parity
are recorded. The breasts, abdomen, and genital tract are
then examined, and cytological smears are made with material
scraped from the cervix and posterior fornix. Finally, if no
clinical abnormality has been found, the patient is informed
and told that she will hear by post within a fortnight whether
her tests are satisfactory. She is also told that, with her permission,
a similar letter giving the results of the smears will be
dispatched to her family doctor by the same post.
When some abnormality has been detected which will
explain a symptom troubling the patient, the matter is explained
to her and she is told that the clinic will write, on her behalf,
to her doctor and discuss treatment with him. All further
treatment will be at the discretion of her own doctor, although
if he wishes he may refer her to a gynsecological clinic.
Where operation would ordinarily be advised, the patient is
told of this and asked to talk matters over with her family
doctor. The general practitioner is given details by letter and
told what procedure or investigation would be carried out if

the patient were in the ordinary practice of the hospital. He is
offered the hospitality of St. Bartholomew's, but it is made
clear that we understand he may prefer to seek elsewhere for
advice or treatment on his patient's behalf.
ATTENDANCE
It is difficult to know how many women have seen our
leaflet and decided not to attend the clinic. Latterly, we
have been willing to see 12 patients each session, although
originally only 6 were given appointments each week.
There is almost always a waiting-list for appointments.
Considering the small amount of advertisement this
scheme has had, there seems to be a genuine demand.
Certainly, patients' friends who are ineligible to attend,
and similar patients of doctors who have heard of the
clinic, have asked for appointments.
Of the 678 patients so far seen, 498 were symptomfree
and attended because they regarded the clinic as a
sensible service. 97 had a specific symptom, such as
vaginal discharge or irritation (52), or menstrual upset
(45). 38 mentioned, of their own volition, that they
were concerned over a family history of cancer. 45
expressed anxiety over a symptom (other than those
already mentioned) not necessarily of a gynaecological
nature.
PATHOLOGY
The abnormalities found are shown in the table.
Postmenopausal bleeding.—10 patients gave a history of
postmenopausal bleeding. 1 other patient complained of
irregular bleeding. Curettage was therefore advised for 11
patients, and has been carried out at St. Bartholomew's
Hospital in 9 of these. No neoplasia was detected in 8, but in
1 adenocarcinoma of the endometrium was found and extended
hysterectomy subsequently carried out. There was a very
early growth (stage I) of the posterior uterine wall near the
fundus uteri. Cytological smears, taken only once before
curettage, were negative.
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