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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 gynaecological 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.
OCCUPATIONAL HEALTH
In the autumn of 1961 Dr. A. Robinson was appointed to carry out a sample survey of occupational
health conditions in the City of London, and took up his duties on 8th January 1962.
During the year Dr. Robinson not only carried out the sample survey but also produced an
excellent interim report "Working in the City" which was well received and commented on in
some length in the press and professional journals. In order to obtain a fair average, every 27th
firm rated as an office, shop or restaurant was listed and the field work of the survey, which was
carried out entirely by Dr. Robinson, was commenced in March after a small pilot survey had been
tried. From March to September Dr. Robinson visited 186 offices, 55 shops and 26 restaurants;
he completed a punch card, which contained 50 questions, for each firm and a pro forma for each
room he visited, in all 1823. In carrying out the survey he recorded that he walked 574% miles
( many of which would have been up and down stairs).
A full appraisal of the useful work cannot be made in this report but to summarise the main
features of the survey a few brief paragraphs on items mentioned in Dr. Robinson's report are
appended.
Space
Only 7.5% of office rooms were overcrowded on the Gowers Standard of 400 c.f. per person.
Lighting
Inadequate lighting was the major environmental fault in City Offices. More than half the
working points measured by daylight and 92% of the working points measured in artificial light
were below the latest recommendations of the Illuminating Engineering Society.
Noise
In 3 in 10 offices work suffered because of external and/or internal noise. Shops were
quite by comparison and restaurants noisier.
Heating
In the colder months the room temperatures of 62% of offices ranged between 70°F. and
75^. which is high compared to temperatures recorded in studies of workers in other occupations.
City shops tended to be rather too cold in winter and too hot in summer.
Cooling
Generally offices, shops and restaurants were not effectively cooled.
Ventilation
In 60% of the offices visited during the cold months all windows were shut and 54% of the
shops depended on the door for ventilation and few, if any, restaurants achieved adequate ventilation.
Most offices employed less than 50 persons and were engaged in various occupations.
Only 17.6% of offices, shops and restaurants provided any medical care.
Sanitary accommodation was good in offices but not so good in shops and restaurants.
Very few offices or shops were provided with cloak-rooms or rest rooms but three-quarters
of the restaurants provided cloak-rooms for outdoor clothing and half had rooms used alternatively
as rest rooms or for meals.
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