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kidney trouble, nervous breakdown, recent surgical operation or
cases awaiting operation, those undergoing treatment for
gynæcological conditions where pregnancy would impede recovery
or undo the benefit of the operation.
Five patients were considered to have no medical grounds
for contraception. It is most unlikely that any such patients
will decide to start a family because they were denied advice at
their local Clinic. They will visit one of the voluntary Clinics
of a private doctor, or continue with some method they had
already evolved, especially if their reasons for desiring advice
were the lack of housing accommodation, financial difficulties, or
poor health in the husband.
The success of an ideal Birth Control Clinic is not indicated
by the numbers attending it. One does not wish it to be only a
bureau for the rapid fitting of as many women as possible per
session with a scientific appliance for the prevention of conception.
In a Birth Control Clinic the doctor is privileged at once to have
the intimate confidences of the patients. They have the opportunity
and the privacy immediately to talk about the physical
basis of marriage, upon the smooth functioning of which its
harmony so largely depends. In reply to the questions necessarily
put by the doctor before fitting a contraceptive often more than
a hint of difficulties is given by the patients, but in a brief and
crowded session it is impossible to pursue these fully and advise
upon them. It seems that from the nucleus of the Birth Control
Clinics there could be developed centres for marriage guidance,
at any rate for the simpler difficulties, with arrangements whereby
the more complicated cases could be passed on to a Psychological
Clinic. If other personnel (non-medical) were trained to teach
the fitting of contraceptives (the patient first being examined and
prescribed for by the doctor) more of the doctor's time could be
given to the patient with difficulties, and the social service value
of these Clinics in helping to build a sound family life could be
greatly developed.
7. As in previous recent years the number of maternity
hospital beds has been totally inadequate to meet the demand.
It is still true, however, that the bed required for strictly medical
reasons has always somehow been found, but the scarcity of
hospital beds has meant the conduction of confinements in home
circumstances well below the standard which had been attained
in the pre-war years, and the hospitals themselves have had the
greatest strain put upon their accommodation. In endeavour to
ease the situation the Middlesex County Council have taken over
the Acton and Wembley Isolation Hospital for adaptation as a
Maternity Annexe, but progress in this plan has been slow.
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