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118
When a diagnosis of the complaint has been made most patients will be found to need treatment
in some form or other.
The cases found to require treatment could be divided into two groups:—
(i.) Women suffering from conditions that might be treated at the Health Centre— These
would be small in number as the scope of out-patient treatment in gynaecological conditions
is very limited. It would merely consist of:—
(a) The provision and fitting of appliances used chiefly as a palliative measure in
certain circumstances in cases of displacement of the female organs.
(b) The supply of drugs for internal use in some cases of bleeding and in certain
conditions associated with the change of life, external use as a lotion chiefly
for cases coming under (a).
(c) Local treatment in a few selected cases. This would need to be carried out
by a doctor or a specially trained nurse.
(ii.) Women suffering from conditions that could not be treated at a Health Centre. This
would comprise by far the greater number of women who were found to require treatment.
The treatment of the majority of gynaecological conditions is of a surgical nature and to
deal with these it is essential for beds to be available together with all the facilities of
staff and equipment provided in a modern hospital that undertakes the treatment of
surgical cases.
In order to carry out the preliminary examination on women attending a gynaecological clinic
for advice and to give what treatment is possible at such a clinic, the following would be required:—
(a) A room specially equipped, on the lines of the gynaecological out-patients department at a
hospital, so that it could be used for gynaecological examinations and certain special
treatments. The equipment would include a special table, facilities for the sterilization
of instruments, douching, etc. Thus equipped, this room would be unsuitable for any
other purpose, apart from the fact that it would be needed for treatments.
(b) Special waiting room accommodation with lavatories.
(c) A specialist in diseases peculiar to women.
(d) A specially trained nurse in charge.
These requirements could not be met at the existing Health Centres, as all the rooms are in
use on different days and at different hours for various purposes and no room can be set apart for this
special work only.
Having regard to these considerations, there appear to be two courses that might be considered:—
(i.) To build a special annexe in connection with Health Centre 3 or as part of a rebuilding
scheme of Health Centres 1 or 2 and to staff it as above. Even if this were carried out,
it will be noted that of the total number of women seeking advice and treatment only a
small percentage could be completely dealt with by the Health Centres alone. The
greater number would, after a general and a preliminary gynaecological examination,
have to be referred elsewhere for further investigation or treatment, or both.
(ii.) To hold special sessions in the evenings at the existing Health Centres, on the lines of the
Cancer Prevention Clinics where no form of treatment is given, to which women might
come and undergo a general and a preliminary gynaecological examination.
If this latter course were adopted, most women would have to be referred to a hospital, as a
large number, as stated above, attending a gynaecological clinic require further investigations and nearly
all require treatment, neither of which would be carried out at the Health Centres. Furthermore,
these women would be subjected to a gynaecological examination on two separate occasions (which
would be unpleasant for the patient)—one by the doctor at the Health Centre and the other by the
doctor undertaking the further investigations and treatment.
In view of the facts the Committee will observe that only very few cases could be adequately
dealt with at a Health Centre and I am unable to recommend the Committee to adopt any scheme for
dealing adequately with the gynaecological conditions of women apart from the wards of a fully equipped
general hospital.
GEORGE F. BUCHAN,
Medical Officer of Health.
January, 1935.