Part 4 out of 6
From the point of view of society as a whole, it is waste that any one
who has had such a long and arduous training as that required for
the medical profession should not use it in service to the community.
There is a form of selfishness not sufficiently recognised, which
consists not in acquiring goods but in acquiring knowledge without
rendering it again in service to one's fellow men and women.
Should the doctor decide _(c)_ to enter the public service, the
question will probably not be in her own control as there is an
ever-increasing tendency on the part of public authorities to insist
on single women or widows only among the medical women whom they
employ. There is a big fight to be waged here--one of the many that
our pioneers have left for us and our successors. The lack of social
instinct which lies behind this edict is amazing. What can be more
anti-social than that a young, healthy, and highly-trained woman
should have to decide between marriage and executing that public work
for which she has with great labour fitted herself? In at least some
cases of which the writer is aware, the demand that a doctor shall
retire on marriage, has led to a decision against matrimony, and this
is not surprising, although very serious as a general problem. The
great need of society at the present day is that the most healthy and
well-trained young men and women should be induced to found families,
and public authorities by this bar put on the trained woman, are doing
their best to hinder marriage.
Medical women have, for their protection, societies of registered
medical women in London and in the north of England and also in
Scotland, these working more or less in touch with one another. In
common with other medical societies they have meetings at which the
advances in medical science are discussed, and they also act in a
modified way as Trade Unions, Members of these societies can always
gain information from them as to the recognised rate of pay in any
particular branch of the work which they may wish to undertake.
Reference has already been made to the excellent work which has been
done by the British Medical Association in uniting the men and women
of the profession and helping both to keep up the salary rate. Without
this aid the women's associations would have been comparatively
helpless, as they would have erred in ignorance, though certainly
not by intention. The gratitude of medical women to this association
cannot therefore be overstated, and I think I am justified in saying
that the same is true with regard to medical men. If their chief
"Union" had not admitted women we might unwittingly have become a
danger to our medical colleagues as black-leg labour. This has been
almost universally the case in other work which women have taken up,
and one cannot help wishing that men in other branches of labour might
speedily realise the fact that women cannot be stopped from working,
and that the only wise thing, from the men's point of view as well as
from the women's, is to admit all to their unions that they may fight
shoulder to shoulder for better labour conditions, and not against
each other. An example of a case where this was realised has already
been quoted under Example 2, page 144.
With regard to the opportunities for post-graduate study:--At first
all the men's medical societies were closed to women, the provincial
societies being among the first to recognise their women medical
colleagues. London, being in this as in all things conservative, took
many years to move, and did so very grudgingly; but now nearly all
the important medical societies admit women, in this falling into line
with the learned professions generally. The Royal Medical Society,
London, at first admitted women to its separate sections only,
while denying them the Fellowship, with which would have gone that
mysterious power which men so deeply resent our possessing--the power
to vote on matters of its internal economy. The authorities of this
society have, however, recently admitted medical women on perfectly
equal terms with men to their Fellowship--a privilege for which we are
deeply grateful, as post-graduate knowledge of recent investigations
is absolutely essential to good work.
In conclusion, the general position of medical women at present may be
shortly summarised as follows:--
Their legal status is _absolutely identical_ with that of men in
every respect, by which is meant that by being placed upon the Medical
Register they have every privilege, duty, and responsibility which
they would have if they were men. In obtaining this and allowing many
other things to be settled by their successors our pioneers showed
their tremendous wisdom.
We have in the medical profession, what women are now claiming in the
State, the abolition of legal sex disqualification. With this firm
platform upon which to stand, it entirely depends upon medical women
themselves what position they will gain in their profession. All other
disabilities and disqualifications are minor and remediable.
This absolute equality of medical men and women before the law
includes the rights to
(1) Practise in any department of medicine in
which their services may be demanded.
(2) Recover fees if necessary.
(3) Sign death certificates.
(4) Sign any certificates for which a medical
signature is essential.
Under this latter heading a curious anomaly arises. If a man is signed
up as a lunatic, he is, for so long as he remains a lunatic, debarred
from using his Parliamentary vote, and, as may be seen from the above,
a medical woman's signature is as valid as that of a man for this
disfranchising certificate of lunacy. The State, therefore, at the
present time allows that a medical woman may be sufficiently learned
and reliable to disfranchise a man, though she be not sufficiently
learned and reliable to vote herself.
The Insurance Act concerned medical women only in the same way that
it affected their men colleagues. The sole reason, therefore, for
mentioning it in this paper is that it affords an indication of two
(1)that the Government therein makes no sex distinction in the
(2)that the bogey of sex cleavage, so often mentioned by the timorous
in the political world, is here, as always where it is put to the
test, proved to be without foundation.
Unfortunately, the Insurance Act divided the medical profession into
two parties; women, no more than men, were unanimous on the subject
and some were to be found on either side.
Women are still debarred from the full use of their medical powers in
the following ways:--
(1) The demand for their services from the general public is at
present not so great nor so universal as that for men. This is not
surprising when it is realised for how short a time there have been
medical women; however, the demand on the part of the public is very
rapidly increasing, naturally, of course, amongst their own sex.
(2) As in other work the tendency is to restrict women to the
lower branches of public work, or to the so-called "blind alley"
occupations. This can only be cured by public demand, and some
improvement is to be noted in this respect. There is, however, no
doubt that general practice affords at present the most unrestricted
field for a medical woman's activity, because there she suffers from
no limitations except those of her own personality in relation to
society. Any patients who are inclined to trust her are absolutely
free to do so, and it is open to her to demand what fees her services
are found to be worth.
If, on the other hand, she enters the public service she may
admittedly qualify herself in every way by attainments and experience
in the lower ranks for one of the higher administrative posts and be
barred simply by sex disqualification. This also will no doubt in time
improve, and the pioneer work that it implies may attract many, but
the progress is necessarily slower.
(3) She is still debarred from full opportunity for specialist work.
(See efforts being made by women themselves to obviate this by the
starting of women's hospitals, p. 149.)
Finally, then, the medical profession should attract women of good
average capacity and general education, good health and certain, even
if moderate, means. Above all do they need public spirit, which will
make them anxious to maintain and improve the excellent position
medical women have so far obtained. It is a very widely interesting
life, bringing those who adopt it out of the study into direct touch
with human affairs.
[Footnote 1: Publisher, G. Sharrow, 28A Devonshire Street, Portland
[Footnote 2: Quite recently the outline of a new scheme was put
before a meeting at the Women's Medical School in London by the
Director-General of the Indian Medical Service. Under this scheme the
Women's Medical Service in India would not be upon the same footing
as the Indian Medical Service (I.M.S.) for men, but would remain as
at present, a Dufferin Association. It would, however, receive a
Government grant of L10,000 yearly, and proper arrangements would be
made for pay, furlough, promotion, and security of tenure. The scheme
is open to criticism on some points, but, as a whole, it marks a
considerable advance on the previous conditions of service in this
department of women's work, and may be welcomed as a genuine if
somewhat belated attempt on the part of the Government to deal fairly
with an urgent question.]
It is not sufficiently well-known that dental surgery as a profession,
opens up a practically unexplored and lucrative work for women.
The training in the British Isles can be carried out in London,
Edinburgh, Glasgow, and Dublin, each of these cities granting their
Licentiate of Dental Surgery. In London, the National Dental Hospital,
and the London School of Medicine for Women (Royal Free Hospital) have
special facilities for women students, including special bursaries
and scholarships, while dental and medical studies can be carried
on concurrently. The course of study includes the passing of a
Professional Preliminary Examination or Matriculation, followed by two
years' mechanical work, and two years' hospital practice. The student
can be articled to a qualified dental practitioner for mechanics, or
can obtain tuition at the Dental Hospital. This branch includes the
preparation of models, vulcanite and metal dentures, crowns, and
The Dental Hospital course for two years includes lectures on Physics
and Chemistry, Dental Anatomy and Surgery, Metallurgy and Materia
Medica. At the same time practical work is done--extractions,
fillings, crowns, bridges, dentures, and the regulation of children's
teeth. At the medical school and hospital, lectures on Anatomy,
Physiology, Surgery, and Medicine must be attended, and dissections on
the human body, and clinics in the ward must be completed. At the end
of each year examinations in the subjects are taken, the whole course
covering a minimum time of four years. The qualification of the
Licentiate of Dental Surgery of the Royal College of Surgeons of
England is now open to women. The composite fee for training extending
over four years, is about L200, but an additional sum of at least L100
is required for incidental expenses. Should the woman student desire
to confine herself to dental mechanics this would materially lessen
the expense. The average wage for a good male mechanic is L120 per
annum. Hospitals can be joined at the age of nineteen, and it is
advisable to begin study soon after leaving school or college.
If it is possible, a woman should obtain a medical qualification as
well as the L.D.S. Much of the work can be taken at the same time as
the dental course. A medical degree enlarges a dentist's sphere of
usefulness and interest and adds to her _locus standi_: on the other
hand, it necessitates two or three years' extra study, and the fees
are increased by several hundred pounds.
The woman dentist will probably find it necessary to start practice on
her own account as soon as she is qualified, as it is not likely she
will be able to obtain an assistantship with men practitioners, but
there are an increasing number of posts open to women, such as dental
surgeon to school clinics or to factories. These posts offer the same
salaries to men and women. Smaller part-time appointments, with an
honorarium attached, can be obtained, and are especially useful to the
newly qualified practitioner who is building up a practice.
It is essential for the woman who intends to succeed in this
profession to have excellent physical and mental health, though
great muscular strength is not necessary. During student life and in
practice, every care should be taken of the general health--exercise
in the open air being especially necessary, though this should not be
too energetic in character. It is a well-known fact that male dentists
doing careful and conscientious work, cannot, as a rule, stand the
strain for many hours daily after they have reached middle age, and
the intending student should consider this point.
The prolonged hours of standing in a cramped position, the confined
space, the exactitude required for minute and painful operations, are
some of the causes of this overstrain. Great self-control and will
power must be exercised as the patients, especially children, are
frequently nervous, and confidence must be imparted to them if the
work is to be well done.
The British Dental Association and the Odontological Society are both
open to women, and male practitioners have always displayed the utmost
courtesy though some prejudice must be expected. The general public
apparently welcome the advent of women dentists as the few qualified
women in London and the Provinces have excellent practices. It is
curious, however, to note that few Englishwomen have taken up the
profession, there being about twelve practising in the United Kingdom,
though in Germany, Russia, and the United States there are great
numbers of women practitioners.
With regard to restrictions from which women at present suffer, one
dental hospital only is open to women in London, and, until recently,
no posts could be obtained. But as more women qualify, these
disadvantages will probably be removed. It is also extremely difficult
to obtain mechanical work in private work-rooms. Women should bear in
mind that they require exactly the same facilities for study as men,
and try to get admittance to all hospitals and posts on an equal
basis--_i.e._, the salary should be equal for equal work, and a
smaller fee should not be accepted.
In deciding whether a practice should be started in London or a
provincial town, the question of capital must be carefully considered,
as it is improbable that the expenses will be met during the first
year of practice. The upkeep necessarily varies with the locality
chosen, and a minimum capital of L150 is desirable.
Pioneer women must be prepared to do their work conscientiously, and
to the utmost of their ability, and they must always remember that
their work will be very severely criticised.
This necessitates frequent inspection of both the clothing and persons
of the children. Certain cases which are found to need attention are
also visited in their homes. The school nurse is so much alone in
her work that she requires to be very experienced and her powers of
observation to be highly trained in order to enable her to detect
signs of ill-health in its early stages. Firmness and kindness
are constantly required in dealing with parents, and tact and
consideration in her dealings with all with whom her work brings her
In the London area the salary begins at L80 rising by L2, 10s.
yearly to L85, and then by L5 yearly to L105. Uniform and travelling
expenses, within the county, are provided. The nurse is required to
contribute to the superannuation fund from which she can ultimately
draw a pension if she remains all her working life in the service of
The hours of work are from 9 A.M. to 4.30 P.M. five days weekly, and
from 9 to 12.30 on Saturdays. Clerical work must be done out of school
hours. Holidays are arranged during the school holidays.
There are 128 nurses working under one Superintendent,
two Assistant-Superintendents, and four Divisional
_B_. There are 42 nurses attached to schools for the physically
defective whose special duties are concerned with the care of the
crippled and delicate children who attend these schools. Certain
special precautions against injury and strain are necessary for these
children, and the nurse receives instructions concerning these from
the visiting doctor. The salary is the same as that mentioned above,
and the nurses get the school holidays. At open-air schools the
nurse's work is somewhat similar to that in the schools for the
_C_. There are 8 nurses now working under the Infant Life Protection
All women who undertake the care of an infant for payment have to be
registered. Of such children, a large proportion is illegitimate. It
is the duty of the nurses to visit every such case. Each nurse has
an area allotted to her; the work is arduous and responsible as the
visitor has full powers under an Act of Parliament summarily to remove
the child if the conditions required by the Act are not complied
with. The nurse who undertakes this work should have been trained
in maternity work (and if possible have been examined by the Central
Midwives' Board). She should also have her certificate from the
Sanitary Institute as she is expected to report on the sanitation
of the premises as well as on the condition of the child. There is a
considerable amount of clerical work in connection with these posts.
The salary of these nurses is good, compared with the usual salaries
for nurses--L120 to L150, with a further rise to L200 after ten years
The superannuation fund, which is compulsory for all permanent
officers, yields a provision of not less than one-third of the average
rate of pay in a case of complete breakdown in health after ten or
more years in the service of the council. The retiring age, apart from
breakdown, is sixty-five years.
The conditions of work in the Provinces are much the same in general
outline as those described above, which prevail in London, except that
in the country the nurse often undertakes in addition the work done in
London by Care Committees and Attendance Officers. This, although it
increases her work also increases its variety.
NURSING IN HOSPITALS FOR THE INSANE
Mental nursing as a profession for educated women has much to
recommend it. It is of absorbing interest to those of a sympathetic
nature and of a scientific turn of mind, and it develops all the finer
qualities, self-control, patience, tact, and common-sense. It gives
scope for originality and accomplishments of every kind. The work
itself is difficult, and is the one of all the many branches of
nursing which demands the closest personal devotion and service, great
as is the necessity for these in all forms of a nurse's work.
Mental nurses are employed in (1) county asylums, (2) mental
hospitals, (3) private work.
(1) _County Asylums_--These may take from 1,000 to 2,000 patients
each. They are usually situated in the country with healthy
surroundings and large grounds, and they are generally placed within
reasonable access to some town.
Probationer nurses are received for training from twenty-one years
of age. They must be of good health and physique. A nurse who is
successful in this branch of work should be able to obtain her
certificate from the Medico Psychological Board at the end of three
years' training. The salary is L19 the first year, with an annual
increase of L1 up to L35. Free board, lodging, washing, medical
attendance, are also supplied and uniform after three months' trial.
The hours on duty are from 6 A.M. to 8 P.M., with two hours off for
meals. Nurses get leave from 8 P.M. to 10 P.M. daily and one day
weekly; they also have fourteen days' holiday after the first twelve
months, increasing subsequently to three weeks a year.
The duties of the nurse in an asylum consist of the care of the
patients, the supervision of the cleanliness of the wards and
linen, and also of the work done by the patients in the various
departments--the needleroom, laundry, kitchen, corridors, etc. It is
obvious that in view of the number of patients, individual attention
is practically impossible. Entertainments of all kinds are provided
for the help and amusement of the patients, and nurses are expected to
assist in arranging these. Consequently any one with a gift for music,
acting, singing, or other accomplishment is an acquisition to the
(2) _Registered Mental Hospitals_.--These, owing to their different
circumstances, vary much in their conditions of service. Most of them
are training-schools and receive probationers of good education, from
twenty-two years of age, for a course of training. This consists of
lectures by the Medical Staff and Matron, the subjects receiving most
attention being Elementary Anatomy, Physiology, and Psychology; and
there is, of course, practical training in the nursing of mental
cases: in some hospitals a course of Massage and Swedish Drill are
added in the fourth year.
Salaries are on the whole lower than in the County Asylums, beginning
at anything from L15 rising to L19 in the third year with a bonus of
L3 on passing the final examination of the Medico-Psychological Board.
There must, however, be set against this lower rate of remuneration,
the fact that these mental hospitals are often situated more centrally
than the county asylums, thus making less expenditure necessary for
travelling to and from the hospital when out on leave. The usual free
board, lodging, washing, medical attendance, and uniform are also
given after three months' satisfactory service.
The hours of duty are from 7 A.M. to 8 P.M. with two hours off for
meals, etc. Leave during a month varies with the different hospitals,
but is usually two whole days, three half days, four evenings from 6
P.M. to 10 P.M., and four evenings from 8 P.M. to 10 P.M.: there is
also annual leave of fourteen days after the first twelve months,
increasing to three weeks after three years' service.
The work in a mental hospital is totally different from that in large
asylums. As there are fewer patients, individual treatment is the
rule, and the nurse gets more intimate knowledge of her patients'
condition, which she may thus do much to ameliorate. Owing to the
homelike freedom allowed, nurses need to be specially patient
and tactful. In return for this, however, by their much closer
companionship with their patients they gain the opportunity of
thoroughly knowing and therefore sympathising with and guiding them,
and on this, successful treatment largely depends. The majority of
the patients in these hospitals are suffering from acute forms of
insanity, and this adds both to the strenuousness and to the interest
of the nursing work: the fact that such patients frequently recover,
acts as a great incentive to the work.
Private asylums are on a different basis and do not as a rule offer
A trained nurse may hope for promotion to posts as Sister of a ward,
Night Superintendent, Assistant Matron, or Matron. These posts demand
personal attributes in addition to good training--_e.g._, powers of
organisation and administration, a knowledge of housekeeping, laundry
work, etc. For the higher posts, training in general nursing is
essential. In all forms of mental nursing it is undoubtedly a great
advantage if the nurse has had a preliminary general training before
entering on the special branch of the work.
The conditions for private mental cases are the same as those
described under private nursing for general work (see page 184). The
fees, however, compare very favourably with those obtained for general
work, being almost universally higher. The great disadvantage is that
the hours are very long and the work necessarily exhausting.
Much has been done of recent years to improve the conditions of
service for workers in institutions, and there is still room for
amelioration. Particularly is this so with regard to the long hours
on duty and insufficient leave, due, chiefly, to shortage of staff.
Increase is also urgently needed in the salaries in every department
so that the nurses may be able to make provision for old age. When, as
now, so many of them are dependent on a pension as the only provision
for their old age, they are bound to stay at one institution for the
whole or nearly the whole of their lives--an arrangement which is not
to the benefit of either party, for "change is necessary to progress,
and the tendency is, from long years of service in one place, to
narrow and lose the adaptability of earlier years."
More arrangements are needed for the recreation of the nurses when
off duty, especially in institutions situated in the country. Swimming
baths would be a real boon; the beneficial effects of this form
of exercise upon both nerves and body being too well known to need
further comment. Its value also in promoting mutual helpfulness is
by no means negligible. Reading-rooms, apart from the general
common-room, are very valuable, as are also tennis courts where they
can be arranged. All these, of course, mean expense, but, if the
better class woman is to be attracted to the work, her interests
must be considered. Moreover, healthful recreations, apart from their
benefit to the nurse herself, must re-act favourably on the patients.
NURSING IN THE COLONIES
Colonial nursing is usually undertaken by those who possess the spirit
of adventure, and do not mind the prospect of pioneering work. Love of
novelty, strong interest in fresh scenes and peoples, a desire to make
more money than can in most cases be made in England, help a nurse in
colonial work, provided that work really means her life, and she loves
it. But let it be emphatically stated that the nurses who are _not_
wanted in the colonies, in any capacity, are those who are failures
in their work in England, or who simply leave the dull work of the old
country with the object of having a good time abroad. Such women may
do immense harm in countries where it is essential to the Empire that
English people should be looked up to with respect and admiration,
and where almost the most important part of an English nurse's work
(_quite_ the most important _if_ she is working in a hospital), is to
make the native nurses, of whatever race they may happen to be, see
the dignity and possibilities of their profession, and be stirred with
the desire to become proficient themselves.
No special training is required for colonial work. A thorough
all-round training, including midwifery, a high standard of nursing
ethics, a knowledge of hospital organisation, and good business
abilities are needed. The rest is chiefly a matter of temperament
and constitution. It goes without saying that a nurse for foreign
climates, whether tropical, as in the majority of colonial posts,
or subject to extremes of heat and cold, such as in Canada, must
be physically strong; she should also be of an even temper and
philosophical disposition, easily adaptable to climate, conditions,
circumstances, and racial peculiarities.
The nature of the work will vary greatly with the locality and the
kind of post undertaken. The colonial nurse who does private work will
find patients and their needs much the same all the world over; she
must, however, be prepared for anything, and ready to make the best of
all things in emergencies.
In tropical hospitals it is altogether another matter. If the nurse
taking a Matron's post in such a hospital is the first European
to have occupied that post, she will probably have every detail to
organise and put in order, from providing dusters for use in the
wards, to arranging off-duty time for the nurses. She will mostly
likely see at once that everything wants altering, and yet she
will have to "make haste slowly," _very_ slowly, or she will have
everything in a ferment, and every one in open rebellion against her.
If she is working in the East, she will have the endless complications
of caste and race and religion to deal with, and will have for some
time, to learn vastly more than she teaches. Her success or failure
will depend very largely upon how she gets on with the medical
department--in other words, upon her own tact and common-sense, and
whether she can so approve herself to the various medical officers
that they will loyally back her up in her attempts at reform. Once
things are established in working order, it is a question of constant
supervision, day by day, for in no tropical hospital is it possible to
expect that native nurses will do their work well and conscientiously,
without the constant example and supervision of their trained Matron
Colonial posts are chiefly to be obtained through the Colonial Nursing
Association, of which offices are at the Imperial Institute, South
Salaries vary considerably, according to climate and the nature of the
work. In very unhealthy climates, such as the west coast of Africa,
the salary is high, and the risks proportionately so.
Private nurses, and those holding subordinate posts in hospitals get
salaries varying from L60, which is the minimum, to L120 a year. An
Assistant Matron may in some few cases get a salary increasing to
L150 or L200. In a large hospital there is the ordinary chance of
promotion--a Sister may be made Assistant Matron, or an Assistant
Matron become Matron; but most colonial posts are simply for a certain
term of years, at the expiration of which the nurse seeks fresh
fields, her passage, both out and home, being paid. If, however, there
should be a desire on both sides for a renewal of the engagement, the
nurse can usually obtain an increase of salary.
A Matron's salary will vary from L100 to L250, in large Government
hospitals in the Colonies where, it must be borne in mind, leave
entails a journey to England, and a very expensive passage. In
colonial posts there is usually six weeks leave yearly (which may be
taken as three months together in the second year), but in most places
there is no bracing climate within a reasonable distance. This, of
course, does not apply to India and Ceylon, where the hills are easily
Each Government has its own arrangements with regard to pensions; some
posts include pensions, but not all. The retiring age is usually
sixty years. There is, unfortunately, no pension obtainable from the
Colonial Nursing Association itself. This is certainly one respect
in which it would be well if an alteration could be made; it is
a question of funds and has already been brought forward for
consideration. There would be vastly more inducement for really
capable nurses, no longer very young (the age limit for joining is
thirty-five) to join the Colonial Nursing Association, and serve their
country in foreign dependencies, if they were assured of even a small
pension after ten years' hard work in trying climates.
NURSING IN THE ARMY AND NAVY
The training required by Army and Navy nurses is that for general
work. Additional experience according to the branch of the service
which the nurse wishes to enter is also useful. Only fully trained
nurses are appointed. Some of the tending of the sick is done by the
men themselves, under supervision.
In the _Military Service_ the salaries are as follows:
Matron-in-Chief, L305; ordinary Matron, from L75 to L150; Sister, from
L50 to L65; Staff Nurse, from L40 to L45, with allowance for board,
washing, etc., and arrangements for leave and pension after twenty
In the _Naval Service _the arrangements are slightly different,
but the salaries work out at about the same. Foreign service is
There is also a small Army Nursing Reserve, but this is quite
inadequate for purposes of defence, and great efforts have recently
been made to supplement it by voluntary organisations, such as the
British Red Cross Society.
This is, at the present time, carried out by the ordinary staff of
prison warders. There are all over England not more than two or three
trained nurses among them, and it is most desirable that properly
trained women should be in charge of prison infirmary wards, just as
much as in the infirmary wards of workhouses. Prisoners are just as
likely to suffer from disease as other people, and they surely do not
forfeit all claim to expert care, simply because they have, perhaps
in a moment of weakness, yielded to temptation. To one form of illness
needing specially expert nursing, they are peculiarly liable--mental
disease. It is almost impossible to gauge the amount of good which
might be done both for the individual and for society by providing
trained nurses to attend to these unfortunate people.
MIDWIFERY AS A PROFESSION FOR WOMEN (OTHER THAN DOCTORS)
This is not a paper to discuss the suitability of women for midwifery.
All through the ages it has been done by women, until early in the
nineteenth century in England and its colonies, it gradually became
customary for men-doctors to attend such cases; apart from this, the
work of midwifery has never been in the hands of men, except when
abnormal cases have required the assistance of a doctor with knowledge
of anatomy and skilled in instrumental delivery. Even before
the passing of the Midwives Act in 1902, statistics proved that
three-quarters of all confinements in this country were attended by
Continental countries have been alive to the need for training the
women who did this work. For instance, in the great General Hospital
in Vienna with its 3,000 beds, 550 beds were kept apart for maternity
wards, and of these, 200 were reserved for the State training of
midwives--a course of _one_ year's duration being obligatory, with
_daily_ lectures on every detail in midwifery from the Professor of
Obstetrics. The present writer attended these lectures daily for six
months in 1885, and was made to feel the importance in teaching of
"hammering" at essentials and of questioning, so that the lecturer
might discover whether he were talking above the head of the least
clever of the audience.
England's population increased so steadily and rapidly during the
nineteenth century, that it seemed to trouble no one that countless
lives of mothers and babies were lost during the perils of
child-birth; it remained the only civilised country of Europe where a
woman could practise as a midwife without any training at all.
For nearly twenty years before the passing of the Midwives Act in
1902, a small band of devoted women laboured in season and out of
season urging on Parliament the need of a bill requiring a _minimum_
of three months' theoretical and practical training and an examination
before trusting a woman with the lives of mother and child.
This historical fact alone is a sufficiently cogent reason for the
now ever-increasing demand on the part of women for the parliamentary
The Central Midwives Board (C.M.B.), a body of eight members (experts
elected by various bodies, such as the Royal Colleges of Physicians
and Surgeons, the British Nurses' Association, the Midwives'
Institute, etc.), now exercises supervision over the midwives of the
whole of England and Wales, though local supervising authorities also
take cognisance of midwives' work and investigate cases of malpractice
and the like. The address of the Central Midwives' Board is Caxton
The training for the examination of the Central Midwives' Board is
based on the method pursued in medical education in English-speaking
countries, viz., there is not one uniform course, but each of the
training schools attached to hospitals follows out its own plan of
training, each hospital having been approved by the Central Midwives'
Board as giving an adequate training for its examination. There are
now seven maternity hospitals in London, where women students may
train in midwifery. Of these, only one--the Clapham Maternity Hospital
(with its training school founded by Mrs Meredith in 1885)--is, and
always has been, entirely officered by women. Here the course advised
is six months, viz., three months in the hospital (Monthly Nursing),
and three months in the hospital and district doing Midwifery proper.
During this time over 200 cases may be seen, and nearly 100 cases
attended personally. The cost of this training is L35 to L40, which
includes board and residence for twenty-six weeks. Students previously
trained elsewhere may take one months' extra training at a cost of
ten guineas. Private doctors and midwives may also take pupils if
recognised as teachers by the Board.
Midwifery training is now required not only by those who are going
to act as midwives, but also by most missionaries, all fully trained
nurses (for matrons' posts or colonial posts) and by health visitors
and inspectors before obtaining appointments.
But it should be borne in mind, especially in considering the present
condition and future prospects of Midwifery as a profession, that even
now a large though ever-decreasing proportion of registered midwives
are still ignorant women who have never passed the Central Midwives'
Board or any other examination, and have had no teaching from any
one more experienced or better informed than themselves. For when
the Midwives' Act came into force in 1903, it was necessary to move
slowly, and so a clause was inserted, permitting women who had been
in _bona-fide_ practice for more than one year before 1902 to continue
their work under inspection and supervision (with many attempts at
teaching them by means of simple lectures and demonstrations). This
plan, or some similar one, was necessary, not only in the interests
of the midwives themselves, a set of decent and kindly, if ignorant
women, who would have been ruined by too sudden a change, but also
because a large number of mothers in England would have been left with
no one to help them in their time of need unless they were prepared
to run the risk of breaking the law. This, until recently, respectable
English women disliked to do.
It is important to remember this fact, when considering the present
and future prospects of the midwife. The untrained woman used to
charge 5s. or 7s. 6d. for her services, and the fact that her name had
been enrolled on the Government Register, that she was subject to
the supervision of an inspector, without having spent anything on her
change of status beyond the 10s. registration fee, did not suggest the
need of any particular change in her scale of charges. Thus 7s.
6d. per case, unfortunately still remains the very common fee for
midwifery, though this now involves, under the rules of the Midwives'
Board, not only the long hours of watchful care at the birth, but ten
days of daily visits to supervise both mother and baby, with careful
records of pulse and temperature, etc., kept in a register. Naturally,
the general public who employ midwives--viz., the poorer classes--do
not differentiate between the trained certificated midwife and the
untrained _bona-fide_ midwife whose name is on the register, and thus
the scale of charges remains very low and the profession, as one for
educated women, is thereby greatly injured.
Granted an intelligent woman is willing to give six months' work and
study and L35 to L40 for her training, what chance has she of earning
a decent living? If she could command 15s. or 17s. 6d. per case
afterwards, she could make a decent living, given fairly hard work and
the acceptance of real responsibility. If she had 100 cases a year,
she would earn L75 at 15s. per case, and so on. This rise in the
fees payable to midwives has just been made possible by the National
Insurance Act of 1911, the framers of which appear to have recognised
the necessary result of the Midwives' Act of 1902. As the _bona-fide_
midwife, who has received no training, gradually dies out, it becomes
necessary to provide the means of paying trained midwives, whom the
people are obliged to employ in place of the old ones, but who would
soon be non-existent were the means of paying them not also provided
by the State.
A 30s. maternity benefit is now given for every confinement of an
insured person or the wife of an insured person. As the patient may
have free choice of doctor or midwife, it seems possible, now that it
has been established that the benefit shall go direct to the mother or
her nominee, that hereafter the greater part of it may be paid over to
the person who can supply that most necessary item of the treatment,
i.e., good and intelligent midwifery with nursing care of mother and
child. Therefore, it is the right moment for the careful, well-trained
popular midwife definitely to raise her fees to all "insured"
patients, being still willing to help the poor at a low fee as before.
It should be remembered that in about one-tenth of all her cases,
medical help will be required, but this case could probably be guarded
against by an insurance fund, if properly organised.
We frankly admit that as things now stand--apart from the possibility
of the maternity benefit being made to help her--midwifery is
financially but a poor profession. But to an enthusiastic lover of
her kind, who has other means or prospects for her future than the
proceeds of her profession, there is much that is attractive in this
most useful calling.
Now let us turn to a consideration of the poor mother. Dr Matthews
Duncan in 1870 put the puerperal mortality at 1 in 100 for in-patients
and 1 in 120 for patients in their own homes--shocking figures for
a physiological event! Miss Wilson, a member of the Central Midwives
Board, stated in 1907 that the average mortality of English women,
from puerperal fever, a preventable disease, is 47 in 10,000 or _1 in
213_, but that in three of the best lying-in hospitals this figure has
been reduced to less than _1 in 3,000_. To quote Miss Alice Gregory
in her article on this subject in _The Nineteenth Century_ for January
1908: "We feel there is something hopelessly wrong somewhere. It
becomes indeed a burning question: By what means have the Maternity
Hospitals so marvellously reduced their death rate?"
The answer is not now far to seek in the opinion of the writer,
who has worked continuously at Midwifery since 1st May 1884. It is
probably wholly contained in the three following points:--
(1) All that makes for scrupulous asepsis in
every detail for the surroundings of the
(2) The absence of "Meddlesome Midwifery."
(3) Pre-maternity treatment, a factor which
the writer considers to be of great importance,
and of which she would like
to have much more experience.
By this is meant the building up of the future mother's health by
improved hygiene and careful, wise dieting and exercising and bathing
during the last three months of pregnancy, which enables many a
stumbling-block to be removed out of the way. Hence, the utility of
pre-maternity wards wisely used. This is, one knows, a "counsel of
perfection"; but every expectant mother should and could be taught how
to treat herself wisely at this time.
These three points are all in favour of the well-trained midwife.
(1) _Scrupulous Asepsis_, if intelligently taught, can be learned in
six months' training, though one feels bound to add it requires moral
"grit" in the character to make one unswervingly faithful in observing
it. The midwife, too, should run no risk of carrying infection from
others, as a doctor might do.
(2) "Meddlesome Midwifery" is not so much a temptation for the midwife
as the doctor, though she also may want to do too much. Patience
combined with accurate knowledge when interference is urgently needed,
is part of her training.
(3) The midwife who becomes a wise friend to her patients will be just
the one to whom the mother will gladly apply early, and who will know
if it is advisable to send for skilled medical advice. Contracted
pelvis, threatened eclampsia, and antepartum haemorrhage are typical
cases, which lose half their terror if diagnosed and treated early.
If ever it is recognised that good midwifery is at the root of the
health of the nation and the new maternity benefit is made to help
in obtaining it, it will at once become worth while for educated and
intelligent women to take to the profession seriously. A practice
could then be worked by sets of two or three midwives in co-operation,
and with proper organisation as regards an insurance fund for securing
operative midwifery from medical practitioners when necessary.
There is ample room for a much larger body of trained midwives than
exists at present, if the health and welfare of the nation are to be
secured, while the women themselves could, under these conditions,
earn a sufficient livelihood.
Trained nurses also specialise in midwifery. They take the full course
of training described above, completing this by passing the Central
Midwives' Board Examination. They do not practise for themselves,
but work only under doctors, thus replacing the monthly nurse. The
improvement in health and comfort of both mother and child, when
nursed by some one thoroughly competent, is very marked.
The fees which they receive for this work are usually 12 to 14 guineas
for the month, and in some cases may rise to 18 guineas.
This work demands a healthy body and cheerful mind, a love of the
work, endurance, and much tact in dealing with the nervous cases for
which this form of treatment is found to be beneficial.
It may be undertaken either
(1) As a separate profession, or
(2) As an additional qualification by trained nurses.
The training must be good and adequate to ensure any success as a
masseuse, so great care should be exercised in the choice of a
school. The many training schools advertised are of varying degrees
of efficiency, and those prepared to train in a few weeks, or by
correspondence only, are obviously unsatisfactory.
On application to the secretary of the Incorporated Society of Trained
Masseuses, information can be obtained with regard to the training
schools in London and the Provinces where a course of instruction in
massage is given, which is accepted by the society as adequate.
The society itself is an independent examining body which insists on
a satisfactory standard for massage workers. It holds two examinations
yearly and grants a certificate to successful candidates. No one may
enter for the examination unless she can show that she has received
her training at one of the schools approved by the society.
Adequate training in massage includes a course of not less than six
months in Elementary Anatomy and Physiology, the Theory and Practice
of Massage and a course of bandaging. Students usually attend the
classes from 10 A.M. to 4 P.M., lectures being given in the morning,
demonstrations and practical work on "model patients" in the afternoon
Sufficiently advanced students are allowed to attend at hospitals or
infirmaries to see--and themselves to carry out under the teacher's
supervision--the treatment ordered for the patients by the doctor. In
this way all students have opportunity during their training of seeing
and giving treatment to the various cases which they may have to deal
with as qualified masseuses when working under private doctors.
Some training schools give their own certificate after training,
and this is useful as a guarantee of the training taken. It is not,
however, such an assurance of efficiency to the medical profession or
the general public as the certificate gained after examination by an
independent examining body.
There is also a further examination held by the society once yearly
in Medical Gymnastics. The minimum time to expend on this is a further
six months after qualifying as a masseuse, so that it takes a year to
gain the double qualification.
In addition to supplying the independent examination in these
subjects, the society watches over the interests of the masseuses. All
its members are bound to observe the rules of the society. The result
of this is threefold.
(1) The doctor is assured that the masseuse
will not undertake cases on her own
diagnosis, but work only under qualified
(2) The public is assured that the masseuse
is a trustworthy woman as well as an
(3) The masseuse herself is protected from
undesirable engagements. This is of
The training for the examination previously
mentioned is from 10 to 15 guineas for those taking
the course. There is generally some reduction
made for nurses. The further course in Medical
Gymnastics costs from 20 guineas.
From this it will be seen that the whole training is comparatively
inexpensive; it is, however, not a profession to be entered lightly.
London is already overstocked and the better openings at the present
time are to be found in the Provinces, in Scotland and the Colonies.
It is well to start, if possible, in a town where the masseuse is
already known either to the doctors, or to some influential residents.
Much depends on the individuality of the masseuse, and one who is
prepared to give all her time to the work, taking every call that
comes, may reasonably expect to make in her first year from L50 to
L100. By the third year a steady connection should be formed, bringing
in an income of L150 to L250. This cannot, however, be expected unless
the masseuse has some introductions to start her in her work.
Fees in the country vary from 3s. 6d. to 7s. a visit, and in London
and some other places they rise to 10s. 6d. for an hour or less.
Hospital and nursing-home appointments are most useful as experience
for the masseuse in her first year; they should be tried before
she finally decides where to start work. Such appointments are
residential, and the salaries offered vary from L30 to L70 a year.
It must not be forgotten that, owing to the short and comparatively
inexpensive training, very many women take up this work,
so that the above excellent results are not realised unless the
masseuse has good introductions. The value of a thoroughly reliable
society such as that mentioned cannot be over-estimated, not only
for its certificate, but also on account of the information it can
give as to the respectability of posts advertised for masseuses.
Many of these are unfortunately merely blinds for undesirable houses.
WOMEN AS SANITARY INSPECTORS AND HEALTH VISITORS
The introduction of women into the public health service is a modern
development, although they have been engaged in it longer than is
Women who are employed in Public Health Work hold office under Local
Sanitary Authorities, and their work must not be confused with that
of the Women Home Office Officials, who were first appointed in 1895;
these inspect factories and workshops, but their powers and duties
are of a different character. For instance, the Women Home Office
Inspectors deal, amongst other things, with the cleanliness of
factories, but not with the cleanliness of workshops, and with the
heating of workshops, while the ventilation of the same workshops is
under the control of the local sanitary officials.
Glasgow was the first county borough to utilise the services of Women
Health Officials, for in May 1870 four "Female Visitors," afterwards
known as Assistant Sanitary Inspectors, were appointed in connection
with the Public Health Department. Their duties were: "by persuasion
principally, to induce the women householders to keep the interiors
of their dwellings in a clean and sanitary condition, and to advise
generally how best this can be maintained." They possessed the same
right of entry to premises as the men inspectors, and were required
to hold the certificate of the Incorporated Sanitary Association of
Scotland. They reported certain nuisances, but themselves dealt
with others, such as "dirty homes or dirty bedding, clothing, and
The work of Women Health Officials in England, dates from the passing
of the Factory and Workshops Act of 1891, when certain duties with
regard to workshops, which had previously been performed by the Home
Office Inspectors, were laid upon Sanitary Authorities.
In the opinion of Dr Orme Dudfield, late Medical Officer of Health
for Kensington: "It soon became apparent that, not only was systematic
inspection necessary, but also that many of the duties involved
were of so special and delicate a nature that they could not
be satisfactorily discharged by male inspectors." He therefore
recommended the appointment of two Women Inspectors of Workshops in
Kensington. In the meantime the city of Nottingham had appointed a
Woman Inspector of Workshops in May 1892, and in accordance with
Dr Dudfield's recommendation two Women Inspectors were appointed in
Kensington in 1893.
These ladies were appointed as inspectors of workshops _only_.
They did not hold Sanitary Certificates, nor had they the status of
Sanitary Inspectors. In practice, this entailed a visit by a male
inspector every time it was necessary to serve a legal notice for
the abatement of any contravention of the Factory and Workshops'
Act. Therefore, when these ladies resigned upon their appointment as
Factory Inspectors, it was decided to appoint the in-coming ladies as
Sanitary Inspectors, with power to deal with these matters themselves.
It was, however, Islington which appointed the first woman with the
legal status of Sanitary Inspector in 1895.
By 1901, eleven women had been appointed in the Metropolitan area as
Sanitary Inspectors, nearly all of them exclusively engaged in the
inspection of workshops. Since that time the number of women appointed
by Local Sanitary Authorities has increased considerably, both in
London and the Provinces. The exact number outside London is only
known approximately, as no register exists which is available to the
public. It is to be hoped that this information may be obtainable
from the last census returns. The figures with regard to London are
published annually by the London County Council, and there are now
forty-one Women Sanitary Inspectors in the Metropolitan area.
Sanitary inspectors in London, whether men or women, are required to
hold the certificate of the Sanitary Inspectors' Examination Board,
the examination for which is the same for men and women. Outside
London no definite qualification is required by the Local Government
Board, but it is usual in county and municipal boroughs for a sanitary
certificate to be demanded from candidates for the position of
Inspector of Nuisances (the term used outside London for Sanitary
Officials). Men and Women Sanitary Inspectors possess equal rights of
entry to premises and equal statutory powers for enforcing compliance
with the law.
The duties of Women Sanitary Inspectors have become very varied and
numerous during the past ten years; they differ considerably according
to locality and to the opinions of the local Medical Officer of
Health. Broadly speaking, before 1905 women in London were mainly
engaged in the inspection of workshops, whereas in the Provinces (with
the exception of Nottingham, Leicester, and Manchester) they were
engaged in house-to-house visitation in the poorer parts of the towns,
with a view to the promotion of cleanliness, giving advice to mothers
concerning the feeding and care of infants and young children, and
the detection of sanitary defects. The inspection of workshops in the
Provinces was a later development.
These varied duties have called for special qualifications, and, in
addition to certificates in sanitation, Women Sanitary Inspectors
usually hold qualifications in nursing or midwifery. The general
education of the women who take up this profession is, on the whole,
superior to that of the men. Most of the women have had a high school
education, and many are University graduates, while the men, as a
rule, come from the elementary schools.
The duties of a Woman Sanitary Inspector are sufficiently varied to
avoid monotony, and may comprise any or all of the following:--
_A_. (1) The inspection of factories in order to
see that suitable and sufficient sanitary
accommodation is provided for women,
in accordance with the requirements of
the Public Health Acts.
(2) The carrying out of the provisions of
the Public Health and Factory and
Workshops Acts, with regard to the
registration and inspection of
_(a)_ laundries, workshops, and workplaces
(including kitchens of
hotels and restaurants) where
women are employed;
_(b)_ Outworkers' premises.
(3) The inspection of tenement houses and
houses let in lodgings, and the enforcement
of the bye-laws of the Sanitary
Authority affecting these.
(4) House-to-house inspection in the poorer
parts of the district.
(5) The inspection of public lavatories for
(6) The carrying out of duties and inspection
(_a_) Notifiable infectious diseases,
such as scarlet fever.
(_b_) Non-notifiable infectious diseases
such as measles.
(_c_) The notification of consumption.
(7) Taking samples under the Food and
Drugs Acts. (This work is rarely
given to women.)
For many of the above duties, women are obviously better fitted than
men, but for the following most important group of duties men are
practically disqualified by reason of their sex:--
_B_. Health visiting. Work in connection with
the reduction of infantile mortality :--
(1) Notification of Births Act, 1907. Visiting
infants and giving advice to mothers
about the feeding and general management
of young children.
(2) Advising expectant mothers on the
management of their health and as
to the influence of ante-natal conditions
on their infants.
(3) Work in connection with milk depots and
(4) Promotion of general cleanliness in the
home and discovery of sanitary defects
remediable under the Public Health
(5) Investigation of deaths of infants under one year of age.
(6) Lecturing at mothers' meetings.
(7) Organisation of voluntary Health
Workers in the district and arrangement
of their work.
_C._ The following duties may also be required
in the Provinces:--
(1) Work relating to the administration of
the Midwives' Act, 1902 (where the
County Council have delegated their
powers to the District Council).
(2) The inspection of shops under the Shop
Hours Act, 1892-94, and the Seats for
Shop-Assistants Act, 1899.
The work described under _C._ 1 and 2, is performed in London (except
in the City) by special inspectors appointed by the London County
Council, who also inspect employment agencies where sleeping
accommodation is provided and carry out certain duties under the
(3) Work in connection with the medical
inspection of school children (performed
in London by the London
County Council school nurses).
The duties of Men Sanitary Inspectors are very clearly defined, and
differ considerably from those of the women. Men are mainly engaged
in the inspection and reconstruction of drains, the detection of
structural defects in the houses of the working classes, the carrying
out of bye-laws with regard to tenement houses, the investigation of
cases of notifiable infectious diseases, the inspection of workshops
and factories, the enforcement of the law with regard to the sale of
foods and drugs and the abatement of smoke nuisances.
As will be seen from the duties enumerated above, Women Inspectors, as
a general rule, are brought into very close and intimate contact with
the homes of the people, and this necessitates the exercise of much
tact and patience. The large demands thus made upon their powers of
persuasion and teaching capacity, involve a considerable strain upon
their nervous energy as well as their physical strength. The work
of the Men Inspectors, on the other hand, being of a more official
character, does not involve the same strain.
There is no uniformity of practice with regard to hours of work,
holidays, remuneration or superannuation, either within or without the
metropolitan area. Each Local Authority makes its own arrangements.
Many have no superannuation scheme and give no pensions. Men and women
working for the same Authority usually work under the same conditions
as to hours and holidays: the rate of remuneration, however, is by no
means the same. The salaries of Women Sanitary Inspectors within the
Metropolitan area range from L100 to L200 per annum, the latter figure
being reached only in two boroughs and in the City of London: whilst
the salaries of the men range from L150 to L350. The average maximum
salary of the women is L150, and the average maximum salary of the men
is L205. Outside London, the salaries of both men and women are lower,
those of the women ranging from L65 to L100, a few rising to L150.
Payments are made monthly, and a month's notice can be demanded
on leaving, though it is frequently not enforced. Another unjust
distinction frequently made between men and women is that the latter
are generally compelled to retire upon marriage, thus enforcing
celibacy on some of our most capable women.
The hours of work are usually from 9 A.M. to 5 or 6 P.M. and to 1
P.M. on Saturdays. If we consider the nature of the work, the holidays
appear most inadequate--viz.: only from two to three weeks per
annum are allowed in London, and from ten to fourteen days in many
The Health Visitor, as a public official, was not known until 1899,
when several were appointed by the City Council of Birmingham. The
name "Health Visitor" was thought to be more feminine and suitable
than that of Inspector, and it was imagined that she would in
consequence be better received in the homes of the people. As a
private society in Manchester had previously engaged women of an
inferior class and education with the title of "Health Visitor," this
designation was deprecated by women already in the profession. Many
smaller provincial towns, however, followed the example of Birmingham,
and appointed Health Visitors instead of Women Sanitary Inspectors.
It was not until later that the Health Visitor was introduced into
London, and in the following way:--
In the Metropolitan area (exclusive of the City) half of the salary
of all Sanitary Inspectors is paid out of the County Rate, and their
duties are defined in Sections 107 and 108 of the Public Health
(London) Act, 1891. As Medical Officers of Health and the public
generally became more and more interested in the question of infant
mortality, Women Inspectors were employed to investigate infant
deaths, to visit houses where a birth had taken place and advise
mothers on infant care, to manage milk depots, to weigh babies, and to
assist at infant consultations, and to do a great deal of work which
hitherto had not been considered the work of a Sanitary Inspector.
There was never any question as to the value of the work done nor of
the efficiency with which it was performed, but the Local Government
Board Auditor took the view that it did not come within the scope of
the order of 1891, defining the duties of a Sanitary Inspector, and
he refused to sanction the payment out of the County Rate of half the
salary of those women who were engaged in Health Visiting work. In
March 1905, the borough of Kensington solved the difficulty for itself
by appointing a Health Visitor and paying the whole of her salary out
of the Local Rate; but less wealthy boroughs felt unable to do this.
It was work which the Sanitary Authorities wanted to undertake; it was
work which the London County Council and the Local Government Board
were desirous of seeing performed, but this technical difficulty stood
in the way. It was overcome by the inclusion in the London County
Council General Powers' Act of 1908, of Section 7, which empowered
Sanitary Authorities in the Metropolitan area to appoint Health
Visitors, and this enabled the London County Council to contribute
half their salaries out of the County Rate. As a matter of fact, at
the present time (November 1913) the whole of the salary of Health
Visitors in London is being paid out of the Local Rate, as the
Exchequer contribution account is completely depleted by the payment
of the moiety of the salary of Sanitary Inspectors.
The essential difference between a Woman Sanitary Inspector and a
Health Visitor is that the Woman Sanitary Inspector is a statutory
officer with a legal position, having definite rights of entry and
certain statutory powers for enforcing the Public Health Acts, while
a Health Visitor is a purely advisory officer, with no legal status
or right of entry or power to carry out any of the provisions of the
Public Health Acts.
In actual practice, the title of Inspector has in no way proved an
obstacle to successful health visiting, as may be demonstrated by
an enquiry into the work now being carried on by Women Sanitary
Inspectors in Sheffield, Leeds, Liverpool, Bradford, London, and other
places. On the contrary, it has enabled officials to obtain an entry
into dirty and insanitary places and to expose cases of neglect, which
might otherwise have remained undiscovered.
The Health Visitor is usually paid a lower salary than the Woman
Sanitary Inspector; this ranges in London from L100 to L120; in the
provinces it may be as low as L65 per annum, and rarely rises above
L100. The hours of work and holidays are, as a rule, the same as for
Women Sanitary Inspectors. The difference in salary has proved a great
temptation to Local Authorities in London to appoint Health Visitors
when Women Sanitary Inspectors would have been more useful and
efficient officers. Indeed, it is to be deplored that very few members
of Local Authorities understood the advantages to be gained by the
appointment of the more highly qualified official. The immediate
effect of Section 7 was that several boroughs, having no women
officials, proceeded to appoint Health Visitors; other boroughs, which
possessed Women Sanitary Inspectors, also appointed Health Visitors.
Seven or eight boroughs re-appointed their women officials in the dual
capacity of Sanitary Inspector and Health Visitor so that the work in
those cases went on as before. An indirect effect has been the almost
complete cessation of the appointment of Women Sanitary Inspectors
and the diminution in their number in some boroughs by the lapse of
appointments on resignation or marriage. The inspection of workshops
where women are employed has, in several instances, fallen back into
the hands of Men Inspectors, whose unsuitability for this work first
called women in England into the Public Health Service.
In September 1909 the Local Government Board issued the following
order with regard to Health Visitors in London:--
"Art. 1. Qualifications. A woman shall be qualified to be appointed a
Health Visitor if she
(_a_) is a duly qualified medical practitioner ; or
(_b_) is a duly qualified nurse with three years' training in a
hospital or infirmary, being a training school for nurses and having a
resident physician or surgeon; or
(_c_) is certified under the Midwives' Act, 1902; or
(_d_) has had six months' nursing experience in a hospital receiving
children as well as adults, and holds the certificate of the Royal
Sanitary Institute for Health Visitors and School Nurses, or the
Diploma of the National Health Society; or
(_e_) has discharged duties similar to those presented in the
regulations in the services of a Sanitary Authority and produces such
evidence as suffices to prove her competency; or
(_f_) has a competent knowledge and experience of the theory and
practice of nurture, and the care and management of young children,
of attendance on women in and immediately after child-birth, and of
nursing attendance in cases of sickness or other mental or bodily
"Art. 2. Every appointment must be confirmed by the Board.
"Art. 6. Enables a Sanitary Authority to determine the appointment of
a Health Visitor by giving her three months' notice, and no woman may
be appointed unless she agrees to give three months' notice previous
to resigning the office or to forfeit a sum to be agreed.
"Art. 8. Outlines the duties of the Health Visitor but prohibits
her from discharging duties pertaining to the position of a Sanitary
Inspector (unless with the consent of the Board she holds the dual
"Art. 9. The Board's approval is required to the salary to be paid
to the Health Visitor, and an allowance in respect of clothing, where
uniform or other distinctive dress is required, may be made."
The Board in their circular letter state that they consider that,
in consideration of the importance of the duties and of the salaries
often paid to Women Sanitary Inspectors in London, the salary ought
not to be less than L100 per annum.
It will be seen from the above that it is quite possible for a Health
Visitor to be appointed practically without any qualification for the
position, and with absolutely no knowledge of Public Health Law and
It is, therefore, apparent that there are two classes of women
officials in connection with Public Health Departments, one on the
same footing as the men, with equal powers and responsibilities, but
remunerated at a much lower rate, and another with a lower status and
a still lower rate of remuneration. The duties of the second class may
be performed equally well by the first, but the duties of the first
cannot be performed by the second. The introduction of the Health
Visitor has therefore lowered the status of the Public Health Service.
The remedy for this state of affairs is for competent woman officials
in the future to be appointed in the dual capacity of Sanitary
Inspector and Health Visitor at an adequate remuneration, and for
the order of 1891 defining the duties of a Sanitary Inspector to be
expanded to meet the developments which have been taking place in the
Public Health Acts since that date.
There are two organisations which Women Sanitary Inspectors may
(1) The Women Sanitary Inspectors' Association, which includes
as members Women Sanitary Inspectors and Health Visitors holding
recognised certificates in sanitation. (Health Visitors holding
official appointments but without these recognised certificates in
sanitation may become associates.)
(2) The Sanitary Inspectors' Association, which is composed of a large
number of Men Sanitary Inspectors and a few Women Sanitary Inspectors.
This is not open to Health Visitors.
There is no approved society for Sanitary Inspectors under the
Insurance Act. The income of the majority of Men Inspectors exempts
them from the operation of the Act, but a large number of Men and
Women Inspectors receiving less than L160 per annum, have joined
the approved society of the National Association of Local Government
To sum up, we may say that on the whole the life of a Health Official
is a healthy and suitable one for a woman of average physique; it
demands great activity, with many hours spent out of doors, and
whoever undertakes it must be prepared for surprises and difficulties.
She may find herself in an office staffed entirely by men, with chief,
committee, and council composed entirely of men--indeed everything
looked at from the male standpoint. She either works singly or in
small groups of two or three, except in a few large towns where the
women officials may number from ten to twenty. Thus isolated and
scattered, it is extremely difficult for the Women Health Officials
to form an effective organisation. What is accomplished under one
Authority may have little or no effect upon another.
One condition which presses heavily on many women is the shortness
of the holidays. The work is always arduous, particularly in poor
districts where one is brought face to face with poverty, disease, and
suffering, and from two to three weeks is not sufficient for rest and
recuperation, particularly as the years pass on.
The creation of public opinion and the advent of a greater number of
women on Municipal Councils and Health Committees is greatly needed
to improve the conditions under which women officials work, and to
support their reasonable demands.
[Footnote 1: Full particulars of this can be obtained from the
Secretary, Sanitary Inspectors' Examination Board, Adelaide Buildings,
[Footnote 2: The above article considers under the term "Health
Visitors" such women only as are serving under public Municipal
Authorities. Unfortunately, since it gives rise to confusion, the
name is also used in connection with officials privately appointed by
various charitable institutions. These have no universally recognised
standard of attainments: some of the so-called "Health Visitors" are
without any qualifications, others, _e.g._, those employed by the
Jewish Board of Guardians, are fully trained and do excellent work,
comparable with that performed by Hospital Almoners. We hope, in a
later volume of this series, to publish an article on their duties and
WOMEN IN THE CIVIL SERVICE
THE HIGHER GRADES: PRESENT POSITION AND PROSPECTS FOR THE FUTURE
The claim that women should be allowed to enter not only the lower but
the higher branches of the Civil Service is being freely made at the
present time. It is very generally felt that posts in which the holder
has to execute judgment and to decide on administrative matters should
be open to women as well as to men.
Many reasons are urged for admitting women more freely to a share in
the responsible work of the Service, but the true basis of their claim
lies in this--that the most successful form of government and the
happiest condition for the governed can only be attained, in the
State as in the family, when masculine and feminine influences work in
It is not, perhaps, widely known that women have already made their
way into many branches of the Service and have done invaluable work
therein. Perhaps the strongest argument that can be urged in favour of
their admission into yet other branches of the Service will be found
in the following brief survey of the appointments held and the work
already done by them in various directions.
_The Local Government Boards_
The credit of being the first Government Department to appoint a Woman
Inspector belongs to the English Local Government Board. As far
back as 1873, yielding to the pressure of public opinion, that Board
appointed a Woman Inspector, with full powers to inspect workhouses,
and district schools. During the short period of her appointment, this
lady did excellent work, and called attention to much needed reforms
in the education of girls in Poor Law Schools. Unfortunately, owing
to a breakdown in health, she was obliged to resign her appointment in
November 1874, and the Local Government Board, either repenting of
its enlightened action, or not appreciating the aid of a woman even
in matters concerning the welfare of women and girls, refrained from
appointing a woman to succeed her. It was not until 1885 that another
Woman Inspector was appointed, and then her work was restricted to the
inspection of Poor Law Children boarded out beyond the Union to which
they belonged. In 1896, once more by reason of the pressure of public
opinion, a woman was appointed as an Assistant Inspector of Poor
Law Institutions in the Metropolis. In 1898 a second Inspector
of Boarded-out Children was appointed, and in 1903 the number of
Inspectors was increased to three, each Inspector having a district
assigned to her.
Four years ago the total number of Women Inspectors was increased to
seven, and the scope of their duties somewhat widened, as will be seen
below. There is now one Superintendent Inspector at a salary of L400
to L450, and six Inspectors at L250 to L350. Candidates for these
inspectorships must have had considerable administrative experience.
They must hold a certificate of three years' training as a Nurse, and
the Central Midwives' Board's certificate is considered desirable.
These qualifications have only been required since 1910.
The duties assigned to the Women Inspectors include (1) the inspection
of boarded-out children, both within and beyond the Poor Law Unions
to which they belong; and (2) the inspection of Poor Law
Institutions--_i.e._, infirmaries, sick wards of workhouses, maternity
wards, and workhouse nurseries: also of Certified Homes, Cottage
Homes, and Scattered Homes.
The duties of the Women Inspectors in connection with the boarding-out
of Poor Law Children include the visiting of officials of Boarding-Out
Committees, and of homes in which children are boarded out; the
Inspector visits a sufficient number of children and homes to enable
her to satisfy herself that the duties of the Boarding-Out Committee
are carried out in a satisfactory manner, and makes a report to the
Board thereon. Women Inspectors arrange their own inspections of
boarded-out children within a prescribed district.
Each of the fourteen districts into which the country is divided for
Poor Law purposes is placed under the care of a General Inspector
(male), whilst the half dozen Women Inspectors are available for
duty in these districts, but only at the invitation of the General
Inspector. If an Inspector omits to arrange for these visits it is
possible for his district to remain unvisited by a Woman Inspector for
an indefinite period. When it is remembered that there are still
194 Unions without a woman on the Board of Guardians, the present
arrangement, by which the Women Inspectors can only inspect Poor Law
Institutions on sufferance, is seen to be indefensible and the need
for reform in this direction urgent.
There is one Assistant Woman Inspector, who is a highly qualified
medical woman, in the Public Health Department of the Board. She has
been in office only a few months, but it has been remarked in more
than one quarter that the enhanced value of the recent report of
the Board's Medical Officer on Infant Mortality is due to her
The jurisdiction of the Local Government Board in London is confined
to England and Wales--Scotland and Ireland having their own Boards in
Edinburgh and Dublin respectively.
The Local Government Board for Scotland appointed a Woman Inspector
for the first time about three years ago, at a salary of L200 a year.
She is a fully qualified medical woman. Her duties include both Poor
Law Work (_e.g._ the inspection of children in poor-houses or boarded
out, enquiries into complaints of inadequate relief to widows) and
Public Health Work (_e.g._ enquiries into any special incidence of
The Local Government Board for Ireland employs two Women Inspectors,
one at a salary of L200-10-L300 and the other at a salary of L200, to
inspect boarded-out children.
There are no prescribed qualifications for these posts; but they
have always been, and still are, held by highly qualified
women--distinguished graduates and experienced in social work; one is
a doctor of medicine.
Sir Henry Robinson, Vice-President of the Local Government Board for
Ireland, said in his evidence before the Royal Commission on the Civil
Service that he would like to have one or two women doctors to go
round the work-houses and to visit the female wards, but the salaries
offered by the Treasury to women doctors seemed to him too low to
attract well qualified women.
_The Home Office_
It was about twenty years ago that the Home Office began to realise
that the ever-increasing number of women and girl workers in factories
and workshops made it imperative that women as well as men inspectors
should be appointed if the Factory Acts intended for the protection of
workers were to be effectually enforced. There was no doubt even from
the first about the usefulness of these Women Inspectors, but in ten
years' time the number appointed for the whole of the United Kingdom
had only increased to eight. At the beginning of the present year,
1913, they numbered eighteen, and only within the last few months has
this number been increased to twenty.
There is one Woman Inspector of Prisons at a salary of L300-15-L400.
(The lowest salary received by Men Inspectors is L600-20-L700.)
There is also one Woman Assistant Inspector of Reformatories and
Industrial Schools. Her salary is L200-10-L300, whilst that of Men
Assistant Inspectors is L250-15-L400.
Women Factory Inspectors are appointed in the same way as men. A
register of candidates is kept in the office, in which the name of
every applicant is entered. When a vacancy occurs a selection is made
from the list, and the best qualified candidates are interviewed by
a Committee of Selection, consisting of the Parliamentary
Under-Secretary, the Private Secretary, the Chief Inspector of
Factories and the Chief Woman Inspector. Generally speaking, about
one half of the candidates interviewed are selected to sit for an
examination in general subjects. At the end of two years' probation
a qualifying examination in Factory Law and Sanitary Science must be
The Principal Woman Inspector is responsible to the Chief Inspector
of Factories for the administration of the Women Inspectors' work
throughout the United Kingdom. Women Inspectors are stationed at
Manchester, Birmingham, Glasgow, and Belfast. The work of the Women
Inspectors is so organised as to be entirely separate from that of the
Men Inspectors, although they cover the same ground. The nature and
scope of the women's work is so generally known that it is perhaps
unnecessary to describe it in much detail. Investigations into cases
of accident affecting women and girl workers or into complaints as to
the conditions under which they work are promptly made by the Women
Inspectors. Women Inspectors (equally with men) have power to enter
and inspect all factory and workshop premises where women and girls
are employed. They are empowered to enforce the provisions of the
Factory and Truck Acts and to prosecute in cases of breach of the law.
They conduct their own prosecutions.
The reports of the Women Inspectors evoked much appreciative comment
during a recent debate in the House of Commons. Some interesting
remarks on their work are also to be found in the evidence given
before the Royal Commission on the Civil Service by Sir Edward Troup,
K.C.B., Permanent Under-Secretary of the Home Office.
The number of Women Inspectors at present employed is not nearly
large enough to cope with the work that needs to be done. It must
be remembered that the staff enumerated above is responsible for the
inspection of factories and workshops in Scotland and Ireland as well
as in England, and that the number of women engaged in industrial work
has increased during the last five years from about one and a half
millions to two millions. The necessity of increasing the number of
Women Inspectors has frequently been urged upon the Government in
the House of Commons and in the press, and it seems probable that the
Government must soon yield to this pressure.
The following extract from the _Women's Trade Union League Quarterly
Review_, July 1913, may be of interest in this connection:--
"That the Women Inspectors' staff in particular is far below the
numerical strength which would enable it to cope adequately--we do not
say completely--with the task presented to it, has long been patent
to every one who knows anything of the industrial world and the
part taken in it by the woman worker. But in 1912 promotions and
resignations left gaps in the already meagre ranks which for some time
were not filled even by recruits, with the result that the number
of inspections was necessarily reduced in proportion. To those who
realise, as we do, the importance of the women inspectors' visits,
both in detecting infringements of the law and in making clear its
provisions and their value to the employer and worker alike, this
decrease, even for a time, of the opportunities which Miss Anderson's
staff enjoy of exercising their beneficent and educative influence
seems altogether deplorable. The recent promise of the Home Secretary
to increase that staff by two is very welcome, but we cannot pretend
to think that such an increase will meet the need which these pages
There is one Woman Inspector of Prisons, a qualified medical woman,
who acts also as Assistant Inspector of State and Certified Inebriate
Reformatories. Her salary is L300-15-L400, whilst the lowest salary
received by Men Inspectors is L600-20-L700.
There is one Woman Assistant Inspector of Reformatories and Industrial
Schools in Great Britain. Her salary is L200-10-L300, whilst that of
Men Assistant Inspectors is L250-15-L400.
_The Board of Trade_
The first woman to be admitted to the higher branches of the Board
of Trade was appointed as a Labour Correspondent in 1893. In 1903 she
became the Senior Investigator for Women's Industries, the salary of
the post being fixed at L450. A Senior Investigator's Assistant was
also appointed at a salary of L120-10-L200, but the salary has now
been increased to L200-L300. These posts are open only to University
women with high honours.
The Senior Investigator, with the help of her Assistant, undertakes
special enquiries into the conditions in women's industries. Perhaps
her most important function is to originate investigations concerning
women, which will yield information likely to be useful to the
Department in the future, when some particular question comes up for
discussion or decision. For instance, when the question of bringing
laundries within the scope of the Trade Boards Act was under
discussion, the investigations previously made by the Women
Investigators into wages and conditions proved invaluable.
There are also three Women Investigators appointed in connection
with the Trade Boards. Their duty is to assist in the collection of
information relating to the scheduled trades, in all of which a large
number of women is employed. They may be called upon to help in the
preliminary work involved in setting up new Trade Boards. They explain
as far as necessary the provisions of the Act to the working women
concerned get nominations of workers to sit on those Boards and
otherwise assist the Boards in carrying out their functions. They also
conduct inspections to see that the law is carried out.
All these appointments are made by the President of the Board of Trade
on the recommendation of the Civil Service Commissioners.
The establishment of Labour Exchanges under the Board of Trade some
years ago gave occasion for the appointment of a considerable number
of women to responsible posts. On the organising staff at the Central
Office there is a Principal Woman Officer at L400-15-L450, who is
responsible for the organisation of the women's work in all the Labour
Exchanges. She has an Assistant at L150-L7, 10s.--L200. A woman also
acts as Secretary to the large London Juvenile Advisory Committee. She
has the acting rank of an Assistant Divisional Officer, although her
salary (L300-15-L400) is less than that received by men Assistant
There are nine Senior Organising Officers with salaries of
L250-10-L350, six of whom are women. The three men holding these
appointments deal with Juvenile work only, whereas some of the women
are in charge of both Women's and Juvenile work. Of the five Junior
Organising Officers at L200--L7, 10s.--L250, three are women. The nine
Assistant Organising Officers at L150--L7, 10s.--L200 are all women.
All these officers are engaged in organising the work of the Juvenile
and Women's Departments all over the country, and inspecting local
offices. There are also twenty secretaries to Juvenile Advisory
Committees, who may be either men or women. The salary for these posts
In the Divisional Offices there are some staff posts open to women
at a salary of L200 to L300. Their work is purely clerical, and is
concerned with Unemployment Insurance.
The original appointments in this branch of the Board of Trade were
made by a Selection Committee on which the Civil Service Commissioners
were represented. Applications were invited by advertisement, and
a large number of candidates was interviewed. The more recent
appointments have been filled by candidates who have first appeared
before a Board, and have then passed a qualifying examination,
conducted by the Civil Service Commission.
_Board of Education_
The Board of Education (or the Education Department, as it was
then called) was established in consequence of the passing of the
Elementary Education Act of 1870. Its jurisdiction was and still is
limited to England and Wales.
Notwithstanding that it was responsible to Parliament for regulating
the conduct of public elementary education all over the country,
and that in those schools there were hundreds of women teachers and
thousands of little girl pupils, it seems not to have occurred to
the Department to call in the aid of women either as inspectors
or administrators until the appointment in 1884 of a Directress of
Needlework. A Directress of Cookery was added in 1891, and laundry
work was brought under her supervision in 1893. It was only when
the passing of the Education Act of 1893 had brought other forms of
education--secondary, technical, and scientific--more completely under
the supervision of the Department that the need for Women Inspectors
began to be felt. In justice to the Department it must be said that
having once realised the need, they did not meet it grudgingly. The
first Women Inspectors were appointed in 1904, and by the spring of
1905 there were no less than twelve, one of whom was appointed as
Chief. Since then the number has been steadily increasing, and there
are now 45--a much more satisfactory rate of progress than that of the
Women Factory Inspectors.
_Educational Inspectors._--There are now 1 Chief Woman Inspector, at
a salary of L650; 45 Inspectors, 8 at L400-10-L500, and 35 at
The method of appointment of Women Inspectors' is similar to that of
men--_i.e._, by nomination of the President of the Board of Education.
The Chief Woman Inspector first interviews candidates, weighs their
qualifications, and reports upon them to the Secretary. There is no
examination on appointment. Besides academic qualifications, which
are the same as those of men, many of the Inspectors have special
qualifications, as well as having had practical experience in
A special class of work is allotted to each Inspector: about 17 of
them are occupied in inspecting Girls' and Infants' Public Elementary
Schools: 15 are responsible for Domestic Subject Centres in Elementary
Schools: 4 for Girls' and Mixed Secondary Schools: 3 for Training
Colleges (women's and mixed): and 3 again for Domestic and Trade
Courses and Girls' Clubs.
In the case of secondary schools, the Women Inspectors pay special
attention to women's subjects, but they also take part in full
inspections. They are not in charge of districts, and therefore do
not carry on the miscellaneous correspondence with the Local Education
Authorities which falls to the lot of a District Inspector. In
relation to domestic subjects, however, the Women Inspectors are
practically in charge of districts, and deal directly with Local
Education Authorities. They inspect the work done by girls, and
look into the organisation of the schools with regard to health,
suitability of curricula, etc.
In the case of elementary schools, the Women Inspectors are attached
to the various districts and are directed by the District Inspectors
(men) as occasion requires, to deal with infants' and mixed schools,
and to carry out routine inspections of public elementary schools.
_Medical Inspectors._--There are one Senior Medical Officer at
L600-L800; one Junior Medical Officer at L400-20-L500; and also three
Inspectors of Physical Exercises at L200-15-L400.
The Women Medical Inspectors take part in the work of the medical
branch in the same way as men; Physical Exercises come under their
The Board of Education also employs three women on the permanent staff
of the Department of Special Enquiries and Reports. The salaries are
L100-L7, 10s-L180, and the posts are pensionable. The duties consist
partly of library work and partly of giving assistance in the general
intelligence work of the office.
The Right Hon. A.H. Dyke Acland said in his evidence before the Royal
Commission on the Civil Service that he did not see why at the Board
of Education the same sort of women who become good inspectors and
headmistresses should not take part in the administrative work of the
_Scotch Education Department_
The first Woman Inspector was appointed by the Scotch Education
Department in 1902, and two others were appointed in 1910. Their scale
of salary is L200-15-L400. They are strictly specialist inspectors for
domestic economy subjects, cookery, laundry, etc., for which they have
qualifications including experience in teaching and inspecting such
Specially qualified women are occasionally employed by the Department
to inspect girls' schools, and are paid a fee according to the time
_National Education Board, Ireland_
Two Women Inspectors are employed by the Irish National Education
Board. Their salary is L150-10-L300, the same as that of Men Junior
Inspectors; Men Senior Inspectors receive L300-20-L700.
There are two Women Organisers, whose duty it is to organise weak
There are also 14 Organisers of Domestic Economy; their work is
similar to that of Inspectors; they travel about and have authority
in the schools; they do not inspect general subjects, but confine
themselves to cookery, laundry and domestic science.
There are also six Women Organisers of Kindergarten.
_The Board of Agriculture and Fisheries._
This Department has recently employed a few women upon various kinds
of scientific work. Three women are appointed as Assistant Naturalists
in the Fishery Branch, at a salary of L150 per annum, and two as
Junior Assistant Naturalists at L2 per week. They are appointed on
the nomination of the President, without examination, but they must
possess the necessary scientific qualifications and have taken a
recognised course of study. These posts are non-pensionable. The
Fishery Branch deals with questions relating to the natural history
and diseases of fish, fish-hatcheries and laboratories, the protection
of undersized fish, the effect of methods of capture, international
investigations, and grants in aid of fishery research. The women
are engaged upon the same work as men, except that they do not write
technical reports and are not liable to be called upon for sea duty.
In the Herbarium and Library of the Royal Botanic Gardens at Kew there
are two Women Assistants at L150-10-L300 (the Men Assistants' scale is
L150-15-L300). Scientific qualifications are required for these posts,
and there is an examination by the Civil Service Commission. The
Library is maintained for official consultative work, to supply the
basis of an accurate nomenclature throughout the establishment and
as an aid to research. The Herbarium aims at representing the entire
vegetation of the earth with especial regard to that of British
possessions. A scheme for preparing a complete series of floras of
India and the Colonies was sanctioned by the Government in 1856, and
has been steadily prosecuted ever since. The principle work of the
staff is the correct identification of the specimens which reach
Kew from every part of the world, and their incorporation in the
Herbarium. It is visited for the purposes of study and research by
botanists from every country.
The scientific work in the various branches of the Board of
Agriculture and Fisheries would seem to afford some scope for women of
scientific attainment. Sir T. Elliott, formerly Permanent Secretary
to the Board, in his evidence before the Royal Commission on the Civil
Service, said he considered that women could do good work in many
directions, and that their help might be especially valuable in
_The Public Trustee's Office._
The Public Trustee's office was established in 1908, under the Act of
1906. Two Women Inspectors--or more correctly speaking, Visitors--are
now employed, one of whom receives a salary of L200 and the other
These Visitors are attached to the special Department set up to take
charge of children (1) left by will to the guardianship of the Public
Trustee, or (2) who have been awarded damages in the High Court either
for injury or for the loss of parents or guardians.
As regards the first-named, the Public Trustee has express powers
under his rules to act either as sole guardian or co-trustee. In these
cases the Women Visitors assist the Public Trustee in discharging his
trust. They visit the children, go thoroughly into the circumstances
of each case, consulting with relatives and family solicitors. Schools
are chosen, holidays arranged, careers decided upon, apprenticeship or
training provided for; medical attendance is secured and even clothing
In all cases concerning children in which an action for damages has
been brought under the Common Law or under Lord Campbell's Act, the
money awarded as compensation is paid over to the Public Trustee,
unless the judge otherwise directs. A large part of the Women
Visitors' work consists of supervising these compensation cases. It is
important to see that the money is spent upon the children, and in
the manner most likely to promote their future welfare--_e.g._,
in providing education or special training. In the case of injured
children, proper medical attention is secured and any instruments or
artificial limbs which may be necessary.
It is becoming increasingly the practice, when funds are raised
locally to help special cases, to place the money collected in the
hands of the Public Trustee, instead of appointing local trustees.
Where the beneficiaries of such funds are women or children--very
often they are widows--it becomes the duty of the Women Visitors to
find out on the spot how the money can best be applied, and to advise
the Public Trustee accordingly.
In all cases the supervision is continued as long as it is required,
but where relatives are found to be competent and willing to take
charge of children the responsibility is left to them.
Such work, concerned as it is with the young and the helpless, seems
peculiarly suited to women. The Public Trustee in his evidence before
the Royal Commission on the Civil Service, stated that the women
already appointed had proved themselves "most efficient."
_The National Health Insurance Commissions._
The Inspectors appointed by the National Health Insurance Commissions
are so recent an institution that it is not yet possible to say
whether the work to be performed by this Department will afford scope
for the employment of a large number of educated women.
It is satisfactory to note, however, that the salaries of men and
women more nearly approximate to equality than in any previous
appointments. The salaries of the Women Commissioners in all four
countries are the same as those of the men, viz., L1,000 per annum.
The English Commission has 10, the Scotch 1, and the Irish 1 Woman
Inspector at L300-10-L400. Men Inspectors begin at the same salary but
rise to L500.
The English Commission has 25, the Welsh 3, the Scotch 5, and the
Irish 4 Assistant Women Inspectors at L100-10-L300. Men Assistant
Inspectors begin at the same salary, but after two years they rise by
L15 to L350.
The English Commission has 19, the Welsh 1, the Scotch 5, and
the Irish 5 Women Health Insurance Officers, on a scale of salary
L80-5-L110, after two years rising by L7, 10s. to L150. This scale is
precisely the same as that of Men Health Insurance Officers.
The duties of Men and Women Inspectors and Officers under the National
Health Insurance Commission are identical in character and scope.
The primary function of these officers is to impose upon the whole
adult population the new conditions created by the Act--_i.e._, they
have to ensure the proper payment of contributions in respect of all
persons liable to be insured.
Trades are assigned to Men or Women Inspectors according as a trade
employs men or women in greater numbers.
The Insurance Commissioners work through the Inspectors in all matters
that are more susceptible to local treatment than to treatment by
correspondence. The Inspectors obtain information and make local
enquiries as to the facts in cases submitted to the Commissioners for
determination under various sections of the Act.
An interesting account of the very varied duties which fall to the
lot of these Officers will be found in the first "Report on the
Administration of the National Insurance Act," Part I., which has
recently been published. The following extract from that Report will
give some idea of the work done by the Women Inspectors, and the
estimate which has been formed of it.
"Inasmuch as the Insurance Commission is the first Government
Department in which a woman staff has been appointed from the outset,
special mention may be made of one portion of the work carried out
by the women inspectors during the past year. The enquiry held in the
autumn by Mr Pope on the objections raised to the inclusion of