Women Workers in Seven Professions Part 17

(2) a.s.sistant medical officer in some asylums and poor law infirmaries.

There is one woman inspector of prisons who is a medical woman, but she is not a medical inspector and was not appointed in that capacity.

It is much to be hoped that women prison medical officers will speedily be appointed on equal terms with their medical colleagues.

The conditions for women prisoners from the standpoint of health are, at the present time, extremely unsatisfactory.

The tendency is to employ more and more women in the public service, and therefore the opportunities are likely rapidly to become more numerous.

The Act, under which medical school inspection was made obligatory, particularly mentioned the suitability of women for much of this work.

It is therefore becoming usual all over the country to have at least one woman school doctor, and in some districts there are several on the staff. This work is not extremely arduous, is free from the heavy strain of private practice, and, if the school medical officer is allowed reasonable freedom in her work, may be made of much interest.

It is, however, somewhat monotonous, and has the great disadvantage that at present the stimulus of promotion is largely absent, as the higher administrative posts are almost universally in the hands of men. This is a disadvantage which will also be gradually, perhaps rapidly removed as the prejudice against women in authority dies down.

After having practised medicine for some years, further degrees indicating experience are open to the medical pract.i.tioner; thus, if she has taken the Bachelors.h.i.+p of Medicine she may, after the lapse of three or four years, enter for her Doctorate. This is gained either by a further examination or by writing a thesis on some subject of original research. If she has taken the Diploma of the Royal Colleges, it is open to her to sit for the Fellows.h.i.+p in Surgery or Members.h.i.+p in Medicine. She is also open to election to the Fellows.h.i.+p in Medicine.

It is extremely difficult to give anything like an adequate idea of the remuneration to be obtained in medicine, as it varies tremendously.

The first posts, which are taken soon after qualification, if really first-rate in the experience which they give, seldom include any salary at all, though board and lodging are provided. Posts which rank as slightly inferior to these, but still give a considerable amount of experience, are often a.s.sociated with honoraria varying from about 50 to 150 a year, including board and lodging.

(a) If we turn again to our three sub-divisions we find that a specialist or consultant cannot expect to earn her working expenses for a good many years. She must have one room at least in a certain specialist quarter of the town, known as the consultants' area, and there the rents are usually high, in London about 150 a year, in the provinces slightly less.

We have already stated that she requires some hospital post; for this she will receive no remuneration, but if the hospital where she works has a medical school attached to it, she may expect to get a certain number of patients through the recommendation of students whom she teaches at the hospital. There is generally also some teaching at the hospitals, for which the students pay definite fees. She may also augment her income by lectures and work of that description. She will probably find it necessary to write papers on her special branch of work and on the cases which come under her observation, but for this she will very seldom be paid. It is, therefore only possible for a girl with some monetary resources independent of her work, to take up successfully a special branch of medicine.

If she elect to become a surgeon, a hospital post is an absolute necessity, and her income will, as in the case of the medical specialist, be delayed. Eventually, however, if she is successful, it is greater than that to be obtained on the medical side. The fees are high, and therefore money can be made more speedily in this branch of the work. People, however, hesitate as a rule to trust a very young surgeon, so she will at first get her work chiefly as a.s.sistant to her seniors and must be content to wait some years for the much bigger fees which she will get as princ.i.p.al. Ultimately she should make 1,000 to 2,000 a year.

(b) If she elect to become a general pract.i.tioner, her outlay at first is probably as great as that of the specialist, if not greater, but the return is quicker, and a great deal depends upon the choice of a neighbourhood. If she chooses an upper middle cla.s.s district she also, like the specialist, must be content to wait, and in fact she is ill-advised to choose such a neighbourhood unless she can rely on some good social introductions.

If she choose a district partly middle and partly lower middle cla.s.s her return will be infinitely quicker. She may expect to cover her expenses in the course of two or three years. The work is, however, incessant and rather hara.s.sing. If she select a working-cla.s.s neighbourhood and have a dispensary, her return will be still quicker, such places frequently paying their expenses in the first or second year. The people are nice to deal with, and the work is interesting, but it is apt to be very distressing for two reasons--(1) that owing to the poverty of the patients they can so seldom be attended under conditions in which they have a fair chance of recovery, and (2) there is apt to be an appreciable amount of dirt.

The most varying reports are given as to the incomes to be made in private practice and it is almost impossible to get at the truth, because it is obviously to everybody's interest to make them appear as high as possible. A woman's practice also is admittedly rather a specialist one. She does not get the general local practice of the ordinary pract.i.tioner, but instead certain selected women who want to consult a member of their own s.e.x. These often live at considerable distances, thus making the work more difficult to arrange and the travelling more expensive than in the case of the ordinary medical man. It is rare for a woman to be able to buy a practice. She must generally build it up for herself, as it is of little or no use for her to buy a man's practice, and there are only very few women's available.

Generally, it may be stated that a woman covers her expenses by about the third or fourth year after starting, and she may ultimately make, according to the district and her success, anything between 400 and 1,500 a year. Frequently two medical women settle together, which seems to be a very good arrangement.

(c) If she elect to enter the public service her outlay is very small.

Beyond equipping herself for this work in certain special branches already described, all that is necessary is that she should be able to keep herself until she obtains a suitable post. The salary given for whole time work in the public service should not be less than 250 a year rising to 400 or 500 a year. In most cases the school doctor gets the school holidays, including the whole of every Sat.u.r.day.

English women who go to India, do so generally in connection with either

(1) a missionary society, or (2) a hospital under the Dufferin Fund.

(1) Many missionary societies engage medical women to treat the native women. Salaries, of course, differ, but are, on the whole, low, as the aim of a missionary is not supposed, primarily, to be financial gain.

Generally somewhere about 110 in English money is given, with an allowance for carriage and house including the chief items of furniture. Leave is also granted with second cla.s.s return fare every five years--in some missions every three years. The medical experience is excellent, the opportunities of doing good professional work are practically unlimited, and the professional position of the doctor quite untrammelled. She is a.s.sisted, usually, by good nurses, under a proper scheme, these being Indian girls superintended by fully trained English sisters.

(2) Under the Dufferin Fund[2] things are very different. It is somewhat difficult to speak of this branch of the work, as it is, at the present time, the subject of enquiry, and it may be legitimately expected that it will, before long, be put on a more satisfactory basis. The fund was originally started by Lady Dufferin as the direct result of a command by the late Queen Victoria, and it was intended to provide the services of medical women for the Purdah women of India who, owing to the strictness of their rules, were not infrequently debarred from the full benefit of medical treatment by men.

Unfortunately, however, the doctor in charge of most of the Dufferin Hospitals is under the local senior civil surgeon, who is a man. As he has the right, if he wishes to exercise it, of seeing any of the patients, and doing any of the operations or other treatment necessary, it is obvious that the hospitals are of little or no use to Purdah women, as they have no guarantee against treatment by a man.

There is also no security of tenure for the doctor who is not allowed to be present at the meetings of the governing body, and may find herself dismissed or transferred from a good post to a bad one at short notice.

The remuneration varies roughly between 250 and 500 a year, with house but no carriage allowance. The doctor is ent.i.tled to add to her salary by private practice. In some towns this is a considerable item, whereas in others it is quite negligible. There is no definite furlough allowance, and the doctor may be removed from her post and required to keep herself on very little for a considerable period of time before being appointed to another hospital. All this causes a severe drain on the resources of doctors without private means. The staff is also frequently inefficient, and the nursing is sometimes very indifferent, being undertaken by Eurasian girls under partly trained women who have never been "home."

In the practice of medicine as in all other branches of women's labour, the question of the effect of marriage upon work is a very important and difficult one. In its general aspect it lies at the very heart of the whole question of the working woman. Its effect on the medical woman varies according to the branch of her profession which she selects. If she wishes to become _(a)_ a specialist or _(b)_ a general pract.i.tioner, she has perfect freedom of choice as to what she will do in the event of marriage; and some women retire while others continue their work. The latter is a much more desirable course from the point of view of medical women as a whole. The medical woman who is married can, better than any one else, render to society certain services in her profession, and it is desirable that these should not be lost. In any event no woman need retire from her work on marriage, though it is, of course, most important that the married medical woman should not deny to herself and to her husband the normal healthy joy of having children. To continue in practice, however, while bearing a child requires a certain amount of expenditure, as such a doctor will need to retire from practice for at least two or three months, probably longer, and is therefore put to the expense of engaging a _loc.u.m tenens._ This ought, however, to be possible when both husband and wife are earning incomes.

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 a.s.sociation in uniting the men and women of the profession and helping both to keep up the salary rate. Without this aid the women's a.s.sociations would have been comparatively helpless, as they would have erred in ignorance, though certainly not by intention. The grat.i.tude of medical women to this a.s.sociation 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 wis.h.i.+ng 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 Fellows.h.i.+p, 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 Fellows.h.i.+p--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 s.e.x 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 things:--

(1)that the Government therein makes no s.e.x distinction in the profession;

(2)that the bogey of s.e.x 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 s.e.x.

(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 s.e.x 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.)