Fortunately, owing to the fact that she had behind her means of subsistence without her salary, she was able to refuse his unsatisfactory offer, although at considerable violence to her feelings, for she had made many friends in the neighbourhood.

_Example 2_.--A husband and wife, both medical, went to settle in a town in the north of England. They both practised, the qualifications of both were excellent, but the woman was the more brilliant of the two, having better degrees and more distinctions. Both applied to be admitted to the local medical society. The man was, of course, accepted, the woman refused on the score of her s.e.x, this meaning that she would be cut off from all opportunity of hearing medical papers and discussing medical subjects with her colleagues. During the next few months a local friendly society was anxious to obtain a medical officer and was offering terms regarded as insufficient by the local doctors. Among others approached by this society was the medical woman in question. Directly the officials of the medical society, which had banned her when her own benefit was concerned, heard that she had been approached by the friendly society, they elected her without asking her consent to the very society from which they had previously excluded her, in order that she might be unable to take the post in question, whereby they might have financially suffered.

_Example 3_.--The exclusion from medical societies referred to under Example 2, like many similar actions in life, tends to recoil on its instigators. For instance, a medical woman in another northern town applied for and accepted a post which the local men had decided was unsatisfactory in some particulars, and for which therefore none of them had applied. They were loud in their denunciations of the woman in question, but owing to the fact that her men colleagues had not recognised her professionally in other ways, she was quite unaware of her offence for several months after undertaking her new duties.

_Example 4_.--Men and women are sometimes appointed on apparently equal terms and conditions to posts which are not, however, really equal, in that there is a chance of promotion for the men but none for the women.

_Example 5_.--In another town in the north of England men and women appointed to do the work of school medical inspection on equal terms recently considered that they were not sufficiently remunerated. They met and decided that they would together apply for better terms. A rumour was then set abroad that the authority under whom they worked would certainly not consider such an increase in expenditure. In this crisis the men on the staff, although they had so far joined with their women colleagues in sending up their pet.i.tion, sent up another of their own, without informing or consulting the women at all, in which they said that they considered it was time that this equality of remuneration for both s.e.xes should cease. They begged the authority to neglect their public appeal, but to grant instead increased remuneration to the men, and the men only. One of the reasons given for this suggestion on the part of the men was that their liabilities were greater. The result of enquiry, however, proved that of the three men, one only was engaged to be married, the other two had no one dependent upon them; whereas of the three women, two were supporting other people--one being a married woman separated from her husband and with two children to support and educate.

_Example 6_.--The following is an instance of the way in which the Government is sometimes responsible for encouraging women's "black leg" labour. Dr Leslie Mackenzie in his evidence given recently before the Civil Service Commission said that the Treasury refused to allow the Scottish Local Government Board to have a woman medical inspector at a medical inspector's salary, but permitted them to engage a woman with medical qualifications at a woman inspector's salary, which was, of course, much less. Sad to relate a woman was found to accept this post.

These examples have been given because it is necessary that a woman intending to adopt the profession of medicine should know the sort of work, quite apart from the treatment of her cases, which a medical woman, worth her salt, has to do. It may be asked how it is, if these difficulties are still constantly arising, that our pioneers were so successful? For several reasons: first, because they were in the best sense women of the world: they understood when to be firm and when to give way. They understood mankind. Secondly, they had an a.s.sured position. This is probably the most essential condition of all for success. Before decent terms and conditions of work can be demanded, the worker must be in such a position financially that she can, if necessary, refuse the work in question, and if possible the employer must be aware of this fact. So often women enter the labour market only when driven by stark necessity, that it is unfortunately the easiest thing in the world to exploit them. People of either s.e.x faced by starvation for themselves or those dependent on them must take the first thing that offers if the conditions be in any way bearable. In my opinion, next to the parliamentary vote, the most powerful lever in raising the condition of women will be the entrance into the labour market of a considerable number of women so trained in Economics that they will always "play the game," and at the same time sufficiently remote from want to be able to resist the sweating employer.

Some people discourage women of independent means from entering the labour market through the mistaken idea that if such women work they are taking away the chance of some other women who are in need. In case any reader may be in doubt on this question, I should like to point out that it is the groups of workers among whom no such economically independent individuals are to be found, that are always exploited by the unscrupulous employer; they are such easy prey.

What really makes women workers afraid of their independent sisters is that extremely pernicious system of payment euphemistically known as "pocket-money." This should be swept off the face of the earth. Even the richer woman has some rights, notably the right to work, and I would suggest that she has this particular, and certainly not unimportant function of raising the rate of remuneration. From my knowledge of her, I consider that she is most anxious to do nothing but good to her fellows. The only thing she needs in order to become a help instead of a menace to her poorer sisters is knowledge of the rules that govern the economic labour market.

Owing to the necessary expense and prolonged training for the medical profession it has probably attracted a larger proportion of working women who were not subject to immediate economic stress than most other branches of work, and it is, in my opinion, due to the presence of such women, that the conditions in it as a whole are so satisfactory.

Having discussed the sort of woman suitable for the medical profession, I now pa.s.s on to a consideration of the course of training which must be taken in order to fit her for the work.

Before beginning her training, the student has to decide what medical qualification she will take. Her choice lies between

(1) A degree of one of the universities, and (2) A diploma.

It is essential to go to some University or Examining Board which admits women and not to one, such as Oxford or Cambridge, where women are denied the degree to which their work ent.i.tles them. As a matter of fact, women medical students are not accepted at Oxford and Cambridge. It is not possible to practise medicine, in a satisfactory way unless one is actually in possession of the qualification. Any one who does so, however well trained, ranks as a quack, and is not legally ent.i.tled to sign death certificates nor to recover fees.

The degrees open to women in medicine, as in other branches of learning, are those of London, Glasgow, Trinity College, Dublin, and, in fact, of all the Universities of the United Kingdom except the two just mentioned.

Qualifying diplomas other than degrees are those granted by:--

(1) The Conjoint Examining Board of the Royal Colleges of Physicians and Surgeons of England.

(2) The Royal Colleges of Scotland.

(3) The Royal Colleges of Ireland.

(4) The Society of Apothecaries of London.

The authorities at the Women's Medical School strongly advise students to take a degree, and that the best open to them, namely, in Great Britain, that of London for the south, or one of the good Scottish Universities for the north. Their reason for this advice is that they feel that it is extremely important that medical women should rank as high as possible in their profession.

At London University there are no s.e.x restrictions. A woman is eligible not only to take the examinations on equal terms with a man, but all the rights and honours (except, of course, the Parliamentary vote) are also open to her. Women may vote for and sit upon the Senate, become members of Convocation and take any of the exhibitions, medals, or scholarships which are offered to candidates at examinations. For this reason women feel attached and like to belong to the London University, and to do it honour.

Having decided which qualification she wishes to take, the candidate applies to be entered as a medical student at a definite school. If she elects to work in _London_ she must follow the course of study at the Royal Free Hospital School of Medicine for Women at 8 Hunter Street, Brunswick Square.

At _Glasgow_ the students are all entered at the Women's College (Queen Margaret's). The medical course is taken in conjunction with men students. At the Royal Infirmary some wards are open to women for clinical instruction.

At _Dublin_ the students are admitted to the degrees and diplomas in medicine, surgery, and midwifery on the same conditions as men.

A special anatomical department with dissecting room, etc., has been erected by the Board of Trinity College for them.

At _Edinburgh_ the arrangements for women students are largely separate from those for the men. The degrees are open to them.

At _Durham_ the degrees are open to women, and most of their work is done with the men.

The same applies to _Liverpool, Manchester, Leeds, Birmingham,_ and _Sheffield_.

The course takes from five to six years, but it is wise to allow the longer time. The preliminary examination in general subjects is taken before admission to the medical school. After this, the first year at the medical school is spent in scientific study, such as Biology, Inorganic Chemistry, etc. Having pa.s.sed her first scientific examination, the student proceeds to the study of the human individual, and deals for the next two years with Anatomy, which includes dissection, Physiology, the study of drugs in Materia Medica and Pharmacology, and Organic Chemistry. When the examination in these subjects has been satisfactorily negotiated, she pa.s.ses on to medical work proper, the study of disease and the result of accident in the living person--in other words, she walks the wards of the hospital and undertakes duties as clerk to physicians and dresser to surgeons, from whom she receives instruction in medicine, surgery, and pathology.

Special branches are also studied, such as midwifery, women's diseases, and affections of the throat, ear, eye, and skin. The treatment of minor accidents also receives special attention. During the whole of this time the student also attends regular courses of lectures on these subjects, and she then takes her final examination.

If this be a degree examination, she becomes, on pa.s.sing it, Bachelor of Medicine, or M.B., and Bachelor of Surgery, Ch.B. or B.S. Having obtained a diploma, she is generally ent.i.tled to style herself a Member or Licentiate of the college of which she has pa.s.sed the qualifying examination, for example, M.R.C.S., L.R.C.P. or L.S.A.

On application, she is then placed upon the Medical Register, and is known as a registered medical pract.i.tioner.

The cost of the training is approximately as follows :--

_For a London Degree._

Fee at the Medical School for Women, if paid as a composition fee in five yearly instalments of 28, 51, 45, 40, and 15; Total:--179, or, if the whole sum is paid on entrance to the school, 160. In addition there is a fee of three guineas for the special study of fevers. These fees include everything in the way of material, except books and instruments for which it is wise to allow another 30. The examination fees of the university are 25. These amounts make no allowance for any failures, and consequent revision of work, and re-entry for examination. In reckoning the expense, the necessary cost of living for the six years must also be included. For those students whose homes are not in London there are flats and boarding-houses where it is possible to live very reasonably. Suitable board and residence can be obtained from about 25s. a week.

_For the Diploma of the Conjoint Board._

The school fees are the same; the examination fees are, however, higher, namely 42.

For other qualifications, the school fees are 20 less for the course.

Certain scholarships are available for students, of which all particulars can be obtained from the secretary of each school.

When a woman becomes a registered medical pract.i.tioner, she is for the first time legally ent.i.tled to treat patients herself, and is entrusted with responsibility. As in most other branches of knowledge in the world, while she has simply been learning and carrying out her duties under authority, she has had no opportunity of really testing her own knowledge. It is, therefore, very generally felt amongst newly qualified medical pract.i.tioners that they need more experience before undertaking quite independent medical work. This experience is best gained by taking hospital posts. By this is meant positions of moderate responsibility, such as that of resident house physician or resident house surgeon in a hospital, where the newly qualified doctor is under the authority of an experienced visiting "chief," but is expected to deal with ordinary incidents as they may arise, to realise the relative importance of different symptoms, and report those that matter to the visiting physician or surgeon.

It is at this stage that the doctor must decide whether she wishes to become

(a) a "specialist" in some particular branch of medicine or surgery, (b) a general pract.i.tioner, or (c) whether she wishes to work in the public service.

(a) If she wishes to be a specialist she must so arrange her future work as to gain experience in the branch which she selects. For this purpose it is necessary to take posts at special hospitals, and ultimately to become a member of the staff of some hospital in the department chosen. Here women find that they are heavily handicapped.

The only hospital of any size in London of which the members of staff are all women is the New Hospital, Euston Road, and this admits only of a small staff, giving opportunities to comparatively few women for special experience.

The Royal Free Hospital, where women take their training as students, has now two women on its staff in the department for gynaecology. It has also a woman anaesthetist, and some of the minor posts, such as clinical a.s.sistant to the outpatients, pathologist, etc., are open to them. All the physicians, the surgeons, and the a.s.sistant physicians and surgeons are, however, men.

Of the hospitals for special ailments in London, none so far admits women to the staff, and it has only recently become possible for them even to form part of the medical audience at the outpatients'

department at some of these special hospitals.

No London Hospital for Diseases of Women and Midwifery (except that of Dr M'Call), or for Diseases of Children (except one recently started by women), or for Diseases of the Eye, or for Diseases of the Ear, Nose and Throat, or for Diseases of the Nervous System, admits women to its staff, although several of them allow women to take appointments as clinical a.s.sistants, pathologists, anaesthetists, and other minor posts. Their admission to the full staff is, perhaps, merely a question of time, and of the naturally slow movement of the British mind towards admitting women to positions of responsibility.

There has, however, been of late years a tendency on the part of medical women themselves to take this matter into their own hands, and new women's hospitals are being started about London where the staff is exclusively composed of women.

(b) If, on the other hand, the newly qualified doctor decides to become a general pract.i.tioner, her course is much simpler. She takes such posts as are available, which she thinks will aid her general knowledge of medicine. Then she selects a neighbourhood, puts up a plate, and waits.

This course also involves delayed earning capacity, as she must be prepared to face outlay for several years without much return. During this time she generally augments the income which she gets from her private practice by other part-time paid work, notably by giving lectures in first aid, etc., by school inspection, where part-time officers are appointed, and other such work. She also generally does a certain amount of voluntary work on that most pernicious system of giving her services in order to get known. It is in this way that doctors are everywhere so terribly exploited. When they are _all_ so busy doing work which they think will bring them into the public view, this becomes of no particular use to any of them, and the only people who benefit, and at the same time scoff, are the members of the general public, who become so used to getting the doctor to work for nothing or next to nothing, that it comes as a shock when they have to pay. It is a healthy sign that the long-suffering doctor is at last beginning to show symptoms of fight, and in the future it may be hoped that doctors, like lawyers, will not be required to give their services free to the community. It may be true that if a man will not work neither shall he eat, but the converse should also be true, that if a man works he should eat, and at present it is not by any means always true of the doctor.

(c) Should she decide to enter the public service, she will still require to take a certain number of posts, especially those dealing with eyes, ears, and skin, and must also obtain the Diploma of Public Health. To gain this diploma she will need to devote several months to post-graduate study in that subject before taking the necessary examination.

The chief posts at present open in the public service to a woman are:--

(1) School medical officer, or a.s.sistant medical officer of health.