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 Place, W.]

[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 a.s.sociation. It would, however, receive a Government grant of 10,000 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.]

II

DENTAL SURGERY

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 pa.s.sing 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 pract.i.tioner for mechanics, or can obtain tuition at the Dental Hospital. This branch includes the preparation of models, vulcanite and metal dentures, crowns, and bridges, etc.

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 200, but an additional sum of at least 100 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 120 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 a.s.sistantship with men pract.i.tioners, 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 pract.i.tioner 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 s.p.a.ce, the exact.i.tude 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 a.s.sociation and the Odontological Society are both open to women, and male pract.i.tioners 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 pract.i.tioners.

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 150 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 contact.

In the London area the salary begins at 80 rising by 2, 10s.

yearly to 85, and then by 5 yearly to 105. 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 Council.

The hours of work are from 9 A.M. to 4.30 P.M. five days weekly, and from 9 to 12.30 on Sat.u.r.days. 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 a.s.sistant-Superintendents, and four Divisional a.s.sistant-Superintendents.

_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 physically defective.

_C_. There are 8 nurses now working under the Infant Life Protection Act.

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 Inst.i.tute 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--120 to 150, with a further rise to 200 after ten years of service.

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.

VIII

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 19 the first year, with an annual increase of 1 up to 35. 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 amus.e.m.e.nt of the patients, and nurses are expected to a.s.sist in arranging these. Consequently any one with a gift for music, acting, singing, or other accomplishment is an acquisition to the staff.

(2) _Registered Mental Hospitals_.--These, owing to their different circ.u.mstances, 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 Ma.s.sage and Swedish Drill are added in the fourth year.

Salaries are on the whole lower than in the County Asylums, beginning at anything from 15 rising to 19 in the third year with a bonus of 3 on pa.s.sing 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 training.

A trained nurse may hope for promotion to posts as Sister of a ward, Night Superintendent, a.s.sistant 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 inst.i.tutions, 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 inst.i.tution 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 inst.i.tutions 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 cla.s.s 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.