(1) All that makes for scrupulous asepsis in every detail for the surroundings of the mother.

(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 pract.i.tioners 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 pa.s.sing 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.

XIII

Ma.s.sAGE

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 ma.s.seuse, 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 Ma.s.seuses, information can be obtained with regard to the training schools in London and the Provinces where a course of instruction in ma.s.sage 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 ma.s.sage 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 ma.s.sage includes a course of not less than six months in Elementary Anatomy and Physiology, the Theory and Practice of Ma.s.sage and a course of bandaging. Students usually attend the cla.s.ses from 10 A.M. to 4 P.M., lectures being given in the morning, demonstrations and practical work on "model patients" in the afternoon hours.

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 ma.s.seuses 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 a.s.surance 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 ma.s.seuse, 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 ma.s.seuses. All its members are bound to observe the rules of the society. The result of this is threefold.

(1) The doctor is a.s.sured that the ma.s.seuse will not undertake cases on her own diagnosis, but work only under qualified direction.

(2) The public is a.s.sured that the ma.s.seuse is a trustworthy woman as well as an efficient worker.

(3) The ma.s.seuse herself is protected from undesirable engagements. This is of considerable importance.

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 ma.s.seuse is already known either to the doctors, or to some influential residents.

Much depends on the individuality of the ma.s.seuse, 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 50 to 100. By the third year a steady connection should be formed, bringing in an income of 150 to 250. This cannot, however, be expected unless the ma.s.seuse 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 ma.s.seuse 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 30 to 70 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 ma.s.seuse 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 ma.s.seuses.

Many of these are unfortunately merely blinds for undesirable houses.

[SUB-EDITOR.]

SECTION IV

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 usually known.

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 a.s.sistant Sanitary Inspectors, were appointed in connection with the Public Health Department. Their duties were: "by persuasion princ.i.p.ally, 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 a.s.sociation of Scotland. They reported certain nuisances, but themselves dealt with others, such as "dirty homes or dirty bedding, clothing, and furnishing."

The work of Women Health Officials in England, dates from the pa.s.sing 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.