Part 17

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 £100 to £200 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 £150 to £350. The average maximum salary of the women is £150, and the average maximum salary of the men is £205. Outside London, the salaries of both men and women are lower, those of the women ranging from £65 to £100, a few rising to £150. 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 provincial towns.

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 depôts, 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 £100 to £120; in the provinces it may be as low as £65 per annum, and rarely rises above £100. 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 infirmity.

"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 appointment).

"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 £100 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 sanitation.

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 join:--

(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 £160 per annum, have joined the approved society of the National Association of Local Government Officers.

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.[2]

[Footnote 1: Full particulars of this can be obtained from the Secretary, Sanitary Inspectors' Examination Board, Adelaide Buildings, London Bridge.]

[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 position.[EDITOR.]]

SECTION V

WOMEN IN THE CIVIL SERVICE

I

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 harmony.

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 £400 to £450, and six Inspectors at £250 to £350. 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 co-operation.

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 £200 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 disease).

The Local Government Board for Ireland employs two Women Inspectors, one at a salary of £200-10-£300 and the other at a salary of £200, 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 £300-15-£400. (The lowest salary received by Men Inspectors is £600-20-£700.)

There is also one Woman Assistant Inspector of Reformatories and Industrial Schools. Her salary is £200-10-£300, whilst that of Men Assistant Inspectors is £250-15-£400.

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 passed.

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.