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 passing 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 practitioner 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 assistantship with men practitioners, 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 practitioner 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 space, the exactitude 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 Association and the Odontological Society are both open to women, and male practitioners 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 practitioners.
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 Saturdays. 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 Assistant-Superintendents, and four Divisional Assistant-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 Institute 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.