(b) If she elect to become a general practitioner, her outlay at first is probably as great as that of the specialist, if not greater, but the return is quicker, and a great deal depends upon the choice of a neighbourhood. If she chooses an upper middle class district she also, like the specialist, must be content to wait, and in fact she is ill-advised to choose such a neighbourhood unless she can rely on some good social introductions.
If she choose a district partly middle and partly lower middle class her return will be infinitely quicker. She may expect to cover her expenses in the course of two or three years. The work is, however, incessant and rather harassing. If she select a working-class neighbourhood and have a dispensary, her return will be still quicker, such places frequently paying their expenses in the first or second year. The people are nice to deal with, and the work is interesting, but it is apt to be very distressing for two reasons—(1) that owing to the poverty of the patients they can so seldom be attended under conditions in which they have a fair chance of recovery, and (2) there is apt to be an appreciable amount of dirt.
The most varying reports are given as to the incomes to be made in private practice and it is almost impossible to get at the truth, because it is obviously to everybody's interest to make them appear as high as possible. A woman's practice also is admittedly rather a specialist one. She does not get the general local practice of the ordinary practitioner, but instead certain selected women who want to consult a member of their own sex. These often live at considerable distances, thus making the work more difficult to arrange and the travelling more expensive than in the case of the ordinary medical man. It is rare for a woman to be able to buy a practice. She must generally build it up for herself, as it is of little or no use for her to buy a man's practice, and there are only very few women's available.
Generally, it may be stated that a woman covers her expenses by about the third or fourth year after starting, and she may ultimately make, according to the district and her success, anything between £400 and £1,500 a year. Frequently two medical women settle together, which seems to be a very good arrangement.
(c) If she elect to enter the public service her outlay is very small. Beyond equipping herself for this work in certain special branches already described, all that is necessary is that she should be able to keep herself until she obtains a suitable post. The salary given for whole time work in the public service should not be less than £250 a year rising to £400 or £500 a year. In most cases the school doctor gets the school holidays, including the whole of every Saturday.
English women who go to India, do so generally in connection with either
(1) a missionary society, or (2) a hospital under the Dufferin Fund.
(1) Many missionary societies engage medical women to treat the native women. Salaries, of course, differ, but are, on the whole, low, as the aim of a missionary is not supposed, primarily, to be financial gain. Generally somewhere about £110 in English money is given, with an allowance for carriage and house including the chief items of furniture. Leave is also granted with second class return fare every five years—in some missions every three years. The medical experience is excellent, the opportunities of doing good professional work are practically unlimited, and the professional position of the doctor quite untrammelled. She is assisted, usually, by good nurses, under a proper scheme, these being Indian girls superintended by fully trained English sisters.
(2) Under the Dufferin Fund[2] things are very different. It is somewhat difficult to speak of this branch of the work, as it is, at the present time, the subject of enquiry, and it may be legitimately expected that it will, before long, be put on a more satisfactory basis. The fund was originally started by Lady Dufferin as the direct result of a command by the late Queen Victoria, and it was intended to provide the services of medical women for the Purdah women of India who, owing to the strictness of their rules, were not infrequently debarred from the full benefit of medical treatment by men. Unfortunately, however, the doctor in charge of most of the Dufferin Hospitals is under the local senior civil surgeon, who is a man. As he has the right, if he wishes to exercise it, of seeing any of the patients, and doing any of the operations or other treatment necessary, it is obvious that the hospitals are of little or no use to Purdah women, as they have no guarantee against treatment by a man.
There is also no security of tenure for the doctor who is not allowed to be present at the meetings of the governing body, and may find herself dismissed or transferred from a good post to a bad one at short notice.