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