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_ Numéro: ó . | WI
SOMMAIRE
Compte-Rendu de la Réunion de Vienne: Report of the Vienna Meeting
Bilan (Balance-Sheet).
Rapport de la Trésorière .
Treasurer | sS Report.
Rapport de la Secrétaire hial Honorary Secretary $ Report :
Dr Balfour's Report : Rapport du Dr Poli-Garnier :
Dr Adler-Herzmark's Report.
Dr Dagny Bang Report.
Rapport du Prof. Sorrentini .
Texte des Veeux adoptés akin :
tO EDITION DE « L’EXPANSION SCIENTIFIQUE FRANCAISE »
VITADONE
Lymphatisme, Scrofule, Pyodermites | 2
VITAMINES A et D
Remplace intégralement l'HUILE DE FOIE DE MORUE : | dans TOJTES SES INDICATIONS a
DOUBLE TITRAGE |. 200 UNITES VITAMINE A PHYSIOLOGIQUE 2000 UNITÉS VITAMINE. D
Nourrissons, 20 gouttes — Enfants, 40 gouttes Adolescents et Adultes, 60 gouttes
AMUNINE
(cuuyxidétense)
VITAMINE A La première ‘préparation: de VITAMINE A concentrée, physiolosiquement titrée
1° = 250 UNITES-RAT ou 1500 UNITÉS NRA 4 Unité-Rat = 6 Unités Javillier) ;
VITAMINE DE CROISSANCE ET ANTI-INFECTIEUSE Même Posologie que “ YVITADONE ”
$ 2 3
Echantillons et Littérature : ETABLISSEMENTS BYLA 26, Avenue de l’Observatoire - PARIS
ASSOCIATION INTERNATIONALE
FEMMES-MEDECINS gth re iy =
z í Dr. Lovejoy B NY ;
Anc. Présidentes : Ce foe Gi! EARL aaa Lady Barrett T. Njeh Présidente : Dr. Thuillier-Landry, 68, rue d’Assas, Paris-VIe,
Miss Martindale, C. B. E., 25, Manchester Square, Londres. W. I.
Dr. Dagny-Bang, Drammensveien 97 B 1, Oslo. Norvege.
Dr. Ferrari Carcupino, Salsamaggiore, Prov. di Parma, Italie.
Vice-Présidentes : Dr. Nechovitch Voutchetitch, Kralja Milana ulica, 84, Belgrade, Yougoslavie,
Dr. Salzmann, Canstatt, b, Stuttgart. Alle- magne.
Dr. Tayler Jones, The Rochambeau, Was- hington D. C, Etats-Unis,
Trésorière : Dr. Requin, 154, avenue Emile Zola, Paris- - XVe,
Secrétaire Générale: Dr. Montreuil-Straus, 75, rue de lAs- somption, Paris-XVIE,
Secrétaires Nationales Correspondantes
Allemagne :
Dr. Elise Hermann, 65, Oberstrasse, Hamburg. Australie :
Dr. Roberta Donaldson, 88 Collins Street, Melbourne. Autriche :
Dr. Dora Brücke Teleky, 4, Freiheitsplatz, Vienne. Belgique : Dr. Vandervelde, Résidence Palace, Bruxelles. Bolivie :
Dr. A. Chopitea, Oruro. Canada :
Dr. Helen Mac Murchy, Department of Health, Ottawa.
mes 2 — Danemark : Dr. Agnete Heise, Pilestraede, 52, Copenhague. _ Espagne : Dr. Elisa Soriano Fischer, 53 Fuoncarral, Madrid. Etats-Unis : _,»Dr. Kate C. Mead, Haddam, Connecticut. France’: . “a Dr Montreuil-Straus, 75 rue de l'Assomption, Paris-XVIE. >; Grände Bretagne : A pr. Doris Odlum, 42, Harley Street, Londres, W.I, *: Hoñgrie. : ' “Dr: Ilona Vegess Rege, Ulloïut 25, III, Budapest IX. Indes : Mrs. Curjel Wilson, M. D., c/o W. R. Wilson, Esq., Pun- jab Secretariat, Lahore. Indes Néerlandaises : Dr. Van der Made. Batavia C. Java
Italie : Dr. Ferrari Carcupino, Salsamaggiore, Prov. Di Parma.
Japon : Dr. Tomo Inouye, 7, Naharakubancho, Kojimachi, Tokio. Mexique : ;
Dr. Antonia Ursua, 15 Plaza Miravalio, Mexico. Norvège :
Dr. Dagny Bang, Drammensveien, 97 B 1, Oslo. Nouvelle Zélande :
Dr. Susannah Sinclair, 4 Cook Street, Mornington, Dunedin. Pays-Bas :
Dr. Maria Philippi, Laan v. Nieuw Oost-Indié, 261, La Haye. Pologne :
Dr Nathalie Zand, Jerezolimska, 43, Varsovie, Suède : i
Dr. Andrea Svedberg, Birgerjarlsgatan, 36, Stockholm. Suisse :
Dr. Marie Feyler, 20, Avenue Juste Olivier, Lausanne, Tchécho-Slovaquie :
Dr. Devetterova, ul, Ch, g, Masarykove, 240, Prague. Uruguay :
Dr Marie Ugon, Rio Branco, 1540, Montevideo, Yougoslavie : -
De Marie Voutchetitch Prita, 84, Kralja Milana ulica, Bel-
grade,
Secrétaire : Miss Napier-Ford. Siège social: Elysée Building, 56, Faubourg St-Honoré, Paris-VIII. Tél. Anjou 18.00
COMPTE-RENDU DE LA REUNION DU CONSEIL
Vienne — 15 au 20 Septembre 19351
La 5° réunion du Conseil de l’Association Internationale “d + Femmes-Médecins s’est tenue à Vienne, du 15 au 20 sept ki 1931 ; elle a réuni près de 200 femmes-médecins appartenantaugt y } : 17 pays suivants : Allemagne, Autriche, Danemark, Etats- the sg France, Grande-Bretagne, Hongrie, Indes anglaises, Indes néðtzaas landaises, Italie, Japon, Laponie, Norvège, Suède, Suisse, Tchéco- -—~ Slovaquie et Yougoslavie.
Toutes les séances ont eu lieu dans les belles salles, gracieu-
sement prêtées, de la Société des Médecins de Vienne, « Haus der Gesellschaft der ‘Aerzte in Wien »,
‘ SEANCE D’OUVERTURE
A cette séance d'ouverture, tenue le 16 septembre à 10 heures, que présidait le Dr Thuillier-Landry (France), Présidente de l'A, I, F. M., assistaient de nombreuses autorités viennoises,
Le Dr Thuillier-Landry ouvre la séance et prononce l’allo- cution suivante :
« En me levant pour ouvrir la cinquième réunion du Conseil de l'Association Internationale des Femmes-Médecins, je ne puis me défendre d’un peu d'émotion et d'inquiétude ; je mesure une fois de plus qu’un titre n’ajoute pas grand chose à la valeur de celui qui le porte, et je me sens un peu confuse d’avoir à représenter l'A. I. F. M. devant une assemblée aussi solennelle.
Sans être encore bien ancienne, notre Association a cependant déjà à son actif un développement et un ensemble de travaux qui mériteraient d’être mis en valeur par une voix plus qualifiée, L'idée de nous associer est née à New-York en 1919, lors d’une première réunion internationale de femmes-médecins organisée par les Associations Chrétiennes de Femmes. Une assemblée constitutive fut tenue à Genève en 1922, puis les grands congrès quinquen- naux prévus par notre Constitution se sont déroulés à Londres et à Paris en 1924 et 1929; des réunions du Conseil ont été tenues à en et à Bologne, analogues à celle qui nous rassemble aujour-
ui.
Le but de notre Association n’est pas de nous réunir entre
femmes pour discuter de questions scientifiques, la science n’est pas différente pour les hommes et pour les femmes. Mais, venues tard à la pratique de la médecine — ou plutôt revenues, car nos doctes historiennes retracent leur passage à travers les siècles — les femmes ont éprouvé d’abord le besoin d’échanger leurs expé- riences de débutantes, de se soutenir et s’aider réciproquement. Et surtout elles ont senti que dans les questions médico-sociales qui intéressent la famille, la femme, l'enfant, elles pouvaient avoir des points de vue particuliers, utiles à définir et à défendre. » «Le nombre des femmes qui se joignent à nous grandit d'étape "en étape ; beaucoup reviennent assidûment à nos congrès malgré bles exigences d’une vie professionnelle très chargée. C’est bien la preuve que notre groupement répond à une aspiration générale et que son activité satisfait au but poursuivi.
Je me vois aujourd’hui, avec un véritable plaisir, environnée de visages familiers et amicaux ; la sympathie que j'y lis m’encou- rage et m’enhardit à parler au nom de toutes.
Sur un certain nombre de points, en tout cas, je serai certaine d'exprimer sans risque d'erreur les sentiments de celles qui m'en- tourent. ;
Tout d’abord nous ne pouvons manquer d'être unanimes à remercier ceux qui nous font l'honneur, en assistant à cette séance d'ouverture, de nous apporter un précieux témoignage de bienveil- lance et de considération, La présence parmi vous de savants des plus illustres, d'hommes de gouvernement, de grands administra- teurs, l'importance qu’ils attachent à notre action, nous encourage à la poursuivre et nous en donne une idée plus élevée. Nous leur en sommes bien vivement reconnaissantes. Nous devons aussi des remerciements particuliers 4 la Société des Médecins de Vienne qui offre aimablement à nos réunions une salle si confortable et si élégante. *
Et maintenant, je veux me tourner vers nos charmantes collègues autrichiennes et leur adresser aussi nos remerciements unanimes pour la cordialité avec laquelle elles nous ont invitées et pour le soin qu'elles ont mis à nous préparer un accueil où le con- fort et la parfaite organisation s'unissent à la courtoisie et à la grace légendaires de l’hospitalité viennoise. Aussitôt présentée, leur séduisante proposition avait été acceptée par d’enthousiastes suffrages. La capitale de l'Autriche avait pour nous attirer le pres- tige éminent de ses savants médecins, l'importance et la nouveauté de ses institutions sociales, et aussi, pourquoi ne pas le reconnaître, la beauté de la ville et de ses monuments, ses musées et sa musique.
Si vieille par son histoire pleine de grandeur, si jeune par son avenir et par les voies où elle s’est résolument engagée, Vienne nous apparaît sous une double face : d’un vieux monde où se sont accumulées les richesses, surgit un monde nouveau qui crée un
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autre ordre de richesses. Il y a dans cette transmutation un moment presque pathétique, qui suscite la méditation et nous amène à réfléchir plus avant sur le sens et le but de tout effort.
Dans le domaine limité de notre activité médicale féminine, je suis persuadée que notre rencontre ici subira l'influence secrète, vivifiante et équilibrée d’un fastueux passé et de perspectives neuves et hardies.
Si nous éprouvons le besoin de nous connaître réciproquement, de discuter ensemble les problèmes qui nous tiennent à cœur, n'est-ce pas pour mettre en commun ce que chaque mentalité et chaque pays peut nous donner tour à tour d'expérience et de stimulant ?
La période difficile que nous traversons, période com- plexe, un peu trouble et parfois angoissante fait surgir des problè- mes qu'il faut avoir le courage d'envisager. Nous femmes- médecins, nous n'avons connu jusqu'à maintenant qu'une suite ininterrompue de progrès. A chacune de nos rencontres nous cons- tations que nous était plus largement ouvert l'accès des écoles, des hôpitaux, des sociétés savantes, des fonctions administratives et universitaires. Il semblait que nous n’aurions plus à enregistrer que des succès grandissants. Depuis notre dernier congrès cepen- dant, bien que de nouveaux titres et de nouvelles distinctions soient venus s'inscrire dans nos annales, nous pressentons que les crises économiques et sociales, que l'extension sans précédent du chômage, chômage qui atteint les travailleurs intellectuels autant -que les travailleurs manuels, risquent, peut-être, de remettre en question ce qui paraissait assuré,
Alors que tant d'hommes restent inoccupés, certains en vien- nent à se demander s’il est bien utile que les femmes travaillent et la tentation surgit, comme unre mède trop facile, d'arrêter les acti- vités féminines. Nous ne voulons pas discuter ici ce que de sem- blables mesures peuvent avoir de brutal et d’injuste. Des interdic- tions de cet ordre, toujours dangereuses et parfois cruelles, ne peuvent se défendre, même quand elles deviennent nécessaires, qui si elles sont justifiées sans contestation possible,
Mais en dehors du point de vue économique, il y a un point de vue humain et un point de vue social dont l'importance me semble primer largement les considérations matérielles, Sans faire „valoir ce que tout être gagne à son propre développement, nous pouvons bien dire que la famille d’abord, la société ensuite, sont les principaux bénéficiaires des progrès de l'esprit féminin et que cet esprit ne saurait être plus utilement fécondé que par les études médicales.
On vante de toute part la sensibilité féminine, et en même temps on reproche souvent aux femmes, non sans raison, ce que cette sensibilité peut avoir d’étroit et de: désordonné ; beaucoup
„d'entre elles, dit-on, ne s'intéressent spontanément qu’à ceux qui
leur sont le plus proche, et même à l'égard de ceux-ci leur sensi- bilité n’est pas toujours un bon guide. L’instinct est loin de pré- munir contre les erreurs et l’égoisme sacré n’est malgré tout qu'égoïsme,
Au cours des études médicales, le contact de nombreux malades et la recherche des soins appropriés sont éminemment propres à élargir cette sensibilité trop restreinte, et à l’orienter vers l’action, On a vu déjà ce que des femmes peuvent faire pour soulager les souffrances dont elles se trouvent les témoins ; ce sont elles qui ont inauguré ces grands mouvements que sont devenus l'organisation du «nursing » et le « service social », et vous entendrez bientôt nos rapporteurs vous exposer comment elles ont senti et compris les misères et les besoins de millions de femmes peuplant d'immenses régions et comment elles ont réussi à leur porter secours. Mélées chaque jour aux drames de la maladie et de la mort, les femmes- médecins n’apprendront-elles pas à soulager encore d’autres souffrances ? Qui peut dire où s'arrêtera leur effort ?
Un des plus grands philosophes de l’humanité, celui-là même qui a eu du monde la représentation la plus pessimiste, Schopen- hauer, a tracé cependant au-dessus de cette vision désolée, les prin- cipes d’une loi morale, et c'est dans la pitié qu'il en a vu le fonde- ment. Félicitons-nous chaque fois qu'une sensibilité ignorante et limitée se transforme en une pitié compréhensive et efficace, en cette pitié qui crée un devoir.
Ce n'est pas seulement d’ailleurs dans l’action sociale que la femme-médecin devient un élément utile de la société. Dans le domaine du travail intellectuel pur et de la recherche scientifique, qui de nous ne connaît actuellement des femmes tenant un rang ‘honorable et parfois éminent ? La société ne saurait se priver sans dommage de la contribution qu’elles pourront apporter à la lente édification collective de la science. Je ne puis m'empêcher de
Citer ici un nom universellement illustre, celui de Mme Curie, mariée et mère ‘de famille cependant.
Et même si nous ne voulons envisager que la simple moyenne des études et du travail médical, ne dédaignons pas les utiles et solides qualités intellectuelles, qu’ils développent. L'observation attentive des faits, l'appréciation de leur importance relative et de l’enchaînement de leurs conséquences, la nécessité de prévoir pour prévenir, la discipline de l'analyse et de l’objectivité, forti- fient la raison et enseignent la sagesse : or, y eut-il jamais de par le monde trop de raison, trop de sagesse ? C’est un excès qu'on n'a pas eu souvent à reprocher à des hommes, ni hélas, à des peuples.
En un temps où l’on souhaite et où l’on recherche pour tous l'élévation du standard de la vie matérielle, nous souhaitohs pour
-tous aussi, hommes et femmes, l'élévation du standard intellectuel ‘et moral et nous aimerions y collaborer. Je disais en commençant que j’espérais, mes ehiees collègues,
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savoir me faire l’interprête de vos sentiments, Je ne crois pas me tromper en affirmant que, ce qui nous attache le plus à notre acti- vité médicale, c’est la possibilité de travailler de toutes nos forces, et avec des forces que nous ne voulons pas voir réduire, à diminuer à travers le monde la lourde masse de la souffrance humaine et à relever pour notre modeste part le niveau intellectuel et moral de l'humanité. C’est là aussi, si vous me permettez de le dire comme nous le pensons, sans ostentation et sans orgueil, la raison d’être et le but primordial de notre Association, »
Le Professeur Wagner-Jauregg, Vice-Président de la Société des Médecins de Vienne, salue les femmes-médecins au nom de sa Société, et leur souhaite la bienvenue. Il rappelle que la Société des Médecins de Vienne a été dès son début prête à accueillir les femmes-médecins et que Mme le Dr Brucke Teleky y a été la pre- mière admise comme membre en 1911. Maintenant, les femmes s'y trouvent au nombre de 29 et il espère que la réunion actuelle hâtera le moment qu’il souhaite où la Société comprendra un nombre égal de femmes et d'hommes.
Le Dr Max Mayer, du Ministère de l'Instruction Publique, prend la parole au nom de son Ministre. Il souligne le fait qu’en Autriche les femmes ont toujours compris la nécessité de s’inté- resser à la vie publique, et rappelle que c’est sous le régime de FImpératrice Marie-Thérèse que l'Hôpital populaire l’ « Allgemeine
‘ Krankenhaus » fut bâti.
Le Prof. Julius Tandler, Directeur du Bureau de Prévoyance municipale, remplaçant le Maire de Vienne, invite les membres présents à visiter les institutions de prévoyance nouvellement créées. Il dit sa conviction que les femmes sont particulièrement aptes à certaines branches de l’art médical, et termine en engageant les femmes-médecins à prendre parti contre la guerre.
Le Dr Thos. Scherer, représentant du Ministre de l'Hygiène publique salue les femmes-médecins, en leur disant qu’elles sont
_prédestinées par la nature à être médecins, et que c’est surtout dans le domaine de la prévoyance sociale qu’elles peuvent exercer leur influence, comprenant mieux la souffrance humaine que les hommes.
Le Dr Roland Grasberger, doyen de la Faculté de Médecine de Vienne, dit combien il a été heureux de répondre à l'invitation qui lui a été adressée. Il rappelle que c’est en 1900 que les premières femmes furent admises à Vienne, comme étudiantes en médecine,
-et qu'aujourd'hui la femme a amplement prouvé qu’elle est à la hauteur -des exigences qui sont les mêmes pour’ les. femmes-méde- -cins que pour les hommes, et il leur souhaite pour l'avenir tout le succès possible. z Le Dr Bauer-Jokl, Présidente de l Association: des. Femmes- Médecins autrichiennes, adresse une cordiale bienvenue à ses
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collégues, et souhaite que la réunion atteigne son but qui est d'essayer d’alléger le fardeau humain et d’améliorer les conditions de tous ceux qui souffrent.
Le Dr Brucke Teleky, Secrétaire nationale Correspondante de l’Autriche remercie ses collègues d’avoir accepté Vienne comme lieu de la réunion. Elle dit que son pays, tout en ne pouvant pas rivaliser avec Londres, Prague et Bologne, à cause de sa situation économique actuelle, offre de grand cœur l'hospitalité à l’A. I. F. M. et espère que ses membres emporteront de Vienne un agréable souvenir.
Le Dr Thuillier Landry remercie les orateurs de leurs paroles aimables et encourageantes et lève la séance.
“REPORT OF THE FIFTH COUNCIL MEETING
Vienna — September 15th - 2oth 19351
The 5th Council Meeting of the Medical Women’s Interna- tional Association was held at Vienna from the 15 th to the 20th of september 1932. Nearly 200 medical women attended the meeting belonging to the following 17 countries : Austria, Czecho-Slovakia, Denmark, Dutch East Indies, France, Germany, Great Britain, Hungary, India, Italy, Japan, Jugoslavia, Lapland, Norway, Sweden Switzerland and-the United States.
All the meetings were held in the fine rooms of the Medical Society in Vienna « Haus der Gesellschaft der Aerzte in Wien », kindly placed at the disposal of the M. W. I. A. by the Society.
OPENING MEETING
At the opening meeting held on september 16th at 10 0/clock, under the chairmanship of Dr Thuillier-Landry (France), Presi- -dent of the M. W. I. A. many Viennese authorities were present,
Dr Thuillier-Landry ‘opened the meeting by retracing the history of the Association, born in New-York in 1919, -constituted in Geneva in 1922, and which had now a considerable following and a wide activity:
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She thanked the distinguished authorities who had consented to honour the meeting by their presence, and her Austrian colleagues for their gracious invitation and hospitality.
She reminded the assembly that to women were due the great movements culminating in the creation of « nursing » and « social service »; that medical women, coming up against disease and death constantly were eminently fitted to alleviate suffering and was there any limit to which their efforts could not attain ? She felt she would be interpreting the opinions of all her colleagues in affirming that one of the principal aims of the M. W. I. A. and she said it without vain ostentation, was to endeavour by every means in its power to diminish in the world the heavy burden of human suffering and to raise the intellectual and moral standard of huma- nity.
Professor Wagner-Jauregg, Vice-President of the Medical Society of Vienna, welcomed the medical women in the name of his Society, which, from the start had been ready to accept medical women and recalled that Mme Brucke-Teleky had been the first to be admitted in 1911. Now there were 29 medical women in the Society and he hoped that the present meeting would help to hasten the moment he looked forward to when they would belong in equal number with their male colleagues.
Dr Max Mayer, from the Ministry of Education, spoke on behalf of the Minister, stressing the fact that in Austria women had always understood the need of taking an active part in public life and that it was during the reign of the Empress Maria Theresa that the City hospital « Allgemeine Krankenhaus » was built.
Professor Julius Tandler, Director of the City Welfare Bureau, representing the Mayor of Vienna, invited the Congressists to visit the newly instituted welfare organisations of the town. He was convinced that women were specially fitted for certain branches of medical activity and exhorted. all medical women -to use their influence in their countries to prevent the recurrence of war.
Dr Thomas Scherer, representing the Minister of Public Health, greeted the medical women present saying they were pre- destined by Nature to be doctors, and that it was especially in the domain of social welfare that they could exercise their activity, understanding better than men the sufferings of humanity.
Dr Roland Grasberger, Dean of the Faculty of Medicine of Vienna, said how happy he had been to accept the invitation extend- ed to him, He recalled that it was in 1900 that the first women were admitted in Vienna as. students of medicine and that to-day they had amply proved that they were equal to the demands made upon them, the same for women as for men, and wished them every success.in.the future. . ..
Dr Bauer- Jokl, President of the Austrian NEET, afi Med- ical Women, addressed a hearty. welcome to her colleagues and
hoped that the meeting would attain its purpose which was to lighten the human burden and improve the conditions of the sufferers.
Dr Brucke-Teleky, Wational Corresponding Secretary for Austria, thanked her colleagues for having accepted Vienna as the seat of the meeting. She said that her town, while being unable to emulate London, Prague and Bologna on account of the present economic situation, nevertheless offered whole-hearted hospitality to the M. W. I. A. and she hoped that its members would carry away pleasant memories of their stay in Vienna.
Dr Thuillier-Landry thanked the orators for their friendly and encouraging words and terminated the meeting.
REUNIONS DU CONSEIL
Le Conseil de l’Association Internationale des Femmes- Médecins s’est réuni le mercredi 16, le jeudi 17 et le vendredi 18 septembre 1931, sous la présidence du Dr Thuillier-Landry.
Le Conseil est heureux d'accueillir les deux nouvelles Associa- tions affiliées : le Japon et la Tchécoslovaquie et de voir les Pays- Bas, les Indes néerlandaises et l’U. R. S. S. représentées dans l’Asso- ciation Internationale chacun par un membre individuel.
Les Pays n'ayant pu se faire représenter à la Réunion de Vienne ont communiqué leurs opinions sur les sujets mis à l'étude et adressé à l'assemblée leurs souhaits de succès.
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Les rapports de la Trésorière et de la Secrétaire générale sont présentés et approuvés. Ils sont publiés dans le présent bulletin.
Désignation des vice-présidentes :
Le Conseil décide que lorsqu'il y aura a remplacer une vice- présidente, une liste de candidatures devra être soumise par le pays à représenter, au Bureau qui choisira sur cette liste.
Rapports des Secrétaires nationales Correspondantes des pays nou- vellement affiliés.
Le Dr Dewetterova pour l'Association Tchèque et le Dr van der Made pour les Indes néerlandaises donnent des renseignements très intéressants sur l’activité des femmes-médecins dans leurs pays respectifs.
Choix du lieu du prochain Congrès Quinquennal :
L'Allemagne, les Etats-Unis et la Suède proposent chacune leur pays comme siège du prochain Congrès, mais en raison de la crise économique actuelle, le choix définitif sera fait ultérieurement par le Bureau.
Sujets de discussions pour le prochain Congrès :
Onze sujets ont été proposés et les deux questions suivantes ont été retenues :
1° Les effets de l'Éducation physique sur la Femme (mens- truation, grossesse, etc.) proposé par le Dr Hoffa, Allemagne.
2° Le contrôle des naissances, proposé par le Dr Téléky, Autriche,
Le Bureau soumet ensuite à la ratification du Conseil un certain nombre de décisions prises au cours de ses réunions men- suelles et lui demande de se prononcer sur les modifications au Règlement qu’il propose.
Modification au Règlement :
Il est décidé de modifier l’article VII paragraphe II en y ajou- tant la phrase suivante : « Le Conseil se compose des Membres du Bureau et des représentantes de chaque pays. »
Il est en outre décidé que les trois Membres du Bureau (Pré- sidente, Trésorière et Secrétaire générale) doivent être présents à toutes les réunions et que le pays qui envoie ces trois membres ne doit pas avoir moins de trois voix au Conseil.
Relations avec les Organisations internationales s'occupant d’ Hygiène et de Médecine sociales :
L'Association Internationale des Femmes-Médecins a déjà organisé un échange régulier de publications avec les grandes Organisations internationales et cherche les moyens d’intensifier cette collaboration.
Le Conseil admet l'envoi d’une représentante aux Congrès de ces Associations lorsqu'une question y sera étudiée au sujet de laquelle l'Association Internationale des Femmes-Médecins aura déjà pris nettement position.
En échange l'A; I. F. M. recevra à ses Congrès des femmes- médecins représentantes de ces Associations.
Collaboration entre l’ Association Internationale des Femmes-Médecins et la Fédération des Femmes Diplômées des Universités :
La Fédération des Femmes Diplômées des Universités pro- pose un certain nombre de vœux au vote du Conseil de l’Associa- tion Internationale des Femmes-Médecins en vue d’assurer une collaboration entre les deux associations.
1° Création d'un Comité de coopération entre la F. F, D. U, et les organisations professionnelles internationales. Ce Comité sera composé d’une représentante de chacune des organisations, ces représentantes devant toutes être membres de la F, F. D. U.
2° Échange par les secrétariats des documents pouvant inté- resser les diverses associations (rapports des Congrès, questions à l'étude, dates des réunions, etc.).
3° Invitation d’une déléguée de chaque association aux Con- grès des autres, avec cette condition que la déléguée de la F. F, D, U. devra être une femme-médecinp our les congrès des femmes- médecins et une juriste pour les congrès des femmes-avocates.
. 4 Réunions entre présidentes des différentes associations ‘lorsque les circonstances le permettront.
5° Entente entre les associations pour que leurs réunions de Conseils et leurs Congrés aient lieu dans le méme pays et 4 des dates rapprochées, afin de permettre la rencontre de leurs membres et de ne pas multiplier les déplacements.
6° Que chaque association offre aux autres associations une petite place dans ses publications internationales pour des commu- nications intéressant les unes et les autres.
7° Nomination, toutes les fois que cela sera nécessaire d’une commission mixte chargée d'étudier une question intéressant les membres de deux ou plusieurs associations.
Tous ces vœux sont adoptés à l'exception du vœu n° 5.
A ce sujet le Dr Thuillier-Landry propose de tenir un Congrès tous les trois ans, rythme adopté par presque toutes les grandes Associations internationales avec entre temps une Réunion du Conseil purement administrative ne comportant pas de discussions scientifiques.
Le Conseil décide le renvoi de cette discussion au prochain Congrès,
Le Dr Montreuil-Straus propose de voter un vœu blamant les mesures d'exception qui privent de leurs postes les femmes-méde- cins fonctionnaires mariées. Cette proposition est adoptée. (Voir texte des vœux à la fin du bulletin.)
Avant de lever la séance, la Présidente propose que les excel- lents Rapports préparés par les Rapporteurs généraux soient pro- pagés le plus possible et demande qu’une liste des personnalités, institutions, bibliothèques, etc., auxquelles ces rapports pourraient être adressés soit communiquée au Secrétariat,
MEETINGS OF THE COUNCIL
The Council of the Medical Women’s International Asso- ciation met on Wednesday the 16th, Thursday the 17th and Friday the 18th of september 1931, under the chairmanship of Dr Thuillier- Landry.
The Council was happy to welcome two new affiliated Asso- ciations : Japan and Czecho-Slovakia and to see the Netherlands, the Dutch East Indies and Russia represented in the International Association, each by an individual member.
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The countries unable to send representatives to the Vienna Meeting had communicated their opinions of the subjects on the agenda and addressed their best wishes for success to the assembly.
Delegates :
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Bauer-Jokl. Brucke- Teleky. Dewetterova. Johanne Naeser. Van der Made. Blanchier. Hartmann-Coche. Montreuil-Straus, Réquin. Thuillier-Landry. Hermann.
Hoffa.
von Muller. Salzmann.
Eaves.
Herzfeld. Martindale, Odlum,
Sharp. Vegess-Rege. Balfour,
Pennell. Sorrentini.
Toda. Nechovitch-Voutchetitch. Dagny-Bang. Ada Nilsson, . Marie Feyler. Kate Mead. O'Malley. Stastny
Tayler- Jones,
The reports of the Treasurer and the Honorary Secretary were presented and approved. They are published in the present bulletin.
Nomination of Vice-Presidents.
The Council decided that when it was necessary to replace a vice-president, a list of candidates should be submitted by the country to be represented to the Officiers who would choose from
this list.
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TARIFS DES ABONNEMENTS : France, 50 fr. ; Etranger {tarif 1), 60 fr. ; Etranger (tarif 2), 70 fr. (4) Le Fascicule : 6 fr. 7
(1) Le tarif n° x est valable seulement pour les pays qui ont accepté une réduction de 50 o/o sur les affranchissements des périodiques : Albanie, Allemagne, Argentine, Autriche, Belgique, Brésil, Bulgarie, Canada, Chili, Colombie, Congo Belge, Costa-Rica, Cuba, Egypte, Equateur, Espagne, Esthonie, Ethiopie, Finlande, Grèce, Guatemala, Haiti, Honduras, Hongrie, Lettonie, Liberia Lithuanie, Luxembourg, Mexique, Nicaragua, Panama, Paraguay, Pays-Bas, Perse, Pologne, Portugal et ses Colonies, République Dominicaine. Roumanie, Russie (U.R.S.S.), San Salvador, Serbie, Tchécoslovaquie Terre-Neuve, Turquie, Union de l'Afrique du Sud, Uruguay, Venezuela.
Reports of the National Corresponding Secretaries of the newly- affiliated associations.
Dr Dewetterova for the Czech Association and Dr Van der Made for the Dutch Indies gave most interesting information concerning the activity of medical women in their respective countries.
Choice of place for the next Quinquennial Congress.
Germany, the United States and Sweden proposed their country as the seat for the next Congress, but by reason of the present economical crisis the definite choice would be left to the Officers to make at a later date.
Subjects for discussion at the next Congress.
Eleven subjects were proposed from which the following two questions were chosen :
1° The effects of Physical Education on Women (menstrua- tion, pregnancy, etc.) proposed by Dr Hoffa (Germany).
2° Birth-Control. proposed by Dr Teleky (Austria).
The Committee submitted to the ratification of the Council a certain number of decisions taken during the monthly meetings and asked the delegates to give their opinion on them.
Modification in the Bye-Laws.
The Council decided to modify article VII paragraphe II by the addition of the following sentence : « the Council is composed of the Officers and of representatives of each country. »
It was further decided that the three Officers (President, Trea- surer and Honorary Secretary) should be present at all meetings and that the country providing these three Officers should not have less than three votes in the Council.
Relations with International Organisations of Medical and Social Hygiene.
The M. W. I. A. had already organised a regular exchange of publications with the important International Associations and was studying the means of intensifying this collaboration.
The Council agreed to send a representative to the Congresses of these Organisations when there was a question on the agenda about which the M. W. I. A. had already taken a definite stand.
In exchange the M. W. I. A. would admit to its Congresses medical women belonging to these Associations.
7h =
Collaboration between the Medical Women’s International Association and the International Federation of University Women.
The International Federation of University Women had pro- posed a certain number of resolutions upon which they asked the Council of the M. W. I. A. to vote, concerning the collaboration betwen the two associations. These resolutions were as follows :
1° Creation of a committee of co-operation between the I. F. U. W. and international professional organisations. This committee would be composed of a representative of each of these organisations who should all be members of the I. F. U. W.
2° Exchange by the secretariats of documents of interest to the various associations (reports of meetings, questions to be dis- cussed, dates of future meetings, etc.).
3° Invitation of a representative of each association to the Congresses of the others, on condition that the representative of the I. F. U. W. should be a medical woman for the Congresses of the medical women and a jurist for those of the women jurists,
4° Meetings betwen the presidents of the different associa- tions when circumstances permitted.
5° Agreement between the associations so that their Council Meetings and Congresses take place in the same country and at a near date so that their respective members might meet and in order not to multiply the number of journeys necessary.
6° Each association should reserve for the other associations a small space in their Bendo publications for communications of interest to each other.
7° Nomination, whenever necessary of a joint commission
for the study of a question interesting the members of two or more
associations.
Allthese resolutions were adopted with theexceptionofnum ber5.
Speaking of this proposal, Dr Thuillier-Landry suggested that the M. W. I. A, should hold a Congress every three years, rhythm of nearly all the big international associations, with a Council Meeting in between which would be purely administra- tive without any scientific discussions.
The Council decided to postpone the discussion of this point until the next Congress.
Dr Montreuil-Straus proposed a resolution condemning the measures taken to deprive medical women of their official posts upon marriage. This resolution was adopted. (see text of resolu- tions at the end of the bulletin).
Before closing the meeting the President proposed that the excellent reports prepared by the Rapporteurs should be circulated as widely as possible and requested that members should commu- nicate to the central office a list of the personnalities, institutions, libraries, etc. to whom these reports might be sent. i
SESSIONS SCIENTIFIQUES
Mercredi 16 septembre à 15 heures 1'¢ réunion sous la prési- dence de Miss Martindale (Grande-Bretagne).
Le Rôle des Femmes-Médecins dans les Pays Exotiques.
Miss Martindale exprime les regrets de l'assistance pour l’absence du Dr Poli Garnier, Rapporteur de la question pour les pays de langues latines, empêchée par un deuil de venir à Vienne.
Le Dr Margaret Balfour (Indes anglaises), Rapporteur pour les pays de langues anglo-saxonnes résume son rapport et propose la création d’un Comité pour intensifier les recherches sur les causes et l’évolution des maladies si fréquentes en pays exotiques qui affectent la grossesse et l’accouchement.
Le Dr Agnel-Billoud (France) prend ensuite la parole pour présenter les conclusions du Dr Poli-Garnier (Algérie). (Ces rapports sont imprimés in extenso à la suite des comptes-rendus.) _ Le Dr Pennell (Indes anglaises) appuie l’idée du Dr Balfour d'organiser une Commission permanente qui s’occuperait des maladies qui prévalent dans les pays exotiques. Elle dit que 1’A. I. F. M. a d’énormes‘possibilités d'action et partant une grande res- ponsabilité. Etant en rapports avec tous les pays il lui serait peut- être possible d'obtenir l'octroi de fonds internationaux pour le travail à faire dans ce domaine, où le manque de fonds est à la base de toutes les difficultés rencontrées. Elle insiste aussi sur la nécessité d'intensifier les recherches, mais ici encore il faut de l'argent.
Elle parle des Écoles de Médecine qui devraient être créées et demande pour elles des femmes-médecins ayant les mêmes qualifications que leurs collègues d'Europe. Au début il était néces- saire d'admettre des diplômes inférieurs, mais devant les difficultés du travail à accomplir les plus hautes qualifications sont mainte- nant requises.
Elle s'élève aussi contre la pratique, souvent rendu nécessaire par le manque de personnel qualifié, de confier à des infirmières ce qui devrait être fait par des médecins. Elle termine en adressant un appel pressant en faveur d’une coopération générale et d'efforts soutenus en vue des améliorations à poursuivre.
Le Dr Dengel (États-Unis), qui a travaillé quatre ans aux Indes, et dont le cœur est encore là-bas, raconte que les femmes de ce pays sont sans appui mais pleines de bonne volonté, et qu’elles acceptent le progrès lentement mais sûrement. Elle déplore le manque de médecins et d’infirmiéres, et constate que cette pénurie est surtout due, pour les femmes, à l'ignorance où elles sont de la situation dans ces pays,.et du. champ d’action immense qui
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s'offre à elles. Le Dr Dengel a fait de nombreuses conférences, à son retour en Amérique, dans les écoles, les clubs, etc., et elle a partout trouvé un intérêt vite éveillé. Elle applaudit à l’idée de la Commission permanente, dont un des buts devrait être de faire connaître dans le monde entier les conditions des pays lointains, persuadée que lorsque les femmes seront renseignées, nombreuses seront celles qui voudront se porter au secours d’autres femmes et de leurs enfants.
Miss Martindale a été très frappée par les remarques du Dr Balfour concernant les coutumes existant dans les pays exo- tiques et des difficultés qu’elles occasionnent ; elle demande notam- ment si A. I. F. M. pourra faire quelque chose d'utile dans la question, récemment discutée en Angleterre, de la circoncision de la femme.
Le Dr Balfour dit que cette pratique, douloureuse et dange- reuse, parfois cause de mort, et toujours de choc pour le système nerveux, a cessé aux Indes mais existe encore dans beaucoup de parties de l’Afrique. Elle serait favorable à son abolition, mais elle souligne l'importance qu'il y a à procéder avec précaution dans l'interdiction légale de certaines. pratiques indigènes, qui cons- tituent le plus souvent des prescriptions religieuses absolues. Elle cite le cas de nombreuses femmes qui, empêchées par la loi de con- tinuer ces pratiques ordonnées par leurs croyances, se voient mises au ban de leurs tribus, et qui n’ont alors d’autre ressource que de devenir des prostituées. D’autres coutumes encore se rattachent, pour l’indigène, à son code moral, et s’il les voit abolir trop rapide- ment il perd la notion du bien et du mal, et le résultat acquis va à l'encontre du but poursuivi. Revenant à la question de la circon- cision féminine, elle conseille d’instituer une enquête plus appro- fondie dans les différents pays, et premièrement de chercher à apprendre les désirs des femmes elles-mêmes sur ce point.
Le Dr Requin (France) croit que ce problème pourrait être étudié par la Commission permanente précitée.
Le Dr Ramsay (Grande-Bretagne) raconte que le Comité exécutif de la Fédération Britannique des Femmes-Médecins a eu à exprimer son opinion sur ce sujet à la demande d’une femme, Membre du Parlement britannique. Après une discussion appro- fondie une proposition a été adressée au Gouvernement anglais recommandant l'abolition de cette pratique qui apparaît comme dangereuse, mais demandant que les méthodes de cette prohibition soient confiées au gouvernement. colonial afin d'obtenir la dispa- rition graduelle de cette coutume après qu’ une propagande Aire priée aurait préparé la voie.
Elle remercie le Dr Balfour pour son excellent rapport, qui éclaire singulièrement le travail demandé dans ces pays et celui déjà accompli, et estime qu'il aura ouvert les yeux à plus d’une femme-médecin.
Parlant de la morbidité maternelle elle estime que chaque pays ayant des colonies devrait donner des instructions 4 ses femmes- médecins sur les meilleures méthodes de prévention, et estime que la Commission permanente proposée ne pourra agir efficacement que par le moyen de sous-comités de membres correspondants, choisis avec grand soin pour les différentes investigations a faire, leur travail étant ensuite centralisé par le Bureau de l'A. I. F. M.
Le Dr Balfour précise que selon son idée, cette Commission permanente ne s’occuperait pas seulement de la morbidité et de la mortalité maternelles, mais de toutes les faces du probleme exo- tique. Elle conseille des cours de perfectionnement pour les femmes- médecins allant travailler dans les pays exotiques, en vue de leur faire connaitre les conditions spéciales qu’elles y rencontreront, les maladies qui y prévalent, etc. Elle voit naturellement des cours différents pour des pays différents, mais il lui semble qu’un stan- dard commun pourrait étre requis, lequel serait communiqué aux gouvernements intéressés, aux écoles de médecine, etc.
Dame Louise Mc Ilroy (Grande-Bretagne) appuie cette pro- position.
Le Dr Balfour donne des explications sur la Commission permanente qu’elle préconise. Elle la verrait composée en Europe de membres qualifiés, avec des membres correspondants aux Colo- nies qui leur enverraient des renseignements; ceux- ci seraient recueillis par le Bureau international. Elle rappelle qu'une com- mission analogue a rendu de précieux services pour la peste.
Le Dr Bauer (Autriche) demande qu’une collègue autrichienne donne des précisions sur les comités consultatifs pour la mater- nité, institution qui n'existe dit-elle dans sa forme précise qu’en Autriche.
Le Dr Téléky raconte que dans ces comités travaillent des femmes-médecins et des infirmières visiteuses, des femmes -les fréquentent depuis le commencement de la grossesse jusqu'à la naissance de leurs enfants, et elles continuent ensuite 4 y venir avec leurs enfants jusqu’à ce que ces derniers aient six ans. De plus la Municipalité de Vienne a organisé un examen du sang pendant la grossesse, afin de lutter contre les maladies vénériennes. La mortalité maternelle et infantile a ainsi beaucoup baissé depuis la guerre.
Le Dr Balfour revient sur l'intervention du Dr Pennell. Elle reprend le cas des femmes-médecins ayant des diplômes inférieurs a ceux demandés en Europe, et dit que ces femmes rendent de grands services ensuite comme assistantes dans les hôpitaux et dans les villages et pour de petites opérations. Elle aussi est de l'avis du Dr Pennell qu’il vaudrait mieux demander le méme standard de qualifications pour toutes, mais ce standard élevé exige une éduca- tion et’une instruction élevées et la question se pose de savoir si dans les pays exotiques le niveau de l'instruction est dès à présent
assez haut et s’il est dès maintenant possible de renoncer à des aides moins qualifiées ? Elle rappelle que souvent les médecins très qualifiés n'aiment pas travailler dans les villages retirés.
Comme le Dr Pennell elle est hostile à l'habitude qu'ont con- tractée certaines femmes-médecins de confier une partie de leur travail à leurs infirmières, mais il ne faut pas oublier que c’est souvent là un cas de force majeure et mieux vaut y avoir recours certaines fois que de laisser mourir une femme en couches par exemple si le médecin est retenu à son poste par des centaines de malades qui l’attendent.
Par contre elle s'élève fortement contre la pratique de certaines municipalités qui confient volontiers à des infirmières ou à des visiteuses le travail qui devrait être fait par des médecins, comme la direction d’un dispensaire, pour la seule raison que la rémunération de ces personnes est moins élevée que celle des médecins.
Elle termine la première séance en disant combien lui ont fait plaisir les paroles enthousiastes du Dr Dengel sur son travail aux Indes, et dit que ce sont des femmes comme elle qu’il faut dans les pays exotiques, où pour véritablement réussir il faut du personnel et de la personnalité.
* * k
Jeudi 17 septembre à 15 heures 2° réunion sous la présidence du Dr Tayler Jones (États-Unis).
Suite de la discussion sur le Rôle des Femmes-Médecins dans les Pays Exotiques.
Le Dr Balfour dit qu’elle estime le moment venu de se former une opinion, maintenant que les femmes-médecins sont employées de plus en plus dans les Colonies, sur les avantages et les incon- vénients comparés de services médicaux spéciaux uniquement confiés à des femmes, ou de services communs aux médecins des deux sexes, Le Dr Balfour invite ses collègues présentes à se pro- noncer sur cette question ; elle rappelle les services rendus et les résultats acquis par le service médical aux Indes, et constate que dans les autres services coloniaux, où les femmes sont admises, en principe, sur un pied d'égalité absolue avec leurs confrères mascu- lins, dans la pratique elles n'arrivent jamais aux postes supérieurs, qui sont toujours confiés à des hommes, ainsi que les postes d’ins- pection lorsqu'il s’agit de surveiller le travail d'hommes et. de femmes,
Le Dr Tayler Jones souligne l'importance de ce problème et invite l'assistance à ne pas prendre sans beaucoup'de réflexion une décision qui pourrait avoir une répercussion importante dans de nombreux pays.
Le Dr Pennell préconise un service unique pour les deux sexes, mais où les hommes dirigeraient les sections pour hommes et les femmes celles pour les femmes, comme cela se fait déjà dans le service de l’Instruction Publique aux Indes. Ceci permettrait de demander aux Gouvernements plus de femmes-médecins. Elle juge d’ailleurs inopportun de soumettre aux Gouvernements des recommandations arrêtées étant donné l’évolution politique actuelle. Elle dit que sans les hôpitaux des Missons qui existent un peu partout les femmes des Indes manqueraient terriblement de soins.
Le Dr Benson (Grande-Bretagne) raconte que lorsque le service médical féminin fut fondé aux Indes un certain nombre de femmes-médecins adressèrent une pétition à la femme du Vice-Roi en vue de l'amélioration des conditions des femmes- médecins aux Indes. A la suite de cette démarche elles reçurent un questionnaire émanant du Gouvernement central qui leur fit comprendre qu'il n’était pas de leur intérêt de solliciter des postes
‘dans des services dirigés par des hommes, souvent médecins mili-
taires, et qu'il leur était naturellement impossible de songer à obtenir des postes dans les services médicaux de l’armée. Elles comprirent donc qu'il était préférable de former des services dis- tincts pour les femmes. Le Dr Benson voit un autre avantage à la création de ces services, c’est qu'ils peuvent s'organiser sur des bases modernes sans subir les entraves d'anciennes règles suran- nées. Elle cite comme exemple le Collège fondé à Delhi, où le service médical féminin est admirablement organisé. `
Le Dr Adamson (Grande-Bretagne) n'ayant pas d'expérience du travail aux Indes voit cependant une objection à un service commun. Elle craint qu’un tel service n’ait tendance à se modeler sur le service d'Hygiène Publique tel qu’il existe en Angleterre, où il arrive généralement que sont seules dévolues aux femmes cer- taines branches d'activités considérées, à tort ou à raison, comme un peu inférieures. Tout en reconnaissant qu'un seul service où les postes de direction et de responsabilité seraient attribués uni- quement d’après les capacités serait l'idéal, elle croit que pour le moment un service spécial pour les femmes-médecins est plus souhaitable.
Le Dr Dengel cite le cas d’un poste supérieur d'inspection du travail dans les Hôpitaux et Missions qui était le seul confié à une femme, et qui depuis quelques années a été supprimé par le Gou- vernement des Indes pour réaliser des économies, Le Dr Dengel dit toute l'utilité que présentait cette inspection, souvent seul point d'attache pour les hôpitaux isolés, souvent leur unique moyen de se tenir au courant des progrès obtenus et des résultats acquis dans les autres parties de l'Inde, et elle fait observer que si ce poste avait dépendu d’un service spécial de femmes il n’aurait jamais été supprimé.
Le Dr Raemi (Suisse) regrette l’absence du Dr Schnabel,
empéchée d'assister à la réunion, qui a travaillé pendant deux ans à l'Hôpital du Professeur Schweizer à Lambarene (Congo), et qui insiste sur l’absolue nécessité d'envoyer des femmes médecins euro- péennes là-bas, pour soigner les femmes indigènes privées de tout soin compétent.
Le Dr van der Made (Indes néerlandaises) dit que dans son pays il n’y a pas encore assez de femmes-médecins pour préconiser l'établissement de services spéciaux pour les femmes; il y en a peut-être 40 ou 50 en tout, en comptant celles au service du Gou- vernement et celles des Missions. Il existe des hôpitaux spéciaux pour femmes, où le Gouvernement nomme deux ou trois femmes- médecins pour les accouchements et pour l'instruction des sages- femmes.
Le Dr Balfour résume la discussion sur la question qu’elle a soulevée en disant que le moment n’est pas encore venu de prendre parti, qu'il faut laisser au temps et à une étude approfondie le soin d'indiquer la solution préférable. Elle rappelle que le service spécial des Indes n’a que seize ans d'existence et que beaucoup d’autres services coloniaux sont plus jeunes encore, et elle trouve insuffisants les renseignements recueillis jusqu'ici. Tout le monde souhaiterait un service unique où les femmes auraient exactement les mêmes possibilités que les hommes, mais si, comme l'a dit le Dr Adamson, cela aboutit à ne leur confier que les postes subal- ternes alors mieux vaut leur réserver des services spéciaux où elles peuvent montrer ce dont elles sont capables. Il est surtout impor- tant pour le travail des femmes-médecins qu’elles puissent atteindre aux postes administratifs. Le Dr Balfour conseille de garder pré- sente à l'esprit la question posée de manière à y répondre ultérieu- rement en toute connaissance de cause.
Elle oriente ensuite la discussion sur le dernier point de son rapport : étant donné la pénurie actuelle de femmes-médecins dans les pays exotiques, est-il préférable de les répartir sur de nombreux points du territoire de façon à secourir le plus possible de malades, ou au contraire de les grouper en un petit nombre de centres, chaque centre se spécialisant dans une certaine branche d'activité médicale ? Elle cite le cas, fréquent dans les Indes et les autres colonies anglaises, d’une seule femme-médecin à la tête d’un hôpital mal équipé, où les malades sont nombreux et où il est difficile de faire un travail soigné ; elle demande s'il serait préfé- rable que le Gouvernement laisse ces hôpitaux à la charge des autorités locales, et concentre son effort sur quelques hôpitaux plus importants comprenant six à huit femmes- médecins, un équi- ‘pement moderne, des installations de Rayons X, etc., et où les Po hôpitaux locaux pourraient éñvoyer leurs: cas: difficiles 2
Le Dr van der Made préconise un grand hôpital central pour les cas difficiles avec de petits hôpitaux locaux pour les cas cou- rants,
Personne autre n’ayant demandé la parole sur ce point le Dr Agnel Billoud au nom du Dr Poli Garnier, parle du vaste champ d’action ouvert aux femmes-médecins au Maroc, et dit qu’il reste énormément a faire, en particulier pour la lutte contre les parasites, où les grands efforts déjà faits donnent des résultats très appré- ciables, et pour les soins à donner aux yeux. Elle dit qu’il faut des femmes-médecins expérimentées et pleines de courage qui ne se laissent pas rebuter par la difficulté de la situation et la malpropreté des indigènes.
Le Dr Thuillier-Landry (France) dit que l'Association Fran- çaise des Femmes-Médecins a eu à intervenir à deux reprises pour faire augmenter en Algérie les traitements des femmes-médecins, nettement inférieurs à ceux de leurs collègues masculins. Elle estime que l'A. I. F. M. devrait proclamer la nécessité de faire soigner les femmes et enfants indigènes par des femmes- médecins et de donner à celles-ci une situation en rapport avec le travail qu'elles ont à fournir. Elle est d'avis qu’une telle proclamation aiderait. l’ Association Française et peut-être d’autres dans leurs efforts pour améliorer les conditions faites aux femmes-médecins dans les pays exotiques.
De plus elle souligne que les femmes-médecins françaises des Colonies insistent sur la nécessité de former de bonnes infirmières indigènes, et elle propose que l'A: I. F..M. émette un vœu dans ce sens faisant ressortir que le service médical dans les pays exotiques ne peut rendre les services qu’on est en droit d'en attendre qu'avec l’aide des infirmières nécessaires.
L'Assemblée accepte ces deux propositions à l'unanimité.
Le Dr Kate Mead (États-Unis) espère que I'A. I. F. M. con- tinuera à bombarder les Gouvernements de résolutions jusqu’à ce qu'ils agissent en. conséquence.
Le Dr Balfour approuve le vote de toute résolution tendant à améliorer les conditions dans les colonies, mais elle rappelle que la situation est différente suivant les pays. Pour ce qui est des infir- mières, par exemple, aux Indes britanniques le Gouvernement connaît maintenant la nécessité d’en avoir en nombre suffisant mais il reste à améliorer leur niveau et leurs études, tandis qu’en certaines parties de l’Afrique il importe d’abord de préparer un grand nombre d'infirmières, le standard de leur formation viendra par la suite. Elle définit ensuite la Commission permanente dont le principe est adopté. (Voir texte des vœux à la fin du Bulletin.)
ae Vendredi 18 septembre à 15 heures 3° réunion sous la prési- dence du Dr Hoffa (Allemagne). Le Dr Balfour soumet au vote de Passe bibs le texte d’une résolution résumant les vœux exprimés la veille sur le travail des
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que des climats différents peuvent déterminer un état physiolo- gique différent. Elle dit par exemple que les femmes d'Italie ne peuvent pas porter des poids aussi lourds que les femmes nor- diques.
Elle estime que la protection de la femme travailleuse n’est pas une question individuelle mais une question intéressant la race, et qu'à travers la femme il faut protéger l'enfant. Si la femme était payée autant que l’homme ce serait là la meilleure des protec- tions. Tout en luttant pour l'égalité de la femme et son élévation sociale, elle réclame pour elle des lois raisonnables de protection dans la maternité.
Le Dr Derscheid-Delcour (Belgique) communique par lettre un court travail par Mme de Craene van Duuren sur la Protection légale. Mme van Duuren s'élève contre cette protection en disant qu'il est peu scientifique de déclarer que la santé et le bien-être d’un groupe d'individus ne peuvent être assurés qu’en les soumet-
‘tant à des restrictions et à des incapacités.
Le Dr Nechovitch (Yougoslavie) dit qu'en 1922 une loi de protection de la travailleuse a été votée, que le travail de nuit est presque partout défendu dans son pays aux femmes, que tous les travailleurs sont assurés. La femme reçoit, pendant deux mois avant et deux mois après son accouchement une allocation se montant à 75 % de son salaire, et son contrat de travail n’est pas interrompu, mais elle n’a pas le droit de travailler pendant ce délai, sans cela elle ne reçoit rien. L’hygiène est enseignée dans les écoles publiques.
Le Dr Bauer (Autriche) est hostile au travail de nuit pour la femme, disant que ce travail n’est en général pas mieux payé que celui de jour ; par contre elle n’estime pas que la femme soit plus susceptible aux poisons industriels que l’homme, sauf cependant pendant la grossesse,
Le Dr Hoffa lève la séance et renvoit la suite des discussions au lendemain.
* * *#
Samedi 19 septembre à g heures 4° réunion sous la présidence du Dr Thuillier-Landry.
Suite de la discussion sur la Protection légale des Travailleuses.
Le Dr Thuillier-Landry rappelle que de nombreux orateurs ont demandé la parole et qu’il est nécessaire de limiter l’interven- tion de chacun à cinq minutes.
Le Dr Kjellberg (Suède) répond aux remarques du Dr Lollini en disant que les femmes latines ne lui paraissent pas différentes des femmes nordiques, et qu’elles portent souvent des poids
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énormes, ce que ne font pas les femmes scandinaves ; elle croit simplement que les femmes du Nord sont plus libres.
Elle ne veut pas de lois de protection spéciales pour les femmes mais des lois générales pour les hommes et les femmes ; ce n’est pas le travail à l'usine qui fatigue la femme mais l'addition, le soir, des travaux domestiques, et si la femme était mieux payée elle pourrait se faire aider dans son travail ménager. Le Dr Kjellberg ne croit pas la femme plus sensible que l’homme aux empoisonne- ments industriels, mais les sujets faibles, hommes ou femmes, sont naturellement plus exposés à ces empoisonnements; elle termine en souhaitant de voir toutes les femmes-médecins se mettre d’accord pour faire admettre les résolutions suivantes : égalité de salaire a travail égal, et classification des travailleurs, au point de vue de la protection, en faibles et forts, et non en hommes et femmes.
Le Dr Rosenthal-Deussen (Allemagne) affirme son accord avec les conclusions des Drs Sorrentini et Adler. Elle demande la protection de l'enfant à travers la femme, et ensuite la protection générale pour les deux sexes. Elle constate qu’on a déja beaucoup fait pour exclure certains poisons des industries, mais qu’à mesure que l’on en élimine certains, de nouveaux apparaissent. Elle ter- mine en adressant des remerciements aux suffragistes qui ont tant obtenu pour les femmes, et dit que celles-ci ne sont pas inférieures aux hommes mais qu’elles sont différentes.
Le Dr Reichart (Tchéco-Slovaquie) voudrait voir la femme assez instruite pour choisir librement elle-même le travail qui lui convient. Elle réclame les mêmes lois pour les hommes et les femmes. t
Le Dr O'Malley (Etats-Unis) estime que :
1° les femmes devraient être libres de travailler la nuit si elles le désirent, l'interdiction étant contraire à leur liberté de citoyen ;
2° chaque pays devrait décider lui-même quelles lois de pro- tection sont les mieux en rapport avec ses besoins économiques et sociaux ;
3° la protection légale ne devrait pas être basée seulement sur une question de sexe, les hommes comme les femmes devant profiter de lois de protection quand les SORE ose de travail sont défectueuses ou malsaines ;
4° de puissantes organisations féminines et l’éducation des femmes contribueront plus que tout à résoudre ce problème.
Le Dr Adamson (Grande-Bretagne) regrette que des pays aussi différents que la Grande- -Bretagne, l'Allemagne, l’Autriche, le Japon, les États-Unis aient été compris dans un même rapport, car les conclusions ne donnent pas une idée fidèle de l'opinion de chaque pays.
Elle dit que l'affirmation que le travail de nuit ne peut pas être
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fait par les femmes, et que la fonction maternelle souffre du travail trop lourd n’a jamais été confirmée dans les rapports par des preuves médicales.
Les femmes ont toujours travaillé, ce n’est que lorsqu’elles arrivent à des postes très bien payés que les législateurs hommes parlent de la nécessité de lois de protection pour elles. Le Dr Adamson exerce depuis vingt ans dans un pays industriel de 500.000 habitants, où les femmes restent à l'usine après leur ma- riage, et elle a pu constater que les cas d’accouchement et de suite de couches pathologiques étaient imputables 4 un défaut de soins pendant la grossesse et l'accouchement, et nullement au travail
exécuté par ces femmes.
Pendant la guerre elle a eu sous sa surveillance 5.000 femmes occupées dans une fabrique de munitions, qui travaillaient une semaine de jour et une semaine de nuit. Toutes subissaient un examen médical avant d’être enrdlées et aucun de celles ayant été jugées aptes à un travail difficile, demandant une forte dépense en force physique, n’a montré ensuite un déplacement même léger du pelvis, et toutes celles qui étaient bien portantes au commence- ment l'étaient à la fin de la guerre. Vers la fin de la guerre le Dr Adamson a obtenu du Gouvernement britannique l’autorisa- tion de faire assurer un service entier de l'usine par des femmes enceintes qui pour des raisons économiques ou personnelles ne vou- laient pas quitter leur travail. Elle traitait ces femmes en tous points comme les autres, la seule différence étant qu’elle suppri- mait le travail de nuit à partir de la 16° semaine de la grossesse et pendant toute sa durée interdisait le maniement des machines a transmission. Ces femmes restaient à leur poste jusqu’au jour de leur accouchement et elles furent examinées après ; il n’y eut pas un seul cas d’enfant mort-né et aucune de ces femmes n’a souffert pat l'effet de son travail. Le Dr Adamson conclut en disant que l’ensemble de ces faits la pousse à appuyer de toutes ses forces la résolution scandinave et comme membre de l'Open Door elle s'oppose à toute mesure restrictive du travail de la femme.
Le Dr Paykull (Suède) laisserait à la femme la liberté de choisir elle-même son travail ; elle est opposée à toute loi spéciale mais verrait volontiers la possibilité pour la femme peu forte de se reposer un certain temps au moment des couches avec une indem- nité. Elle s'élève contre la prime d'allaitement de douze mois, déclarant que toutes les femmes-médecins sont d’accord pour conseiller l'alimentation mixte à partir du 6° ou du 7° mois.
Le Dr Balfour dit qu'aux Indes anglaises les femmes-médecins ont préconisé la protection. Ce pays devient rapidement un pays industriel, 250.000 femmes travaillent régulièrement et autant illicitement, et leur nombre augmente tous les jours. Elle a eu l’occasion d'observer ce qu'il en était de la maternité dans les industries cotonnières où les femmes faisaient une journée de huit
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heures, plus six heures de travaux domestiques chez elles, com- .mençant à cinq heures pour terminer à dix heures du soir.
Elle constate que la santé de ces ouvrières comparée à celle d’autres femmes de même condition mais qui ne travaillaient pas, était meilleure, que pendant la grossesse il y avait moins de ma- ladies, mais il y avait plus de morts-nés ; d’où elle conclut que le travail n’est pas mauvais pour les femmes elles-mêmes mais qu'il peut l'être pour les enfants. Elle propose que chaque pays décide la question pour lui-même, la protection étant plus utile à certains qu’à d’autres.
Le Dr Gordon (Grande-Bretagne) définit. la position de la travailleuse aujourd’hui en Angleterre. Elle est protégée par une législation sous le contrôle du Ministère de l'Intérieur, et les assu- rances nationales de maladie et de chômage améliorent encore sa situation. De plus les usines importantes ont leurs propres services médicaux.
La période de la guerre a permis à la femme, qui partout a dû remplacer l’homme, de montrer ce dont elle était capable.
Depuis la guerre de nombreux directeurs d’usines ont organisé des services purement volontaires dits de « prévoyance industrielle ». L’importance de ces services varie avec l’importance des usines, leur situation urbaine ou rurale et la largeur de vues du directeur. A titre d’exemple de ces organisations elle cite celle de la fabrique de biscuits à Londres où elle exerce, et qui comprend deux inten- dants d’usine (welfare supervisors), un homme et une femme, une infirmière et un médecin (elle-même). Ce service s'occupe de l’organisation des cantines, du chauffage, de l'éclairage, de l’aéra- tion et du nettoyage des salles, de la création de cercles sportifs et sociaux, de l'examen médical de tous les candidats au travail, de l’examen médical périodique des jeunes ouvriers et de tous ceux plus spécialement exposés à un risque professionnel. On fait le diagnostic et le traitement des maladies et accidents sans gravité, les soins des dents et des yeux, des consultations industrielles ; on envoie à l'hôpital les victimes d'accidents graves.
Le Dr Zahalkova (Tchéco-Slovaquie) dit que la base de la protection de la mère est l'assurance sociale. Elle voudrait l'assu- rance obligatoire pour toutes les catégories de travailleurs, l'État devant contribuer au paiement des primes pour les moins fortunés ; — et que cette assurance obligatoire soit étendue même aux personnes qui ne travaillent pas. Elle voudrait voir établir des Centres où les femmes trouveraient les renseignements relatifs à leurs droits, des soins médicaux pour elles et pour leurs enfants, etc.
Le Dr Ramsay (Grande-Bretagne) supplie l'assistance de ne pas voter de vœu réclamant une aggravation des lois de protection de la femme, et s'associe énergiquement aux résolutions des Asso- ciations scandinaves. Les femmes sont arrivées en Angleterre, au prix de combien d'efforts, à sie admettre le principe d'égalité :
égalité de salaire, mémes possibilités que les hommes, et elle est au désespoir de voir que certaines femmes présentes qui occupent une situation importante peuvent encore parler complaisamment du « complexe d'infériorité » de la femme, cette vieille idée que les hommes pour leur tranquillité personnelle s’efforcent d’inculquer aux femmes. Elle estime que beaucoup de personnes attachent trop d'importance à l'aspect de la question relatif à la maternité, qui représente au plus le quart de la vie de travail d’une femme, et dit que pendant la guerre lorsque les femmes étaient payées presque autant que les hommes leurs enfants n’ont pas eu a souffrir parce que leurs mères travaillaient.
Elle termine en lisant a l’assistance la Charte de la Femme, publiée par l'Open Door International à Berlin en 1929.
Le Dr Sharp (Grande-Bretagne) s'oppose au vote de résolu- tions demandant l'aggravation des lois actuelles de protection, qui iraient à l'encontre des buts poursuivis.
Le Dr Tayler Jones (Etats-Unis) demande des lois de protec- tion identiques pour les hommes et pour les femmes, et croit que les méthodes pour arriver à cette fin peuvent être différentes selon les pays.
Le Dr Blanchier (France) trouve que le sexe n’est pas le seul facteur dont il faut tenir compte en établissant des lois et qu'il faut penser à l'enfant, être fragile qu'il s’agit de protéger plutôt que la femme; elle propose à l'assemblée un vœu dont le texte sera voté en fin de séance. (Voir plus loin.)
Le Dr Lubinger (Autriche), médecin d’une caisse de secours depuis 1903, préconise des lois spéciales pour la. protection des femmes en tenant surtout compte de l'effort qu’elles ont à fournir, „en plus de leur travail rémunéré, pour remplir leur rôle de ména- gères et de mères.
Le Dr Thuillier-Landry dit que la liste des personnes ayant demandé la parole est épuisée, et que toutes ont pu exprimer libre- ment leurs vues ; elle propose de soumettre d’abord au vote de l’Assemblée les principes affirmés dans les vœux sur lesquels les trois Rrapporteurs généraux ont réalisé un accord, et qui sont au nombre de quatre, le texte exact devant être mis au point ulté- rieurement par les soins du Bureau international. Ces vœux con- cernent :
10 l’examen médical périodique des travailleurs ;
2° l’organisation de cours de médecine industrielle dans les Universités ;
3° le contrôle du travail à domicile ;
4° l'application du principe VII du pacte de la Société des Nations « salaire égal sans distinction de sexe pour un travail de valeur égale », à
(Voir texte des vœux).
=) 20e
Ces principes sont adoptés à l'unanimité.
Le Dr Thuillier-Landry donne ensuite lecture du vœu du Dr Blanchier, demandant que la maternité soit prévue dans les lois d'assurance. (Voir texte des vœux.)
Ce vœu est adopté à l'unanimité.
Le Dr Thuillier-Landry, revenant à la résolution adoptée la veille sur l’organisation d’une Commission permanente pour l'amélioration des conditions dans les pays exotiques, demande, au nom de lA. I. F. M. au Dr Balfour et au Dr Pennell de bien vouloir prendre la direction de cette Commission et choisir elles- mémes leurs collaboratrices.
Les Drs Balfour et Pennell ayant accepté, le Dr Thuillier- Landry les remercie et toute l’assistance les acclame.
Le Dr Thuillier-Landry donne ensuite lecture de la résolution proposée la veille au Conseil par le Dr Montreuil-Straus (France) sur le travail de la femme-médecin mariée,.et dont elle a préparé le texte en collaboration avec Miss Martindale et le Dr Hoffa. (Voir texte des vœux.)
Ce vœu est adopté à l’unanimité.
Ensuite elle dit combien il lui est agréable d'adresser les remerciements de toute l'assistance à Mme le Dr Bauer, Présidente de l’Association autrichienne, qui en plus de la parfaite organisa- tion de la réunion, a bien voulu assurer les traductions allemandes, à Mme le Dr Brucke-Teleky, l'abeille diligente du congrès, et à chacune des aimables collaboratrices autrichiennes qui toutes ont contribué à l'agrément et au succès de la réunion. Elle remercie l’active et aimable secrétaire, Miss Napier-Ford, que l’Assemblée entière applaudit. Elle donne rendez-vous à tous les membres au prochain Congrès de 1934, et déclare la réunion terminée.
Miss Martindale se lève à son tour et au nom de l'assistance entière qui l’approuve chaleureusement, exprime des remercie- ments et des félicitations au Dr Thuillier-Landry, Présidente qui a si bien conduit les débats et qui a permis le succès de ces intéres- santes et agréables réunions.
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SCIENTIFIC SESSIONS
Wednesday, September 16th at 3 o'clock, Ist General Meeting under the chairmanship of Miss Martindale.
The Role of Medical Women in Exotic Countries.
Miss Martindale expressed there grets of the assembly for the unavoidable absence of Dr Poli Garnier, Rapporteur of the question for Latin countries.
Dr Margaret Balfour (India), Rapporteur for English-speaking countries, gave a résumé of her report and proposed the creation of a Committee to intensify research into the causes and evolution of those diseases so prevalent in exotic countries which affect | pregnancy and child-birth.
Dr Agnel Billoud (France) presented the conclusions of Dr Poli Garnier. (These reports are published in extenso at the end of the account of the Vienna Meeting.)
Dr Pennel (India) seconded Dr Balfour’s suggestion for the organisation of a Standing Committee to enquire into the diseases prevailing in exotic countries. She pointed out that the M. W. I. A. had great possibilities of action and therefore great responsibilities and suggested that the Association, being in touch with all coun- tries, might be. able to secure international funds for the work to be accomplished, lack of funds being at the root of all difficulties encountered. She also insisted on the necessity for research but here again money was needed.
She spoke of the Medical Schools to be created and claimed for them medical women having the same qualifications as their European colleagues. If in the beginning inferior diplomas had to be allowed it was now necessary, in view of the difficult work to be performed, that the highest qualifications should be required.
She also condemned the practice, often rendered necessary by lack of qualified personnel, of entrusting to nurses what should be the care of doctors, and concluded by a vehement appeal in favour of wide cooperation and sustained effort in face of the improve- ments to be sought after.
Dr Denge (U.S. A.) who worked for four years in India and whose heart wasstill there, said the women in India are helpless but goodnatured and accept progress slowly but surely. She deplored the want of doctors and nurses which she attributed to the lack of knowledge of women in general of the conditions existing and of the vast field of action open to them.
She said that the numerous lectures she had given since her
Te he
return to America in schools, clubs etc, had everywhere aroused the keenest interest. She applauded the idea of a Standing Committee, one of whose aims should be to make known all the world over the conditions existing in these far-off lands and voiced her convic- tion that once women knew and understood the situation many of them would want to go to the assistance of other women with their children. ;
Miss Martindale said how much she had been struck with Dr Balfour’s remarks concerning the customs existing in exotic countries and the difficulties they caused, and wondered whether the M. W. I. A. could do anything useful in the question of the circumcision of women, for instance, question recently discussed in England.
Dr Balfour replied that this practice, painful and dangerous, a cause sometimes of death and always of great nervous shock, had ceased in India but was still common in many parts of Africa. She favoured the abolition of the custom but insisted on the im- portance of proceeding with caution before declaring illegal cer- tain native practices, which are generally absolute religious pres- criptions, and cited the case of numerous women who, forbidden by law to continue the practices ordained by their beliefs, found themselves ostracised by their tribes with nothing left but to become prostitutes. Other customs form part of the moral code of the native and if they are abolished too rapidly he loses the notion of right and wrong and the result is the opposite of that looked for. Considering the question of femal e circumcision she advised a survey of the matter in the different countries with a view primarily of learn- ing the wishes of the women themselves in the matter.
Mme Requin (France) thought that this subject might be one for the study of the Standing Committee proposed.
Dr Ramsay (Great Britain) stated that the Executive Com- mittee of the British Federation of Medical Women had to consi- der this question at the request of one of the women members of Parliament. After careful discussion the Committee tendered a proposal to the British Government recommending the abolition of this custom but that the methods of its suppression should be left to the Colonial Office so that by appropriate propaganda its gradual disappearance might be obtained.
She thanked Dr Balfour for her excellent report which threw light on the work already accomplished and that remaining to be done and felt that it must have opened the eyes of more than one medical woman. |
Speaking of maternal morbidity Dr Ramsay considered that each country should instruct its medical women as to the best methods of prevention, and that the Standing Committee recom- mended could only work efficaciously by means-of a sub-comimittee of specially appointed correspondents responsible for special inves-
tigations, their work being subsequently co-related by the Com- - mittee of the M. W. I. A.
Dr Balfour defined further her idea of this Committee which would not only examine the question of maternal morbidity and mortality but would deal with every phase of the exotic problem. She advised post-graduate courses for medical women intending to work in exotic countries so that they might learn the particular conditions that they would find there, the special diseases that they would have to contend with, etc. Naturally these courses would be different in different countries but recommended, if possible, a common standard which could be communicated to the various governments, Medical Schools and so on.
Dame Louise Mc Ilroy (Great Britain) seconded this proposal.
Dr Balfour gave further details concerning the proposed Standing Committee. She saw it composed of qualified members in Europe with corresponding members in the colonies who would
provide them with infofmation which would be centralised in the
International headquarters, and recalled the valuable service rendered by a committee of this kind against plague.
Dr Bauer (Austria) asked one of her Austrian colleagues to give the assembly certain information regarding the consulting committees for maternity, committees which only exist, it would appear, in their particular form in Austria.
Dr Teleky (Austria) explained that in these Eommiittees worked medical women and visiting nurses, that women came to them from the commencement of pregnancy and that after delivery they continued to frequent them with their children until the age of six. Further the Municipality of Vienna had organised blood exa- mination during pregnancy in order to fight against venereal disease. Thanks to these committees, maternal and infant mortality had greatly diminished, since the war.
Dr Balfour referred to the remarks made earlier by Dr Pennell, and considered the case of medical women having inferior diplomas to those required in Europe, and stated that these women rendered valuable service as assistants in hospitals and villages and for the performance of minor operations, She agreed with Dr Pennell that it would be better to insist on the same requirements for all, but as a high standard necessitates also a very good education she wondered whether the standards of education were as yet high enough in exotic countries for it to be possible to dispense with: assistants with inferior qualifications ? She pointed out that medical women with very high qualifications often distiked working in isolated villages.
As Dr Pennell, she opposed the practice adopted by certain medical women of entrusting part of their work to nurses, but said it- must not be forgotten that it was often a case of dire necessity, and that it was better to do this than let a woman die undelivered, for
instance, if the doctor were retained at her post by hundreds of waiting patients.
She protested strongly, homes against the tendency of certain municipalities who are always ready to give to nurses or health visitors work which should be done by doctors, as for instance the direction of a dispensary, for the sole reason that they are not obliged to give them such high remuneration as to medical women.
She brought the first meeting to a close by saying what great pleasure Dr Dengel’s enthousiastic words about her work in India had given her, and that it was women of her sort that were needed in exotic countries where, to succeed well the two requirements were : personnel and personality.
* * *
Thursday, September 17th at three o'clock second scientific session under the chairmanship of Dr Tayler-Jones (U. S. A.).
Continuation of the discussion on the Role of Medical Women in Exotic Countries.
Dr Balfour stated that she thought the moment had come to form an opinion, now that medical women were employed more and more in the colonies, as to the relative merits of a separate medical service for women or of a common service for doctors of both sexes, and invited her colleagues present to give their views on the subject.
She recalled in this connection the services rendered and the results obtained by the Medical Women’s Service in India and pointed out that in the other colonial services where women were admitted in theory, on terms of absolute equality with men, in practice they never attained to the higher posts, which were always given to men, nor to the posts of inspection when there was work to inspect performed by both men and women.
Dr Tayler-Jones insisted on the importance of the problem and begged the assembly not to make any decision which might have far-reaching results without due reflection.
Dr Pennell was in favour of one common service for both sexes, but in which men would be at the head of the sections for men and women those for women, as is the case already in the educational service in India. She felt the moment was not ripe for putting any set scheme before the transitory government in view of the uncertainty of what would be the political evolution. She remarked that were it not for the Mission hospitals which existed almost everywhere the native women of India would be terribly lacking in necessary care.
Dr Benson (Great Britain) related that when the Women’s Medical Service was founded in India a certain number of medical women sent a deputation to the wife of the Viceroy to improve
the conditions of medical women in India. As a result of this they
received a questionnaire from the Central Government from which they gathered that it was not to their interest to sollicit posts in services directed by men, many of whom were army doctors, and. that it was quite impossible to expect to obtain posts in any of the army services. They understood that it would be better to form separate services for women. Dr Benson saw another advantage in the creation of such services, wich could be organised on an
entirely modern basis without the hindrances of old and obsolete regulations. She quoted as an example the College founded at Delhi where the women’s medical service is admirably organised.
Dr Adamson (Great Britain) said she had not any experience of work in India but that she saw an objection to a common ser- vice for men and women. She feared that such a service would be likely to be modelled on the lines of the public health service in England where it was becoming customary to entrust to women certain branches considered slightly junior. While agreeing that the ideal would be a unified service where the posts of direction and responsibility would be attributed on merit alone, she felt that the moment for this had not yet come and that therefore a special service for women was more desirable.
Dr Dengel recounted the case of a higher post of inspection of the work in hospitals and missions which was the only post of its kind entrusted to a woman and which, a few years ago had been suppressed by the Indian Government for reasons of eco- nomy, and said how helpful this inspection was, being often the only means for the isolated hospitals to be kept in touch with other medical women and with the progress realised in other parts ` of India, and maintained that had this post been under the control - of a medical women’s service it would never have been suppressed.
Dr Raemi (Switzerland) regretted the absence of Dr Schnabel, prevented from coming to the Meeting, who had worked for two years at Professor Schweizer’s hospital at Lambarene and who insisted on the absolute necessity of sending European medical women there to take care of the native women left entirely without competent treatment.
Dr Van der Made (Dutch East Indies) said that in her country there were not yet enough medical women to make the creation of a separate service for women possible ; there were not more than 40 or 50 medical women counting the government services and those in the missions. She explained that there were special hos- pitals for women where the government appointed two or three medical women for the obstetrical services and for the training of mid-wives.
ie 36 —
Dr Balfour resumed the discussion of the question she had. raised by saying that the moment did not yet seem to have come to take sides, that time and a profound study of the subject would point the way to the wisest solution. After all the special women’s service in India had only been in existence 16 years and many other colonial services were much younger and she considered the information available so far insufficient. Every body would like to see a common service where women would have exactly the same chances as men, but if, as Dr Adamson feared this were to
result in their only being given the junior posts, then it would be far better to reserve for women special services where they would have a chance to show of what they were capable. What was par- ticularly important for medical women was that they should be able to arrive at administrative posts, and Dr Balfour advised the Association to keep the question always in mind so as to be able later to settle the problem with complete understanding of all its aspects.
She then directed the discussion to the final point in her report, namely to decide whether, in the present state of penury of medical women in exotic countries, it were better to scatter those available on many points of the territory, in order to relieve as many sick as possible, or on the contrary to group them together in a small number of centres, each centre to specialise in a certain
ranch of medical activity ? She cited the instance, common in India and other British possessions, of a single medical woman at the head of a hospital often poorly. equipped and with a great number of patients, so that it was almost impossible to do work of a high standard, and she wondered whether it would be pre- ferable for the Government to leave these hospitals to be financed by local bodies and to concentrate on a smaller number of hos- pitals of greater importance, with from six to eight medical women, modern equipment, X-Ray installation etc. to which the smaller hospitals could send their more complicated cases ?
Dr Van der Made counselled a large central hospital for difficult cases with small local hospitals for ordinary cases.
No other member having asked to spéak on this subject Dr Agnel-Billoud, in the name of Dr Poli-Garnier (Algiers) spoke of the vast field of action open to medical women in Morocco, of the good work already accomplished, giving excellent results, and of the great amount still to be done, notably in the fight against parasites and against diseases of the eye. She emphasised the need for medical women of high qualification and courage who would not be rebuffed by the difficulty of the situation and the want of. cleanliness of the natives.
Dr Thuillier-Landry (France) said that the French Associa- tion of Medical Women had intervened on two occasions to secure an increase.in the salaries paid to medical women in Algeria, as
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these salaries were distinctly inferior to those paid to their male colleagues. She considered that the M. W. I. A. should proclaim the necessity for native women and children to be looked after by medical women, who should receive suitable remuneration in return for the efforts they would be called upon to furnish. She was of the opinion that a proclamation of this sort would help the French Association, and perhaps others in their attempts to im-
. prove the conditions of medical women in exotic countries.
She further stated that the French medical women in the Colonies always insisted on the need of forming good native nurses, and proposed that the M. W. I. A. should pass a resolution to this effect, laying stress on the fact that medical service in exotic coun- tries cannot do the good it ought to do without the help of the required nurses.
The assembly adopted these two proposals unanimously.
Dr Kate Mead (U.S. A.) hoped that the M. W. I. A. would
continually bombard the various governments with resolutions
until they at last decided to take the necessary steps in consequence.
Dr Balfour approved the vote of any resolution likely to improve conditions in the colonies, but recalled the fact that the situation varied greatly in different countries. Regarding nurses, for example, the government in India was aware of the need for sufficient nurses but there their standard and training had to be improved, whereas in certain parts of Africa it was the number which was needed, the standard of their training would come later. She then defined the Standing Committee, the principle of which was adopted. (See text of the Resolutions at the end of the Bulletin.)
* * x
Friday, September 18th at 3 o'clock 3rd General Meeting under the chairmanship of Dr Hoffa (Germany).
Legal Protection of Women Workers.
Dr Sorrentini (Italy), Dr Dagny Bang (Norway) and Dr Adler Herzmark (Austria) resumed their reports and their conclusions. (These reports will be found in extenso after the accounts of the meeting.)
Dr Hoffa declared the discussion open.
Dr Kruger (Germany) pronounced herself in favour of laws of protection for women, especially regarding night-work and ma- ternity. She said that in certain parts of Germany .40 % of the women workers were married and that in the end they wore them- selves out by the accumulated fatigue of night-work, domestic duties and the care of their children. Women could not judge for
ae ale
themselves at what moment they should leave off their work during pregnancy, afraid to lose a day’s pay they would stay on
‘until the last minute and for the same reason would return to their
work as soon as possible after delivery. Legal freedom did not
‘alas, imply economical freedom. Dr Kruger spoke particularly of
the work of women in weaving and spinning factories, where they are constantly obliged to bend and stretch and cannot rest a mo- : ment, their work being regulated by the machines themselves.
Dr Thuillier-Landry asked to be allowed to make the suggest- ion that the three Rapporteurs should get together before the meeting on the following day to endeavour to come to an agree- ment on a number of conclusions calculated to obtain the unani- mous approval of the assembly. She felt that all the congressists would favour for example a general improvement of the working conditions of men and women, the development of the teaching of hygiene, the liberty for pregnant women to interrupt their work without breach of contract, a sufficient maternity insurance to allow of the necessary rest and an effectual supervision of work in the homes for both men and women etc.
Dr Niisson (Sweden) thanked Dr Dagny Bang, in the name of her Swedish and Danish colleagues, for her report and said that in Sweden the medical women and women in general had protested against the law of 1909 which prohibited night-work for women. She considered night-work harmful for men and for women, harmful for family life, and recommended shift-work, with the duration of each shift reduced to seven hours and night-work to a strict minimum.
Dr Lollini (Italy) felt it was impossible for the women of Latin countries to judge these matters in the same light as the women of Northern countries, and thought that difference of climate might determine a difference of physiology. The women of Italy, for instance, were incapable of carrying such heavy weights as the women of the North.
She considered that the protection of working women was not an individual question but one which interested the whole race and that through the women it was necessary to protect the child. If women were as well paid as men that would be their best pro- tection. While fighting for equality of women and for their social improvement she nevertheless desired for them reasonable laws of protection in maternity.
` Dr Derscheid-Delcour (Belgium) communicated by letter a short study on legal protection by Mrs de Craene van Duuren, who was opposed to laws of protection for women declaring that it was unscientific to declare that the health and well-being of a whole group of individuals could only be assured by submitting them to restrictions and incapacities.
Dr Nechovitch (Jugoslavia) said that in 1922 a law for the
POA AE AAI 2 TOE Sy ES E BE
à à 4 $ l RA gi À d
j |
protection of women workers had been voted, that night-work was forbidden for women in almost all parts of Jugoslavia and that all workers were insured. Women received during two months before and two months after child-birth an allocation equal to
‘75 % of their salary, and their working contract was not broken
but that if they worked during that period they received no allo- cation. Hygiene was taught in the state schools.
Dr Bauer (Austria) was hostile to night-work for women, saying that this work was not generally better paid than day-work ; on the other hand she was not of the opinion that women were more susceptible to industrial poisoning than men, except, how- ever, during pregnancy.
Dr Hoffa ajourned the discussion to the following day.
* * *
Saturday, September roth at 9 a. m. 4th General Meeting under the chairmanship of Dr Thuillier-Landry.
Continuation of the discussion on Legal Protection of Women Workers.
Dr Thuillier-Landry reminded the assembly that many orators had sent in their names and that therefore the time allotted to each must not exceed five minutes,
Dr Kjellberg (Sweden) replied to the remarks made by Dr Lollini saying that the Latin women did not seem to her-differ- ent from the Northern women and that the former often carried enormous weights which the latter never did; to her the only difference was that the women of the North were freer.
She did not want special protective laws for women but general laws for men and women ; it was not the work in the factory, she contended, that tired the woman but the addition of her domestic duties in the evening and that if she were better paid she could
_afford to have help in the home. Dr Kjellberg did not consider
women more susceptible to industrial poisoning than men but admitted that weaklings, whether men or women were naturally more exposed to such poisoning. She concluded by hoping that the medical women would agree to work towards the enforcement of the following resolutions : equal pay for equal work and the classification of workers, from the point of view of protection, into the strong and the weak, not into men and women.
Dr Rosenthal-Deussen (Germany) confirmed her agreement with the conclusions of Dr Sorrentini and Dr Herzmark. She claimed protection of the child through the woman and general measures of protection for both sexes, She noted that much had already been accomplished to eliminate certain poisons from indus- try but that as fast as some were eliminated others appeared. She
concluded in addressing a vote of thanks to the suffragists who had gained so much for women, and said that women were not inferior to men but different from them.
Dr Reichart (Czecho-Slovakia) would like to see women sufficiently educated to be able to choose freely for themselves the work for which they were fitted. She claimed the same laws for women as for men.
Dr O’ Malley (U. S. A.) was of the opinion that :
1° women should be free to work at night if they chose, pro- hibition being contrary to their rights as a citizen ;
2° each country should decide for itself the protective laws most suited to its individual needs, economically and socially ;
3° legal protection should not be based merely on a question of sex, men as well as women should profit by protective measures when conditions of work were unfavourable or unhealthy ;
4° powerful feminine organisations and the education of women would contribute more than anything else to resolve the problem.
Dr Adamson (Great Britain) regretted that countries as differ- ent as Great Britain, Germany, Austria, Japan and the United States had been included in the same report, as the conclusions did not give a faithful picture of the opinion of each country.
She stated that the assertions that women could not do night-work and that their maternal function suffered from too heavy work were not in one single instance supported by medical proof.
Women had always worked, it was only when they reached highly paid positions that the male legislators began to talk of the necessity for protective measures for women. Dr Adamson had worked for 20 years in an industrial community of 500.000 inha- bitants, where women remained in the factory after their marriage - and she had noted that difficult labour or disabilities after child- birth were the result of improper care during pregnancy and deli- very and not in any way the fault of their work.
During the war she had had under her supervision 5.000 women occupied in a munition factoryand working alternate weeks by day and by night. All had to undergo medical examination before being enrolled and not one of those women who had been considered fit for difficult work entailing physical strain had showed at the end of it the slightest pelvic displacement, and all who started work fit were also fit at the end of their term of employment. Towards the end of the war Dr Adamson had been allowed, by the British Government to staff a department in an engineering works enti- rely by pregnant women who wished to remain at work for econo- mic or mental reasons. The only difference she made in the treat- ment of these women being that at the end of the 16th week of
PATENT 1 6H es TA,
WENT SUSU AIRE a PU ES
pregnancy she removed them from night-work and vetoed their employment on a lathe from the time of notification of their preg- nancy. These women remained at work until the day of child- birth and were afterwards examined to determine their physical state and there were no cases of still-birth nor had these women suffered any harm from their employment.
In view of these facts Dr Adamson whole-heartedly sided with the medical women from Scandinavia and as a member of the « Open Door » she was opposed to any restrictive legislation for women workers.
Dr Paykull (Sweden) would leave the woman free to decide for herself the work she should take-up; she was opposed to any special laws for women but would like to see it made possible for women who were not strong to rest for a while at the time of child- birth, with an indemnity. She objected to the premium for breast- feeding over a period of twelve months saying that all medical
- women were now united in declaring that mixed feeding should
begin after the sixth or seventh month.
Dr Balfour said that in India medical women had favoured protection. This country was rapidly becoming an industrial country, 250.000 women worked openly and as many clandes- tinely and their numbers were increasing every day. She had had occasion to observe maternity conditions in the cotton factories where women did an 8-hour day and then worked 6 hours at home, starting their day at 5 am. and finishing at 10 pm.
She had found that the health of these workers, compared to that of other women of similar condition but who did no outside work was better, that during pregnancy there was less disease, but that on the other hand there were fewer births and the babies born weighed less than those of the other women and that there were a greater number of stillbirths. From this she concluded that work was not bad for the women themselves but that it was per- haps bad sometimes for the children, and suggested that each country should decide the problem for itself, protection being more useful in some than in others.
Dr Gordon (Great Britain) defined the position of he woman worker today in England. She is protected by legislation adminis- tered by the Home Office and National Health Insurance and unemployment insurance also improve her conditions and in addition big factories have their own medical services.
The war period she said had everywhere given the women a
-chance of proving what they were capable of.
Since the war many employers had organised supplementary services known as Industrial Welfare and purely voluntary. The importance of these services depended on the broad-mindedness of the employer, the size and ressources of the firm and the urban
- or rural distribution of its employees. As an example she described
Re ey Ñ the working of the welfare service in the large biscuit factory in London where she is employed, comprising two welfare super- i visors, a man and a woman, a nurse and a doctor, herself, This service organised canteen arrangements, heating, lighting and ventilation, sports clubs. and work guilds, medical examination of all applicants for work, periodic examinations of the young and those exposed to special risk, diagnosis and treatment of minor illnesses and accidents, arrangements for dental and eye treatment and industrial consultations and dispatch to hospital of major accidents.
Dr Zahalkova (Czecho-Slovakia) said that the basis of pro-
tection for the mother was health insurance. She would like to see compulsory insurance for all categories of workers, the State contributing to the premiums of the less well-off ; she would even see this insurance extended to non-workers. She recommended the creation of Centres where women could find all information concerning their rights, the medical care obtainable for them- selves and their children etc.
Dr Ramsay (Great Britain) begged the assembly not to vote any resolution which would tend to increase the laws of protection of women workers already in existence and approved heartily the stand taken by the Scandinavian Associations. Women had succeed- ed at last in England she said, at the price of enormous effort, in getting the principles recognised of equal pay for equal work, equal possibilities with men and she was in despair to see certain women present occupying positions of importance who could still speak complacently of women’s « inferiority complex », that old idea that men, for their personal ends had always inculcated into women’s minds. She considered that too much importance was attached to the maternity aspect of the question, that, after all, the years a woman bore children represented at most a quarter of her working life and said that, during the war, when women were paid almost as much as men, their children did not have to suffer because their mothers worked.
She ended by reading to the assembly the Manifesto and Charter for the economic emancipation of the woman worker, published by the Open Door in Berlin in 1929.
Dr Sharp (Great Britain) opposed the vote of any resolutions tending to aggravate the protective laws already existing, as that would go against the aims in view.
Dr Tayler- Jones (U. S. A.) demanded laws of protection iden- tical for men and women, and considered that the means of attain- ing this end might vary with the different countries.
Dr Blanchier (France) felt that sex should not be the only factor in determining laws and that it was the fragile organism of the child that should be protected through the mother and sub-
A
AE PE AANE
PO DST En I
SRE PR TERRES (dont
ATEN FES Al
mitted to the assembly a resolution which should be voted on at the end of the meeting (see below). Dr Lubinger (Austria) attached, since 1903 to an Insurance
‘Benefit Association, was in favour of special laws of protection
for women, remembering especially the effort they have to furnish in addition to their paid work, in order to fulfill their duties as housewives and as mothers.
Dr Thuillier-Landry stated that all the orators had spoken and that all. had had complete liberty for the expression of their views and proposed that the assembly should first of all vote upon the principles contained in the Resolutions drawn-up by the three Rapporteurs in agreement, the exact wording of these reso- lutions to be arranged by the Officers later. These resolutions, four in number, covered the following points :
1° regular medical examination of workers ;
2° organisation of courses of industrial medicine in the Universities ;
3° inspection of home-work ;
4° application of principle 7 of the Pact of the League of.
Nations « equal pay for equal work without distinction of sex ». (see text of resolutions.)
These principles were unanimously adopted.
Dr Thuillier-Landry then read the resolution of Dr Blanchier, claiming that maternity should be taken care of under insurance laws. (See text of resolutions.)
This resolution was adopted unanimously.
Dr Thuillier-Landry referred to the resolution adopted the previous day concerning the creation of a Standing Committee for the improvement of conditions in exotic countries and in the name of the M. W. I. A. requested Dr Balfour and Dr Pennell to assume the direction of this Committee and to choose for themselves their collaborators.
Dr Balfour and Dr Pennell having accepted, Dr Thuillier- Landry thanked them and the whole assembly applauded them.
Dr Thuillier-Landry proceeded to read the text of the reso- lution by Dr Montreuil-Straus (France), on the work of married medical women, proposed the preceding day to the Council and drawn-up by her in collaboration with Miss Martindale and Dr Hoffa. (See text of resolutions.)
This resolution was unanimously adopted.
Finally she spoke of the great pleasure it was to her to express the thanks of all present to Dr Bauer, President of the Austrian Association, who, as well as the perfect organisation of the meeting had also been kind enough to assume all the German translating, to Dr Brucke-Teleky, the working bee of the Congress and to each and everyone of the ladies of the Austrian committee who
had all so kindly contributed to the success and enjoyment of the meeting. She thanked the aimiable and energetic secretary, Miss Napier-Ford, who was applauded by the whole assembly. She invited all members present to the next Congress in 1934 and declared the meeting at an end.
Miss Martindale rose in her turn and in the name of all pre- sent, who most warmly approved, expressed the gratitude and the congratulations of the assembly to Dr Thuillier-Landry, President, who had so excellently led the debates and who had made possible the success of the interesting meetings,
VISITES D’HOPITAUX ET RECEPTIONS
L’Association autrichienne des Femmes-Médecins avait tout mis en œuvre pour assurer le succès de la Réunion. Les congres- sistes ont pu admirer les hôpitaux et cliniques de Vienne, les remarquables institutions sociales de la ville ainsi que les beaux établissements de physiothérapie ; citons entre autres la Kinder- klinik, de réputation mondiale, l’Allegemeine Krankenhaus (hôpital populaire), le Centre de Triage pour Enfants, les maisons ouvrières, les jardins d’enfants de la Nouvelle Vienne, le Dianabad, etc.
De nombreuses réunions amicales — une charmante soirée d'accueil au Club des Femmes-Médecins de Vienne, un thé au Cercle féminin, un lunch au Dianabad — ont permis aux congres- sistes d'apprécier le charme proverbial et la cordialité de lhos- pitalité viennoise. Les membres français du Bureau ont offert une réception au Grand Hôtel.
Le Président de la République autrichienne a bien voulu recevoir les délégués ; il leur a exprimé son plaisir de les voir choisir Vienne comme lieu de réunion, ses félicitations pour l’œuvre déjà accomplie et ses vœux pour celle qu’inlassablement elles se promet- taient de poursuivre.
Des visites accompagnées ont été organisées dans les merveil- leux musées dont Vienne peut, à juste titre s'enorgueillir, ainsi qu'au Château de Schonbrunn, au Kobenzl, à Baden et au Semme- ring, et aussi à la Manufacture de Tabac et à d’autres industries de la ville,
Les remerciements de toutes les congressistes vont à l’Asso- ciation autrichienne, à sa Présidente Mme Bauer - Jokl à Mme Brücke-Teleky, à Mmes Kaminer, Feldmann, Fischer- Hofman et à toutes les dames du Comité qui se sont dépensées sans compter au service de l'Association internationale.
* * *X
L’Association hongroise des Femme-Médecins avait eu la charmante idée d'inviter tous les membres réunis à Vienne à passer deux jours à Budapest, où un programme très bien combiné leur a permis de goûter en un temps malheureusement trop court, les beautés de la ville et de ses musées, l'intérêt de ses hôpitaux, de ses œuvres sociales et de ses établissements thermaux.
Parmi ces visites nous signalons celles de l’établissement ther- mal si renommé de Saint-Gellaert, de l'Institut de Pédiatrie où Mme le D" Revesz a reçu ses visiteuses à déjeuner, du Sanatorium Schabenberg, de l’Asile d’Aliénés, du Parlement, etc.
Uue soirée d’accueil à l'hôtel Ungaria, avec de la musique tzigane, un thé au Cercle des femmes-médecins hongroises où de merveilleux costumes nationaux ont été présentés, un lunch offert par le Comité des établissements thermaux de la ville, ont charmé toutes celles qui ont eu le privilège de faire le voyage à Budapest.
Comme à Vienne, aucun effort, aucune peine n’ont été épar- gnés pour assurer aux congressistes un séjour instructif autant qu’agréable et l’A. I. F. M. exprime toute sa reconnaissance à F Association hongroise, à sa Présidente, le Dr Todt, au Dr Vegess- Rege, au Dr Gémessy-Piroska, à Mme Ugron et à toutes les dames du Comité.
VISITS OF THE HOSPITALS AND RECEPTIONS
The Austrian Association of medical women had. not left a stone unturned to assure the success of the meeting. The con- gressists were able to admire the hospitals and clinics of Vienna, the remarkable social institutions of the municipality as well as the fine establishments of physiotherapy ; let us mention among others the Kinderklinik, of world fame, the Allegemeine Kran- kenhaus (general hospital), the Clearing House for Children, the workmen’s dwellings and the kindergartens of « New Vienna », the Diana Baths, etc.
Numerous friendly gatherings — a delightful reception of welcome at the Medical Women’s Club of Vienna, a tea party at the Women’s Club, a lunch at the Dianabad — gave the congres- sists ample chance to appreciate the proverbial charm and the cordiality of Viennese hospitality. The French Officers of the Committee gave a reception at the Grand Hotel.
The President of the Austrian Republic kindly received the delegates; he expressed his pleasure that the M. W. I. A. had chosen. Vienna as the seat of the Meeting, his congratulations for the work already accomplished and his wishes for the success of
— 46 —
the work which the Association, untiringly, proposed to carry on.
Conducted visits were organised to the marvellous museums of which Vienna may be justly proud, to the Chateau of Schon- brunn, to the Kobenzl, to Baden and the Semmering, to the Tobacco Factory and other manufactures of the town.
The grateful thanks of all the congressists go to the Austrian Association, to its President Mme Bauer-Jokl, to Mme Brucke- Teleky, to Mme Kaminer, Mme Feldmann, Mme Fischer-Hof- man and all the ladies of the Committee who gave unsparingly of their time and their energy in the service of the International Association.
* x *
The Hungarian Association of medical women had had the charming idea of inviting all members présent at Vienna to spend two days in Budapest, where a well-arranged programme made it possible for them to enjoy in all too short a time the beauties of the town and its museums, the interest of its hospitals, its social institutions and its thermal establishments. —
_ Of these visits we would mention specially that of the well- known Baths of St-Gellaert, of the Institute of Pediatrics where Mme Revesz invited her guests to lunch, of the Schabenberg ‘Sanatorium, of the Mental Hospital, of the House of Parliament etc.
A reception of welcome at the Hotel Ungaria, with tzigane music, a tea party at the Medical Women’s Club where marvellous national costumes were displayed, a lunch offered by the Committee of the Thermal Establishments of the town, all delighted those who were privileged to undertake the journey to Budapest.
As in Vienna, no efforts, no amount of trouble had been spared to ensure to the congressists a trip as instructive as it was agreeable and the M. W. I. A. wishes to express to the Hungarian Association its heartfelt thanks, to the Hungarian President, Dr Todt, to Dr Vegess-Rege, Dr Gémessy-Piroska, Mme Ugron and all the ladies of the Committee.
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BILAN du 1° Mai 1929 au let Septembre 1931 Balance-Sheet from May 1 st 1929 to September 1st1931
Dépenses
Frais de Secrétariat Appointements de la! Secrétaire ........
Bulletin, Impression | et Expédition... ..| Frais de banque... .
Total des dépenses
Recettes
En caisse au 1°r mai 1929 et au 1er jan-| vier 1930 et 1931
Cotisations .........
Majorations et dons .
Publicité dans le Bulletins is.
Intérêts en banque..
Total des Recettes ..
Balance
Excédent des Re- cettes
Lier -e|-22:486 49e
Mai-Décembre |Janv.-Décembre|Janv.-Septemb.| TOTAL 1929 1930 1931 des se 2 années 4 Frs . Frs Frs Frs 499 59 | 2.448 00 | 2.387 70 | 5.335 29 5.000 00 | 12.000 00 | 9.000 00 | 26.000 00 4.500 00 | 1.500 00 | 6.000 00 4.570 00 | 14.510 20 | 12.263 30 | 31.343 50 62 17 HS SS) 80 70 10.069 59 | 33.520 37 | 25.169.53 | 68.759 49 12.353 83 | 22.486 39 | 39.743 81 7.852 65 | 37.511 00 | 38.545 35 | 83.909 00 9.449 50 | 8.550 00 | ~ 650 65 | 18.550 15 3.000 00 | 4.400 00 | 4.777 50 | 12.177 50 316 79 97 10 413 89 32.555 98 | 73.264 18 | 83.814 41 | 115.050 54 32.555 98 | 73.264 18 | 83.814 41 | 115.050.54 —10.069 59 |-33.520 37 |-25.169 53 |-68.759.49 *39.-743 81 | 58.644 88 | 46.291.05 TRE PTE +12.363.83 58.644.88
RAPPORT DE LA TRESORIERE Réunion du Conseil de Vienne 16 Septembre 1981
L'équilibre budgétaire de l'Association internationale n'avait pu être maintenu, pendant quelque temps, que grâce à des dons et à une majoration volontaire des cotisations, supportée pour la plus grande part par l’Association britannique.
Depuis ces deux dernières années, nous avons pu équilibrer .notre budget en conservant un excédent de recettes supérieur aux sommes fournies par les dons et majorations volontaires, Aussi, proposons-nous au Conseil de remercier les Associations nationales qui ont bien voulu répondre à l'appel de l'Association internatio- nale à un moment difficile, et de les prévenir qu'il estime n’avoir plus à leur demander cet effort actuellement.
Mais il est désirable pour notre comptabilité que chaque Association nationale paie régulièrement sa cotisation à l’Associa-
>
tion internationale au début de chaque nouvelle année, à raison:
de 1/2 dollar pour chacun de ses membres ayant payé sa cotisation dans le courant de l’année précédente.
S’il ya dans les Associations nationales des cotisantes en retard, mieux vaut régler pour elles quand elles auront payé, où ajouter leur part à la cotisation de l’année suivante, plutôt que de surseoir au règlement de la cotisation internationale, laquelle est due, aux termes du règlement, le 1°T janvier de chaque année.
Actuellement plusieurs Associations n’ont pas encore réglé leur cotisation de 1930, et certaines n’ont pas répondu à nos appels depuis déjà plusieurs années.
Nous devons signaler qu’il y a une injustice dans le fait que certaines Associations paient régulièrement alors que d’autres ne paient rien. Et dans ces conditions, il devient très difficile de faire le compte exact des membres de l’Association,
Si nous recherchons pourquoi, en dépit de ces circonstances défavorables, la situation financière de l’Association est en progrès, nous constatons que c’est la publication du Bulletin semestriel de l’Association Internationale qui grevait lourdement son budget, lors du précédent quinquennat. Or, le Bulletin de juin 1929 a été remplacé par les Rapports du Congrès, dont les frais d'impression ont été assumés entièrement par l'Association française, ce qui a représenté une économie sérieuse pour l'Association internationale.
En outre, les quatre Bulletins de notre Association, imprimés à Paris depuis 1929 coûtent beaucoup moins cher que ceux publiés
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à Londres, d’une part parce que les frais d'impression sont moindres ` d’autre part parce que la publicité que nous ont confiée certains fabricants de produits pharmaceutiques couvre plus du tiers de nos frais.
Mais il ne faudrait pas conclure des chiffres de notre Bilan à une situation plus brillante qu'elle n’est en réalité ; car désor- mais, nous ne ferons plus appel à des majorations volontaires, ce qui diminuera sensiblement nos recettes ; par contre, la réunion de ce Conseil entraîne quelques dépenses supplémentaires pour le Secrétariat, et en outre, nous devons prévoir une réserve d'environ 30.000 francs pour faire face aux frais d'organisation du prochain Congrès.
Notre excédent de recettes dépassant les charges que notre Association aura à assumer au cours de ces prochaines années, nous pouvons envisager l’avenir avec confiance.
TREASURER’S REPORT Vienna Council Meeting. September 16th 1931
For some time the balance of the budget of the M. W. I. A. has only been possible thanks to donations and a voluntary increase in the subscriptions — increase. borne for the most part by the British Federation.
For the last 2 years we have been able to maintain a credit balance in excess of the amounts provided by the donations and voluntary subscriptions, and so we propose that the Council should pass a vote of thanks to those National Associations who so kindly responded to the appeal of the International Association at a diffi- cult time and advise them that, for the time being, this additional effort will not be required of them.
But it is highly desirable for our accounts that each National Association should pay the subscription to the M. W. I. A. regu- larly at the beginning of each new year calculated at the rate of half- a-dollar for every paid-up member in the preceding year.
If there are late subscribers in the National Associations it would be better to settle for them when they have paid, or add their share to the following year’s subscription rather than post- pone payment of the International dues which, according to the Bye-Laws should be paid each year on January 1 st.
At the present time several associations have not yet paid their subscription for 1930 and certain have not replied to our reminders for some years.
We should like to point out that there is an injustice in the fact that some associations pay regularly while others pay nothing at all, and this makes it extremely difficult to calculate the exact number of members belonging to the International Association.
If we seek the reason why, in spite of these unfavourable circumstances the financial situation of the Association has improv- ` ed, we find that it was the six-monthly publication of the Bulletin of the M. W. I. A. which was a heavy drain on the budget during the last quinquennial period, whereas the Bulletin of June 1929 was replaced by the reports of the Paris Congress. As the cost of printing these reports was borne entirely by the French Association a considerable saving was effected for the International Associa- tion. Moreover the 4 Bulletins of our Association published in Paris since 1929 have cost much less than those published in Lon- don, partly because the cost of printing is less and partly because the publicity purchased by certain pharmaceutical specialities covers more than a third of our expenses.
But we must not think, from the figures of our balance-sheet, that the situation is more favourable than it really is, for in the future we shall not ask a voluntary increase in the amount of the subscriptions and this will considerably diminish our assets; the Council Meeting throws certain supplementary expense on the secretariat and we must keep a reserve of about 30.000 francs to meet the expenses of organising the next Congress.
The amount of our credit balance being in excess of the expenditure that the Association will be called upon to meet during the next few years we feel that we may look forward to the future with confidence.
RAPPORT DE LA SECRETAIRE GENERALE
-Réunion dir Conseil de Vienne = 16 Septembre 1931
Depuis le Congrès de Paris d’avril 1929, un premier rapport annuel de la Secrétaire générale a été, en conformité avec les règle- ments, publié dans le bulletin n° 2 de juin 1930, mais ce rapport n'ayant pu être soumis à l'approbation du Conseil, il nous paraît intéressant pour notre travail futur et la collaboration que vous voudrez bien y apporter |par vos suggestions et vos critiques, de vous présenter aujourd'hui un exposé complet de l’activité de l’Association internationale des Femmes-Médecins depuis le Con- grès de Paris jusqu’à ce jour.
Pour répondre aux buts fixés par les Statuts de notre Asso- ciation, le bureau s'est efforcé d’une part, d'accroître le nombre des Associations nationales et des membres individuels affiliés et.de resserrer les liens qui unissent entre elles les différentes Associations nationales par l'intermédiaire des Secrétaires natio- nales Correspondantes, — d'autre part, d'assurer dans la mesure du possible la coopération des femmes-médecins dans les ques- tions qui se rapportent à l'hygiène internationale en engageant une utile collaboration avec les organismes internationaux s’occupant de médecine et d'hygiène sociales.
Développement de I’ Association internationale des Femmes-Médecins et répartition de ses Membres.
Le nombre des Associations affiliées à A. I. F. M. s’est depuis le Congrès de Paris accru de façon continue.
Le Japon qui n’était représenté que par deux membres indi- viduels a demandé en février 1930 l’affiliation de l’Association japonaise des Femmes-Médecins qui comprend mille membres et a communiqué les Statuts de cette Association.
La Tchéco-Slovaquie, représentée seulement par 1 membre individuel a formé une Association de 60 membres qui s’est affiliée én juin 1930.
L'Uruguay, représenté par 1 membre individuel, a 5 nouvelles adhérentes et annonce qu’une section de femmes-médecins com-
-posée.de 32 femmes-médecins sur un total de 36 demandera pro-
chainement son affiliation à l'A. I. F. M. Ê
Des Associations de femmes-médecins, outre celle de Victoria précédemment constituée, se sont organisées dans les différents États australiens et vont prochainement former une Fédération.
Trois nouveaux pays : la Hollande, la Russie, les Indes néer- landaises, sont représentés, chacun par un membre individuel.
Nous avons perdu malheureusement contact, malgré tous nos efforts, avec nos deux membres individuels de Turquie et de Chine, mais nous nous sommes mis en rapport avec d’autres femmes- médecins de ces deux pays pour les engager à faire partie de l'A. I. F. M.
Nous sommes de même entrées en correspondance avec des femmes-médecins d'Argentine, Roumanie et Finlande et espérons qu'elles pourront se joindre à nous et former dans leurs pays respectifs des Sections ou Associations affiliées.
La répartition actuelle de nos membres est approximative- ment la suivante :
Allemagne SERRES RS RER EVA RC 600 AUS EN AITO E eA ASE TE PAR nn à 130 + PAL UETICHE Tes RAT a s ei Rogie sake siete 30 Belgique sates ner nes RS win Sens eo eens weeds 60 Bolivio E AC NA TRS tree ee I Canada rora Ne A AN Rte a 68 LD aneM anes eoh o aa e tse ea a 50 Espagne ns RS a E a RE a AN DAA Etats Unis REC a EP Ta e hie ween 597 BTANCE Aet aro e r PA E ale a NN AR 273
Grande“ Bretagnen minnie Gh nn eer E S50
FONGEN E e neers e e E E a ae 2 NA ESE EA E IRA So AN Aaa Pen 288 Indes néerlandaises t aan ee ai e a sone ae I TOUS ES Uae E N ar S aie 90 + HOES RS e e CLOG LES G RER A Ne ER RE OOO, MEXIQUE ET EEA sions E O e a 25- NORVEGE ER os e mio Ar Ea ees aes 62 Nouvelle-Zélande n Ao E E ee 5I Pays BAS PRAIRIE I Pologne rs te SR AT AR ee is 8 20 RUSTO BOL SETA RIT RIE CAS TREES i ER ne I Sagede PERS MA tA Vy ADE ACSA SLE 40 + SUISSE Oo OL RIM TAU TR MES ea 35 Fchéco= Slovaquie Iri. MOST RE 60 Urügua yan ESRI ESO BOSE Ree OES 6 Yougoslavie. TASSE RESTES Eee 30: +
Ota wari eee
+ Chiffres. du Congrès de Paris (1929) le secrétariat n'ayant pas reçu de.nouvelle liste depuis cette date.
Relations du Secrétariat général avec les Secrétaires nationales Corres- pondantes et les Membres de l’ Association.
Pour maintenir la communauté d'intérêt des différentes Associations, le Secrétariat général envoie tous les trois ou quatre mois une lettre circulaire aux Secrétaires nationales Correspon- dantes pour les tenir au courant des documents ou propositions reçus au Bureau international qui peuvent intéresser leur Asso- ciation.
Il leur a aussi fait part des aimables propositions des femmes médecins allemandes, danoises et hongroises qui offrent l’hospi- talité aux collègues de passage, les a prévenues d’un voyage d’études médicales en Egypte et aux Indes, leur a adressé un compte-rendu de la Conférence tenue par l’Open Door International à Berlin,
‘en juin 1929, et leur a communiqué la Charte de la Mère et les
vœux se rapportant à l’hygiene adoptés par le Conseil international des Femmes, en mai 1931 (ces communications sont en général
reproduites dans les publications des Associations nationales).
Le Secrétariat général s’est aussi tenu en rapport constant avec les Secrétaires nationales Correspondantes pour les mettre au courant de l’organisation de la Réunion du Conseil de Vienne et du voyage à Budapest préparé en collaboration avec les Asso- ciations autrichiennes et hongroises et leur a soumis les proposi- tions pour l’ordre du jour de la réunion du Conseil en les priant de leur communiquer les leurs.
Le Bulletin de l'Association a paru régulièrement deux fois par an et a publié les comptes-rendus du Congrès de Paris, les nouveaux status et règlements, les rapports annuels des Secrétaires nationales Correspondantes et toute la documentation se rappor- tant à la réunion du Conseil de Vienne y compris les questionnaires rédigés par les Rapporteurs généraux. Antérieurement à l'envoi du premier bulletin, les 4 rapports scientifiques présentés au Con- grès de Paris ont été envoyés à tous les membres n’ayant pas assisté au Congrès.
Coopération des membres dans la préparation des travaux scientifiques devant être discutés à Vienne.
Le Bureau a demandé la collaboration de toutes les Associa- tions d’abord pour le choix des Rapporteurs généraux en les priant de présenter des rapporteurs qualifiés, ensuite pour l'élaboration du travail commun en envoyant individuellement à tous les membres, par la voix du Bulletin, les questionnaires sur le Rôle des Femmes- Médecins dans les pays exotiques et la Protection légale de la Travailleuse. Au 1°" mai, dernier délai officiel pour recevoir la documentation demandée par les Rapporteurs, des réponses aux questionnaires avaient été envoyées au Secrétariat international pat 45 femmes-médecins spécialisées dans ces questions et résidant
dans 24 pays différents. Ces chiffres n'indiquent qu’une partie de la contribution apportée par nos membres car un grand nombre des réponses ont été envoyées directement aux Rapporteurs géné- raux.
Collaboration avec les organismes internationaux s'occupant d'hygiène et de médecine sociales.
Le Bureau s’occupe activement de créer une utile et amicale collaboration entre lA. I. F. M: et les organismes internationaux s’occupant d'hygiène et de médecine sociales.
Il a établi un échange régulier de publications avec la Ligue des Sociétés de Croix-Rouges, l’Union Internationale contre le Péril Vénérien, l'Union Internationale de Secours aux Enfants, l'Union Internationale contre la Tuberculose, la Société des Nations et le Bureau International du Travail, et en France avec’ l'Office National d'Hygiène Sociale.
Il met à jour une liste de femmes-médecins présentées par les différentes associations et qualifiées pour représenter l’A. I. F. M dans ces groupements internationaux.
Collaboration avec la Fédération des Femmes diplômées des Universités.
La Fédération des Femmes diplômées des Universités ayant soulevé la question de possibilité d'échange de personnel médical féminin, l'Association internationale des Femmes-Médecins a désigné 3 de ses membres : Mmes les docteurs Thuillier- Landry (France) ; Dagny Bang (Norvège) ; Salzmann (Allemagne), pré- sidente et vice-Présidentes de l'Association internationale des Femmes-Médecins pour étudier cette question avec 3 membres désignés par la Fédération.
Une réunion a été tenue à Paris le 20 octobre 1930 entre les Présidentes et Secrétaires générales des trois Associations inter- nationales, des Femmes diplômées des Universités, des Femmes- Avocats et Magistrats et des Femmes-Médecins en vue d'étudier les moyens pratiques de réaliser une coordination de leur travail lorsque celui-ci se rapporte à des questions intéressant à la fois l’une et l’autre de ces organisations.
Renseignements généraux.
L'Office de renseignement a fonctionné de façon satisfaisante et a pu venir en aide à plusieurs femmes-médecins désireuses, notamment, de suivre des cours de vacances dans différentes facultés,
Le Bureau a eu a déplorer la démission de sa vice-Présidente Lady Barrett, ancienne Présidente de l'Association internationale des Femmes-Médecins. Lady Barrett ne pouvant, en raison de ses
multiples occupations assister aux réunions du Bureau, a Paris, a préféré se retirer et sur la proposition de la Fédération britan- nique des Femmes-Médecins, le Bureau a élu pour la remplacer Miss Martindale, ancienne Secrétaire générale de l'Association internationale des Femmes-Médecins, actuellement Présidente de la Fédération britannique. .
Miss Martindale, malgré les charges absorbantes de sa vie professionnelle, a pu venir de Londres à Paris plusieurs fois, pour assister personnellement aux réunions du Bureau.
Dr Salzmann a de même pu assister à l’une de ses réunions.
Comme vous le voyez, nous somines heureuses de constater le développement de notre Association, les relations engagées avec les organismes internationaux s’occupant de médecine et d'hygiène sociales et la bonne entente qui a régné entre tous nos membres pour la préparation des travaux de la réunion de Vienne, Mais le travail accompli ne doit pas nous empêcher de mesurer et de préparer celui qui nous attend. .
Dans une Association comme la nôtre où, grace à l'excellente direction du Bureau qui nous a précédé, nous comptons depuis plusieurs années environ 25 pays affiliés et plus de 3.500 membres, la première question que nous devons nous poser à chaque réunion. du Conseil n’est plus « Combien sommes-nous ? » mais « Qu’avons- nous fait — que devons-nous faire ? » Que devons-nous faire pour réaliser un des buts essentiels proposés par nos statuts, c'est-à-dire pour coopérer à l'hygiène internationale et travailler au bonheur de l'humanité ?
Laissez-moi vous dire que dans ce domaine, la Secrétaire générale ne peut être qu'un lien et l’expression d’une volonté commune et que notre champ d'action pourrait être plus vaste et notre influence plus efficace si les Associations affiliées nous appor- taient par la voie de leur Secrétaire nationale Correspondante une collaboration plus intime et plus continue, si la correspondance, les échanges de vues, de projets à étudier, de réalisations utiles à faire connaître s’établissaient avec plus de régularité entre notre Bureau central et tous nos membres.
L'A. I. F. M. telle qu’elle existe aujourd’hui représente une force, mais cette force ne deviendra réellement bienfaisante et Tear que par notre mutuelle confiance et notre incessante colla-
oration.
HONORARY. SECRETARY'S REPORT
Vienna — April 16th 1931
Since the Paris Congress in April 1929 the Honorary Secretary, as stipulated in the Bye-Laws, issued her first annual report which was published in bulletin 2 of June 1930, but, as this report could not be submitted to the approval of the Council, we felt it would be interesting for our future work and the share that you will take in it by your suggestions and your criticisms to present to you today a complete picture of the activity of the Medical Women’s International Association since the Paris Congress.
In order to fulfill the aims of our Association as set forth in the Constitution, the Officers have endeavoured to increase the number of affiliated National Associations and Individual Members on the one hand, and to strengthen the bonds uniting the various National Associations through the intermediary of the National Correspon- ding Secretaries, and on the other hand to ensure, as far as possible, the cooperation of medical women in questions of international hygiene by establishing a useful collaboration with international organisations concerned with medical and social hygiene.
Growth of the M. W. I. A. and distribution of its members.
The number of associations affiliated to the M. W. I. A. has increased continuously since the Paris Congress.
Japan, represented only by two individual members, naa in February 1930 the affiliation of the Japanese Association of Medical Women comprising one thousand members, and commu- nicated the Constitution of this association.
Czecho-Slovakia, represented only by one individual member, has formed an Association of 60 members which affiliated in June 1930.
Uruguay, represented by one individual member, has five new members, and announced that a section of medical women compo- sed of 32 members out of a total number of 36 medical women would shortly ask to affiliate.
Associations of medical women have recently been organised in the different states of Australia, besides that of Victoria already existing, and will shortly form a Federation.
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Three new countries, Holland, Russia and the Dutch Indies are’now represented each by an individual member.
We have unfortunately lost contact, in spite of our efforts, with our two individual members from Turkey and from China, but we have been in touch with other medical women in these two countries, to try and get them to join the M. W. I. A.
We have also corresponded with medical women in the Argen- tine, in Roumania, and in Finland and hope they may join us and ultimately form Sections or Affiliated Associations in their res- pective countries.
The present distribution of our members is approximately the following :
VAIS CHAU yO RR en ER dE oes 130 + AUSTIN es ai aline 30 BAUME RSR M ERA SR 60 BOUA e ee K AE NT ee I GO EAR A Re Te E 68 Ezecho Slovakia RENE E een aR 6o Denmat E ESE A EE E eres 50 Bute hI east Indo e A E eE ee EAr arr S I BANGON: E lE E Se PO Ae EN le OE 273 (COMM SEAG Ee & ON T A RS 600 GRETA RER RIL OTIS In AE SIS) AURA ES OS eles soe OTE OE Ce seins 28 INR RE E Pee Rae ee a OEE 288 HORAIRE enr go + GDA EN ie ON ean oer she te he Te QOO GJ UROSIADIG ear Re career ieee: 30 WA DUC ESR es Bs RCs A CREO UE Oe 25 als Netherlands . ;
New zealand e s es rE a RE PROS 5I NORMES LR A A A ROLES E E EA 62
POL OMG RS ae cost eie cheiri ste ae tre 20 RUSIAN Eae recu A aT de ees A I A TORR eos A e TERISI ABT AST 22 STAG RER RSS AR Darga A TOn e ne 40 + Switzerland. e rer exes A r ATE oi te dot 35 Cited SS ALES ie os 597 (DEAR D SORT RE MU NE RO RES 6
+ +
. + Note : Figures from the Paris Congress (1929), no new list having been received since that date.
Relations betwen the Central Office and the National Corresponding Secretaries and the Members of the Association.
In order to maintain a current of interest with the different Associations the Central Office has sent out a circular letter every three or four months to the National Corresponding Secretaries to acquaint them with documents or proposals received by the International Association likely to be of interest to their National Associations.
It has also informed them of the kind proposals of the medical women of Germany, Denmark and Hungary who offered hospi- tality to their colleagues passing through, of medical tours arranged in Egypt and India, has sent them an account of the Conference | held by the Open Door International in Berlin in June 1929 and communicated to them the Mother’s Charter of Rights and the Resolutions passed by the International Council of Women in May 1930. (These communications are generally reproduced in the publications of the National Associations.)
The Central Office has also kept in constant touch with the National Corresponding Secretaries concerning the organisation of the Vienna Meeting and of the journey to Budapest arranged in collaboration with the Austrian and Hungarian Associations and has submitted to them the proposals for the Agenda of the Council Meeting and invited their suggestions.
The Bulletin of the M. W. I. A. has appeared regularly twice a year and has published the accounts of the Paris eee the new Constitution and Bye-Laws, the annual reports of the N, C. S. and all the information concerning the Vienna Meeting including the questionnaires prepared by the Rapporteurs. Prior to the issue of the first Bulletin the four scientific reports presented at the Paris Congress have been sent to all members not able to be present.
Cooperation of members in the preparation of the scientific reports for discussion at Vienna.
The Committee sollicited the collaboration of all the Asso- ciations, first for the choice of the Rapporteurs by asking them to submit names of qualified persons, and secondly for the preparation of the work to be done in common by sending to all members individually, through the pages of the Bulletin, the questionnaires on the Role of Medical Women in Exotic Countries and on Legal Protection for Women Workers. By May rst, latest official date fixed for receiving the documentation asked for by the Rapporteurs, replies to the questionnaires had been sent to the Central Office by 45 medical women, specialised in these subjects, residing in 24 different countries, These figures indicate only a part of the contribution afforded by our members, a large number of replies having been sent direct to the Rapporteurs.
Collaboration with International Organisations of Medical and Social Hygiene.
The Committee has tried actively to create a useful and friendly collaboration betwen the M. W. I. A. and the international associations concerned with medical and social hygiene.
It has instituted a regular exchange of publications with the League of Red Cross Societies, the International Union for the Pre- vention of Venereal Disease, of Tuberculosis, the International « Save the children » Association, the League of Nations, the Inter- national Labour Office, and in France the « Office National d'Hygiène Sociale. »
It is preparing a list of medical women presented by the different associations and qualfied to represent the M. W. I. A. in these international organisations.
Collaboration with the International Federation of University Women.
The International Federation of University Women having raised the question of the possibility of an exchange of feminine medical personnel, the Medical Women’s International Association designated there of its members : Drs Thuillier-Landry (France), Dagny-Bang (Norway) and Salzmann (Germany), President and vice-Presidents of the association, to study this question with three members designated by the I. F. U. W.
A meeting was held in Paris on October 20th 1930 between the Presidents and Honorary Secretaries of the three International Associations, the University Women, the Women Jurists, and the Medical Women with a view to studying the practical means of co-ordinating their work when this work covers questions which are of interest to them all.
General Information
The information bureau has functioned satisfactorily and has been able to assist several medical women desirous, particu- larly, of following post-graduate courses in the various faculties,
The Committee has to record with regret the resignation of its vice-President, Lady Barrett, former president of the M. W. I. A. Lady Barrett being unable, on account of her many occupations, to take part in the Committee meetings preferred to resign. On the recommendation of the British Federation of Medical Women the Committee elected, to replace her, Miss Martindale, former Hono- rary Secretary of the M. W. I. A. and present President of the British Federation.
Miss Martindale, in spite of the manifold claims of her pro- fessional life has managed to come from London to Paris several times to be present at the Committee meetings.
Dr Salzmann has also been able to be present on one occasion.
As you see, we are happy to note the development of our Asso- ciation, the relationship with international organisations of medical and social hygiene and the perfect understanding which has reign- ed among all our members for the preparation of the work for the Vienna Meeting, But the work accomplished must not prevent us from realising and preparing for the work that lies ahead of us.
In an Association like ours where, thanks to the excellent management of the Committee which preceded us, we have for some years numbered about 25 affiliated countries and over 3.500 members, the first question which we must ask ourselves at each Council Meeting is no longer « how many are we ? » but « what have we done — what must we do ? » What must we do to fulfill one of the essential aims of our Constitution which is to cooperate in international hygiene and to work together for the well-being of humanity ?
May I remind you that in this domain the Honorary Secretary can only be a link and the expression of a common purpose, and that our field of action would be greater and our influence more telling if the Affiliated Associations would work in more intimate and regular cooperation with us through the medium of their Na- tional Corresponding Secretaries, and if the correspondance, the exchange of points of view, of projects to be studied and of advan- tages gained which it would be helpful to make known could be established with more regularity between our Central Office and all our members.
The M. W. I. A. as it exists today represents a power, but this power will only become really efficacious and beneficial through our mutual confidence and our unceasing collaboration.
REPORT
ON The Role of Medical Women in Exotic Countries
BY Dr MARGARET I. BALFOUR C. B. E., M. B.
Former Director of the Women’s Medical Service in India Rapporteur Général (India)
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“ Exotic countries ’’ is defined as countries outside Europe and the scope of the present report is confined to such countries inhabited or governed by the non-Latin speaking races. A ques- tionnaire addressed: to medical women was issued by the Central Office and National Corresponding Secretaries of the International Association of Medical Women and replies have been received from 40 medical women working in India, the Dutch Indies, Peisia, Malaya, China, Japan, Egypt, the Soudan, Palestine, Hongkong, Trinidad, East Africa, West Africa, Greenland, Canada and New Zealand. I fee that we owe these medical women very great gratitude for the t me and pains they have taken in answering the queries. I have hought it be t not io enter their names in the body of the report, but to indicate the sources of
-my information by numbers which reier to the appendix where their names and countries are given. Some of the medical women have given detailed and vivid pictures of the countries in which they are wo king and of the conditions of their work, and their papers are such as to rouse keen intere t. Sifting and selecting from this mass of information has been no easy task. One medical woman, replying to one of the questions (of which there are 62 in the questionnaire) gives seven sub headings, and remarks, that an essay might be written on each (10) ! A reply from the U.S. Department of Labour says ‘I realised at a glance that prac- tically every question it (the questionnaire) contained was one which would require months of research and upon which we have no complete information’ (28). I have supplemented the mate- rial received by getting information from missionary societies and Government reports. But the length of this paper is limited and I fear it will only be possible to give a superficial summary of the conditions of work in exotic countries and of the problems which confront.medical women, leaving out many points of interest and only touching lightly on some important questions.
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The subject matter of the questionnaire will best be consi- dered in two parts :
I, — The special needs which require the presence of medical women in exotic countries and the extent to which these needs are being met.
II. — Suggestions for forwarding the work of medical women in exotic countries in order to meet the meeds more fully.
1. — The special needs are as follows :
1° Habits and customs of the people: 2° Conditions of childbirth.
3° Infant Mortality.
4° Venereal Disease.
5° Miscellaneous.
1° HABITS AND CUSTOMS OF THE PEOPLE
The most urgent of these is the purdah system, which pre- vais in India, and under which women are kept secluded in their house: and are not allowed to shew their face, to any man other than a near relative. This means that.they may not consult men doctors, or attend hospitals with male patients or staffs. They cannot shew themselves to a male doctor in childbirth and cases have occurred where they preferred to die undelivered rather than do so. Purdah is most common among the Mahommedan population in India and less common among the Hindu popula- tion. In many parts of the country Hindu women are quite free of it. It is estimated that out of a population of 120.000.000 women about 30 million keep purdah. But there is no doubt purdah is less than before and that many families, who observed it formerly, do not do so now. Others still observe it, but less strictly ; they will on occasion, consult male doctors, though with restrictions and precautions. The orthodox still keep it strictly. Purdah does not occur so severely in other countries with Mahommedan populations, such as Persia, Egypt and Palestine, but even there, it is the custom for Mahomedan women to be more or less sec- luded and attendance by their own sex is essential. This preference which women have for attendance by their own sex, quite apart from. purdah, especially in matters connected with obstetrics and gynecology, is emphasized in the replies from the great majo- rity of the countries.
From India « the habits and customs of the people of India make it not only advisable but essential to have medical wo- men » (2). :
From the Dutch Indies «Their religion does not forbid native women to be treated by male doctors, but I know by my own
experience it is much easier for a medical woman to be admitted than it is for a man. And when the woman is in labour and in dan- ger she will not object to a man’s help, but if she is pregnant and: not in danger, she mostly will not consent to go to a male doctor: to be examined. (12) -
From Persia “In a Moslem country like Persia men are not allowed to see a woman’s face if she is not of their own family. This means that any examination which is needed very seldom takes place... no man can do a gynaecological examination (13)
From China ‘Very advisable to have women doctors, because of feelings of modesty on (ea part of the patient — not absolu- tely. necessary’ (17).
From Africa « Native women would never accept treatment from a man were a woman available, as all their manner of life and their reticence leads to this preference » (23).
From Palestine « The seclusion of Moslem women (about 7. 5 per cent of the whole) makes it very advisable to have medical women. Otherwise many of them are out of reach of medical treatment » (27).
From Egypt « The majority of women (both Moslems and Christians) dislike going to men doctors. The majority of men dislike having their women attended by men, especially for mat- ters of gynaecology » (42).
From the Soudan « The hareem customs among the Moslem population makes a woman doctor necessary for all women’s
work » (43). From Canada too, regarding the need for medical women « As anywhere else — a geat asset, if women doctors are up to
standards and ideals » (15).
A custom which is often commented on, especially as_regards India, is early marriage. It is noteworthy that, although ten medi- cal women from India have replied to the questionnaire, none have mentioned early marriage as an important factor in maternal or infant mortality. This does not mean that ear lymarriage does not occur, and’that it, as well as early pregnancy, does not sometimes lead to deplorable consequences, but it indicates that it does not bulk largely as a cause of maternal and infant mortality in the gene- ral population. The cases occasionally seen are distressing enough to make all medical women champions of the young wives and there is also some evidence that very early pregnancy predisposes to stillbirth and neonatal mortality (38). The following extract from Persia might equally refer to cases seen in India. « Though the mar- riage ceremony: takes place in many cases when the girl is nine years old, and the girl lives in her husband’s house, as a rule sexual connection does not follow until after the first menstrual period. But it is a geat mistake to believe that Persian girls mature early‘
. they do not do so'at first. Certainly a girl of seventeen may look
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as old as an English girl of twentyfive, but that is because she may have had two or three children. The twelve year old child is often a little undeveloped creature, she has left school on her marriage at the age of nine, consequently she is very ignorant. She leads a very sedentary life, does not know how to play games, and it is this kind of child who is brought into hospital, her perineum rip- ped to her anus, following her first sexual conncection with her husband. She may be literally demented with the shock. Such cases are not rare » (13). Reference to early marriage is also made from Palestine as a cause of infant mortality (27) and from Egypt as a cause of delay in labour (31).
The general habit of life which is so common among the Mos- lem races is well described in a paper from the Soudan. « The woman of the Northern Soudan is a lady of large dimensions, whose ambitions in life are to be fat and to bear children. She begins life as an adorable brown baby and becomes a slim and attractive, graceful, small girl with beautiful manners. At the age of ten her nerves are first undermined by the horrible custom of circumcision and the tribal marks are cut on her face with a razor. A short time later she becomes hareem and is a prisoner within the four walls of the mud compound, She is now being fattened and prepared for marriage, which, with luck, takes place at fifteen or sixteen. From twenty to thirty she is so busy bringing children into the world, that she does not have time to look after those already belonging to her. Soon after thirty she becomes a grand- mother and as such she takes over charge-of her daughter’s chil- dren, whom she looks after well, according to her lights. These lights, in most cases, consist of allowing them to feed on dates, native bread, etc. and if convenient, to suck from her own breast. When remonstrated with, she says « What can you expect, we are only cattle. » Not only is there an appalling waste of infant life and health as a result, but also, there is an equally appalling waste of womanhood » (43).
The practice of female circumcision, referred to -above, is described in a paper from Nigeria under childbirth. It is also referred to in a paper from Egypt. It is known to be practised in some parts of India, or was formerly. A curious custom which prevails among some tribes in Arabia, is that of sewing up the vulva before puberty, a track being left for the menses. This may cause trouble at the first childbirth.
Other factors met with, which have to be contended. with, are described in various papers as ignorance of the people, poverty and malnutrition — a writer from Hongkong reports an enquiry, as a result of which it was found, that a number of people among whom enquiry was made, had a sum equivalent to three shillings and eightpence per head, per month, for all purposes. Similar facts might be given'from India and, no doubt, from other countries.
(2) THE CONDITIONS OF CHILDBIRTH
There is a certain uniformity in the replies to the question- naire on the subject of attendance in labour. With the exception of Canada, New Zealand and Japan, all state that the attendance is mostly by untrained midwives. From the descriptions given, the Indian dai, the Dutch Indian dukun and the African untrained midwife (and the untrained midwives of other countries) all bear
a close family resemblance. In Africa « their only qualification
needs to be that of marriage and to be the mother of a child » (23) In Persia « puerperal sepsis is so rife that the women think something has gone wrong if they do not get fever following a confinement. The native midwives of course are at the root of it all, filthy and ignorant » (13). In India (where the dais often form a hereditary caste) « unskilled attendance causes death through failure to reco- gnise abnormalities, unnecessary interference in normal cases and lack of asepsis » (2). The description of a delivery case in Nyassa- land would probably read for most of the exotic countries we are considering :
« The woman is separated from her family and put into a hut, with the filthiest of rags for clothing and nothing that has any claim to cleanliness is allowed to touch her. Soap and water are unknown quantities. Then she is given no food from the begin- ning of labour until after delivery, with the result that a prolonged labour results in the mother being doubly exhausted. Naturally this causes much maternal mortality, which would be higher still were it not for the saving qualification that they make no vagi- nal examination. (unfortunately, that saving qualification is not usually found everywhere, M.I.B.) Any old rag is used to wrap the new born babe in, often with resulting tetanus and septicae- mia. When inertia occurs, nothing is done and the woman is then the victim of the consequence of pressure of the head on the parts of the vagina. Many a time, one can tear away the labia like a piece of tissue paper. Intravaginally the results are appalling. If death does not occur from septic absorption and the vagina heals, there is either the most distressing vesico-vaginal fistula or such contrac- tion that the birth of another child is impossible. » (23)
A paper from Sierra Leone says « in the Protectorate women will not go to hospitals as inpatients — for one thing there are no women nurses to look after them. They never have men doctors in their own homes. Confinements take place outside in the « bush », superintended by a relative. If the child is not delivered in a rea- sonably normal time, the women are beaten and cruelly treated. If there is any abnormality they die, as no doctor, European or African, is asked to help by the relatives-of the woman.» (23 b)
Antenatal disease is said to be infrequent in China, One writer says « the women seem very healthy in pregnancy » (16). Another
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puts antenatal disease as approximately 2 per cent of the total morbidity, postnatal disease at 3 per cent, intranatal complications at.20 per cent and unskilled attendance at 75 per cent (18). Osteo- malacia is mentioned as present in some parts of the country.
In the other countries, excluding Canada, New Zealand and Greenland (which does not give particulars) antenatal disease is said to be more or less common, although some writers consider the evils of unskilled attendance to be greater.
Diseases known in Europe, such as eclampsia and haemor- rhage occur. In addition the following are reported Anaemia — In India this appears as an acute condition in the latter half of pregnancy, although a similar condition is found, more rarely, in non pregnant women. It differs from the secondary anaemias caused by malaria and ankylostomiasis, and is believed to be connected with nutritional factors. It is at present under observa- tion. It is a large cause of maternal death in India (5) (8) (9) (zo). Similar conditions are reported from Malaya (29) Africa (21b) (23) and Hong Kong (39).
Osteomalacia. — This is reported from many parts of India (2) (3), etc. and from China (16) (17), also from Egypt, (42), etc. One case is reported from Tanganyika in East Africa (22). The disease has been investigated both in India and China. Particulars are given of one district in the Kangra Valley where an investigation was made (3). 51 per cent of the people were.affected with some degree of rickets or osteomalacia, although they had abundant sunshine.. The diet was poor. This disease sometimes leads to severe pelvic contraction and consequent difficulty in labour, stillbirth and maternal death. Owing to the lack of medical aid the women not infrequently die undelivered. It is said they may linger as long as eleven days before death relieves them, the un- trained dais meanwhile exerting all their powers by kneeling on the abdomen, branding the woman with hot irons, etc., etc. Kashmir, in the North of India is also severely affected by this disease, see the little book « Behind the Purdah » by Dr. Kathleen Vaughan.
In some parts. of Persia there is severe pelvic contraction among carpet makers. Little girls are sent at an early age to work in the factories and are required to sit all day in constrained atti- tudes. It is not stated whether the contraction is a manifestation of rickets, but many Caesarian Sections are done in the Mission Hospitals for women (13) (13 b).
Beri beri is reported from South India (6), Malay (29), the Dutch Indies (11) (12), Japan (25), Hong Kong (39). It occurs usually inthe puerperium or during lactation, but sometimes during pregnancy and has serious effects on mother and child. It is perhaps connected with a deficiency of Vitamin B.
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Sutika, another puerperal disease, is reported from Bengal, but has not been investigated.
Malaria is a serious complication of pregnancy and labour in India, Persia, China, Africa and the West Indies. This is especially emphasized in papers from West and East Africa (23 b) (23). The former writer says that 85 per cent of the children suffer from enlarged spleen, and malaria, often quite untreated, is a large cause of maternal mortality in childbirth and of premature birth.
Circumcision. — The cicatrization which sometimes takes place after this operation is by some said to lead to difficulty in labour. A writer from Kenya says, « the practice, which, in essen- tials, consists of a cliteridectomy, but which is often accompanied by the removal of part of the labia minora or even labia majora, results in a hard cicatrix surrounding the vaginal orifice..... To our views, of course, it is a stupid and mutilating custom, but to them it is an integral part of their tribal laws... Circumcision of females to them is as important as ritual circumcision of the male to the ortho- dox Jew. Any attempt to prohibit such a practice by law or force
would make the fanatic more fanatical, whereas education would
probably, after two or three generations, lead to its abandonment. Apart from this, any difficult cases of labour I have seen were emphatically not the result of circumcision. » (40)
Weight carrying.— This together with diet, is referred to by a writer from Africa as causing pelvic contraction, the promontory being forced downwards, owing to heavy weights carried on the head by young girls. (40).
Other maternal diseases mentioned as contributing to maternal mortality in different countries are gonorrhoea, syphilis, tuber- culosis, pellagra, ankylostomiasis, bilharzia and tetanus. Puerpe- ral sepsis is nearly always mentioned as very common,
The above extracts and remarks make a black picture of mater- nity, but the following shews another aspect.
« In the North West Frontier Province (India) the Moslem tribeswomen have hitherto led a nomadic life, or at all events, a very healthy, out of door, open air, life, of work and movement ; and one finds very little difficulty of labour among them. It is usual for them to have their children born even when on the march and the whole process is over in.a short time, the woman squatting for it. She cuts the cord on a stone and ties the end with a thread from her chader, waits for the afterbirth to appear, buries this and resumes her march. Sometimes she may ride on one of her hus- band’s camels for an hour or two ». (2)
The evidence of other writers shews that in India, Malay, and probably. in other exotic countries, labour, uncomplicated, is easy and quick. Investigations in India and China have shewa
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that the maternal pelvis is smaller than in European countries, but so is the foetal skull. When there is no antenatal disease, the rapidity of the labour saves the mother from many of the conse- quences due to environment and unskilled attendance.
As regards statistics for maternal mortality, few countries have been able to give them. Where illiteracy prevails, vital sta- tistics must be doubtful. In parts of India and elsewhere, special efforts have been made to find the incidence of maternal mortality and the following shew some figures probably substantially cor- rect.
New Zealand ..... Dans 4.8 per 1.000 live births 1929-30 Canada ots Re eee OAN — — 1926-29 BOMDAY.. 0. D AL OS e ne ee io Re 1929 Calcutta ...,...........,380 — — — — 1926 Madraso ie critics SRO pe en 020; Murshidabad Dist enquiry 12.0 — — — — 1918-23 Malaya (Singapore) ....... 7.8 — — — — 1928 Trinidad ee ae eres MOD DDR ae ee ee 1923-25
In all the countries under discussion, the first task of the ear- lier medical women was to organise some kind of nursing service. In this they sometimes had the assistance of European nursng sisters. Later, Governments came forward to assist, especially in the work of training midwives. There are now, therefore; in all these countries,. especially in the older ones, a number of nurses and midwives belonging to the country, with a greater or less amount of education and training, but all very superior to the indi- genous, untrained midwives.
But the poverty of most of the people makes it difficult for them to employ educated midwives, even if they were enlightened enough to see the advantages, which, in most cases, they are not. Moreover, in these vast areas of country, where educated and enlightened people are few, or altogether lacking, it is not safe to send young women to work alone in villages. Apart from that, in most of these countries women are in a minority, so there is no class of unmatried women who can make work their first objec- tive. For these reasons medical women, in dealing with people outside hospitals, must make all possible use of married women and must even avail themselves of the sérvices of the untrained midwi- ves. In India many efforts have been made to train these. women and the concensus of opinion is that improvement can be effected, if it is to be in any way permanent, their work must be kept under supervision. A trained midwife can watch and check the work
- of a.good number. of dais, and such midwives should themselves be supervised by medical women. To make such schemes really effective, compulsion must be used and legislation must be intro-
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duced, requiring the registration of all practising midwives and prescribing penalties for neglect of rules. (2) (8) (ro). Madras has passed an Act of the kind, regulating the training and practice of midwives (6) (10). A sitnilar Act is at present pending before the Punjab Legislative Council (3) and one is under consideration by the Government of Bombay.
In China, it is stated, a comprehensive scheme for the regula- tion of midwives’ practice is shortly to be carried out (16) (33). A training school for midwives was opened by the Central Chinese Government at Peking in 1929. This is under the charge of two Chinese medical women, assisted by a Chinese nurse who has the English C.M.B. diploma. Three courses of training are given (1) a two years course for those who have passed from the High Schools, (2) a six months course for those who have passed from the Pri- mary Schools, (3) a two months course for the practising untrai- ned midwives. All are taught to conduct cases in the attached maternity hospital, as well as outside, and the untrained midwives are allowed to practice under the supervision of a trained midwife supervisor. They are required to buy a specified outfit. A Mid- wives Act has been passed, so that compulsion is used to get the untrained midwives to attend and to follow the rules laid down. It is the intention to open four other Central Schools in large towns in addition to 21 Provincial Schools, one for each Province of China and to train during the next 50 years 100,000 midwives. (33)
In. British Africa the training of midwives is carried out, as is usually the case in India too, in scattered areas, in existing maternity wards and hospitals. Some Provinces of British Africa have passed Acts regulating training and practice of midwives and others have it under consideration (30).
In Malaya such an Act is in force, applied to the 3 chief towns of the Straits Settlements (29).
In the Dutch Indies the training of midwives is regulated by Government, but not their after-practice. Special training schools for midwives are carried on, under the charge of medical women
12). In Hong-Kong legislation has been passed, but it is not pos- sible to enforce it for the whole colony (39).
A writer from India says « it is doubtful whether legislation can be successful until public opinion on the subject is stronger » (10). This isa very true remark and several of the writers, who des- cribe legislation as having been passed in their countries, remark, that it is as yet only applied to certain localities, or, that it is not yet fully enforced. (29) (39) (40) (41).
Missions, charitable organisations and Governments have opened maternity wards and hospitals. which in some parts of these countries are well attended —- in others few, except.abnormal cases, enter.
This question of maternal mortality is one of grave importance and means an enormous wastage of life. In India alone there are approximately 8.000.000 births annually, and if we take the mater- nal mortality, as shewn in the Murshidabad investigation, at 12 per 1.000 births, the maternal deaths work out at over 100.000 annually.
(3) INFANT MORTALITY
The rate of infant mortality is not so difficult to ascertain as that of maternal mortality, but even so, those who have attemp- ted to supply the information, do it with an element of doubt. In some of the countries, laws have been passed requiring the regis- tration of births, and Local Bodies are empowered to adopt these laws or not as they see fit. Even where such laws are adopted, they are not always enforced by penalties. In certain of the large towns of India great efforts are made to get correct vital statistics, and a special staff is kept who pay house to house visits and so collect the information. In Singapore, a birth registration certifi- cate is required for admittance to school and this has been suc- cessful in greatly improving the registration. In Tanganyika (E. Africa) efforts are being made to get correct vital statistics by keeping one area under close observation. Balls of coloured string, each representing a different class and age, are issued to the head- men of villages, the people file before them and a knot is made on the correct string for each person (30). This gives an idea of some of the difficulties of getting information, where the people are illiterate and the Government is short of funds.
The fact which tends most to vitiate statistics on infant mor- tality in such countries is, that it is easier for an infant birth to escape notice than for an infant death to do so — hence deaths are recorded and births are not, and the resulting rate of infant mortality is too high. As vital statistics tend to become more correct, the infant mortality rate apparently falls.
The following rates are either obtained from the replies to the questionnaire, or from the Public Health Reports of the coun- tries in question.
New Zealand ............. 34 per 1.000 births ...... 1929 Canada es Cesena ue eer Oye Svan ST O2 ERA eee en eee De SR ETO08 Malaya (FE MS NE ig AE T020 West Africa Lagos ........ 134 — sd dink 1026 Breetownes tr et te OAy = 1926 East Africa Kohama (Tang.) 258 — Lier 102 Palestine +56 ones 2 i 180 RC
JAPAN A oe oe cies sue ee AO ty . eee eee 1929 VERMA ns , 325 tees O30
E lel
tek elles]
In most of the countries the infant mortality during the first month is estimated as one third to one half of the mortality for the first year.
Where statistics are so unreliable and medical certifica- tion of death is lacking, except in a few cases, it is not possible to get much definite information as to causes, but nearly every paper expresses the opinion that infant mortality is high. Different writers mention as causes, difficult childbirth, ignorance of mo- thers, prematurity. Tetanus is given as a cause in China, parts of Africa and parts of India, beri beri in Malay, the Dutch Indies, parts of India, parts of Africa and Hongkong. Malaria is refer- red to, especially in Africa. Of the Gold Coast it is said « malaria- indirectly - is probably the great cause of infant mortality, because of the very severe anaemia which accompanies it in ba-
bies » (21 b). Of Sierra Leone it is said «the cause of deaths, ;
either directly or indirectly, in the majority of cases appeared to
be malaria... 85 per cent of school children had enlarged spleen »:
(23 b). The importance of premature birth as a cause of neonatal death is put forward and the suggestion made that it may be con- cerned with a nutritional factor (38).
The movement known as Maternity and Child Welfare for the prevention of disease in mothers and children has only opened out in exotic countries during the past 15 or 20 years. In some cases it began by the efforts of medical women in connection with their hospitals, while in other cases it was commenced by lay workers. ‘
In India, after a number of scattered beginnings, a School for training Health Visitors was opened by a voluntary Association in Delhi in 1918. There are now 7 such Schools in different parts of India and many Indian and Anglo-Indian Health Visitors are in charge of centres in different parts of the country, although the number is small compared to the population. There is a diffi- culty in getting the people and sometimes the employers to realise that prevention is the object of the movement and that treatmer.t should form no part, except in special clinics under qualified men or women. Otherwise the centres tend to become inferior dispen- saries and there is a danger that Governments and Local Bodies may employ Health Visitors for medical work because they are cheaper than medical women. The work is largely carried on by lay organisations with occasional grants in aid from Governments ‘ or Local Bodies. The Association of Medical Women in India has, for some time, been trying to secure that a medical woman should be appointed as Assistant Director of Public Health in each Pro- vince, to organise and co-ordinate Child Welfare work. This has recently been carried out in the Madras Presidency. In the United Provinces a medical woman holds a somewhat similar position. In the Punjab a trained and educated Health Visitor is in charge of
the Government School for Health Visitors. She also travels through the Province inspecting and reporting on the work of the passed Health Visitors who are working in centres assisted by Government. The Punjab Government gives generous finan- cial aid to Local Bodies which undertake this work. With the excep- tion of these three Provinces, however, no women are appointed by Government to direct Child Welfare activities. Two of the most important All India voluntary Associations for Child Welfare, the Lady Chelmsford All India League and the Indian Red Cross Society have recently agreed to join forces and to form a joint Bureau of Maternity and Child Welfare under the control of an experienced medical woman. Her authority will, of course, only extend to the work assisted by the two organisations, but it is hoped her influence will be great.
In China, Child Welfare work is being carried on in connec- tion with some missions and also by Government and some Local Bodies. There are 2 Child Welfare centres in Peking — one in connection with the Union Medical College, the other under the Municipal ty and run by the medical women of the Midwives School already described. Both are very successful (33).
In Malay and in Africa, Child Welfare work is carried on both by Missions and by Government.
In Palestine, the work was begun after the war by Jewish or- ganisations and other communities, seeing the good results, follow- ed suit. Government now also carries on centres, but employs
` no medical women. It has been urged to appoint a medical woman especially for the supervision of newly trained midwives, but so far has not done so (27).
In Egypt, Infant Welfare work is carried on by Government as well as by Missions (31).
In Trinidad, it is carried on by Government, and charitable organisations (41), in Hongkong chiefly by charitable organisations, but Government is said to be maturing plans for its furtherance. :
In the Dutch Indies, Persia and Greenland, infant welfare has not yet developed to any extent:
Although, as has been shewn, infant mortality rates are believ- ed to be high in all these countries (leaving out of consideration New Zealand and Canada), no general investigations have been made by their Governments to throw light on the causes. Excep- tions to this, to some extent, were the investigations at Murshi- dabad in Bengal and at Kahama in Tanganyika, where definite areas were or are being kept under special observation, These investigations, however, were not undertaken specially to throw light on infant mortality (though they may do so), but rather, to verify vital statistics. No medical women were, or are, employed in connection with them. Other enquiries of that nature would be of great value and would lead to better results for money spent
on Maternity and Child Welfare. But, as so much of the infant mortality is due to domestic conditions and to pregnancy diseases, it would be far better if medical women were employed to make the observations. A small enquiry of this nature has been under- taken in the Punjab during the coming year by Mrs. Curjel Wilson, M. D. A rural area and an urban area will be kept under close observation for a definite period, all cases of infantile disease noted and the causes of death, as far as possible, investigated.
Mention should be made here of the « Save the Children International Union » which in June last held a Conference at Geneva on the welfare of African children. More detailed infor- mation on infant mortality in Africa can be obtained from the papers read there, which are shortly to be published.
(4) VENEREAL DISEASE
It is always difficult to estimate the incidence of venereal disease in a community and it is more so in these exotic countries, where facilities for treatment are few. Some writers refer to the recently published report on stillbirth in India by Dr. Christine Thomson (5) (10). This gives the positive rate of a large series of women in a Madras Maternity Hospital, where the blood was tested by Wasserman’s method, as 12.5 per cent in comparison with 9 per cent in a similar series in Glasgow (Scotland). The pa- thological examination of stillborn foetuses shewed 18.5 per cent « certain » or « probable » syphilis as compared with figures ranging from 9.5 to 17.5 per cent from England. It is to be expected, however, that in India and the other exotic countries with which we are dealing, venereal disease would be greater in seaport towns like Madras and less in village areas. Also, that it would be greater in some tribes and communities than in others. Most of the replies to the questionnaire pass over the question of incidence without reply, but the following extracts shew that in some cases it is a serious problem.
From India « I still remember a very sad episode this spring, when we had to send a bunch of 14-16 women and children back to their village in Swat because we could not afford to give them more than two salvarsan injections each, with the other routine treatment, as they could only pay two rupees per head for the grown ups for treatment, stay and all..... most of them had secon- dary, very painful eruptions in their throats and some were ter- tiary. A young woman was pregnant in the 6 th month..... They told me that many people in their village suffered from this di- sease » (35)
From Egypt « I know of one or two villages where practi- cally every inhabitant shews signs of specific disease and nothing is being done (31)
= 14
From Persia « Most women have had either syphilis or gonor- rhoea, the rarity being to find a man who has not had some form of venereal disease at one time or other. There is no reliable evi- dence of the rate of incidence among women and children. The Zoroastrian Moslem villager and tribespeople are the cleanest li- ving people in Persia and one does not meet with so much venereal disease among them as among the Moslem town dwellers. » (13)
From West Africa « Many consider syphilis to be of major importance (in causing antenatal deaths) » (32)
« In two of the three native locations round Nairobi are num- bers of detribalised women — their one resource lies in prostitu- tion. In the reserves, of which I have no practical experience, the incidence of V.D. varies with each tribe. (40).
Those who have replied about venereal disease agree that in all countries there are very few facilities for the treatment of women — that is, very few clinics under medical women. Such are found in Canada and New Zealand, a very few in India, at least one in Singapore, some in Africa, one in Trinidad. Noothers are reported.
Medical women in Mission and other hospitals have in many cases taken special courses of instruction in modern methods of treatment for venereal disease and are competent to carry it out, but are much hampered by the cost of the drugs, their patients being, as a rule, too poor to contribute (35) (37). One instance is related where adequate grants are received from Government (5) ` and one where a small grant was received from the Red Cross (35) But most of these non-official medical women receive no encoura- gement to treat venereal disease or to assist with propaganda. The high cost of the drugs is increased in some countries by a heavy rate of duty.
(5) MISCELLANEOUS NEEDS Under this heading comes research, especially in connection
with childbirth and infant mortality, also in connection with.
women’s industries. There is also medical inspection of school- children, employment in connection with jails and mental hospitals and administration.
In New Zealand some research has been carried on by medical women working under the Health Department — « A survey of the menstrual function of Training College students and senior High School girls » by Dr Grace Stevenson, « Postural deformities of New Zealand School Children » by Dr. Mary Champtaloup. There has also been a recent enquiry into Stillbirth and Neo-natal death by Dr. C. N. Hector.
In Canada it is stated there are opportunities for women under- taking research « to some extent ». A report on Maternal Morta- lity in Childbirth was published some years ago by Dr. Helen Mac- Murchy.
In India women are employed as temporary workers by the Indian Research Fund Association, but not on a permanent footing as is the case with men. Funds were also made available by Lady Irwin, the wife of the late Viceroy. Research has been done on anaemia of pregnancy by Dr. Lucy Wills and others, on osteo- malacia by Dr, Curjel Wilson, Dr. Lucy Wills, and Dr. Grace Stapleton, on early infant mortality and maternity conditions of industrial workers by Dr. Margaret Balfour and on Stillbirth and Neo-natal death by Dr. Christine Thomson. An account of the last has been published as a special report and the progress of the others have been given by articles in the Indian and British medical press during the past five years.
Reference has already been made to the « Save the children International Union » and its recent conference. A report on Infant Mortality in West Africa was read by Mrs. Blacklock, M. D., and has been printed.
No further research has been reported in the answers to the questionnaire although, no doubt, articles by medical women appear from time to. time in the Journals of the different countries.
India is rapidly becoming an industrial country and women are being employed in increasing numbers in China, Africa, Malay and Japan. In 1922-23 an enquiry was made into the conditions of the jute and cotton industries, so far as women were concerned, by two medical women in India, who were loaned, for the purpose, by the Women’s Medical Service. At the present time two medi- cal women are employed in connection with factories in India, one with the status of factory inspector in Bombay, the other in con- nection with welfare work in Nagpur. There are also some welfare centres in factories under Health Visitors (although very few). In Bombay two non-medical women investigators are employed in a subordinate capacity to collect data regarding the family life, etc. of workers. Considering that India employs something like 250.000 women in factories alone, this is an almost negligeable provision.
Medical women are employed in school inspection in India, China, Malay, parts of Africa, the Dutch Indies, Hongkong and Trinidad, but it is stated, not to anything like an adequate extent. School inspection is often begun by missionary societies in connec- tion with their schools and afterwards introduced by Government and Local Bodies.
No employment of medical women in connection with jails is reported from any country. One is reported to be employed in the Mental Hospital, Lahore (3).
One of the most important questions affecting women’s medi- cal work is that of organisation or administration. The heads of all Governments are men, their Councils are composed of men and the heads of the medical departments are men. They have little
ro
opportunity of getting to know the habits and customs of the wo- men of a country and little experience of the best way to improve them. It is sometimes difficult for medical women working in the less important posts of a service to represent their needs and espe- cially to press for some important change, which they are aware will greatly improve their results. If they give trouble and especially if they fight for anything they feel strongly about, a black mark is apt to be put against their names, It is therefore of great impor- tance that women, and especially medical women, should be asso- ciated with the Governments of all countries, either to advise upon, or to organise, medical and preventive work among women and children.
At the present time, in Canada, a medical woman is Chief of the Division of Child Welfare. In India a medical woman admi- nisters the Women’s Medical Service. Other women sit on its
Governing Body, but there is no woman connected with the Medi- .
cal or Public Health Department of the Government of India or attached to the India Office in London. A medical woman holds the position of Superintendent of Medical Aid to Women in the United Provinces and another is Assistant Director of Public Health in Madras — otherwise no medical women are attached to any of the Provincial Governments in India. In one of the large Indian States a medical woman was, some years ago, appointed Principal Medical Officer, to inspect and administer all medical institutions in the State. She was not relieved of her other duties and the work proved too much, so the Department is now admi- nistered by a Committee of three, of whichshe is one. Quite recent- ly a medical woman has been appointed a member of the Colonial Advisory Medical and Sanitary Committee of the British Colonial Office in London. In the Dutch Indies a woman has been appoin- ted Vice Director of the Pasteur Institute.
With these exceptions, no women are reported as holding posts which would give then opportunity for organising work among women and children and remedying abuses which are sometimes
apparent. DASA ; It will be well here to epitomise the replies given to the last question — « Has the presence of medical women facilitated the
creation of new services well received by the population (hospitals for women and children, maternity hospitals, dispensaries and consultations for women and children) ¢ Do you consider that the activity of medical women has improved the hygiene of the woman and child ¢ Can you furnish proof of this by statistics. or otherwise $ »
The answer to the first of these questions is nearly always a simple affirmative, One or two reply more fully — « Yes, the expan- sion of these services has been almost entirely due to the presence of medical women in India » (10).
«I consider that the presence of women medicals in this coun- try has undoubtedly saved the lives of numbers of women and chil- dren and by all thinking Persians this is generally acknowledged and appreciated » (13).
The answer to the second question, when given, was usually in the affirmative, but with a rider that no statistics were available. There is only one dissentient who thinks that medical women in India have had so much work in hospital that hygiene is considered a side issue. Also, that they have no assistance in the school or the home. When teaching in hygiene is given in the schools, the pupils going home find the conditions so bad, the majority do not attempt to be hygienic (5).
In contrast to this — « The improvement in hygiene is at self-evident fact. Adequate proof is not easy to supply, but infant mortality decreases where there are proper Child Welfare schemes, e.g., in Madras, the infant mortality rate for the whole city was 256.6, while that of children under the care of the Child Welfare scheme was 171.6 in 1929 » (10).
From the Dutch Indies — « I am convinced that the activity of medical women has improved the hygiene of the native woman and her child, also when they give teaching to native girls. I cannot furnish proof of this by statistics, but..... I could tell you a great deal about my experiences in this matter » (12).
From Canada — « Statistics $ How could one ¢ Still it is true, They (medical women) go more into detail of cause and effect. care more for the individual child. As school inspectors and cli- nic heads they put everything possible into salvaging the child brought to their notice » (15).
From Africa, where much of the medical work has started recently, one reply says « Too soon to judge yet » (21). Another says « After 5 years, the result of the work has been that personal hygiene is taught in all elementary schools. Teachers attend classes. on hygiene and all school children must pass an examination in hygiene. The general superficial hygiene of the children has im- proved, e.g. there is less chigger flea infection — more cleanliness. of the body — an active interest in exterminating mosquitoes. Apart from this, the diseases from which the children suffer re- main unaltered as they were not treated until 1930 » (23 b).
From Nyassaland — « The women who work there, find that their work increases very quickly and more and more women are coming to be treated, especially in V.D. and maternity. There is every evidence too, that these poor women are beginning to apply the knowledge that is taught them and we look forward to a much reduced maternity and infant mortality deathrate. (23)
We now come to the question — how is the need for medical women being met ¢
In Canada and New Zealand the conditions are practically
R S
those of Europe. Education is universal, the population are mostly Christian in religion and medical women engage in private prac- tice, while a few hold Government appointments and are treated on similar terms with men.
In all the other countries, except Greenland, medical women are working in connection with Christian missions. There are 229 such women with degrees or diplomas of the British Empire, of whom 155 are working in India, and there are others, though fewer in number, holding degrees and diplomas of other nations. Those who have replied to the questionnaire say, the conditions of their work are satisfactory, in so far as they are treated equally favourably as their male colleagues and have freedom to organise and develope their own work, so far as funds permit, They speak of the great interest of the work and of the urgent necessity for more workers if the needs of the women and children are to be met at all adequately. In India they are usually in charge of, or attached to, separate women’s hospitals with a staff of women nurses. In China, Persia and Africa the hospitals are usually mixed and the medical woman is in charge of the women’s wards.
With reference to Government service, in West and East Africa and Malay, medical women are employed on the same terms as men, at least at the beginning of their service. In West Africa 16 women are employed, mostly on Maternity and Child Welfare work, in East Africa 5 and in Malay 19, some being enga- ged in Maternity and Child Welfare and some in taking charge of the women’s wards in general hospitals. After a few years service promotion is made by selection, not by seniority, and up to the present, only men, and not women, have been so selected. The tendency, so far, is for the women to be left in the lower grades where the work is less responsible — major surgery, for instance, is done by the senior surgeon and the large general hospitals will
be under male superintendants. It must be remembered, however,.
that it is only of recent years that women have been admitted to these Colonial Services and that few have served long enough for promotion to the senior grades. (21) (21 b) (23 b).
In India, women are not admitted to the Government ser- vice (Indian Medical Service), but a grant of Rs 3.700.000 is paid annually by the Government of India to the Countess of Duffe- rin’s Fund for the carrying on of a Women’s Medical Service. This consists of 47 medical women and is administered by a medi cal woman Chief Medical Oficer, selected at intervals from the ranks of the service. The members of the service are appointed to the charge of separate women’s hospitals in different parts of India and also staff a medical college for Women students and part of a medical school for women sub-assistant surgeons. The pay is less than that of the men’s service, especially in the senior grades, There is no pension, but.a Provident Fund. The-higher posts are
M
all filled from the ranks of the service and there is plenty of oppor- tunity for obstetric and surgical work. During 1930, 1410 abdo- minal operations were performed by the medical women of this service (2) (3) (5) (8) (34).
In addition to those in the Women’s Medical Service, a few medical women are employed by Provincial Governments, usually to take subcharge of the women’s wards in general hospitals. These are often of the grade of sub-assistant surgeon (3). In Madras it is stated that the rates of pay and provision for pension are the same as for the men, but the senior posts, which carry the higher pay, are very seldom accorded to women (5).
In the Dutch Indies, women are appointed to the Govern- ment medical service on the same terms as men. They take charge of the women’s wards in the general hospitals or of Schools for training midwives. They are not as a rule appointed to the higher posts, but there is no fundamental restriction (12).
In Greenland, a medical service is provided by the Danish Government and women are admitted to this on the same terms as men. Since 1908, 5 medical women have been employed at one time or another. The work is partly done in hospitals for men and women and partly by travelling round the coast by boat, carrying medicines. Midwives are also trained (24).
In Persia, there are no women in Government medical service, nor are any Persian women yet available for medical education.
In China, some medical women are employed by Government on the same terms as men, especially for the training of midwives (33).
In Egypt, a few medical women are employed by Government, chiefly in school inspection (42).
In Palestine, there are, so far, no medical women in Govern- ment employment.
A fair number of Indian, Chinese and Japanese women study and practise medicine. In the Dutch Indies the first indi- genous medical woman passed out of the Batavia College a few years ago. Some have passed from the Singapore Medical College. One or two Egyptian medical women have qualified in England — since the last two years women have been admitted to the Medi- cal School in connection with Cairo University and now 5 or 6 are studying there (42).
Co-education is the rule in Canada, New Zealand, the Dutch Indies and Malaya.
In China and India there is co-education in some parts and separate women’s schools and colleges in other parts.
In Japan there äré separate medical schools for women (25).
In Palestine there is an American Medical College at Beyrout. Women have only recently been admitted and none have, so far, passed out (27).
aes Ysa
The following are the dates given when the first medical woman began to work in the different countries.
India....... 1869 first Indian medical woman 1886
China kass. 1876 — Chinese — — 1913 (Peking) New Zealand 1896 sn Persia tera os 1897
Dutch Indies 1908 Greenland .. 1908 Tanganyika . 1913 Nyassaland . 1923 Nigeria..... 1925 rinidad ATOS Eoy ieena 1921 about The Soudan. 1926
In the older countries, such as India and China, a fair number of medical women are in private practice, but almost entirely in the larger towns. As a general rule the people are too poor and not sufficiently enlightened to make private practice possible in the villages. This touches on an important question, the crying need for medical women in village areas, but one which is too large to embark on here.
The information shews that in all these exotic countries efforts have been made to provide medical aid by women and that mis- sions, especially, hdve done inculculable service ; but in all these countries there are still immense tracts without medieal women and many millions who have no opportunity of consulting their own sex, even if any medical assistance is available for them.
Full opportunity is given in the older countries such as India and China also in Malaya, Japan and the Dutch Indies for the medical education of women. At the Peking Union College, a
years intern appointment is given to each student before gradua- `
tion, (33) and in the Singapore Medical College each has a house post after graduation (29). One of the writers from India speaks of the lack of hospital appointments for young medical women (7).
` The countries where education is more backward confine themselves to the training of midwives, nurses and health visitors.
\
PART II )
Suggestions as to how the work and usefulness of medical women can be improved have been made by many writers and are epito- mised as follows :
(the figures refer to the names of the writers in the appendix)
(x) India The provision of laboratory technicians.
HU Coe
(2) India
The education of the people.
Organised welfare in villages.
Multiplication of training schools for health workers and maternity nurses.
Introduction of rational courses of hygiene into school curri- cula.
Abolition (gradual, perhaps) of the lower qualification of sub-assistant surgeon.
Persistent, organised efforts to get registration of midwives and doctors.
Improvement in the standard of education of nurses and midwives.
(3) India
To employ the personnel of the Women’s Medical Service in a few hospitals, completely organised with specialist depart- ments, instead of in the 21 present incompletely staffed and equipped establishments, `
(6) India
Staffing all women and children’s hospitals with qualified medical women ; opening more antenatal clinics and infant wel- fare centres in the country ; the representing in the Public Health Department of more women doctors; the improvement of the existing system of school medical inspection; the appointment of women doctors in the executive department of the medical service, who will be responsible for the service conditions of women doctors employed. Medical women are needed in factories, police staff, jail and mental hospitals.
. (7) The Women’s Medical Service should encourage higher studies and give importance to higher examinations of the Local Universities, as criteria for promotion to the senior service. In the absence of any other highly organised services, the tendency is more and more for women to settle into general practice in a large town. Bombay, for instance, is overctowded with general practitioners. The services of some of these could be very well utilised by having centres for medico social work in large villages,