The nature of the work of pharmacists and student nurses in
hospitals and the importance to the public that it should not be
performed by those overfatigued, make it a proper subject for
legislative control as to hours of labor of women so employed.
Whether there is necessity for limiting the hours of labor of
women pharmacists and nurses in hospitals is a matter for
legislative, and not judicial, control, and the legislature is not
prevented by the due process clause of the Fourteenth Amendment
from limiting such labor to eight hours a day or a maximum of
forty-eight hours a week. Such a restriction is not so palpably
arbitrary as to be an unconstitutional invasion of the liberty of
contract.
Miller v. Wilson, ante, p.
236 U. S. 373,
followed in regard to the right of the legislature to limit the
hours of labor of women other than pharmacists and student nurses
employed in hospitals in California.
An exception of graduate nurses from the operation of a statute
limiting the hours of labor of women is not so arbitrary, either as
to female pharmacists or student nurses in hospitals, as to make
the statute unconstitutional as denying equal protection of the
law. The distinction in their employment is one of which the
legislature may take notice.
Enforcement of a state police statute will not be enjoined on
the ground that it violates the equal protection provision of the
Fourteenth Amendment where the bill fails to show, as to the
persons attacking the statute, any such injury, actual or
threatened, as warrants resort to a court of equity.
The California Statute of 1911, as amended in 1913, limiting the
hours of labor of women in certain employments, including those in
hospitals, to eight hours in any one day or a maximum of
forty-eight hours a week is not unconstitutional under the
Fourteenth Amendment either as unduly abridging the liberty of
contract or as denying equal protection of the law because graduate
nurses were excepted therefrom.
Page 236 U. S. 386
The facts, which involve the constitutionality under the
Fourteenth Amendment of the California Women's Eight Hour Labor
Law, are stated in the opinion.
Page 236 U. S. 388
MR. JUSTICE HUGHES delivered the opinion of the Court.
This is a suit to restrain the enforcement of the statute of
California prohibiting the employment of women for more than eight
hours in any one day, or more than forty-eight
Page 236 U. S. 389
hours in any one week. The act is the same as that which was
under consideration in
Miller v. Wilson, 236 U.
S. 373, as amended in 1913. By the amendment, the
statute was extended to public lodging houses, apartment houses,
hospitals, and places of amusement. The proviso was also amended so
as to make the statute inapplicable to "graduate nurses in
hospitals." Stat. (Cal.) 1913, p. 713.
The complainants are the trustees of "The Samuel Merritt
Hospital" in Alameda, California, and one of their employees, Ethel
E. Nelson. Their bill set forth that there were employed in this
hospital approximately eighty women and eighteen men; that, of
these women, ten were what are known as "graduate nurses" -- that
is to say, those who had
"pursued and completed at some training school for nurses in a
hospital, courses of study and training in the profession or
occupation of nursing and attending the sick and injured,"
and had received diplomas or certificates of graduation. By
reason of their qualifications, they were paid "a compensation
greatly in excess of that paid to female pupils engaged in nursing
in hospitals while students of the training school."
It was further averred that, in addition to these ten graduate
nurses, certain other women were employed in the hospital, one as
bookkeeper, two as office assistants, one as seamstress, one as
matron or housekeeper, five who were engaged in ordinary household
duties, and one -- the complainant Ethel E. Nelson -- as
pharmacist. It was stated that this complainant was a graduate
pharmacist, licensed by the state board; that she also acted as
storekeeper, but that her chief duty was to mix and compound drugs
for use in the treatment of the hospital patients. The general
allegation was made that these last-mentioned eleven employees
performed work that was in no manner different from that done by
"persons engaged in similar employments or occupations and not
Page 236 U. S. 390
employed in hospitals." The apprehended injury to the
complainant Nelson by reason of the interference of the statute
with her freedom to contract was specially alleged.
It was also set forth that the hospital maintained a school with
a three years' course of study wherein women were trained to nurse
the sick and injured; that in this school there were enrolled
twenty-four in the third-year class, eighteen in the second-year
class, and twenty-three in the first-year class; that a part of the
"education and training" of these "student nurses" consisted in
"aiding, nursing, and attending to the wants of the sick and
injured persons" in the hospital, this work being done while the
student was pursuing the prescribed course of study; that the
student nurses were paid $10 a month during each of the first two
years of their course and $12.50 a month in the third year, and
were also provided throughout the three years "with free board,
lodging, and laundry." It was averred that the cost to the hospital
of maintaining the school was $2,500 a month, and that the cost of
procuring the work to be performed by graduate nurses that was
being done by the student nurses would be not less than $3,600 a
month. It was set forth as a reason why the work of the student
nurses was done at less expense, that their compensation was paid
not only in money, board, etc., but also partially in their
education and training, their attendance on patients being, in
itself, an indispensable part of their course of preparation. It
was said further that their hours of labor must be determined by
the exigencies of the cases they were attending.
The enforcement of the act with respect to these student nurses,
it was stated, would require the hospital either to cease the
operation of the school or largely to increase the number in
attendance in order that an equal return in service could be
obtained, and such increase would involve a greatly enlarged
expense.
The complainants attacked the act on the grounds
Page 236 U. S. 391
that it interfered with their liberty of contract, and denied to
them the equal protection of the laws, contrary to the Fourteenth
Amendment. And in support it was asserted in substance that labor
in hospitals did not afford, in itself, a basis for classification;
that there was no difference between such labor and the "same kind
of labor" performed elsewhere; that a hospital is not an
unhealthful or unsanitary place; and, generally, that the statute
and its distinctions were arbitrary.
Upon the bill, an application was made for an injunction pending
the suit. It was heard by three judges and was denied. The appeal
in No. 362 is from the order thereupon entered.
The defendants, the officers charged with the enforcement of the
law, filed an answer. On final hearing, the complainants made an
offer to prove that
"all the allegations of fact set forth in the bill were true;
that the fact that a woman was a graduate nurse merely showed that
she had completed a course of study for the treatment of the sick,
but that the course of study which a woman must take for that
purpose was not prescribed by law or fixed by custom, but was such
as any hospital or training school might, in the discretion of its
governing officers, see fit to prescribe; that the difference
between a graduate nurse and an experienced nurse is a difference
of technical education only, and that there is no standard by which
this difference can be measured; that graduate nurses working in
and employed by hospitals do not ordinarily perform therein the
work of nursing the sick, but act as overseers to assistants to the
medical staff."
The district judge thereupon stated that, upon the hearing of
the motion for an interlocutory injunction, it had been held that
the complaint did not state a cause of action, and that it was
considered unnecessary to take the evidence. The offer of proof was
rejected, and the bill of complaint dismissed. No. 363 is an appeal
from the final decree.
Page 236 U. S. 392
1.
As to liberty of contract. The gravamen of the bill
is with respect to the complainant Nelson, a graduate pharmacist,
and the student nurses. As to the former, it appears that a statute
of California limits the hours of labor of pharmacists to ten hours
a day and sixty hours a week. Stat. (Cal.) 1905, p. 28. In view of
the nature of their work, and the extreme importance to the public
that it should not be performed by those who are suffering from
overfatigue, there can be no doubt as to the legislative power
reasonably to limit the hours of labor in that occupation. This the
appellants expressly concede. But, this being admitted to be
obviously within the authority of the legislature, there is no
ground for asserting that the right to contractual freedom
precludes the legislature from prohibiting women pharmacists from
working for more than eight hours a day in hospitals. The mere
question whether, in such case a practical exigency exists -- that
is, whether such a requirement is expedient -- must be regarded as
a matter for legislative, not judicial, consideration.
The appellants, in argument, suggest a doubt whether the statute
is applicable to the student nurses, but the bill clearly raises
the question of its validity as thus applied, and urges the serious
injury which its enforcement would entail upon the hospital.
Assuming that these nurses are included, the case presented would
seem to be decisive in favor of the law. For it appears that these
persons, upon whom rests the burden of immediate attendance upon,
and nursing of, the patients in the hospital, are also pupils
engaged in a course of study, and the propriety of legislative
protection of women undergoing such a discipline is not open to
question. Considerations which, it may be assumed, moved the
legislature to action have been the subject of general discussion,
as is shown by the bulletin issued by the United States Bureau of
Education on the "Educational Status of Nursing" (Bulletin,
Page 236 U. S. 393
1912, No. 7). With respect to the "hours of duty" for student
nurses, it is there said (pp. 29-32):
"These long hours have always formed a persistent and at times
an apparently immovable obstacle in efforts to improve the
education of nurses and to establish a rational adjustment of
practice to theory. . . . Ten or more hours a day in addition to
class work and study might be endured for a period of two years
without obvious or immediate injury to health. The same hours
carried on for three years would prove a serious strain upon the
student's physical resources, inflicting perhaps irreparable
injury. The conclusions reached in this first study of working
hours of students (1896) were that they were universally excessive,
that their requirement reacted injuriously not only upon the
students, but eventually upon the patients and the hospital, that
it was a short-sighted and unjustifiable economy in hospital
administration which permitted it to exist. Fifteen years later,
statistics show that though the course of training has now in the
great majority of schools been lengthened to three years, shorter
hours of work have not generally accompanied this change, and that
progress in that direction has been slow and unsatisfactory."
After quoting statistics, the bulletin continues:
"In speaking of hours, it must be remembered that these
statistics refer only to practical work in ward, clinic, operating
room, or other hospital department, and not to any portion of
theoretical work; that the ten hours in question are required of
the student irrespective of lectures, class, or study. This
practical work, also, is in many of its aspects unusually exacting
and fatiguing; much of it is done while standing, bending, or
lifting; much of it is done under pressure of time and nervous
tension, and to a considerable degree the physical effort which the
student must make is accompanied by mental anxiety and definite,
often grave, responsibility. Viewed from any standpoint whatever,
real nursing is difficult,
Page 236 U. S. 394
exacting work, done under abnormal conditions, and all the
extraordinary, subtile, intangible rewards and satisfactions which
are bound up in it for the worker cannot alter that fact. Ten
hours, or even nine hours, of work daily of this nature cannot
satisfactorily be combined with theoretical instruction to form a
workable educational scheme. . . . How largely the superintendents
of training schools feel the need of improvement in this direction
may be gathered from the fact that over two thirds of the replies
to the questions on this subject suggested shorter hours as
advisable or necessary, that a large proportion of these stated
their firm belief in an eight-hour day, and that almost every reply
which came showed clearly in one way or another the difficulties
under which the schools were laboring in trying to carry on the
hospital work with the existing number of students."
Whatever contest there may be as to any of the points of view
thus suggested, there is plainly no ground for saying that a
restriction of the hours of labor of student nurses is palpably
arbitrary.
As to certain other women (ten in number) employed in the
hospital, such as the matron, seamstress, bookkeeper, two office
assistants, and five persons engaged in so-called household work,
the bill contains merely this general description, without further
specifications, and from any point of view it is clear that, with
respect to the question of freedom of contract, no facts are
alleged which are sufficient to take the case out of the rulings in
Muller v. Oregon, 208 U. S. 412;
Riley v. Massachusetts, 232 U. S. 671;
Hawley v. Walker, 232 U.S. 718, and
Miller v.
Wilson, 236 U. S. 373.
2.
As to the equal protection of the laws. The argument
in this aspect of the case is especially addressed to the exception
of "graduate nurses." The contention is that they are placed
"on one side of the line, and doctors, surgeons, pharmacists,
experienced nurses and student nurses
Page 236 U. S. 395
and all other hospital employees on the other side of the
line."
So far as women doctors and surgeons are concerned, the question
is merely an abstract one, as no such question is presented by the
allegations of the bill with regard to the complainant hospital.
Southern Railway v. King, 217 U.
S. 524,
217 U. S. 534;
Standard Stock Food Co. v. Wright, 225 U.
S. 540,
225 U. S. 550.
With regard to other nurses, whether so-called "experienced" nurses
or student nurses, it sufficiently appears that the graduate nurse
is in a separate class. The allegations of the bill itself show
this to be the fact. It is averred that the graduate nurses are
those who
"have pursued and completed at some training school for nurses
in a hospital, courses of study and training in the profession or
occupation of nursing and attending the sick and injured, and have
received, in recognition thereof, diplomas or certificates of
graduation from said courses of study."
And, in the appellants' offer of proof, it is said that
"graduate nurses working in and employed by hospitals do not
ordinarily perform therein the work of nursing the sick, but act as
overseers to assistants to the medical staff."
It may be, as asserted, that the difference in qualifications
between a graduate nurse and an "experienced nurse" is a difference
of technical education only, but that difference exists, and is not
to be brushed aside. It is one of which the legislature could take
cognizance. Not only so, but as such nurses act as overseers of
wards or assistants to surgeons and physicians, it would be
manifestly proper for the legislature to recognize an exigency with
respect to their employment making it advisable to take them out of
the general prohibition. Again, with regard to the complainant
Nelson, who is a graduate pharmacist, while she has been graduated
from a course of training for her chosen vocation, it is a
different vocation. The work is not the same. There is no relation
to the supervision of the wards, and, putting mere matters of
expediency aside, there is no basis for concluding that
Page 236 U. S. 396
the legislature was without power to treat the difference as a
ground for classification.
As to the ten other women employees, the validity of the
distinction made in the case of graduate nurses is obvious. It
should further be said, aside from the propriety of classification
of women in hospitals with respect to the general conditions there
obtaining (
Louisville & Nashville R. Co. v. Melton,
218 U. S. 36,
218 U. S.
53-54), that the bill wholly fails to show as to the
employment of any of these persons any such injury -- actual or
threatened -- as would warrant resort to a court of equity to
enjoin the enforcement of the law.
And the objection based upon the failure of the legislature to
extend the prohibition of the statute to persons employed in other
establishments is not to be distinguished in principle from that
which was considered in
Miller v. Wilson, supra, and cases
there cited.
Decrees affirmed.