The Real Life Downton Abbey (27 page)

Yet by the close of the first decade of the twentieth century, there are significant advances. There’s a much wider understanding of the importance of hygiene. Some progress has been made in treating infectious illnesses like diphtheria. X-ray machines are introduced – radiotherapy treatment for cancer is first used in 1900; and the improvements in surgical procedures since anaesthetics were introduced in 1846 are enhanced by the pioneering work of Glasgow surgeon, Joseph Lister (later Lord Lister), who discovers the use of antiseptics in surgery to prevent sepsis or poisoning of wounds, making operations safer. (Listerine mouthwash is named after him.)

After the introduction of free school meals in 1906, the following year the educational authorities start to undertake the medical inspection of all children at school. This system starts off slowly. But as it goes on, it proves to be a huge leap forward as a preventative health measure. Now doctors can check and control childhood ailments and physical defects. Higher nursing standards too, as promoted by the remarkable efforts of Florence Nightingale, start to take effect.

There are also new remedies and medicines available to buy over-the-counter from the chemist or apothecary. Aspirin, for instance, first goes on sale in 1905. Yet in rural areas, working people still tend to stick to the old remedies and potions, using spices, ointments and herbs: country doctors tend not to be up to speed on the newest developments. And the medicines on sale from the chemist are for the rich and well heeled. The majority of ordinary people can’t afford them. Nor can they afford to visit a GP if they’re sick. And so what actually takes place when illness or sickness strikes in the country house is a clear reminder of the vast unbreachable divide between those above and below stairs.

In most aspects of medical care, the rich use their money to enjoy better quality medical services than the poor. The sole exception to this, until the early twentieth century, is hospital care. Mostly, the poor rely on charity – or traditional remedies.

The toffs can afford the best medical help available. The presence of a leading specialist in any field can be requested should they wish. Their eminent, respected doctors mostly treat royalty and the elite. Local, respected country doctors are sometimes called upon, but the toffs have the luxury of going after the ‘second opinion’. Or third. Which is not always such a good idea if the doctors disagree.

Having a retinue of servants around to help in a sickroom means hospital is not always required, even if surgery is involved, since the wealthy family can, if they wish, have a surgical procedure performed at home. But most
country-house
mistresses will travel to a private nursing facility in London to give birth: country doctors are not always trusted when it comes to something as important as childbirth.

When children fall ill, too, there are always nursery staff in place to look after them. The country-house childhood of Viola Bankes and her siblings, the upper-crust family living at the vast Kingston Lacy estate in Dorset (as mentioned in Chapter 6) is a perfect example of this:

‘When Daphne, Ralph and I were young, the nursery and school room suite often became a children’s hospital. There was always a trained nurse in residence for Ralph [her young brother]. Irish nurse Collins followed Nurse Startin, then Jewish Nurse Levy was rushed from London when we had chicken pox, the local doctor from Wimborne lamenting that it was a ‘great responsibility’ looking after us. Chicken pox gave way to measles, then scarlet fever, then diphtheria and whooping cough. Ralph even managed to acquire conjunctivitis after being sneezed over by an elephant in the zoo.’

She goes on to describe the medicines on offer: ‘In the nursery, the principal remedy was called ‘Blue Magnesia’ [magnesium oxide, used with water to relieve indigestion, heartburn and constipation] because it was kept in a bottle wrapped round with blue paper to keep out the light. It was a clear liquid of no taste or use but perhaps it occasionally healed by suggestion.

‘The detested castor oil was found in every nursery cupboard then. For bruises, we had a sweet smelling ointment in a small shapely jar called ‘Pomade Divine’, shortened to ‘
ma-divine
’ by us. When styes, boils and abscesses lodged with us, probably because we were over-fed, we would wander down to the kitchen where little Jinky [a kitchen maid] would whisk up a frothy, yellow liquid made from Brewer’s yeast.’

When little Ralph slides down the banister of the big staircase in the Kingston Lacy house, right onto the stone floor and breaking his arm in three places, amputation is initially advised by a doctor.

‘But Mama withheld her permission. Luckily, she knew a brilliant surgeon, William Arbuthnot Lane, who later became a baronet when he operated successfully on a princess of the Royal House. Sir Arbuthnot […] was a gentle, amiable, quietly spoken man with fearless, steel grey eyes. He performed operations on fractures which other doctors treated cautiously, though often very inadequately, without surgery. He was one of the first surgeons to insist on the use of sterile caps, masks and gowns and pioneered a ‘no touch’ technique, using
long-handled
instruments.’

Following the operation, Ralph’s arm heals. He subsequently learns to play the violin, becomes a good horseman and can shoot well, too.

Sir Arbuthnot’s methods of close observation of the patient, and similar work by Dr Joseph Bell in Edinburgh, help inspire the creation of the famous fictional detective, Sherlock Holmes. And Sir Arbuthnot is called in again by Henrietta Bankes to successfully remove Viola’s appendix when she is thirteen.

‘I soon recovered and there were magnificent compensations at the time. In the London nursing home, I acquired a taste for Ovaltine [a hot chocolate malt drink, first launched in 1909], which I had never come across before and my appetite was coaxed back into life by the most delicious fish soufflés.’

Viola’s recollections make it clear that a sick child in the upstairs part of the house is treated in comfort at home or in a private hospital or nursing home. The aristocratic children are unlikely to wind up in the local cottage hospital, the most common source of medical care in country areas. Initially, these small cottage hospitals are funded by patient contributions and donations. As they grow in popularity, they are mostly supported by local fund-raising events run by the rich landowners and aristocrats. They’re not as good as the big teaching hospitals in the cities. And then, as now, quality of care sometimes depends on location. But some do have operating theatres where GPs or consultants can carry out operations.

So what happens when one of the below stairs staff falls sick? Traditionally, the aristocratic families take responsibility for their servants’ healthcare, especially those growing old after a lifetime of service. Old servants who can’t work any more are frequently well treated as faithful retainers: in some instances, they get a cottage or almshouse on the estate to live out their last years. Employers are not paying pensions because it is considered that country-house servants are well paid and could save.

Nonetheless, because the landed gentry and aristocrats then become actively involved in helping fund local hospitals, there is initially a system in place where free medical care is provided for rural local people via tickets handed out to the poorest families in the area. Sometimes servants benefit from this ticket system of free local medical care. Their relatives or families too might access some form of healthcare support, if there are working people in the family, by using subsidised Benefit Clubs, available to everyone in the local community.

The first port of call for any servant feeling unwell or sick is the housekeeper. Part of her remit is to keep a well-stocked medicine cabinet to dish out a variety of ointments and remedies for certain complaints and ailments. She may not have all of the following items in her cupboard, but these are some of the remedies and chemical concoctions people use at this time. Many can be purchased over-the-counter at the chemist’s shop without any kind of prescription:

• Smelling salts (if someone feels faint)
  
• Castor oil (to help digestion and avoid constipation)
  
• Camphorated oil (to ease coughs and chest complaints)
  
• Eucalyptus oil (sometimes taken on sugar cubes to swallow, to help ease coughs and kill bacteria in sickrooms)
  
• An inhaler like Wright’s Coal Tar Vaporizer (for blocked noses or coughs)
  
• Poultices made from mustard and hot water spread on a flannel (for sore throats)
  
• Sloan’s Liniment (for rubbing onto sore muscles)
  
• Peppermint oil with hot water (for indigestion)
  
• Arrowroot powder (a herbal remedy to treat stings and alleviate nausea; also useful for food poisoning)
  
• Fuller’s Earth ointment (for cuts or burns)
  
• Gregory’s Powder (a vile tasting mixture of rhubarb, ginger and magnesia, used as a laxative)
  
• Calomel (a dangerously toxic compound of mercury and chloride, used as a laxative and diuretic)
  

Branded cough medicines are popular, too. Hallston’s Cough Medicine is one such medicine – but the problem with medicines like these is that they sometimes contain large quantities of ether or opium and are quite addictive. Housemaids are known to become so keen on them, they secrete a bottle under their mattress: they aid sleep but also produce a not unpleasant woozy, trance-like state. So the housekeeper usually keeps such cough medicines in a separate place – the poisons cupboard is really the best place for them. Another popular medication, which the toffs usually source on their travels to France, is a small, pretty tin of tablets called Cachets Faivre, pain relief medications containing quinine and caffeine, to be taken for bad headaches or migraines.

Like the cough mixtures, some of the chemical compounds are known today to be toxic and quite dangerous to use. In the seventeenth and eighteenth centuries, country-house staff frequently concocted a wide range of herbal potions and remedies, in the times when branded medicines were not widely available and the entire estate was very much a
self-sufficient
enterprise. And so the older, traditional remedies continue to be quite effective.

But what’s the next step if the housekeeper’s medicine cabinet can’t help or the illness is quite serious? This is very much down to the household, the relationship between the housekeeper and the staff – and the attitude of the family towards their servants’ health. Paying for a doctor to tend a sick servant is, for some wealthy families, a step they don’t want to take. Ever. Tragically, Viola Bankes’s story confirms this:

‘The servants received very different treatment when they were ill. Usually, their sufferings passed unnoticed, they themselves being too modest and too loyal to our mother to mention them. Just as our nursery maid, Alice, had died of neglected appendicitis, so Beatrice Christopher, a third housemaid, was, much too late, discovered to have tuberculosis.’

And therein lies the problem. Even if they are sick and in need of a doctor, the hierarchical system of the house means that some servants are unlikely to make a fuss beyond talking to the housekeeper about their ailments. Sometimes they suffer in complete silence, perhaps out of a misplaced loyalty, perhaps out of fear of being unable to work. Despite the advances in medicine, sickness and early death are still very much part of the Edwardian world: for every l,000 babies born, l50 don’t make it to the age of five.

So while the mistress of the house, accompanied by her older daughters, continues to fund-raise and make her regular visits around the estate, delivering soup, handing out unwanted clothing, dispensing to the needy, if a tenant pipes up and mentions their concerns about any kind of illness, they get sympathy, soup or kindly concern. But not necessarily a doctor. In the fictional
Downton Abbey
household of kindly Lord Grantham (Hugh Bonneville), the cook, Mrs Patmore (Lesley Nicol), needs a visit to an eye specialist – which is subsidised by her generous employer. It’s a moving scenario. But in reality, it’s not always the case.

While the country’s overall standard of living improves in the early years of the twentieth century, this does not apply to a huge chunk of the working population.

First of all, house rents have gone up, thanks to rate increases, to pay for the draining and lighting improvements in the cities. As a result, the working poor fork out a large percentage of their earnings in rent, leaving them with little to spend on food, clothing and basic necessities. And they often live in horrendously overcrowded conditions, leading to the spread of illnesses like tuberculosis.

Two important social surveys of the times reveal the shocking truth:

Charles Booth, a wealthy ship owner, investigates living conditions in London in the years 1889–1907 in a series of volumes entitled
Life and Labour of the People of London
. What emerges is that almost one person in three in the capital lives in continuous poverty. And about one tenth of London’s population is driven to crime to survive, many constantly living on the edge of starvation.

This follows Seebohm Rowntree’s house-to-house survey of the city of York, a relatively prosperous railway town. In 1901, Rowntree’s work entitled
Poverty: A Study of Town Life
, reveals that 28 per cent of the people of York earn less than the minimum amount needed to meet the basic needs of a household.

In other parts of the country, poverty is even more shocking. In 1914, around a third of everyone living in Newcastle-upon-Tyne and Sunderland lives more than two to one room, and in Scotland, nearly half the population live in houses with only one or two rooms. In mining villages in Glamorgan, Durham and Staffordshire the unpaved streets are caked with filth – and these are villages almost entirely without drains.