The Real Life Downton Abbey (28 page)

In the nineteenth century the ‘deserving poor’ received free medical and surgical treatment in charitable or voluntary hospitals by means of a system where they had to produce a letter of admission written by a wealthy benefactor or employer. The very poor or old could obtain free care through Poor Law hospitals (usually infirmaries attached to workhouses), though these were transferred to the care of local authorities in 1926. Over time, the voluntary hospitals start to offer good treatment and medical facilities. So if a poor person needs an operation, they can receive top-quality free treatment in a big city teaching hospital. By the early twentieth century, these hospital facilities become sought after by everyone. Upper- and middle-class people can receive their paid-for treatment in private wards if they wish. Or they pay for treatment in a private hospital or nursing home. The fees are strictly for the rich: four guineas (£4, 4s) for a week in a private hospital in 1902.

People who can’t afford private care but are not poor enough to qualify for charity must either use some form of insurance or pay a direct contribution towards the cost of hospital care. Frequently, workers pay into a ‘Saturday fund’, schemes where in return for a small weekly contribution people are given access to hospital, should they need it. And similar schemes operate all over the country for access to a GP, usually run by Friendly Societies or sick clubs. These schemes are very popular with working men, but working women and their families are often excluded from the schemes, so they cannot benefit from them.

GPs perform a wide range of services. In rural areas, they might practise surgery or deliver babies, as well as treating patients for minor complaints and prescribing medicines for a range of illnesses. Their fees vary considerably because they tend to charge according to the patient’s financial situation. Some GPs charge from 2s 6d up to 10s 6d for a visit in 1917. For midwifery they charge from 1 guinea (£1, 1s) to five guineas (£5, 5s) for delivering a baby. But some early twentieth-century GPs build up practices by lowering their fees for working people to as little as one shilling or even sixpence per consultation.

Sir William Arbuthnot-Lane is a Scottish surgeon, regarded as the best abdominal surgeon in the country. He operates on Edwardian royalty, politicians and many society figures. He also sets up the first plastic and reconstructive surgery unit to cope with war injuries following World War I. Ahead of his time by many decades, after World War I he creates The New Health Society, to promote exercise and eating fruit, vegetables and bran to help bowel problems.

Both he and Joseph Bell, Scottish personal surgeon to Queen Victoria, are early pioneers in forensic pathology, emphasising the importance of making a close, detailed observation of a patient before making a diagnosis. To illustrate this, Bell takes a total stranger and, by observation, works out the person’s job and their recent activities. Thanks to the skills of these two men, Arthur Conan Doyle, who has previously served as a clerk at the Royal Edinburgh Infirmary, goes on to pen the acclaimed detective story of Sherlock Holmes – whom he admits is partly based on the observant work of these two eminent doctors.

One of the more popular dieting fads of 1910 is ‘Fletcherism’ a somewhat eccentric view of nutrition propagated by Horace Fletcher, a wealthy American who claims that all bodily weakness is a result of the way people eat their food.

Fletcher believes that food should be kept in the mouth and chewed until all the flavour has been taken out; this means chewing endlessly until the food is liquefied – and if it can’t be reduced to liquid, it must be spat out. He also believes that the proof of this is greatly reduced bowel movements, claiming that he only goes to the toilet once a week or even once a fortnight. ‘Munching parties’ are held where the guests must spend five minutes chewing each small piece of food – and stopwatches are used to ensure the right amount of chewing. Even
The Lancet
, the esteemed British medical journal, endorses his principles. And for some, following Fletcherism does result in weight loss.

Here are some of his diet guidelines:

• eat no breakfast at all
  
• eat what you want, when you want it – provided you chew it properly
  
• keep a bowl of sugar lumps or candy on the dining table
  
• wine must be swilled around the mouth
  
• foods which dissolve quickly are of the greatest value
  

In the early part of the twentieth century respiratory diseases are a major cause of death for both sexes, especially from illnesses like TB (often known as consumption).

Unscrupulous ‘quacks’ (an unqualified or fake doctor) sometimes advertise miracle cures for consumption to gullible newspaper readers. An American graduate from Michigan, Derk P Yonkerman, claims he has a treatment for TB by introducing copper into the blood in order to kill the bacilli; after selling the product, called Tuberculozyne, in the US, he launches it in the UK in 1903. The product costs £2,10s for a month’s treatment and consists of two bottles of liquid: after each meal, the patient is advised to put thirty drops of each into a glass of milk, stir well and drink straight away. The British Medical Association analyses the liquids which are found to contain glycerine, potassium bromide, oil of cassis, tincture of capsicum, cochineal (to give a bright red colouring), oil of almond, sugar, water and a tiny amount of copper. Total cost of ingredients: two-and-a-half pence.

‘Now, instead of the American public being fleeced by the English medical fakers, the American quack is finding the English public “good pickings”,’ says the American Medical Association publication,
Nostrums & Quackery.
Unfortunately, the US food and drug laws around advertising claims are more stringent than those in Britain at the time – so quacks like Derk Yonkerman can use these wildly exaggerated claims in his UK advertising – and fleece many unsuspecting sick people in search of a miracle cure.

In 1902, The Dowager Countess of Scarborough founds The Sandbeck Nursing Association, a Benefit Club scheme for all those living in the community, where local working people contribute a nominal sum, according to their income, in order to access the services of a qualified nurse in their home. The cost is two shillings a year – half a penny a week – plus a one-off fee of two shillings and sixpence. ‘The occurrence of illness in a family of the poorer classes usually finds the members of it destitute of the commonest sick appliances, ignorant of the simplest means of nursing and unconscious of preventable sanitary evils surrounding the patient,’ says
The Tickhill Parish Magazine
, Doncaster. And thanks, in part, to the efforts of the lady of the manor, money collected at fund-raising events helps to fund Doncaster Royal Infirmary & Dispensary – so local people can access its in- and outpatient facilities.

Condoms made of animal gut have been in use since the nineteenth century and can be purchased by the wealthy. But they only start to be used by ordinary people during World War I when they are handed out to soldiers to lessen the effects of venereal disease. Early versions of diaphragms or Dutch caps (a protective device that a woman inserts into her vagina) are also available. But they are costly, ten shillings for a cap, unaffordable for ordinary working people. And given the strong moral attitudes against illegitimacy and unmarried sex, many still believe that such things are merely a licence for promiscuity. Although the term ‘birth control’ is coined by US contraception campaigner Margaret Sanger in 1914, contraception only starts to become more openly discussed in the twenties, following the opening of UK birth control campaigner Mary Stopes’s family planning clinic in London in 1921.

Sexually transmitted diseases like syphilis and gonorrhea are rife at this time, as they have been for centuries. There are no known cures for what is called ‘the French pox’, closely associated with prostitutes and immoral sexuality. In Victorian times, some men believed that intercourse with a virgin child would actually cure venereal disease. Syphilis is sometimes treated with mercury, which is not always successful, yet there is no workable treatment for either gonorrhea or syphilis until the development of antibiotics many years later. A Royal Commission is set up in 1913 to enquire into the prevalence of venereal diseases; it advises more educational work and propaganda to help reduce the incidences of these illnesses. So when war breaks out in 1914, the distribution of contraceptives to soldiers becomes a priority to attempt to halt the spread of these diseases.

Many famous people are known to have contracted these sexually transmitted illnesses, including Henry VIII. And some historians claim that Winston Churchill’s father, Lord Randolph Churchill, contracted syphilis as a young man in the red light district of Paris, one reason cited for the long ‘together but apart’ marriage with his wife, Jennie. Isabella Beeton, writing her famous
Book of Household Management
at the age of twenty one, is reputed to have contracted syphilis from her publisher husband, Sam, on their honeymoon; she dies, aged twenty eight, following the birth of their fourth child; there is some debate as to whether this was in fact the cause of her demise.

In 1911 there were 100 people aged 100 or over in UK; today there are 12,000 UK centenarians.

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