by Jacky Hyams
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.
THE SHOCKING TRUTH
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.
All this underlines the fact that country-house servants still feel, in many ways, that they are more fortunate than most. Yet one significant development between 1911 and 1912 places millions of working people at the heart of a rapidly growing new attitude to social problems. Back in the Victorian years, poverty and deprivation are accepted as part of life. Now, it is believed that the Government ought to step in to address the huge inequalities in society.
The Old Age Pensions Act for over-seventies on low incomes is introduced in 1908. And in 1911, the ruling Liberal Party politicians, and the then Chancellor of the Exchequer, David Lloyd George, want to go much further with a system of national health insurance. Germany and New Zealand have already pioneered such schemes. Now, Lloyd George’s proposals for a contributory health insurance scheme, where employers, workers and the State all contribute small sums of money, by means of stamps placed on cards, will make health insurance compulsory for workers earning less than £160 a year. It means that every insured worker is entitled to medical care by a doctor, and a weekly sickness benefit (7s 6d a week for women, 10s for men) for twenty-six weeks if they are unable to work.
There is huge opposition to this. Some employers don’t welcome the idea of the extra cost. The doctors’ professional body, the British Medical Association, furiously denounces it. Petitions and demonstrations opposing the new scheme take place on the streets. Newspapers with big middle-class readerships come out against it. Nonetheless, the National Health Insurance Act is introduced in July 1912. It’s a major reform for the lower-paid worker. It helps safeguard health and make the nation fitter. Yet many servants and their bosses are not in favour of the new scheme. Some servants resent the idea of money being taken from their meagre pay packets. But whatever their feelings, the Act marks the beginning of something much greater, the beginning of what eventually comes to be called the Welfare State to be created after 1945. And although within two years, the onset of World War I with Germany will create havoc with everyone’s lives, rich or poor, the ties binding the servants to their masters are loosened: they will no longer have to rely on their masters’ goodwill if they choose to seek out treatment for their ailments or illnesses.
THE COST OF MEDICAL CARE
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.
THE COST OF SEEING A GP
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.
THE REAL SHERLOCKS
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.
THE DIET DOCTOR
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 al
l 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
THE QUACK
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.
THE BENEFIT CLUB
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.
CONTRACEPTION
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.
VENEREAL DISEASE
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.
A LONGER LIFE
In 1911 there were 100 people aged 100 or over in UK; today there are 12,000 UK centenarians.
Cycling was a new form of recreation for the Edwardians at the start of the 20th Century.
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First published in paperback in 2011
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