The District Nurse in the Cotswolds
PUBLISHED: 09:32 05 January 2011 | UPDATED: 15:38 20 February 2013
From bringing new life into the world to laying out the dead, and even delivering the odd christmas stocking, the district nurse has played an important role in the lives of many.By June Lewis
My most treasured childhood Christmas present is not some expensive toy or prettily dressed doll, but a scrapbook lovingly made for me by Nurse Twinning, the district nurse who first slapped life into me and took a personal interest in me and my doings for the rest of her life. I had always thought that Nurse Twinning was specially designated by Father Christmas to deliver my Christmas stocking. I would lie awake listening for the hoot and hiss of the last train - on which I assumed he had travelled from Oxford (my narrow little world ended at Oxford some thirty miles away) and then, without fail, some time later there would be the familiar creaking and tinkle of a bell - not from any fairy tale sleigh, but Nurse's ancient bicycle being propped up against the wall below my bedroom window. And, behold - there would be the stocking at the foot of my bed in the morning. I always resisted the temptation to peek out of the window to see her arrive on those magical nights, but I did wonder whether she came in a long red cloak and I did not want to see her as anything different from Nurse as I knew and loved her.
With her apple rosy cheeks, buffed by years of wind and rain, with wispy grey curls fringing her round navy blue cap, and buttoned up in the regulation navy blue gaberdine raincoat, Nurse was central to the lives of our community. Her comings and goings on her creaking 'sit up and beg' bicycle were watched with great interest by the matrons of the neighbourhood, for it was from her bulging black Bailey bag that she produced a baby brother or sister for our childhood friends, or had the necessary things for what the grown-ups called 'laying out' the folk that we understood to have 'passed on to a better world'. It was little wonder that such a pivotal figure was so respected and revered as Nurse was, for she was, at least to my young mind, the Alpha and Omega of life itself. Between the role of getting one into this world and attending those leaving it, Nurse was also 'Nitty Nora' at our primary school: her probing fingers traversing our heads in search of the dreaded 'unclean' among us; to her small, lead-paned cottage we would go with our bumps and bruises, bad stings and scratches that 'turned funny' as well as for our rations of rose hip syrup and concentrated orange juice and cod liver oil and malt. Rarely did we come away without a square of home-made fudge, or a well washed apple or scrubbed young carrot from her pretty garden. Afternoon tea with Nurse was a special occasion: daintily cut sandwiches and feather light scones, topped with home made jam, served on rose patterned plates and all set on an exquisitely embroidered cloth, as snowy white as her starched apron covering her blue serge dress. Often this peaceful and homely scene would be broken by the urgent knocking on the heavy oak door and anxious voices calling Nurse away on yet another visit, after hastily chalking a message on the small slate she kept in her side window saying Nurse Out. And out Nurse went on her creaky, squeaky old bicycle to help yet another of 'her' families.
District Nurses' bicycles superseded the donkey cart which a directive of 1892 stated that 'experience has shown that one nurse can efficiently nurse a rural district within a radius of three to four miles of her home, where a donkey cart is provided'. Nurse Elizabeth Malleson had two donkeys and a bicycle to serve her extended district of nine villages and hamlets around Gotherington, but in view of the ever increasing workload by 1901 she hoped that 'if a rough quiet pony could be substituted for one of the donkeys it would be very desirable, although this would mean some increase in expense'. Nurse Elizabeth did not get a pony, rough, quiet or otherwise, until 1910 when she provided the necessary additional funds herself. She had reminded her patients some four years previously that 'it is always expected that some vehicle should be sent for the nurse to a confinement. Summonses of this nature often come when the donkey is too tired to go further, after work, and bicycling may be impossible'. From this report it is obvious that more concern was shown for the donkey than for the nurse, regardless of her tiredness and the number of hours she had already worked.
Elizabeth Malleson was the pioneer of county nursing and the small Cotswold village of Gotherington was its birthplace. A contemporary and ardent admirer of Florence Nightingale, whose reforms in hospital nursing are legendary, Elizabeth Malleson moved to Dixton Manor House in 1881 with her husband Frank on his retirement from a successful business as a wine merchant. In stark contrast to the busy social life she was used to in London, Elizabeth found in the poorer rural isolation of the country a challenge that she was more than able and willing to meet. Within their first year at Dixton, the Mallesons rented a room in one of the larger houses in the village, raised funds from bazaars and jumble sales to furnish and equip it and a small band of volunteers to help run it as a Reading Room where the men folk could read, play dominoes or cards and socialise in the evenings away from the public house. The women and girls were able to meet in the Reading Room in the afternoons to read or attend classes in knitting and cookery. Members and their friends were treated to the Manor for occasional dances and Christmastide entertainment, tea and supper.
It was this close contact with the villagers that brought the need of skilled nursing to remote rural areas, particularly for women in childbirth whose only help was so often at the hands of a Dickensian type village crone more versed in folklore and superstition than basic hygiene and home nursing. Determined to do something positive about it, Elizabeth raised 21 12s. 6d in donations from an appeal she made in 1883 through the local Liberal newspaper, Cheltenham Examiner, and founded the Village Nursing Association. Two years later Elizabeth was able to record: 'After careful searching a suitable woman was found, accustomed to country life, and already trained as Midwife and sick nurse. She came to Gotherington early in September 1885. Some waiting was to be expected while the village women got to know here and to trust her. But Nurse Mary turned this time to good account, neither fatigue, distance, nor bad weather daunted her and she has proved herself most kindly, energetic, devoted and suited to her position.'
Despite the encouraging start, paying the nurse's wages and medical costs, with patients making minimal donations on a sliding scale, exhausted the funds within two years. Meanwhile, a public awareness of the crucial need for district nurses was being generated by Florence Nightingale and William Rathbone, a philanthropic merchant of Liverpool. Together they produced a plan to submit to Queen Victoria who was being urged to decide how the remaining 70,000 should be spent from her Golden Jubilee Fund, donated by over three million women of Britain,. The Queen was keen. She was 'enchanted' with Florence Nightingale, she had entertained her at Balmoral and offered her a 'grace and favour' apartment in Kensington Palace - which was gracefully declined. Elizabeth Malleson's approach to Florence Nightingale for her support brought some searching questions as to Elizabeth's credentials for setting up and running a national nursing association, the funding and how suitable nurses and midwives would be recruited. Elizabeth, of equally strong and singular character, but lacking the long experience and wider knowledge, questioned the great Florence's fundamental belief that nurses should be educated ladies; there appears to be no further correspondence between them.
The whole story of how the resolute Elizabeth Malleson, dominant and dedicated, confident and competent, was so instrumental in founding the rural district nursing service, with fascinating insight into the lives of the nurses themselves, the society in which they had to prove themselves and the prejudices against the whole concept of nurses in private homes, is detailed in a recently published book by Dr Carrie Howse.
Dr Howse was a nurse herself in the 1970s and is an award winning historian whose study of rural district nursing from its beginnings in the Cotswolds set in the national context before the days of the National Health Service makes those distant memories of the old family nurse belong to the pages of 'once upon a time' - just like the medley of pictures in my old scrapbook.