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A Tale of Two Nurses

Early 20th Century nursing on "Downton Abbey"

Sybil and IsobelJanuary 27, 2013 -- The demise of Lady Sybil in the episode of Downtown Abbey broadcast on PBS tonight in the United States marked the sad end of one of the popular U.K. show's two nurse characters. It's true that the show's third season has really featured no nursing from the independent, idealistic young Sybil or from her senior nursing colleague Isobel Crawley, the crusading (and at times grating) mother of Downton heir Matthew. But in the first two seasons, which followed the Downton household through the First World War, creator Julian Fellowes and the other producers did offer a few notable glimpses of British nursing of the era. These ranged from portrayals of Isobel as a formidable health system organizer with clinical knowledge that in some ways rivaled that of the local physician, on the one hand, to some unfortunate suggestions that nursing amounted to unskilled tending that could be done by any of the Downton females. The show has at least managed to present nursing as an early outside-the-home career option for strong, idealistic women who sought to contribute more broadly to their war-torn societies--and as a harbinger of a more egalitarian world in which women would enjoy more control over their own destinies. Clarkson and IsobelIt's too bad that, in popular media depictions about our own era, when women can become physicians, we are far less likely to see strong, able female characters choose nursing.

Early in the first season of Downtown Abbey, originally broadcast in the U.S. in 2011, we meet Isobel Crawley (right), mother of Matthew, a middle-class lawyer who turns out to be heir to the vast Downton estate and fortune. Although it does not seem that Isobel needs to work to support herself, in the second episode viewers learn that she was trained as a nurse. She volunteers at the local hospital, where she works with Richard Clarkson (right), a local physician who seems fairly open to her forthright input. Dowton Abbey charactersIsobel tests Clarkson's receptiveness when she pushes him to try a new-fangled adrenaline treatment for a tenant farmer who has dropsy (edema). This advocacy encounters the opposition of the Dowager Countess (right) of Grantham, the acerbic matriarch who helps to oversee the hospital, since the Grantham family supports it financially. However, Isobel prevails and the adrenaline treatment works. As if that were not annoying enough to the Dowager Countess, Isobel manages to maneuver her way into sharing oversight authority over the hospital. Isobel downplays her own status and training, but here she is a strong advocate with surprising expertise.

In the show's second season, broadcast in the U.S. in 2012, Lady Sybil begins her nursing journey. She is the daughter of the Earl of Grantham (Robert Crawley), who is the son of the Dowager Countess. He presides over the Downton household along with Lady Grantham, a.k.a. the Countess of Grantham, a.k.a. Cora, an American (both right). Their daughters are Edith, Mary, and Sybil (left-to-right at the right). But Sybil alone displays a keen interest in being engaged in and useful to the wider society. In the first episode, which takes place in 1916, Sybil is eager to aid the British war effort, so she persuades Isobel to get her enrolled in a 2-month training course as an "auxiliary nurse." Although no one else in Sybil's family seems to be well acquainted with the idea of hard work (unlike their army of servants), Sybil's mother Cora and her grandmother, the Dowager Countess, actually approve of Sybil's plan. Perhaps ironically, the very traditional butler Carson (right) seems less sure that it's appropriate for one of the Downton ladies.

In the second episode, the Crawley family agrees to allow Downton to become a hospital for those who have returned wounded from the war, which seems only natural since the house is actually larger than some hospitals. The local physician Clarkson, who is also a military officer, appears to have overall responsibility for the Downton facilities as well as the local hospital. But Isobel Crawley lobbies to manage the Downton facilities directly. Unfortunately for her, the scheming young servant Thomas also has his sights on that role. Thomas served as a medic in the war, but intentionally managed to get a non-life-threatening wound so as to be sent home. Thomas's ally O'Brien (both right), maid to Cora, slyly turns Cora against Isobel. In the end, Thomas appears to be given responsibility for organizing the overall hospital operations, with Cora and Isobel to act as co-liaisons between Thomas and Clarkson. Isobel does seem to have authority over the nurses, but she desperately tries to inject herself into other aspects of the operation. Isobel would seem to be far more qualified than Thomas or, needless to say, Cora. But Isobel's efforts begin to earn resentment. The show leaves it to the viewer to decide how much of this is Isobel being controlling and abrasive, and how much she is being unfairly shunted aside because of disrespect for the skills of nurses (and women who are not the Countess of Grantham).

Sybil the nurseMeanwhile, Lady Sybil has completed her nursing course--about which we hear virtually nothing more--and she begins nursing at Downton and at the nearby hospital. However, we see little direct care from her. And although the wounded soldiers at Downton do receive some psychosocial care, it seems to come mostly from the usually directionless Lady Edith, who actually talks to the men, fetches books for them, and otherwise makes herself useful.

In the third episode, Isobel's chafing at her limited role reaches a crisis point. She clashes with Lady Grantham, who has apparently been changing the nurses' schedules without consulting Isobel. In response, Isobel is abrasive and shrill, confronting Cora and eventually threatening to leave--which Cora is quite happy to have her do. Matthew as soldierSo Isobel goes to serve in a Red Cross hospital in war-torn France, where her son Matthew (right) is an officer on the front lines. Unfortunately, although Isobel is aggressive about her need to run things and occasionally mentions that she has actual health care training, the show really does not emphasize that her nursing skills make her more qualified than the others to run the Downton hospital and we doubt viewers will get that. Indeed, at one point the physician Clarkson, normally a fairly reasonable figure, informs Isobel that there's no real skill in convalescent care, which is of course absurd, but again, the show really gives viewers no reason to doubt it. Of course, "convalescent care" consists of a great deal of nursing, so the idea that there is no skill involved fits well with common misconceptions. 

Similarly, although Lady Sibyl continues to provide nursing care in the later episodes, that seems to consist mostly of bustling here and there, and as the season goes on there are repeated suggestions that nursing really requires no training or skill. Sybil and BransonSybil does have one brief scene in the fourth episode in which we at least see her providing care that requires toughness, namely cleaning up Matthew, who has returned from the front banged, bloody, and possibly paralyzed. Lady Mary, who is attracted to Matthew, wants to help care for him, and Sibyl tells her, correctly, that it can be hard to take. But in the third episode, when Sybil's chauffeur and budding love interest Branson (right) dismisses her work as basically amounting to little more than fetching tea and pillows, and she has no real response, viewers may conclude the judgment is harsh but essentially correct. The fourth episode includes references to unskilled care by Mary and others as "nursing." In the sixth episode, Lord Grantham refers to all his daughters "nursing" the wounded officers at Downton--though only Sybil has actually had any training. And when several characters contract the deadly Spanish flu then sweeping the globe, Grantham notes that all his daughters are "nurses," so they can provide care if needed.

In the fifth episode, the war ends, and Isobel would like Downton Abbey to remain a hospital. Not surprisingly, that doesn't happen. And here, the show seems to present her mainly as an annoying crusader and control freak; seemingly gone is the health expert with some judgment that we saw in the first season. And so Cora and the Dowager Countess, knowing that Isobel will continue to pester them, come up with an effective plan to distract her with a different crusade aiding war refugees. Off Isobel goes to pursue it, unaware that she has been played.

As for Sybil, in the sixth episode she and the chauffeur Branson finally reveal their plans to marry. In response to this threat to the prevailing social order, Lord Grantham with 3 daughtersLord Grantham has a series of fits. In one, he suggests that Sybil's pursuit of nursing was one factor that led her down the wrong path, presumably toward radical egalitarian ideas and a greater sense of feminine independence. Sybil declares that she doesn't need the family any more because she will get a paying job as a nurse (!), and Branson has gotten a job as a journalist. And no less than Lady Grantham doesn't think her husband's views are quite fair. In fact, she suggests--in a quick change of course--that she herself anticipates working with cousin Isobel in her refugee project! In addition to being an oblique bit of redemption for Isobel, this suggests that the shifting wartime roles have changed things for women, even aristocratic ones, who are now more likely to seek some work outside the home. And perhaps this is at least one notable contribution the show has made to public understanding of the profession. Nursing was one of the few paths open to women who wanted or needed a career in this era, including women from well-off families--like the family of Florence Nightingale herself. Ultimately Lord Grantham relents and gives the young couple his blessing.

Sybil's death bedThough Sybil and Branson remain in love, their union is plagued by trouble, culminating in Sybil's death tonight--a death that might not have happened if the family had heeded the local physician Clarkson's correct judgment that she had eclampsia, rather than the assurances of the pompous obstetrician Lord Grantham brought in to manage her care. Once Sybil starts having seizures, they can do nothing; CPR is decades away. In these scenes, nurses appear to be present only to serve the physicians and provide unskilled tending; they are rarely seen and never heard. In this photo, the nurse stands in the background. She is irrelevant to care.

Isobel and EdithAnd with Sybil gone, the potential for good portrayals of the profession would appear to rest with Isobel. She is a character who, based on her current crusade to help ex-prostitutes, seems as righteous as ever--she is a committed advocate, without a doubt--though she also seems as likely as ever to be seen as somewhat naïve. And her campaign for the prostitutes, which seems to focus on job training and support, is certainly compatible with nursing's holistic approach. Perhaps Isobel will, at some point, impress us with her nursing as she did in the first season.

In any event, though the overall portrayal of nursing on Downton Abbey has been mixed at best, we do appreciate that the producers have made some effort to show the profession's place in the evolution of women in the workplace and society.


You can send your comments to Downton Abbey's creator and writer Julian Fellowes at If you do write a letter, please copy us so that we can see your thoughts and suggestions at Thank you!


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