In Western society, which we call civilisation, this did not occur, and a dozen or more complications, some of them deadly, were superimposed on the natural hazards: overcrowding, staphylococcal and streptococcal infection; infectious diseases such as cholera, scarlet fever, typhoid and tuberculosis; venereal disease; rickets; multiple and frequent childbirth; the dangers from infected water. If you add to all this the attitude of indifference and neglect that often surrounded childbirth it is not hard to understand how childbirth came to be known as “the curse of Eve”, and how women could often expect to die in order to bring forth new life.
The Midwives of St Raymund Nonnatus held their clinic in a church hall. The idea today of conducting a full-scale antenatal clinic in a converted old church hall is horrifying, and sanitary inspectors, public health inspectors, every inspector you can think of would be there condemning it. But in the 1950s it was by no means condemned, in fact the nuns were highly praised for the initiative and ingenuity they had shown in the conversion. No structural changes had been made, apart from the installation of a lavatory and running cold water. Hot water was obtained from an Ascot water heater fixed to the wall near the tap.
Heating was provided by a large coke fire in the middle of the hall. It was a black cast iron construction which had to be lit earlier in the morning by Fred, the boilerman. Such coke fires were very common in those days, and I have seen them even in hospital wards. (I recall one ward where it was the practice to sterilise our syringes and needles by boiling them in a saucepan placed on the stove). These stoves were very solid, flat topped, and you had to fill them by opening the circular lid and tipping the coke in from a coke-hod. It required quite a bit of muscle power. The stove was situated in the middle of the space, so that heat was radiated all around. The flue went straight up the middle, to the roof.
A few examination couches were available, with movable screens to provide privacy, and wooden desks with chairs, where we wrote up our notes. A long marble-topped surface stood near the sink, upon which we placed our instruments and other equipment. A gas jet stood on this surface, with a box of matches beside it. This single jet of flame was used continuously for boiling up the urine. I can smell it now, more than fifty years later!
The clinic, and those like it all over the country, may sound primitive today but it had saved countless thousands of lives of both mothers and babies. The Midwives’ clinic was the only one in the area until 1948, when a small maternity unit of eight beds was opened in Poplar Hospital. Prior to that, the hospital had no maternity unit even though Poplar was said to have a population of fifty thousand people per square mile. When the decision was taken after the war to open a hospital unit, no special provision was made. Quite simply, two small wards were allocated for maternity – one for lying-in, and the other for delivery, doubling-up as an antenatal clinic. This was inadequate, but it was better than nothing at all. Accommodation, equipment, technology, were not really important. What was important was the knowledge, skill and experience of the midwife.
Clinical examination was what I shrank from the most. It can’t be as bad as last week, I thought as we prepared to open the doors. I shuddered as I remembered it. Thank God I was wearing gloves, I thought. What would have happened if I had not?
She had been in my mind on and off for the whole of the past week. She had flounced into the clinic at about 6 p.m. in her hair curlers and slippers, a fag hanging from her lower lip, and with her were five children under seven. Her appointment had been for 3 p.m. I was clearing up after a not too stressful afternoon. Two of the other student midwives had left, and the third was still with her last patient. Of the Sisters, only Novice Ruth remained, (a “novice” in the religious life, not in midwifery). She asked me to see Lil Hoskin.
It was Lil’s first antenatal visit, even though she had had no periods for five months. This is going to take another half an hour, I sighed to myself as I got out the notes. I scanned through them: thirteenth pregnancy, ten live births; no history of infectious disease; no rheumatic fever or heart disease; no history of tuberculosis; some cystitis but no evidence of nephritis; mastitis after the third and seventh babies, but otherwise all babies breastfed.
Her previous notes gave me most of her obstetric history, but I needed to ask some questions about the present pregnancy.
“Have you had any bleeding?”
“Nope.”
“Any vaginal discharge?”
“A bit.”
What colour?”
“Mos’ly yellowish.”
“Any swelling of the ankles?”
“Nope.”
“Any breathlessness?”
“Nope.”
“Any vomiting?”
“A bit. Not much though.”
“Constipated?”
“Yep, not ‘alf!”
“Are you sure you are pregnant? You haven’t been examined or tested.”
“I should know,” she said meaningfully, with a shriek of laughter.
The children by now were rushing around all over the place. The hall, being large and virtually empty, was like a great play area for them. I didn’t mind – no healthy child can resist a wide open space, and the urge to run is powerful if you are only five years old. But Lil thought she must exercise some show of authority. She grabbed a passing child by the arm and dragged him to her. She gave him a great blow across the side of the face and ear with a heavy hand, and screamed.
“Shut up and behave yourself, you li’l bleeder. And that goes for the lot of you and all.”
The child squealed with pain and the injustice of the blow. He retreated about ten yards from his mother, and screamed and stamped, until he could scarcely breathe. Then he paused, took a deep breath, and started all over again. The other children had stopped running around, and a couple started whimpering. A happy but noisy scene with five little children had been turned in an instant into a battlefield by this stupid woman. I hated her from that moment.
Novice Ruth came up to the child, and tried to comfort him, but he pushed her away, and lay on the floor kicking and screaming. Lil grinned and said to me: “Don’t mind him, he’ll get over it.” Then louder, to the child: “Shu’ yer face or yer’ll get another.”
I couldn’t bear it, so to prevent her doing any more harm, I told her that I must examine her urine, gave her a gallipot, and asked her to go into the lavatory to supply a sample for me. After that, I said, I would want to examine her, and would need her undressed below the waist, and lying on one of the couches.
Her slippers slapped across the wooden floor as she went. She came back giggling, and gave me the specimen, then flopped over to one of the couches. I ground my teeth. What has she got to giggle about, I thought. The child was still lying on the floor, but not screaming so much. The other children looked sullen, making no attempt to play.
I went to the work surface to test the urine. The litmus paper turned red, showing normal acidity. The urine was cloudy, and the specific gravity high. I wanted to test for sugar, and lit the gas jet. I half filled a test tube with urine, and added a couple of drops of Fehlings solution, and boiled the contents. No sugar was present. Lastly, I had to test for albumen by refilling the test tube with fresh urine, and boiling the upper half only. It did not turn white or thick, indicating that albumen urea was not present.
This took about five minutes to complete, during which time the child had stopped crying. He was sitting up and Novice Ruth was playing with him with a couple of balls, pushing them back and forth. Her refined, delicate features were offset by her white muslin veil which fell down as she leaned over. The child grabbed it and pulled. The other children laughed. They seemed happy again. No thanks to their rough and brutal mother, I thought as I went over to Lil, who was now lying on the couch.
She was fat, and her flabby skin was dirty and moist with perspiration. A dank, unwashed smell rose from her body. Have I got to touch her? I thought as I approached. I tried to remind myself that she and her hu
sband and all the children probably lived in two or three rooms with no bath, or even hot water, but it did not dispel my feeling of revulsion. Had she not hit her child in that heartless manner, my feelings might have softened towards her.
I put on my surgical gloves, and covered her lower half with a sheet, because I wanted to examine her breasts. I asked her to pull up her jumper. She giggled, and wobbled around, pulling it up. The smell intensified as her armpits were exposed. Two large pendulous breasts flopped down either side of her, prominent veins coursing towards huge, near-black nipples. These veins were a reliable sign of pregnancy. A little fluid could be squeezed from the nipples. Just about diagnostic, I thought. I told her this.
She shrieked with laughter. “Told you so, didn’t I?”
I took her blood pressure at that point, and it was fairly high. She will need more rest, I thought, but I doubt if she will get it. The children had recovered their spirits, and were racing about once again.
I pulled her jumper down and uncovered her abdomen, which was large, the skin simply covered with stretch marks. The slightest pressure from my hand showed a fundus above the umbilicus.
“When was your last period?”
“Search me. Las’ year, I reckons.” She giggled, and her tummy flopped up and down.
“Have you felt any movements yet?”
“Nope.”
“I am going to listen for the baby’s heart beat.”
I reached for the pinard foetal stethoscope. This was a small metal, trumpet-shaped instrument, used by placing the larger end over the abdomen, and then pressing the ear against the flattened smaller end. Normally the steady thud of the heartbeat could be heard quite clearly. I listened at several points, but could hear nothing. I called Novice Ruth, as I felt I needed confirmation, and also an assessment of the duration of pregnancy. She couldn’t hear a heartbeat either, but thought that other signs indicated pregnancy. She asked me to do an internal examination to confirm it.
I had been expecting this, and dreading it. I asked Lil to draw her knees upwards and part her legs. As she did so, the odour of stale urine, vaginal discharge, and sweat wafted up to greet me. I struggled to control the nausea. I mustn’t be sick, was all I could think of at that moment. Tufts of pubic hair stuck up in clumps, matted together by sticky moisture and dirt. She might have crabs, I thought. Novice Ruth was watching me. Maybe she understood how I was feeling – the nuns were very sensitive, but they spoke little. I dampened a swab with which to clean the moist bluish vulva, and it was whilst I was cleaning her that I noticed that one side was very oedematous, swollen with fluid, whilst the other was not. I started to part the vulva with two fingers, and it was then that my finger encountered a hard, small lump on the oedematous side. I rubbed my finger over it several times. It was easily palpable; hard lumps in soft places make one think of cancer.
I could feel Novice Ruth watching me very closely all the time. I raised my eyes, and looked at her questioningly. She said, “I’ll get a pair of gloves. Do not proceed just yet, nurse.”
She returned a couple of seconds later, and took my place. She did not say a word until she withdrew her hand, and covered Lil again with the blanket.
“You can put your legs down now, Lil, but stay where you are, please, because we will want to examine you again in a minute. Come with me to the desk, will you, nurse?”
At the desk, which was at the other end of the room, she said to me very quietly: “I think the lump is a syphilitic chancre. I am going to ring Dr Turner straight away and ask him if he can come to examine her while she is still here. If we send her away with instructions to go to a doctor, there is a high chance that she will not go. The spirochaeta pallida of syphilis can cross the placenta and infect the foetus. However, the chancre is the first stage of syphilis, and with early diagnosis and treatment there is a good chance of cure, and the baby will be spared.”
I nearly fainted, in fact I remember having to grip the table before I could sit down. I had been touching her – the revolting creature – and her syphilitic chancre. I couldn’t speak, but Novice Ruth said to me kindly, “Don’t worry. You were wearing gloves. You won’t have caught anything.”
She left to go to Nonnatus House to ring the doctor. I couldn’t move. I sat at the table for a full five minutes, fighting down wave after wave of nausea, and shuddering. The children were playing all around me, perfectly happy. There was no movement from behind the screen, until the low, steady sound of contented snoring penetrated my ears. Lil was asleep.
The doctor arrived about fifteen minutes later, and Novice Ruth asked me to accompany him. I must have looked pale, because she asked, “Are you all right? Will you manage?”
I nodded dumbly. I couldn’t say no. After all, I was a trained nurse, accustomed to all sorts of frightful situations. Yet even after five years of hospital work – casualty, theatre, cancer patients, amputations, dying, death – nothing and no one had caused such profound revulsion in me as that woman Lil.
The doctor examined her and took a scrape of tissue from the chancre for the pathology lab. He also took a sample of blood for a Wassermann’s test. Then he said to Lil, “I think you have a very early infection of venereal disease. We…”
Before he had finished speaking she gave a great baying laugh. “Oh Gawd! Not again! That’s a laugh, that is!”
The doctor’s face was stony. He said, “We have caught it early. I am going to give you penicillin now, and you must have another injection each day for ten days. We must protect your baby.”
“Please yourself,” she giggled, “I’m easy,” and winked at him.
His face was expressionless as he drew up a massive dose of penicillin and injected it into her thigh. We left her to get dressed, and went over to the desk.
“We will get the results from pathology on the blood and serum,” he said to Novice Ruth, “but I don’t think there is any doubt about diagnosis. Would you Sisters arrange to visit daily for the injections? I think if we ask her to come to surgery she won’t bother, or will forget. If the foetus is still alive, we must do our best.”
It was well after seven o’clock. Lil was dressed, and yelling to the children to come with her. She lit another fag, and called out gaily, “Well, tara all.”
She looked knowingly at Novice Ruth, and said, with a leer – “Be good” – and shrieked with laughter.
I told her that we would call each day to give her another injection. “Please yerself,” she said with a shrug, and left.
I still had all my cleaning up to do. I felt so tired my legs could hardly move. The moral and emotional shock must have contributed to the fatigue.
Novice Ruth grinned at me kindly. “You have to get used to all sorts in this life. Now, do you have any evening visits?”
I nodded. “Three post-natal. One of them up in Bow.”
“Then you go and do them. I will clean up here.”
As I left the clinic, I thanked her from the bottom of my heart. The fresh air revived me, and the cycle ride dispelled my fatigue.
The following morning, when I looked at the day book, I saw that I had to administer the penicillin injection to Lil Hoskin, Peabody Buildings. I groaned inwardly. I had known it would have to be me. The instruction was that it should be my last call before lunch, and that the syringe and needle should be kept separate from the midwifery case, also, that I should wear gloves. I didn’t need telling.
The Peabody Buildings in Stepney were notorious. They had been condemned for demolition about fifteen years before, but were still standing and still housing families. They were the worst type of tenements, because the only water came from a single tap at the end of each balcony, where the only lavatory was situated. There were no facilities in the flats. My attitude towards Lil softened. Perhaps I would be like her if I had to live in such conditions.
The door was open, but I knocked.
“Come on in, luvvy. I’m expecting you. I’ve got some water ready for you.”
H
ow kind. She must have gone to a lot of trouble to get water and heat it up. The flat was filthy and stinking. Hardly a square inch of floor space could be seen, and small children, naked from the waist down, tumbled around all over the place.
Lil seemed different in her own surroundings. Maybe the clinic had intimidated her in some way, so that she had felt the need to assert herself by showing off. She did not seem so loud and brash in her own home. The irritating giggle, I realised, was no more than constant and irrepressible good humour. She pushed the children around, but not unkindly.
“Get out of it, yer li’l bleeder. The nurse can’t get in.” She turned to me. “Here you are. You can put your things down here.”
She had gone to the trouble of clearing a small space on the table, and had put a washing bowl beside it, with soap and a grubby towel.
“Thought you’d need a nice, clean towel, eh ducky?”
Everything is relative.
I put my bag on the table, but took out only the syringe, needle, ampoule, gloves and cotton swab soaked in spirit. The children were fascinated.
“Get back, or I’ll clip your ear,” Lil said gaily. Then to me, “Do you wants me leg or me arse?”
“Doesn’t matter. Whichever you prefer.”
She lifted her skirts and bent over. The huge round backside looked like a positive affirmation of solidarity. The children gawped, and crowded in closer. With a shrill scream of laughter Lil kicked backwards, like a horse.
“Garn. Aint you seen this before?”
She roared with laughter, and the bottom wobbled so much it was impossible to inject it.
“Look, hold on to the chair and keep still for a second, will you?” I was laughing now.
She did, and the injection was over in less than a minute. I rubbed the area hard to disperse the fluid, as it was a large dose. I put everything into a brown paper bag to keep it separate. Then I washed my hands and dried them on her towel, just to please her. We carried our own towel, but I thought that to use it would be a conspicuous snub.
Call the Midwife Page 8