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 husband 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 injectio
ns? 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.”
How 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.
She came to the door with me, and out onto the balcony, all the children following. “See you tomorrow, then. I’ll look forward to yer comin. I’ll ’ave a nice cup of tea for yer.”
I cycled off with much to think about. In her own surroundings, Lil was not a disgusting old bag, she was a heroine. She kept the family together, in appalling conditions, and the children looked happy. She was cheerful and uncomplaining. How she had come to pick up syphilis was none of my business. I was there to treat the condition, not to judge.
The next day when I called, I was so pre-occupied with wondering how I could decline the offer of a cup of tea, that when the door opened, I stood staring awkwardly, stupidly, at Lil, who was not Lil. She looked a bit shorter and fatter, the same slippers, the same hair curlers, the same fag - but different.
A familiar screech of laughter revealed toothless gums. She poked me in the stomach. “Yer thinks I’m Lil, don’ yer? They all thinks that. I’m ’er mum. We looks like two peas, we does. Lil’s had a mis an’ gorn to ’ospital. Good riddance, I sez. She’s got enough with ten o’ them, an’ him in an’ out all the time.”
A few questions elicited the facts. Lil had felt ill shortly after I had left the previous day, and was later sick. She had lain down on the bed, and sent one of the children to fetch Gran. Contractions had started, and she was sick again. Then she must have become unconscious.
Gran said to me, “I’ll cope with a mis any time, but not a dead woman. No, sir.”
She’d called a doctor, and Lil was taken straight to The London Hospital. We later learned that a macerated foetus was extracted. It had probably been dead for three or four days.
RICKETS
It is hard to imagine today that until the last century no woman had any specialist obstetric care during pregnancy. The first time a woman would see a doctor or midwife was when she went into labour. Therefore, death and disaster, either for mother or child, or both, were commonplace. Such tragedies were looked upon as the will of God, whereas, in fact, they were the inevitable result of neglect and ignorance. Society ladies would have a doctor visiting them during pregnancy, but such visits were not antenatal care and would probably be more like social calls than anything else, because no doctor was trained in antenatal care.
The pioneer in this branch of obstetrics was a Dr J. W. Ballantyne of Edinburgh University. (Indeed some of the greatest discoveries and advances made in medicine seem to come from Edinburgh.) Ballantyne wrote a paper in 1900 deploring the abysmal state of antenatal pathology, and urging that a pre-maternity hospital was necessary. An anonymous gift of £1,000 allowed the first ever bed for antenatal care to be inaugurated, in 1901, at the Simpson Memorial Hospital. (Simpson, another Scot, developed anaesthetics.)
This was the first such bed in the civilised world. It is an incredible thought. Medicine was developing rapidly. The staphylococcus had been isolated; so had the tuberculous bacillus. The heart and circulation were understood. The functions of liver, kidneys, and lungs had been ascertained. Anaesthetics and surgery were advancing apace. But no one, it seems, thought that pre-maternity care might be necessary for the life and safety of a pregnant woman and her child.
It was ten years later, in 1911, before the first antenatal clinic was opened in Boston, USA. Another opened in Sydney, Australia, in 1912. Dr Ballantyne had to wait until 1915, fifteen years after his seminal paper, before he saw an antenatal clinic open in Edinburgh. He, and other far-sighted obstetricians, were faced with bitter opposition from colleagues and politicians who regarded antenatal care as a needless expenditure of public money and medical time.
At the same time the struggle by visionary and dedicated women was in progress to gain properly regulated training in the art of midwifery. If Dr Ballantyne was having a hard time, these women found it harder. You have to imagine what it was like to be on the receiving end of vicious antagonism: sneering, contempt, ridicule, slights about one’s inte
lligence, integrity and motives. In those days, women even ran the risk of dismissal for their opinions. And this treatment came from other women, as well as men. In fact, “in-fighting” between various schools of nurses who had some sort of training in midwifery was particularly nasty. One eminent lady - the matron of St Bartholomew’s Hospital - branded the aspiring midwives as “anachronisms, who would in the future be regarded as historical curiosities”.
The medical opposition seems to have arisen mainly from the fact that “women are striving to interfere too much in every department of life”.2 Obstetricians also doubted the female intellectual capacity to grasp the anatomy and physiology of childbirth, and suggested that they could not therefore be trained. But the root fear was - guess what? - you’ve got it, but no prizes for quickness: money. Most doctors charged a routine one guinea for a delivery. The word got around that trained midwives would undercut them by delivering babies for half a guinea! The knives were out.
In the 1860s the Council of Obstetrics estimated that, out of around 1,250,000 births annually in Britain, about 10 per cent were attended by a doctor. Some researchers put the figure as low as 3 per cent. Therefore, all the rest - well over one million women annually - were attended by women with no training, or by no one at all, other than a friend or relative. In the 1870s Florence Nightingale wrote Notes on Lying-in Infirmaries, drawing attention to “the utter absence of any means of training in any existing institution”, saying “it is a farce or mockery to call women who attend childbirth, midwives. In France, Germany, and even Russia they consider it woman-slaughter to practice as we do. In these countries everything is regulated by Government - with us, by private enterprise.” The guinea earned by doctors for a delivery was a significant part of their income. The threat of being undercut by trained midwives had to be resisted. The fact that thousands of women and babies were dying annually for want of proper attention did not come into it.
Call The Midwife: A True Story Of The East End In The 1950S Page 8