We were told to prepare a side-ward to receive a possible case of eclampsia. It was during my first six months of midwifery training, and the ward sister showed me and another student how this should be done. The bed was pushed against the wall, with pillows stuffed down the crack. The head of the bed was padded with more pillows and secured tightly with sheets. Oxygen was brought in: a mouth wedge and airway tube were in readiness, also suction apparatus. The window was covered with a dark cloth to black out most of the light.
Margaret was deeply unconscious on admission. Her blood pressure was so high that the systolic was over 200 and diastolic 190. Her temperature was 104 degrees Fahrenheit and her pulse was 140. A catheter specimen of urine was obtained and tested. So heavy was the deposit of albumen that upon boiling the urine turned solid like the white of an egg. There was no doubt of the diagnosis.
Eclampsia was, and still is, a rare and mysterious condition of pregnancy, with no known cause. Usually there are warning signs before onset known as pre-eclampsia, which responds to treatment, but if untreated may progress to eclampsia. Rarely, very rarely, it occurs with no warning in a perfectly healthy woman, and in the space of a few hours it can develop to convulsion stage. When this stage is reached, the pregnancy is unstable, and the foetus unlikely to survive. The only treatment is immediate delivery of the baby by Caesarean section.
Theatre had been alerted and was ready to receive Margaret. The baby was dead on delivery, and Margaret returned to the ward. She never regained consciousness. She was kept under heavy sedation in a darkened room, but even then she had repeated convulsions that were terrifying to see. A slight twitching was followed by vigorous contractions of all the muscles of the body. Her whole body became rigid, and the muscular spasm bent her body backwards, so that for about twenty seconds only her head and heels rested on the bed. Respiration ceased, and she became blue with asphyxia. Quite quickly, the rigidity passed, followed by violent convulsive movements and spasms of all her limbs. It was hard to keep her from hurling herself on to the floor, and quite impossible to keep a tongue wedge in place. With the violent movements of the jaw she bit her tongue to pieces. She salivated profusely, and foamed at the mouth, which mingled with the blood from her lacerated tongue. Her face was congested and horribly distorted. Then the convulsion subsided, and a deep coma would follow, lasting for an hour or so and followed by another convulsion.
These terrible fits occured repeatedly for a little over thirty-six hours, and on the evening of the second day, she died in her husband’s arms.
All this flooded into my mind in the few seconds that I stood at the sink, looking at the sample of Sally’s urine. David. What had happened to that poor man? He had staggered out of the hospital half blind, half mad, dumb with shock and grief. Sadly, in nursing, and particularly in hospital nursing, you meet people during some of the most profound moments in their lives, and then they are gone from you for ever. There was no way that David would be hanging around the maternity hospital where his wife had died, just to reassure the nurses. And equally, hospital staff could not go chasing after him to find out how he was coping. I remembered with gratitude what he said to me just after she died, and the words of some great writer (I cannot recall who), came to mind:
He who loves knows it. He who loves not, knows it not.
I pity him, and make him no answer.
There was no time to mope. I had to see Sister and report on Sally’s condition.
Sister Bernadette was in charge on that day. She listened to my report, looked at the urine sample, and said, “There may be contamination from a vaginal discharge, so we will take a catheter specimen of urine. Could you just get things ready for catheterisation, please, while I go over to Sally and examine her.”
When I took the tray over to the couch Sister had already made a full examination, and confirmed everything I had reported.
She said to Sally, “We are going to insert a small tube into your bladder to drain off some urine for testing in path. lab.”
Sally protested, but eventually submitted, and I catheterised her. Then Sister said to her, “We think there is a problem with this pregnancy that requires absolute rest, and a special diet, and certain drugs to be administered daily. For this, you must go to hospital.”
Sally and her mother were alarmed.
“What’s up? I feels all right. Just a bit of a headache, that’s all.”
Her mother butted in, “If there’s anything wrong with our Sal I can look after ’er. She can take it easy at home, like.”
Sister was very firm. “It’s not just a question of taking it easy and staying in bed some of the time. Sally has to have absolute bed rest, twenty-four hours a day, for the next four to six weeks. She will have to have a special no-salt diet, with low fluid intake. She will need to have certain sedative drugs four times a day. She will need to be watched carefully, and her pulse, temperature and blood pressure will have to be taken several times every day. The baby’s progress will also have to be checked daily. You cannot possibly do all this at home. Sally needs immediate hospital treatment, and if she does not get it, the baby will be at risk, and also the health of the mother.”
This was a very long speech for Sister Bernadette, who was usually very quiet. It was absolutely effective, though, for it silenced Sally’s mum, who gave a squeak, and said nothing.
“I am going now to ring the doctor, to ask him if he can find a bed for you immediately at one of the maternity hospitals. I want you to stay where you are, lying quietly on the couch. I don’t want you to go home.”
Then she said to Enid: “Perhaps you would go home and get some things for Sally in hospital - nightdresses, toothbrush, things like that, and bring them back here.”
Enid scurried off, glad of something to do.
Sally had a couple of hours to wait before an ambulance came, and she was taken into this in a wheel chair. I think she was bewildered by all the fuss and the attention she was getting, especially as she didn’t feel ill, had walked to the clinic, and was quite capable of walking out.
Sally was taken to The London Hospital in Mile End Road. She was admitted to the antenatal ward, where there were ten to twelve other young women in just the same stage and condition of pregnancy as herself. She received complete bed-rest, even to the extent of being pushed to the toilet in a wheel chair. She was sedated, and given a specific diet and low fluid intake. Over the next four weeks her blood pressure gradually came down, the oedema subsided, and the headache passed. At thirty-eight weeks of pregnancy, labour was induced. Sally’s blood pressure began to rise during the labour, so as soon as she was fully dilated, she was given a light anaesthetic, and a fine healthy baby was delivered by forceps.
Mother and baby both remained well during the post-natal period.
Eclampsia is as much a mystery today as it was fifty years ago. It was, and still is, thought to be caused by some defect in the placenta. But nothing has been proven, even though thousands of placentas must have been examined by researchers attempting to isolate this supposed “defect”.
Sally’s case was typical of pre-eclampsia. Had she not been diagnosed, and received prompt and expert treatment, her condition could have led to eclampsia. But the simple treatment that I have described - total rest and sedation - may have averted its development.
Margaret, who died in that ghastly way, had a very rare onset of sudden, violent eclampsia, with no warning signs, and no preeclamptic phase. I have never seen another such case, but they do still occur occasionally.
Pre-eclampsia and eclampsia are still leading causes of maternal and perinatal mortality in the UK, in spite of modern antenatal care. What befell the women with pre-eclampsia when there was no antenatal care? It does not take a great deal of imagination to answer that one. Yet doctors who advocated the study of and provision for proper antenatal care were regarded, one hundred years ago, as eccentrics and time-wasters. The same attitude poured scorn on the idea of a structured and regulated train
ing for midwives.
Let those of us who have borne children thank God that those days are now past.
FRED
A convent is essentially a female establishment. However, of necessity, the male of the species cannot be excluded entirely. Fred was the boiler-man and odd-jobber of Nonnatus House. He was typical of the Cockney of his day and age. Stunted growth, short bowed legs, powerful hairy arms, pugnacious, obstinate, resourceful; all these attributes were combined with endless chat and irrepressible good humour. His most striking characteristic was a spectacular squint. One eye was permanently directed north-east, whilst the other roved in a south-westerly direction. If you add to this the single yellow tooth jutting from his upper jaw, which he generally held over his lower lip and sucked, you would not say he was a beautiful specimen of manhood. However, so delightful was his optimism, good humour and artless self-confidence that the Sisters held him in great affection, and leaned on him heavily for all practical matters. Sister Julienne had a particularly strong line in helpless feminine appeal, “Oh Fred, the window in the upper bathroom won’t close. I’ve tried and tried, but it’s no use. Do you think ...? If you can find time, that is ...?”
Of course Fred could find time. For Sister Julienne he would have found time to move the Albert Docks. Sister Julienne was deeply grateful, and praised his skill and expertise. The fact that the window in the upstairs bathroom was fixed permanently closed from that time onwards was no inconvenience, and not mentioned by anyone.
The only person who did not respond with delight to Fred’s particular brand of Cockney charm was Mrs B., who was a Cockney herself, had seen it all before, and was not impressed. Mrs B. was Queen of the Kitchen. She worked from 8 a.m. to 2 p.m. each day, and produced superb food for us. She was an expert in steak and kidney pies, thick stews, savoury mince, toad-in-the-hole, treacle puddings, jam roly-poly, macaroni puddings and so on, as well as baking the best bread and cakes you could find anywhere. She was a large lady with formidable frontage, and a particular glare as she growled, “Nah then - don’ chew mess up my kitchen.” As the kitchen was the meeting-point for all staff when we came in, often tired and hungry, this remark was frequently heard. We girls were very docile and respectful, especially as we had learned from experience that flattery usually resulted in a tart or a wedge of cake straight from the oven.
Fred, however, was not so easily tamed. For one thing, the orientation of his eyes being what it was, he genuinely could not see the mess he was making; for another, Fred was not going to kowtow to anyone. He would grin at Mrs B. wickedly, suck his tooth, slap her ample bottom, and chuckle, “Come off it, old girl.” Mrs B.’s glare would turn into a shout, “You ge’ out of my kitchen you ugly mug, and stay ou’.” Unfortunately Fred couldn’t stay out, and she knew it. The coke stove was in the kitchen, and he was responsible for stoking it, raking it out, opening and shutting the flues, and generally keeping it in good order. As Mrs B. did much of her cooking, and all of her baking, on that stove, she knew that she was dependent on him. So a strained truce prevailed between them. Only occasionally - about twice a week - a shouting match erupted. I noticed with interest that during these altercations neither of them swore - no doubt this was out of respect for the nuns. Had they been in any other environment, I felt sure the air would have been blue with obscenities.
Fred’s duties were morning and evening for boiler stoking and extra time by arrangement for odd jobs. He came in seven days a week for the boiler, and the job suited him very well. It was a steady job, but it also allowed him plenty of time to pursue the other activities he had built up over the years.
Fred lived with his unmarried daughter Dolly in the lower two rooms of a small house backing on to the docks. He had been called up during the war but, due to his eyesight, had been unable to enter the armed services. He was therefore consigned to the Pioneer Corps, where, if Fred is to be believed, he spent six years serving King and Country by cleaning out latrines.
Compassionate leave was granted to him in 1942, when his wife and three of their six children were killed by a direct hit. He was able to spend a little time with his three living children, who were shocked and traumatised, in a hostel in North London before they were evacuated to Somerset, and he was ordered back to the latrines.
After the war, he took two cheap rooms and brought up the remains of his family single-handed. It was never easy for him to find a regular job, because his eyesight was erratic, and because he would not commit himself to be away from home for long hours - he knew that his children needed him. So he had developed a wide range of money-making activities, some of which were legal.
Whilst we, the lay staff, took our breakfast in the kitchen, Fred was generally attending to his boiler, so there was plenty of opportunity to press him for stories, which we did unashamedly, being young and inquisitive. For his part Fred would always oblige, as he clearly loved spinning his yarns, often prefaced by, “You’re never going to believe this one.” A laughing audience of four young girls was music to his ears. Young girls will laugh at anything!
One of his regular jobs, and the best paid he assured us, as it was highly skilled, was that of a cooper’s barrel bottom knocker for Whitbreads the brewer. Trixie, the sceptic, snapped, “I’ll knock your bottom for you”, but Chummy swallowed it whole and said gravely, “Actually, it sounds frightfully interesting. Do tell us more.” Fred liked Chummy, and called her “Lofty”.
“Well, these here beer barrels, like, they’ve gotta be sound, like, and the only way of testin’ ’em is by knockin’ the bottoms and listening. If it comes up wiv one note, it’s sound. If it comes up wiv anover, it’s faul’y. See? Easy, bu’ I can tell you, it takes years of experience.”
We had seen Fred in the market selling onions, but did not know that he grew them. Having the ground floor of a small house gave him a small garden, which was given over to onions. He had tried potatoes - “no money in spuds” - but onions proved to be a money-maker. He also kept chickens and sold the eggs, and the birds as well. He wouldn’t sell to a butcher, “I’m not ’aving no one take ’alf the profits”, but sold directly to the market. He wouldn’t take a stall either, “I’m not paying no bleedin’ rent to the council”, and laid a blanket on the floor in any space available, selling his onions, eggs and chickens from there.
Chickens led to quails, which he supplied to West End restaurants. Quails are delicate birds, requiring warmth, so he kept them in the house. Being small, they do not need much space, so he bred and reared them in boxes which he kept under the bed. He slaughtered and plucked them in the kitchen.
Chummy, always eager, said, “You know, I think that’s frightfully clever, actually. But wouldn’t it be a bit whiffy, what?”
Trixi cut her short. “Oh, shut up. We’re having our breakfast,” and reached for the cornflakes.
Fred’s enthusiasm for drains was enough to put anyone off their breakfast. Cleaning out drains was obviously a passion, and his north-east eye gleamed as he poured out the effluvial details. Trixie said, “I’ll stuff you down a drain, if you don’t watch it,” and made for the door, toast in hand. But Fred, a poet with rod and suction, was not to be discouraged. “The best job I ever had was up in Hampstead, see? One of them posh houses. Lady’s real la-di-da, toffee-nosed. I lifts up the man’ole cover an’ there it is, like, fillin’ the whole chamber: a frenchy - a rubber, you know - caught at the inflow end, an’ blown up with muck an’ water. Huge, it was, huge.”
His eyes rolled expressively at their different angles as he expanded his arms. Chummy shared his enthusiasm, but not his meaning.
“You never seen nuffink like it, a yard long, an’ a foot wide, strike me dead. Ve lady, ever so posh like, looks at it an’ says ‘oh dear, whatever can it be?’ an’ I says ‘well if you don’t know, lady, you musta bin asleep’ an’ she says ‘don’t you be saucy, my good fellow’. Well, I gets the thing out, an’ charges her double, an’ she pays up like a lamb.”
He grinned impi
shly, rubbed his hands together, and sucked his tooth.
“Oh, jolly well done, Fred, good for you. It was frightfully clever getting double the fee, actually.”
Fred’s best line, with the highest profit margin, had been fireworks. His unit of the Pioneer Corps had been attached to the Royal Engineers in North Africa for a time. Explosives had been in daily use. Anyone, however humble, working with the REs, is bound to learn something about explosives and Fred had picked up enough to give him confidence to embark on fireworks manufacture in the kitchen of his little house after the war.
“S’easy. You just need a load of the right kind of fertiliser, an’ a touch of this an mix it wiv a bi’ of that an’ bingo, you’ve got yer bang.”
Chummy said, wide-eyed with apprehension: “But isn’t it frightfully dangerous, actually, Fred?”
“Nah, nah, not if you knows what you is a-doin’, like what I does. Sold like nobody’s business, they did, all over Poplar. Everyone was wantin’ ’em. I could’ve made a fortune if they’d left me alone, the bleeders, beggin’ yer pardon, miss.”
“Who? What happened?”
“Rozzers, police, got ’old of some of me fireworks an’ tested ’em, an’ sez they was dangerous, an’ I was endangering ’uman life. I asks you - I asks you. Would I do anyfing like that, now? Would I?” He looked up from his position on the floor, and spread out his ash-covered hands in innocent appeal.
“Of course not Fred,” we all chorused. “What happened?”
“Well, they charged me, din’t they, but the magistrate, he lets me off wiv a fine, like, because I ’ad three kids. He was a good bloke, he was, the magistrate, but he says I would go to prison if I does it again, kids or no kids. So I never done it no more.”
His most recent economic adventure had been in toffee apples, and very successful it was, too. Dolly made the toffee mixture in the little kitchen, while Fred purchased crates of cheap apples from Covent Garden. All that was needed was a stick to put the apple on, dip it in the toffee, and in no time at all rows of toffee apples were lined up on the draining board. Fred couldn’t imagine why he hadn’t thought of it before. It was a winner. One-hundred per cent profit margin and assured sales with the large number of children around. He foresaw a rosy future with unlimited sales and profits.
Call The Midwife: A True Story Of The East End In The 1950S Page 10