Farewell To The East End

by Jennifer Worth

  We continued plodding along, circling around a group of little girls playing hop-scotch.

  ‘Two policemen arrived. They took notes and spoke with the doctor. Then they questioned me. It was awful. They weren’t nasty or bullying or anything like that ... it was just being questioned about a death, and seeing them write down everything I said that was so awful. I must have looked as white as a sheet, because the doctor was very kind and assured me that I was in no way at fault. I had been asked to tell them everything I knew, you see. They asked to see my records, and took my notes away with them. I think I had filled in everything correctly. I don’t know. It’s like a bad dream.’

  She looked ill.

  ‘You need a good hot cup of tea,’ I said, ‘We’re nearly at the convent – good thing too. You look just about finished.’

  ‘It’s the shock, I suppose.’

  ‘I’ll say it is!’

  ‘I’m cold, too.’

  ‘Not surprising. You had no sleep last night?’

  ‘A couple of hours, then I had to go out.’

  By now we had reached Nonnatus House. I took both the bikes to put them away. Cynthia said she had to report to Sister Julienne as soon as she got in.

  In the bicycle shed Sister Bernadette was putting her bike away.

  ‘Ah, Nurse Lee. Just the person I wanted to speak to. Did I see you cycling with no hands down the East India Dock Road?’

  Sister Bernadette was a midwife whom I both respected and admired, but she could be very sharp.

  ‘Me? Oh, er, well perhaps ...’

  ‘I am sure it was you. I can’t think of any other midwife who would cycle in that nonchalant fashion down the main road. And were you whistling by any chance?’

  ‘Whistling? Well, I’m not sure. I can’t quite remember, but I suppose I might have been.’

  ‘You certainly were. Now look here, Nurse Lee, you are not one of the local lads. You are a professional woman. They can do that sort of thing, but you can’t. It’s too casual, too lackadaisical. It gives the wrong impression. It simply won’t do.’

  ‘I’m sorry, Sister.’

  ‘Don’t do it again, Nurse.’

  ‘No, Sister. I won’t, Sister.’

  But I did, and I’m sure she knew that I did!

  Cynthia did not come in for lunch. She had been sent to bed with a couple of aspirins and some hot chocolate. Sister Julienne said grace and when we were seated told everyone what had happened.

  ‘Humph,’ grunted Sister Evangelina, ‘alive and healthy at six o’clock. Dead at ten. Sounds like smothering to me.’

  ‘Oh no, Sister. I am sure you are wrong. They are a nice family. They wanted the baby. They wouldn’t do a thing like that.’ Sister Julienne was shocked.

  ‘Can’t be sure. No one can. These secrets are well kept. There have been more unwanted babies smothered than I’ve had hot dinners. Desperation drives people to do it.’

  ‘But these people are not desperate,’ Sister Julienne replied. ‘I agree with you that desperation might lead a starving family to smother a newborn baby, but those days are past.’

  Chummy, Trixie and I were wide-eyed with interest. We had heard nothing like this before, coming as we did from middle-class backgrounds. But Sister Evangelina had been born into the slums of Reading in the 1890s and had experienced more poverty and deprivation than we could ever dream of.

  ‘But wouldn’t they be caught?’ asked Chummy.

  ‘Probably not.’ Sister Evangelina glared at Chummy, and then at Trixie and me. ‘You young girls! Ignorant! Don’t know anything of the past! So many babies were born, and so many died, that the authorities would never have noticed a few smothered here or there – especially if a relative had assisted at the birth, and no one else. The family could just say the baby was still-born.’

  ‘But why?’ asked Trixie.

  ‘I’ve told you: desperation. Poverty, starvation, homelessness, that’s what drove people to do it. Read your history books!’

  Sister Evangelina was a formidable lady. Her temper was irascible, and the fuse short. We dared not press her.

  Aristocratic Sister Monica Joan, who was in her nineties and whose mind was not entirely reliable, had eaten very little. She picked at the mashed potato and onion gravy which Mrs B had lovingly prepared for her, pushed her plate aside and sat fingering her spoon, turning it this way and that as she held it between thumb and forefinger, with the other three fingers arched fan-like. She was watching the changing light in the bowl of the spoon and the reflections of those around her. She giggled.

  ‘Now you are upside down. Now the right way up, but your face is all fat ... hee, hee, hee! Now it’s thin. This is such fun. You should have a look.’

  She appeared to be completely absorbed in the spoon and her own thoughts, and I doubted whether she had taken in a word of the previous conversation. How wrong one can be.

  Sister Monica Joan had the instincts of an actress, and her timing was impeccable. She dropped the spoon onto the table with a clatter. Everyone jumped and looked at her. She was now the focus of attention, which she relished. She looked coolly around the table at each of us, and said unhurriedly: ‘I have seen several cases of smothered babies, or perhaps I should say, where I have strongly suspected smothering, but could not prove it.’

  She looked around to judge the effect of her words.

  ‘We had a young maid at the convent – not this House, the one that was bombed out – she was a sweet girl from a respectable family. After a few months, it became clear that she was pregnant.

  She was only a girl of fourteen. We were quite shocked, but kept her on, with her mother’s approval, until her time. Then we delivered her baby in their little house. One of our Sisters delivered it, and everything appeared to be satisfactory, if an illegitimate baby in a respectable family can be described as satisfactory. At any rate, mother and baby were alive and well when the Sister left them. A few hours later a note was brought to the convent saying that the baby had passed away. The Sister went to the house and found the baby dead, and the child-mother deeply asleep. She could not be roused. It looked like a sleep induced by laudanum. An inquest was held, but nothing was proved.’

  Sister Monica Joan picked up the spoon again and turned it in the light, gazing intently at the changing shapes.

  ‘Everything looks so different from varying angles, doesn’t it? We see things one way and assume it is correct. But then, move the light just a fraction ...’, she turned the spoon slightly, ‘and you see it quite differently. Very often the death of a baby was seen as a blessing, not as a tragedy.’

  ‘Very true,’ grunted Sister Evangelina, ‘if a family already had half a dozen mouths to feed, and no food and no work, it would be a blessing.’

  ‘Poverty. Grinding, abject poverty with no end.’ Sister Monica Joan turned the spoon again, gazing at it. ‘We were the greatest empire the world had ever seen. We were the richest nation in the world. Yet turn the light just a little and you see destitution so terrible that men and women were driven to kill their own babies.’

  ‘Surely you exaggerate, Sister?’ said Sister Julienne in a shocked voice.

  Sister Monica Joan turned her elegant head and raised an eyebrow. No one could have looked less like a champion of the poor!

  ‘I do not say it happened all the time, nor that every family was guilty. But it happened. You are too young to have seen the conditions in which working people lived. A thousand people crowded into a slum street of decaying buildings with no lavatories, no furniture, no heating, no blankets, no water except the rainwater that seeped through the rotten roofs and walls and basements. And above all, never enough to eat. In this I do not exaggerate. I have seen it. And not just one street, but hundreds of them. An endless warren of slums, housing hundreds of thousands of people. Read General Booth or Henry Mayhew, if you don’t believe me! Of course babies died all the time, and of course some were helped on their way by a desperate parent. What else would you expe
ct?’

  Trixie, Chummy and I could not speak. Her words and her appearance were so compelling that nothing further could be said. But Sister Julienne spoke.

  ‘Let us thank God that those days are past. Such poverty will never be seen again in this country, though it exists in many parts of the world, especially since the last war, and we must pray for those people.’

  At that moment Mrs B came in with pudding, which she took over to Sister Julienne. Mrs B was Queen of the Kitchen – an excellent and valued cook.

  ‘I’ve made a nice junket ’ere for Sister Monica Joan. A strawberry one. I knows as ’ow she likes strawberry best.’

  ‘Junket! Ooh yummy. And strawberry too!’

  In an instant Sister Monica Joan changed into a little girl at a birthday party, contemplating the feast with gleaming eyes. She said no more about the sinister disappearance of babies, but quietly I resolved to read General Booth and Mayhew on the subject.

  Cynthia was rested, but subdued and sad, when she came down for tea at four o’clock. She carried out her evening visits as usual, and over the subsequent days she continued her duties. But we could all see that the baby’s death was weighing on her mind.

  The post-mortem report was received a week later. The baby had died of atelectasis.

  Atelectasis means a non-expansion of the lungs. It is not a disease or malfunctioning of the lungs. During foetal life the lungs are airless and collapsed (i.e. in a state of atelectasis). When the baby is born, with the first intake of breath, the lungs expand. However, small patches of atelectasis, or non-expansion could (and still can) remain for a few hours or even days, and these patches could go undetected. If the baby’s general condition was good there would be no cause to suspect a collapsed or unexpanded area of lung.

  Cynthia’s baby was full-term and breathed vigorously at birth with perhaps only three-quarters of the lung capacity; he had a good colour and a good heartbeat and cried and kicked lustily, so there was no cause for alarm. However, a newborn baby is very delicate. As he lay still and sleeping, the effort to breathe with a reduced lung capacity may have been too much for him. Breaths would have become shallower and shallower until the lower lobes of the lungs were not expanding at all. They would then collapse, causing a larger area of atelectasis to develop. Shallow breaths drawn only into the upper lobes of the lungs cannot feed sufficient oxygen into the body to sustain life. The baby would simply have breathed more slowly and more feebly, until even the upper lobes collapsed, and the baby died.

  Cynthia was completely exonerated by the post-mortem report. It confirmed that with the baby’s first breaths the greater part of the lungs had expanded but had subsequently collapsed during the four hours when the baby was alone with his mother. The question of why the mother did not notice anything unusual (for example, difficulty in breathing, change of skin colour from pink to blue to pallid white, with limpness of muscle tone) and raise the alarm was left unanswered.

  No blame was attached to Cynthia, and no fault was found in her delivery or her immediate postnatal care. However, the whole experience had a deeply depressing effect on a sensitive young girl who kept asking herself, ‘Could I, should I have done something differently?’ and the trauma did not easily go away.

  LOST BABIES

  How could a baby be born and then disappear? It seems impossible, but in fact it was not so very difficult. It would depend on who knew about the pregnancy in the first place, who knew about the birth, and whether the birth was registered or not.

  Family births have always been recorded in parish registers, but this was not obligatory. Since 1837 parents have been required to register a birth with the General Register Office, but it took nearly a century for this law to be enforced. Scarcity of medical care, the high expense of that provision, and vast numbers of births caused thousands of babies to be born and to die unregistered. Still-born babies were not registered until 1929. This made it easy for families to describe babies who had lived for a short time and subsequently died as ‘still-born’.

  In the 1870s it was estimated that, out of approximately 1.25 million births annually in the UK, only 10 per cent of women had any medical attention (another survey put the figure as low as 3 per cent). Therefore each year over a million women must have given birth with no medical attention. The death rate was enormous. In the 1870s it was estimated that in some of the poorest areas, maternal deaths were around 25-30 per cent and infant deaths around 50-60 per cent. These figures were estimated and collected by the pioneers calling for the training and registration of midwives.5

  The first Midwives Act was passed in 1902. Prior to that, midwifery was largely an untrained profession. Any woman could call herself a midwife and go around delivering babies for a fee. She was also called ‘the handy-woman’ in many communities. She had many roles and dwelled in the shadowland of respectability and the law. She was a solo private practitioner, answerable to no one. At the turn of the nineteenth century it was estimated that around 40,000 handy-women were practising in Great Britain, many of them calling themselves ‘midwives’. Some of these women had acquired a knowledge of childbirth handed down through generations, and they were good and conscientious practitioners. However, others were slatternly and often illiterate. Many women could not afford even a handy-woman, and delivered themselves, with just the help of a friend or older relative. No woman had any antenatal care, not even if she was rich, so the fact of pregnancy was not recorded.

  With this lack of medical attention it would have been easy for a baby to be born and to die without anyone knowing, apart from the immediate family, who may have had any number of reasons for wanting to conceal the birth.

  Illegitimacy was the main reason for hiding a birth. Young people today cannot imagine the disgrace that was once attached to a birth out of wedlock. So great was it that sometimes a young girl would commit suicide rather than reveal she was pregnant. Many a poor woman would conceal the pregnancy beneath her skirts, work until the day she went into labour, deliver the baby herself, and go straight back to work. If she did not register the birth, who would be any the wiser? If the baby died, as many did, who would know? The rich had a more subtle way of dealing with an errant daughter – she could be certified ‘insane’ and confined to a mental asylum for the rest of her life. The baby would then be removed and placed in a private home or orphanage, with no stain attached to the family.

  Another reason for concealing a dead baby was the expense of a funeral. A burial cost money, and every respectable working-class mother spent a few pennies each week on insurance to cover family deaths. A pauper’s grave was the ultimate disgrace, and to be thus shamed in front of her neighbours was every self-respecting woman’s dread. But many could ill-afford burial insurance, so it would be better for women caught in this trap to pretend it had never occurred and slip the little body into the river. In the 1950s I nursed a woman who had done just that thirty years earlier.6

  If the respectable poor were driven to conceal the birth and death of a baby because of the cost of registration and burial, what of the abject poor?

  In 1880 nine dead babies were found in a box on the steps of an undertaker in Long Lane, Bermondsey, East London. This was reported in all the newspapers. Would a doctor or midwife have attended the birth of these babies? Would these infants have been registered by parish or state? Could the parents, or at least the mothers, be traced? Not a chance. These nine babies would have been but a few of the nameless children thrown into an unmarked grave, the offspring of the abject poor who were destitute and starving, who were outside any census and beyond enumeration, and whom Charles Booth (1844-1916), the first social statistician, numbered at 255,000 for all London and at 1.95 million for Great Britain as a whole.7 Later surveys considered this estimate to be conservative, stating that the figure was nearer to 3 million.

  Obvious mental or physical disability was another reason for concealing a birth. Fear was the catalyst – fear, amongst the poor, of having to support a
sickly child who could contribute nothing to the family income. There was also fear of the stigma attached to having a disabled child. It was widely supposed that congenital defects were due to something vaguely sinister ‘in the blood’, which would mark the family out from its neighbours. The baby could be left to die (probably with the connivance of the mother, or the women who had helped with the birth) and then described as still-born. The father would probably have been unaware of any impairment, because men rarely had anything to do with birth in those days. ‘Women’s matters’ were taboo, a silence enforced as much by women as by men.

  The upper classes – aristocracy and royalty – were particularly fearful of the stigma of a disabled child in the family. It could lead to ostracism because of so-called ‘tainted blood’, and the upper classes were not above smothering their own babies at birth.

  Poverty led to the abandoning of babies. How much of this really went on I don’t know, but we midwives were always being told about it. The women of Poplar would say ‘Gor! You don’ wanna go dahn Lime’ouse [or Bow or Millwall or wherever]. Dreadful people vey are. Leaves ver babies on doorsteps, vey do.’ And women of Limehouse would say exactly the same about the women of Poplar! We got the impression that babies were being left in droves on the doorsteps of every other parish. However, we never saw it, and no baby was left on the convent steps during the 1950s. I personally know a lady who comes from Manchester, and was born in 1940. She tells me that she was an abandoned baby. She was found on a doorstep one morning along with the milk bottles. The baby was very sickly, but although the couple who found her were poor, they arranged for her to go into hospital and paid for the specialist baby care. Then they fostered her for the rest of her childhood.

  There are many reliable records of babies being left on workhouse steps, or at the door of one of the state-run orphanages in earlier years. These babies would be named by the workhouse and registered as ‘parents unknown’.