Call The Midwife: A True Story Of The East End In The 1950S

MORNING VISITS

It was about 6 a.m. when I arrived back at Nonnatus House after Muriel’s delivery, and I was ravenous. A night’s work, and a six to eight mile cycle ride can sharpen a young appetite like nothing else. The house was quiet when I entered. The nuns were in Chapel, and the lay staff not yet up. I was tired, but I knew that I had to clean my delivery bag, wash and sterilise my instruments, complete my notes and leave them on the office desk before I could eat.

Breakfast was laid out in the dining room, and I would take mine first, then go to bed for a few hours. I raided the larder. A pot of tea, boiled eggs, toast, home-made gooseberry jam, cornflakes, home-made yoghurt and scones. Heaven! Nuns always have a lot of home-made food, I had discovered. The preserves came from the many church bazaars and sales that seemed to go on throughout the year. The delicious cakes and biscuits and crunchy bread were made either by the nuns or by the many local women who came in to work at Nonnatus House. Any staff who had missed a meal through being called out had a free run of the larder. I was deeply grateful for this liberality, which was so unlike hospitals, where you had to plead for a bit of food if you had missed a meal for any reason.

It was a royal feast. I left a note asking to be called at about 11.30 a.m., and persuaded my tired legs to carry me up to my bedroom. I slept like a baby, and when someone roused me with a cup of tea, I couldn’t remember where I was. The tea reminded me. Only the kind Sisters would send a cup of tea up to a nurse who had been working all night. In hospital it would be a bang on the door, and that would be that.

Downstairs I looked at the daybook. Only three calls before lunch. One to Muriel, and two visits to patients in the tenements that I would pass on the way. Four hours of sleep had refreshed me completely, and I got out the bike and cycled off in high spirits in the sunshine.

The tenements were always grim looking, whatever the weather. They were constructed as a four-sided building with an opening on one side, all the flats faced inwards. The buildings were about six storeys high, and sunlight seldom reached the inner courtyard, which was the social centre for the tenement dwellers. The courtyard contained all the washing lines and as there were literally hundreds of flats in each block, they were never without loads of washing flapping in the wind. The dustbins were also in the courtyard.

In the times I am writing about, the 1950s, there was a lavatory and running cold water in each flat. Before the introduction of these facilities, the lavatories and water were in the courtyard, and everyone had to go down to use them. Some of the tenements still retained the lavatory sheds, which were now used to house bikes or motor cycles. There did not seem many of them - perhaps three dozen at the most, and I wondered how there could have been enough lavatories for the occupants of about five hundred flats.

I threaded my way through the washing, and reached the stairway that I wanted. All the stairways were external, made of stone steps, and led up to a balcony, facing inwards, which ran the length of the building, going round all the corners, continuously. Each of the flats led off this balcony. Whereas the inner courtyard was the centre of social life, the balconies were the lanes, teeming with life and gossip. The balconies for the tenement women were equivalent to the streets of the terraced house dwellers. So close was the living space, that I doubt if anyone could get away with anything without all the neighbours knowing. The outside world held very little interest for the East Enders, and so other peoples’ business was the primary topic of conversation - for most it was the only interest, the only amusement or diversion. It is not surprising that savage fighting frequently broke out in the tenements.

The tenements looked unusually cheerful in the noonday sun when I arrived that day. I picked my way through the litter and dustbins and washing in the courtyard. Small children crowded around. The midwife’s delivery bag was an object of intense interest - they thought we carried the baby in it.

I found my entry, and climbed the five storeys to the flat I wanted.

All the flats were more or less the same: two or three rooms leading off each other. A stone sink in one corner of the main room; a gas stove and a cupboard constituting the kitchen. The lavatories, when they were introduced, had to be installed near the water supply, so they were situated in a corner, near to the sink. The installation of lavatories in each flat had been a great leap forward in public hygiene, because it improved the conditions in the courtyard. It also avoided the necessity of chamber pots in every flat which had to be emptied daily, the women carrying them downstairs to the emptying troughs. The ordure in the courtyards used to be disgusting, I was told.

The tenements of London’s East End were built around the 1850s, mainly to house the dock workers and their families. In their day, they were probably considered to be adequate housing, quite sufficient for any family. They were certainly an improvement on the mud-floor hovels that they replaced, which barely protected a family from the elements. The tenements were brick built with a slate roof. Rain did not penetrate and they were dry inside. I have no doubt that 150 years ago, they were ever considered to be luxurious. A large family of ten to twelve people in two or three rooms would not have been judged as overcrowding. After all, the vast majority of mankind has lived in such conditions throughout history.

But times change, and by the 1950s the tenements were considered to be slum areas. The rents were a lot cheaper than the terraced houses, and consequently only the poorest families, those least able to cope, entered the tenements. Social law seems to suggest that the poorest families are often the ones that produce the greatest number of children, and the tenements were always teeming with them. Infectious diseases ran through the buildings like wildfire. So did the pests: fleas, body lice, ticks, scabies, crabs, mice, rats, and cockroaches. The pest control men from the council were always busy. The tenements were deemed unfit for human habitation and evacuated in the 1960s, and stood empty for over a decade. They were finally demolished in 1982.

Edith was small and stringy, and as tough as old boots. She looked a good deal older than forty years. She had brought up six children. During the war they had been bombed out of a terraced house, but it had not been a direct hit, and the family had survived. The children were then evacuated. Her husband was a dock labourer, and she was a munitions worker. After the bombing, she and her husband had moved into the tenements, which were cheaper to rent. They both lived there throughout the entire Blitz, and miraculously the tenements, which were the most densely populated dwellings, were not hit. Edith did not see her children for five years, but they were reunited in 1945. The family continued to live in the tenements, because of the rent, and because they had become used to the life. How anyone could manage in two rooms with six growing children was always beyond my understanding. But they did, and thought nothing of it.

She had not been pleased to fall pregnant again, in fact she was furious, but like most women who have a baby late in life, she was besotted with the little thing when he arrived, and cooed over him all the time. The flat was hung with nappies all over the place - there were no disposable nappies in those days - and a pram further reduced the living space in the crowded room.

Edith was up and doing. It was her tenth day after delivery. We kept mothers in bed for a long time after delivery in those days - ten to fourteen days known as the “lying-in” period. Medically speaking, this was not good practice, as it is far better for a woman to get moving as soon as possible, thus reducing the risk of complications such as thrombosis. But this was not known back then, and it had been traditional to keep women in bed after a birth. The great advantage was that it gave the woman a proper, and well-earned, rest. Other people had to do all the household chores, and for a brief period, she could lead a life of idleness. She needed to gather her strength, because once she was on her feet again, everything would devolve to her. When you consider the physical effort required to carry all the shopping up those stairs: coal and wood in the winter, paraffin for stoves, or rubbish carried down to the dustbins in the courtyard; if you consider the fact that to take the baby out, the pram had to be bumped down the stairs, one step at a time, and then bumped up again to get home, often loaded with groceries, as well as the baby, you might begin to understand how tough those women had to be. Almost every time you entered the tenements, you would see a woman bumping a big pram up or down. If they lived at the top, this would mean about seventy steps each way. The prams had big wheels, which made it possible, and were well sprung, which bounced the baby around. The babies loved it, and laughed and shrieked with glee. It was also dangerous if the steps were slippery, because the whole weight of the pram had to be controlled by the handle, and if the mother missed her footing or something happened and she let go, the pram and baby would go cascading down the length of the steps. I always helped when I saw a woman with a pram by taking the other end, therefore half the weight, which was considerable. The whole weight, for a woman alone, must have been tremendous.

Edith was in a grubby dressing gown, down-trodden slippers and hair curlers. She was simultaneously feeding her baby and smoking. The radio was blaring out pop music. She looked perfectly happy. In fact she looked a better colour, and younger than she had a couple of months earlier. The rest had obviously done her good.

“Hello, luvvy. Come on in. How about a nice cup of tea?”

I explained that I had other calls to make and declined the tea. I was able to see how feeding was going. The baby was sucking voraciously, but it struck me that Edith’s thin little breasts probably did not contain much milk. However, it was far better for her to continue than to put the baby on to formula milk straight away, so I said nothing. If the baby fails to gain weight, or shows real signs of hunger, we can talk about it then, I thought. It was our practice to visit each day post-natally for a minimum of fourteen days, so we saw a lot of each patient.

It became the fashion about that time to put babies on to formula milk, and to suggest to the mother that this would be best for the baby. The Midwives of St Raymund Nonnatus did not go down this path, however, and all our patients were advised and helped to breastfeed for as long as possible. A fortnight of rest in bed helped to facilitate this, as the mother was not tiring herself by rushing around, and all her physical resources could go into producing milk for the baby.

As I glanced around the crowded room, the minimal kitchen area, and the general lack of facilities, it flashed through my mind that bottle-feeding would be the worst thing for the baby. Where on earth would Edith keep bottles, and tins of formula milk? How would she sterilise them? Would she bother to? Or even bother to keep them clean, never mind sterilising? There was no refrigerator, and I could well imagine bottles of half-consumed milk left lying around the place, to be given a second or third time to the baby, with no thought to the fact that bacteria quickly builds up in milk that has been left to go cold, and then warmed up again. No, breastfeeding would be much safer, even if there was not quite enough milk.

I remember lectures during my Part I midwifery training about the advantages of bottle-feeding, which sounded very convincing. When I first came to work with the Nonnatus Midwives, I thought them very old fashioned in always recommending breastfeeding. I had not taken into account the social conditions in which the Sisters worked. The lecturers were not dealing with real life. They were dealing with classroom situations and ideal young mothers who existed only in the imagination, from educated middle-class backgrounds, women who would remember all the rules, and do everything they were told to do. These classroom pundits were remote from silly young girls who would get the formula mixed up, get the measurements wrong, fail to boil the water, be unable to sterilise the bottles or the teats, fail to wash the bottles. Such theorists could not even imagine a half-empty bottle being left for twenty-four hours, then given to the baby, nor envisage a bottle rolling across the floor, picking up cat hairs, or any other dirt. Our lecturers never mentioned to us the possibility of anything else being added to the formula, such as sugar, honey, rice, treacle, condensed milk, semolina, alcohol, aspirin, Horlicks, Ovaltine. Perhaps such a possibility had never come the way of the writers of these textbooks. But they had been encountered often enough by the Nonnatus nuns.

Edith and her baby looked quite happy, so I did not disturb them, but said we would call the next day to weigh the baby, and to examine her.

I had another visit to make, to Molly Pearce, a girl of nineteen who was expecting her third baby and who had not turned up at the antenatal clinic for the last three months. As she was very near to full term, we needed to assess her.

There was noise coming from inside the door as I approached. It sounded like a row. I’ve always hated any sort of row or scene, and instinctively shrank away. But I had a job to do, so I knocked on the door. Instantly there was silence inside. It lasted a couple of minutes, and the silence seemed more menacing than the noise. I knocked again. Still silence, then a bolt pulled back, and a key turned - it was one of the few times I had known a door to be locked in the East End.

The unshaven face of a surly looking man stared suspiciously at me through a crack in the door. Then he swore obscenely, and spat on the floor at my feet, and made off down the balcony towards the staircase. The girl came towards me. She looked hot and flushed, and was panting slightly. “Good riddance,” she shouted down the balcony, and kicked the doorpost.

She looked about nine months pregnant, and it occurred to me that rows of that sort could put her into labour, especially if violence was involved. But I had no evidence of that, as yet. I asked if I could examine her, as she had not been to antenatal clinic. She reluctantly agreed, and let me into the flat.

The stench inside was overpowering. It was a foul mixture of sweat, urine, faeces, cigarettes, alcohol, paraffin, stale food, sour milk, and unwashed clothes. Obviously Molly was a real slattern. The vast majority of women that I met had a true pride in themselves and their homes, and worked desperately hard. But not Molly. She had no such home-making instincts.

She led me into the bedroom, which was dark. The bed was filthy. There was no bed linen, just the bare mattress and pillows. Some grey army surplus blankets lay on the bed and a wooden cot stood in the corner. This is no place for a delivery, I thought to myself. It had been assessed as adequate by a midwife some months earlier, but quite obviously the domestic conditions had deteriorated since that time. I would have to report back to the Sisters.

I asked Molly to loosen her clothes and lie down. As she did so, I noticed a great black bruise on her chest. I enquired how it had happened. She snarled and tossed her head. ”’Im,” she said, and spat on the floor. She offered no other information, and lay down. Perhaps my unexpected arrival has saved her from another blow, I thought.

I examined her. The baby’s head was well down, the position seemed to be normal, and I could feel movement. I listened for the foetal heart, which was a steady 126 per minute. She and the baby seemed quite normal and healthy, in spite of everything.

It was only then that I noticed the children. I heard something in the corner of the dark bedroom, and nearly jumped out of my skin. I thought it was a rat. I focused my eyes in that direction, and saw two little faces peering round from behind a chair. Molly heard my gasp, and said, “It’s all right. Tom, come ’ere.”

But, of course, there must be young children around, I thought. This was her third pregnancy, and she was only nineteen, so they would be under school age. Why hadn’t I noticed them before?

Two little boys of about two or three years old came out from behind the chair. They were absolutely silent. Boys of that age usually rush around, making no end of noise, but not these two. Their silence was unnatural. They had big eyes, full of fear, and they took a step or two forward, then clung to each other as though for mutual protection and retreated behind the chair again.

“That’s all right, kids, it’s only the nurse. She won’t hurt you. Come ’ere.”

They came out again, two dirty little boys, with snot and tear marks staining their faces. They were wearing only jumpers, a practice I had seen a lot in Poplar, and for some reason I found it particularly repellent. A toddler was dressed only at the top, and left naked from the waist down. It seemed to be especially prevalent among little boys. I was told that the women saved on washing this way. The child, before he was toilet trained, could then just urinate anywhere, and there would be no nappies or clothes to wash. Children would run around the tenement balconies and courtyards all day like this.

Tom and his little brother crept out from the corner, and ran to their mother. They seemed to be losing their fear. She put out an arm affectionately and they cuddled up to her. Well at least she’s got some mothering instincts, I thought. I wondered how much time those little children spent behind the chair when their father was at home.

But I was not a health visitor, nor a social worker, and there was no point in speculating on that sort of thing. I resolved to report my observations to the Sisters, and told Molly that we would come back later that week, to ascertain that everything was available for a home delivery.

I still had Muriel to visit, and it was with great relief that I left the foul atmosphere of that flat.

The bright cold air outside and the cycle ride down to the Isle of Dogs refreshed my spirits, and I sped along.

“Hello, luvvy, how’s yourself?” was the greeting shouted at me by several women, known and unknown to me. This was always the greeting called out from the pavement. “Lovely, thanks, ah’s yerself?” I always replied. It was difficult not to slip into the cockney lingo.

I don’t believe it, I said to myself, as I turned into Muriel’s street, she can’t be here already. Sure enough, Mrs Jenkins was there with her stick and her string bag, her head scarf over her curlers, and the same old long mildew-encrusted coat that she wore summer and winter. She was talking to a woman in the street, hanging intently on to to every word. She saw me slow down and came up to me and grabbed my sleeve with her filthy, long nailed hands.

“How is she, and the little one?” she rasped.

I was impatient, and pulled my arm away. Mrs Jenkins turned up at every delivery. No matter how far the distance, how bad the weather, how early or late in the day, Mrs Jenkins would always be seen hanging around the street. No one knew where she lived, or how she got her information, or how she managed to walk, sometimes three or four miles, to a house where a baby had been born. But she always did.

I was irritated and passed her without speaking. I regarded her as a nosy old busybody. I was young, too young to understand. Too young to see the pain in her eyes, or to hear the tortured urgency in her voice.

“’Ow is she? An’ ve li’l one. ‘Ow’s ve li’l one?”

I went directly into the house without even knocking, and Muriel’s mother immediately came forward, busy and smiling. These older generation mothers knew that they were absolutely indispensable at times like these, and it gave them a great sense of fulfilment, an ongoing purpose in life. She was all bustle and information. “She’s been asleep since you left. She’s been to the toilet and passed water. She’s had some tea and now I’m getting her a nice bit of fish. Baby’s been to the breast, I’ve seen to that, but she aint got no milk yet.”

I thanked her and went up to the room. It looked clean, fresh and bright, with flowers on the chest of drawers. Compared to the filth and squalor of Molly’s flat, it looked like paradise.

Muriel was awake but sleepy. Her first words to me were, “I don’t want no fish. Can’t you tell mum that? I don’t feel like it, but she won’t listen to me. She might listen to you.”

Clearly there was a difference of opinion between mother and daughter. I did not want to be involved. I checked her pulse and blood pressure - normal. Her vaginal discharge was not excessive; the uterus felt normal too. I checked her breasts. A little colostrum was coming out but no milk, as her mother had said. I wanted to try to get the baby to feed, in fact that was the main purpose of my visit.

In the cot the baby was sleeping soundly. Gone was the puckered appearance, the discoloration of the skin from the stress and trauma of birth, the cries of alarm and fear at entering this world. He was relaxed and warm and peaceful. Nearly everyone will say that seeing a newborn baby has an effect on them, ranging from awe to astonishment. The helplessness of the newborn human infant has always made an impression on me. All other mammals have a certain amount of autonomy at birth. Many animals, within an hour or two of birth, are up on their feet and running. Others, at the very least, can find the nipple and suck. But the human baby can’t even do that. If the nipple or teat is not actually placed in the baby’s mouth and sucking encouraged, the baby would die of starvation. I have a theory that all human babies are born prematurely. Given the human life span - three score years and ten - to be comparable with other animals of similar longevity, human gestation should be about two years. But the human head is so big by the age of two that no woman could deliver it. So our babies are born prematurely, in a state of utter helplessness.

I lifted the tiny creature from his cot and brought him to Muriel. She knew what to do, and had started squeezing a little colostrum from the nipple. We tried brushing a little of this over the baby’s lips. He was not interested, only squirmed and turned his head away. We tried again, with the same reaction. It took at least a quarter of an hour of patiently trying to encourage the baby, but eventually, we persuaded him to open his mouth sufficiently to insert the nipple. He took about three sucks, and went off to sleep again. Sound asleep, as though exhausted from all his efforts. Muriel and I laughed.

“You would think he’d been doing all the hard work,” she said, “not you and me, eh, nurse?”

We agreed to leave it for the time being. I would be back again in the evening, and she could try again during the afternoon, if she wanted to.

As I went downstairs, I smelt cooking. It may not have been to Muriel’s liking, but it certainly got my gastric juices going. I was starving, and a delicious lunch awaited me at Nonnatus House. I bade them goodbye, and made for my bicycle. Mrs Jenkins was standing over it, as though she were keeping guard. How am I going to get rid of her? I thought. I didn’t want to talk. I just wanted to get back to my lunch, but she was hanging on to the saddle. Clearly she was not going to let me go without some information.

“’Ow is she? An’ ve li’l one. ‘Ow’s ve li’l one?” she hissed at me, her eyes unblinking.

There is something about obsessive behaviour that is off-putting. Mrs Jenkins was more than that. She was repellent. About seventy, she was tiny and bent, and her black eyes penetrated me, shattering any pleasant thoughts of lunch. She was toothless and ugly, in my arrogant opinion, and her filthy claw-like hands were creeping down my sleeve, getting unpleasantly close to my wrists. I pulled myself to my full height, which was nearly twice hers, and said in a cold professional voice, “Mrs Smith has been safely delivered of a little boy. Mother and baby are both well. Now, if you will excuse me, I must go.”

“Fank Gawd,” she said, and released my coat sleeve and my bicycle. She said nothing else.

Crazy old thing, I thought crossly as I rode off. She ought not to be allowed out.

It was not until about a year later, when I was a general district nurse, that I learned more about Mrs Jenkins . . . and learned a little humility.