Farewell To The East End

BACK-STREET ABORTIONS

A woman’s right to control her own body is so taken for granted now that younger people can scarcely believe that abortion used to be a criminal offence in the UK punishable by a prison sentence for the woman and the abortionist. The Criminal Abortion Act of 1803 was law for 165 years. It was only repealed in 1967.

There have always been women who wanted or needed an abortion. For rich women it was relatively easy – a clandestine visit to a secret address, often abroad, where a doctor working in an unregistered clinic would operate illegally, and usually successfully, leaving little damage to the woman. Sometimes it was possible to procure an abortion legally if two doctors, one a psychiatrist, would testify that the woman seeking the abortion was mentally and physically incapable of carrying the pregnancy to full term. It cost a lot of money, but the risk of prosecution was removed.

For poor women it was a different story. Most working-class people lived in a perpetual state of poverty, the whole family crowded into one, two or at most three rooms, with not enough food, lighting or heating. Contraception was inadequate, and women had too many children, far more than they could decently house or feed. Another baby was frequently a disaster. For single women pregnancy was a catastrophe, and many preferred suicide to the stigma of bearing an illegitimate child.

So millions of women sought an abortion. The first method attempted was usually a simple vaginal douche. But this was unlikely to work, because the fluid has to enter the uterus to be effective. If a caustic solution was used it caused chemical burns to the vagina and cervix.

Thousands of women tried medicinal ways of evacuating the uterus. Violent purgatives, such as a pint of Epsom Salts, were used. Gin and ginger, turpentine, raw spirit, aloes and sloes were also employed. None of them worked. Disreputable newspapers and journals advertised what they called ‘cures for menstrual blockage’ for a sum of money. These were poisonous and sometimes fatal. Quinine was common, and some ‘cures’ even contained arsenic or mercury.

‘Wise women’ have known for millennia that the black fungal growth on rye grain will induce an abortion. It was called ‘ergot’, and was also known to cause the deadly disease commonly called St Anthony’s Fire. When I was a young pupil midwife doing my theoretical training at a teaching hospital, a colleague was having an affair with a doctor and she became pregnant. She stole a bottle of ergometrine from the ward medicine cupboard and took the tablets over a period of days until she aborted. She became terribly ill, but such was her desperation that she continued working throughout. If Matron had discovered that she was pregnant, my colleague would have been dismissed, and if it had come to light that she had been stealing ergometrine, her name would have been removed from the register (she was an SRN) and very likely reported to the police for prosecution under the Criminal Abortion Act.

Some women tried violent methods, such as falling downstairs, or half drowning, or taking a scalding hot bath, in the hope that they would provoke a spontaneous miscarriage. If the woman survived, she would usually still be pregnant, because one would virtually have to kill the mother before the foetus could be destroyed.

Driven to extremes by despair, women would go to unbelievable lengths in trying to make themselves miscarry. Knitting needles, crochet hooks, metal coathangers, paper knives, pickle spoons, curved upholstery needles, spokes of bicycle wheels have all been forced into the uterus by desperate women who preferred to do anything rather than continue the pregnancy.

How any woman could push an instrument through the closed os of her own cervix is more than I can imagine – but it has been done, times without number, sometimes successfully.

I have given talks to women’s groups on the early days of midwifery. In the course of many of these talks, some lady in the audience has told us a story about a grandmother or great aunt who had induced an abortion on herself. I have heard many such stories, and in diverse circumstances, and they are all so dismally similar that the oral evidence cannot be in doubt.

One story, related by a lady at a Women’s Institute meeting, will suffice: ‘My aunt was a respectable single woman of thirty-five living with her mother, who was very proud of the family reputation. While on holiday my aunt became pregnant and tried to abort herself with a crochet hook. She bled profusely, and her mother found out what was going on. The old lady was so horrified at what the neighbours might say that at first she refused to call a doctor. It was not until it became obvious that her daughter would die that, in great secrecy, she summoned a doctor who performed an evacuation of the uterus and suturing on the kitchen table of their home, Afterwards he said, “this must not go beyond the walls of this house. No one but we three will know what has happened tonight.” The story was not told in the family for forty years.’

The doctor had saved the woman’s life but he had risked his career in doing so. Had the story become known and his name reported to the General Medical Council he would have been brought up before a disciplinary committee for professional misconduct. He might have got away with it by pleading that it was a life-saving emergency operation, but there would have been no certainty of exoneration and whatever the outcome such an experience would have been traumatic for a conscientious doctor.

The alternative to attempting to make oneself miscarry was a visit to an illegal abortionist. Back-street abortionists favoured one of two methods: the surgical procedure or the flushing-out method. Both are highly dangerous, and only a doctor trained in surgery is competent to conduct an abortion. However, that did not stop countless numbers of women practising for a fee. They had a vague idea of female anatomy and operated with improvised instruments such as those described, or with obsolete instruments often stolen from a hospital. There was no sterility, no anaesthetic, no proper lighting, and operations frequently took place on kitchen tables.

It is easy to push a metal object into the vagina, but the cervix lies at nearly a ninety-degree angle to the vaginal wall. Without surgical knowledge the instruments could easily miss the cervix and go straight through the vaginal wall. Working blind, abortionists had been known to push a sharp object into the bladder or rectum. If the instrument did enter the uterus, it was sometimes pushed right through and out the other side. Even if all these hazards were avoided, bleeding was frequently uncontrollable.

In my book Call the Midwife, I recall meeting Mary, a young Irish girl who was lured into prostitution. She told me the tragic story of her only friend in the brothel, who became pregnant. The madam called in an abortionist, who used the surgical method. The girl haemorrhaged and died in Mary’s arms. Her body disappeared, and no one was prosecuted.

In 2004 a film about an abortionist – Vera Drake – was released. It is a brilliant film exploring the social dilemmas of the time. The film is probably regarded by millions as an accurate template of back-street abortions in the 1950s, but it does contain inaccuracies.

In the film, the flushing-out method was favoured. Vera Drake was seen supposedly pumping a solution of carbolic soap and water into a woman’s uterus with a Higginson’s syringe. But what she was doing was no more than a simple vaginal douche, which was unlikely to have any effect on the course of pregnancy because the fluid would only enter the vagina, not the uterus.

Flushing-out may seem less traumatic than the surgical method – in the film it is made to look very simple, even gentle – but it is still fraught with danger. Firstly, the caustic solution has to be exactly right; too weak and it will have no effect, too strong and it will burn the mucosa of the internal organs. Secondly the quantity of fluid and the rate of introduction into the uterus have to be accurate. One of the most severe pains a human being can endure is the sudden distension of a hollow organ. If too much fluid is pumped too fast into the uterus it could cause shock, a sudden drop in blood pressure, heart failure and even death.

At a talk I gave to the East London History Society in 2006, a woman in the audience told us that, in the 1930s, in the small Essex village where she was born, there was a bona fide midwife who was also an abortionist. She was a good practitioner, experienced and respected. A mother in the village came to her and said that her fourteen-year-old daughter was pregnant and begged her to carry out an abortion. The woman did not want to, but the mother pleaded so earnestly that eventually she agreed. The flushing-out method was used, and the girl died on the table. Mother and abortionist were sent to prison.

As nurses and midwives we often had to clear up the mess after a bungled abortion, especially when we worked on gynaecological wards. The outcome for these women was frequently chronic ill health. Conditions such as anaemia, scar tissue with adhesions, prolapse with chronic pain, incontinence, cystitis or nephritis could be expected, along with many others. Thrombosis of the leg was not uncommon. This could lead to a clot travelling in the bloodstream and lodging in the lungs. Anticoagulants were not available until the 1950s.

I have seen much mutilation and two deaths. The first was a girl of nineteen whose internal mucosa and cervix had been burned by a carbolic acid or some other caustic solution used during a flushing-out abortion. There was little we could do, and she lingered for a while, but she was in constant agony and died after a few days.

I recall another tragic woman, the mother of five children, who developed a massive sac of pus in the peritoneum after a surgical abortion. We tried to drain it without success, and for many weeks pus oozed from her abdomen. The five children coming into hospital just before their mother died can never be forgotten.

The Criminal Abortion Act 1803 was repealed in 1967. Knowing that I had been a midwife I was sometimes asked if I approved of it or not. My reply was that I did not regard it as a moral issue, but as a medical issue. A minority of women will always want an abortion. Therefore it must be done properly.[13]