Farewell To The East End

SOOT

Within the midwifery practice it was noticed that several babies had developed various infections: sticky eyes, pustules, aural discharge, diarrhoea, an infected umbilical stump. Not all babies were affected, but of those that were, one became quite ill. Swabs were taken for analysis, and the report came back from the pathology lab. All the infections were caused by the same strain of staphylococcus aureus. Where was it coming from?

All Sisters and nurses had to be screened, and the analysis proved that Cynthia was carrying a staphylococcus aureus infection, which she was passing on to the babies. Gentle Cynthia was horrified that she was the cause, especially as she did not look or feel ill in any way. But the report from the lab was incontrovertible. She was taken off work straight away and treated with antibiotics, and the infection cleared.

All the babies were also treated with penicillin, and they recovered. In previous decades, before the advent of antibiotics, some of the babies affected might have died. Certainly one or two would have developed chronic otitis media, or pink eye, or a lung infection, which could lead to something worse. But antibiotics, being new in those days, were more effective.

Cynthia was off work for two weeks, and returned to the district with confidence. No more infections occurred amongst the babies.

The first case Cynthia went to on returning to work was in a comfortable little house in Bow. It was a nice sort of home to be working in and everything was going well: the young mother having her fifth baby was progressing in labour; her mother was looking after the four young children downstairs; her grandmother, an experienced matriarch for whom childbirth was less alarming than a visit to the dentist, was competently helping Cynthia. She – the grandmother – was looking at the fire.

‘Sulky ole fire, that. Needs a bi’ of life in it afore this baby’s born. We wants a nice warm room for ve new baby, eh, nurse?’

She picked up the poker, stirred the sluggish embers and opened the air vent. Flames leaped up the chimney. There was a rumbling from somewhere near the roof and a cascade of soot fell, completely dousing the fire. The grandmother screamed and rushed forward with a sheet of newspaper in an attempt to contain the soot in the grate. But there was a second rumble, louder than the first, and another fall of soot came rushing down the chimney, smothering the poor woman and flying all over the room. Cynthia’s sterile delivery equipment, carefully laid out on the chest of drawers, was covered in soot; the white bed linen was black; the lovingly prepared crib with its white lace and bows was black; Cynthia, aseptically prepared for delivery in a sterile white gown, cap, mask and gloves, was black; and the woman lying on the bed was black, although she was past caring – the second stage of labour was approaching and she was suffering a massive contraction prior to full dilation of the cervix. Cynthia gazed at the scene and raised her gloved hands in horror. Her first instinct was to wash them, and she rushed over to where the washing bowl stood. But a film of soot was floating on the water, and soot clung to the sticky wet soap. She tore off her gloves and was relieved to see clean hands.

‘Oh my Gawd,’ moaned the grandmother, ‘I never seed nuffink like it. What’s you goin’ ’a do, nurse?’

‘There is nothing I can do. If a baby is going to be born, no power in the world will stop it. We will have to continue like this. You go downstairs for some more hot water, and take this bowl with you and get it washed. You can also ask if there is any more clean linen in the house. I don’t think there will be time to get another sterile delivery pack from Nonnatus House, but you could try.’

With the last contraction the waters had broken, and viscous amniotic fluid was flowing over the absorbent mattress coverings. Falling particles of soot were rapidly sticking to it.

As Cynthia spoke particles of soot blew off her mask, so she tore the thing off. She would be better without it. The upper part of her face and eyes were black, her mouth, nose and chin were white. She looked like a comic turn.

Poor Janet, sweating profusely from the pain and pressure of advanced labour, had soot sticking to her entire body. It had even managed to penetrate beneath her nightdress. She raised her legs and vaguely rubbed her hands down her thighs, perhaps to wipe the soot away, but it only served to make thick, slimy black streaks.

‘Oh Gawd, wha’ a mess,’ she moaned, beginning to pant. ‘Vere’s anuvver contraction comin’, I can feel it. Aaah ...’ she groaned in agony.

Cynthia did not need to make a vaginal examination. She could see the head descending.

‘Don’t push, Janet, whatever you do. Just pant, quickly, like a little dog. In, out, in, out – quick, shallow breaths. That’s right, keep panting. I need to turn you over onto your left side in order to deliver the baby.’ (We were taught, in those days, to deliver on the side.)

In the meantime the grandmother had taken the washing bowl away and returned with clean hot water. She also had some clean towels and sheets.

‘We can take ’er into anuvver room, nurse.’

‘That would be nice, but I doubt if it will be possible. The baby might drop out on the landing! See here, I’m holding the head back as it is. Another contraction and it will be born.’

‘Oh Lor, vis is awful. Jim’s gone down the road to ring ve Sisters, but he’s not goin’ ’a be in time, is he?’

‘No. Just keep panting, Janet. Everything is all right. A bit of soot isn’t going to do you or the baby any harm.’

Cynthia’s warm, soft voice had a reassuring effect on the two women. The contraction was passing. Janet looked up and relaxed. She giggled, and then began to laugh uncontrollably.

‘You do look funny, you two. If only you could see yourselves ... oh no, not again ... aaah ...’

Another contraction came within seconds of the last.

‘This is it,’ she gasped, holding her breath.

‘Yes it is. Now you have to turn over quickly.’ Cynthia beckoned to the grandmother. ‘Bring me those clean towels. Can we get this dirty maternity pad out of the way and put the towels under her, so that there is a clean surface for the baby to be born onto?’

They changed the linen, but it was not so easy to contain the soot. Their hands were filthy, and touching anything made matters worse. Cynthia turned the pillow over, so that there was a clean surface on which Janet could lay her head, but even that soon got dirty as her hair streaked across it. Her grandmother tried washing Janet’s forehead in cold water, which helped a little.

The delivery was not complicated, but childbirth is sometimes a gory business and blood and amniotic fluid can get everywhere. Mixed with soot, the mess was quite indescribable. The baby, a little girl, wet and sticky, was covered in black slime, and clumps of soot. With swabs and clean water Cynthia washed it away and held the baby upside down in order to drain mucus from her throat (this procedure was thought to be helpful in those days, and we were taught to do it). The baby screamed lustily. Cynthia looked at her sterile delivery tray in despair. At this stage she would normally have cut the cord, but the scissors, clamps, swabs and sterile water were filthy.

At that moment she heard heavy footsteps on the stairs and the sound of Sister Evangelina’s voice grumbling.

‘What is all this about needing a new delivery bag? Calling me out to bring one! I’ve had to cycle half a mile to bring it. The impertinence! I suppose the nurse messed up the first one. These young midwives! Can’t be trusted to do anything properly.’

The door opened. Sister Evangelina entered, stared at the scene in disbelief, and exclaimed ‘What the devil have you been up to?’ Then she laughed. She laughed so much it shook the house. She fell against the door frame holding her stomach, then sat down on a chair and threw her head back, knocking her wimple askew.

Sister Evangelina was a large and impressive lady. She was what is usually described as a ‘rough diamond’. Born into a large family in the slums of Reading at the turn of the last century, she had grown up in desperate poverty. The First World War offered her the chance of escape from the treadmill of inherited penury. She had left school at twelve to work in a biscuit factory and at the age of fifteen had gone to work in a munitions factory. Later she had moved to a military hospital, where she trained as a nurse, and where the one romance of her life had occurred, though she never spoke of it. She joined the Sisters of St Raymund Nonnatus, becoming fully professed as a nursing nun, and had worked in Poplar for thirty years, including during the Blitz. She was a great favourite of the people of Poplar, largely because of her down-to-earth, no-nonsense approach to their ailments, her rough-and-ready ways and her crude language. Of course, she had a completely different vocabulary and use of language within the convent. In fact, with us she could be extremely dour and grumpy, and not easily given to laughter. Yet on this occasion she could not stop. Her face, which was red and mottled at the best of times, turned a deep crimson, and her nose shone like a beacon. She slapped her hand on the mantelshelf to steady herself and took out a giant-sized handkerchief with which to wipe her streaming eyes and nose. ‘Ooh, I’m peeing me drawers. You don’t know what you look like, you three – you’ve made me pee me drawers, you have.’ And off she went into paroxysms of laughter again.

Sister Evangelina also enjoyed earthy vulgarity. In fact basic bodily functions were an endless source of amusement to her. This predilection for lavatorial humour was something she shared only with her Cockney patients. Within the convent she was very prim and proper, and I doubt her Sisters in God ever saw the crude side of Sister Evangelina.

She slapped her ample thighs and leaned forwards, nearly choking. In alarm Cynthia thumped her back. When she could speak, Sister gasped, ‘Talk about the Black and White Minstrel Show – this is the Black and White Midwives’ Show!’

Sister Evangelina did not possess a subtle wit, and her jokes were heavy, but she was delighted with her pun, and kept repeating ‘Black and White Midwives – have you got it? Black and White ... Oh dear, now I’m doing it again – I’ll have to have one of your sanitary towels before I can get home.’

By now, the children had come running upstairs to see what all the laughter was about. They had been alarmed when their granny had appeared, all black, demanding clean water and soap and clean sheets. They had heard rapid conversation which they did not understand, and then seen their father rushing down the road to make a telephone call. When a very large and cross-looking nun had entered the little front room, stamping and grumbling, they had hidden behind the sofa. It was all very intimidating. But then they heard guffaws of female laughter descending the stairs and brightened considerably, rushing upstairs before anyone could stop them.

The children burst in through the door, and stood stock-still for a second or two whilst they took in the scene, scarcely able to believe that grown-ups could get into such a state. Everyone was black. Everyone was laughing. The big nun, her white veil streaked with soot, was rocking backwards and forwards with her face so red she looked as though she might burst. Somewhere in the mess a baby was screaming. The children positively let rip. They jumped up and down and bounced on their mother’s bed, to the alarm of Cynthia, because the baby was still attached to its mother. They rolled on the floor, getting as much soot on themselves as they could and smearing it on each other’s faces. Their grandmother tried to establish order and keep control, but she didn’t stand a chance.

The big red nun laughed so much she was wheezing and coughing. ‘Oh dear oh dear, this is going to finish me. Pass me that towel. I can’t contain myself.’ She stuffed the towel up her skirts and wiped it around her legs. The children couldn’t believe their luck, and crowded around, lying on the floor trying to get a look at a nun’s knickers.

Meanwhile, all the laughter must have been good for labour, because the third stage was progressing rapidly. The third stage of labour can be an anxious time for a midwife, and requires a great deal of knowledge, experience and care to enable the placenta to be delivered complete. But Cynthia hardly had to do anything. Janet couldn’t stop laughing and the placenta just slid out in one piece. It was a revolting sight, bloody and slimy and covered in soot, but at least it was out. Placenta and baby, of course, were still attached!

‘Sister, I shall need clean scissors and clamps and swabs,’ said Cynthia quietly.

Sister Evangelina was not just a comedy act for the children’s entertainment. She was a professional nurse and midwife, and her mood changed instantly.

‘We will have to take the baby into another room and scrub up thoroughly. We cannot cut the cord in these conditions. As it is, the soot is not going to harm the baby. But I am not sure what would happen if it got into the bloodstream.’

Disappointed children were shooed away and taken downstairs. The baby, with the placenta still attached, was carried into another bedroom, and with sterile equipment the cord was cut.

The job of cleaning up fell to the grandmother. It took her about four days, and she needed a holiday to recover.