‘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 expect?’
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.
5
I have drawn on several sources for this chapter. For more information a full list is given in the bibliography.