Call the Midwife: A True Story of the East End in the 1950S

took her blood pressure at that point, and it was fairly high. She will need more rest, I thought, but I doubt if she will get it. The children had recovered their spirits, and were racing about once again.
     
    I pulled her jumper down and uncovered her abdomen, which was large, the skin simply covered with stretch marks. The slightest pressure from my hand showed a fundus above the umbilicus.
     
    “When was your last period?”
     
    “Search me. Las’ year, I reckons.” She giggled, and her tummy flopped up and down.
     
    “Have you felt any movements yet?”
     
    “Nope.”
     
    “I am going to listen for the baby’s heart beat.”
     
    I reached for the pinard foetal stethoscope. This was a small metal, trumpet-shaped instrument, used by placing the larger end over the abdomen, and then pressing the ear against the flattened smaller end. Normally the steady thud of the heartbeat could be heard quite clearly. I listened at several points, but could hear nothing. I called Novice Ruth, as I felt I needed confirmation, and also an assessment of the duration of pregnancy. She couldn’t hear a heartbeat either, but thought that other signs indicated pregnancy. She asked me to do an internal examination to confirm it.
     
    I had been expecting this, and dreading it. I asked Lil to draw her knees upwards and part her legs. As she did so, the odour of stale urine, vaginal discharge, and sweat wafted up to greet me. I struggled to control the nausea. I mustn’t be sick, was all I could think of at that moment. Tufts of pubic hair stuck up in clumps, matted together by sticky moisture and dirt. She might have crabs, I thought. Novice Ruth was watching me. Maybe she understood how I was feeling - the nuns were very sensitive, but they spoke little. I dampened a swab with which to clean the moist bluish vulva, and it was whilst I was cleaning her that I noticed that one side was very oedematous, swollen with fluid, whilst the other was not. I started to part the vulva with two fingers, and it was then that my finger encountered a hard, small lump on the oedematous side. I rubbed my finger over it several times. It was easily palpable; hard lumps in soft places make one think of cancer.
     
    I could feel Novice Ruth watching me very closely all the time. I raised my eyes, and looked at her questioningly. She said, “I’ll get a pair of gloves. Do not proceed just yet, nurse.”
     
    She returned a couple of seconds later, and took my place. She did not say a word until she withdrew her hand, and covered Lil again with the blanket.
     
    “You can put your legs down now, Lil, but stay where you are, please, because we will want to examine you again in a minute. Come with me to the desk, will you, nurse?”
     
    At the desk, which was at the other end of the room, she said to me very quietly: “I think the lump is a syphilitic chancre. I am going to ring Dr Turner straight away and ask him if he can come to examine her while she is still here. If we send her away with instructions to go to a doctor, there is a high chance that she will not go. The spirochaeta pallida of syphilis can cross the placenta and infect the foetus. However, the chancre is the first stage of syphilis, and with early diagnosis and treatment there is a good chance of cure, and the baby will be spared.”
     
    I nearly fainted, in fact I remember having to grip the table before I could sit down. I had been touching her - the revolting creature - and her syphilitic chancre. I couldn’t speak, but Novice Ruth said to me kindly, “Don’t worry. You were wearing gloves. You won’t have caught anything.”
     
    She left to go to Nonnatus House to ring the doctor. I couldn’t move. I sat at the table for a full five minutes, fighting down wave after wave of nausea, and shuddering. The children were playing all around me, perfectly happy. There was no movement from behind the screen, until the low, steady sound of contented snoring penetrated my ears. Lil was asleep.
     
    The doctor arrived about fifteen minutes later, and Novice Ruth asked me to accompany him. I must have looked pale, because she asked, “Are you all right? Will you manage?”
     
    I nodded dumbly. I couldn’t say no. After all, I was a trained nurse, accustomed to all sorts of frightful situations. Yet even after five years of hospital work - casualty, theatre, cancer patients, amputations, dying, death - nothing and no one had caused such profound revulsion in me as that