Farewell To The East End
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
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