Farewell To The East End

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