Historical records from the 18th and 19th century document cases of scurvy at a level that is unsupported by archaeological evidence. Scurvy is a nutritional condition that results from vitamin C deficiency and it commonly occurs during times of famine. The characteristic bone lesions formed upon the re-introduction of vitamin C into the diet have long been used by archaeologists to identify the disease in skeletal remains. This post explains how recent improvements in bioarchaeology technology and techniques have been used to identify the disease in victims of the Irish Famine (1845-1852) and suggests that early studies showing lower rates of scurvy may have missed signs of the disease.
Ever since the invention of the bicycle in the late 19th century, cycling has been promoted as a healthy and invigorating outdoor pursuit. However, concerns have also abounded about the potential health risks of engaging in the sport. As explained in a post by Professor Hilary Marland over at the Wellcome Trust history blog, in late-19th century Britain there were conflicting attitudes towards cycling. It was regarded by some as a therapeutic activity while others saw it as a dangerous pastime for women.
Catherine, Duchess of Cambridge is expecting her second child and news reports have stated that she is once again experiencing severe morning sickness known as hypremesis gravidarium. To find out more about royal births through history take a look at this interesting post by medical historian Dr Laura Dawes.
Call the Midwife is a highly-acclaimed BBC drama series that follows a group of midwives working in the Poplar district in London’s East End during the late 1950s. Inspired by the memoirs of Jennifer Worth, the programme combines engaging plotlines with accurate scientific information about childbirth and midwifery as it was practised in that period.
For the purposes of this post, I will limit my discussion to the pilot episode, which focuses the arrival of newly qualified young nurse Jenny Lee at the nursing convent of Nonnatus House. She struggles to adjust to the poverty, squalor, and hardship that she is faced with in the dockland slums as well as the challenges of treating expectant mothers in these unsanitary conditions.
For a drama series, Call the Midwife displays an impressive level of attention to detail in its portrayal of midwifery in the 1950s. The nurses cycle around the district carrying a box of tools (such as soap, dressings, forceps, and scissors) and as depicted in the television programme, midwives were actually issued with a case of equipment and a bicycle for transport (Rhodes, 1999). They were also expected to advise expectant mothers on diet and hygiene and provide ongoing ante-natal, post-natal and neo-natal care (Rhodes, 1999). Like the character of Jenny, the majority of women trained as nurses before undergoing additional training in midwifery and most became respected members of their communities (Rhodes, 1999).
Midwives were expected to work independently and call a doctor for assistance only during emergencies (Rhodes, 1999). This medical hierarchy and code of practice is reflected onscreen when a woman begins haemorrhaging after going into premature labour and Jenny calls a doctor for assistance. The midwives are portrayed as caring and competent professionals dedicated to improving the health of their communities.
Call the Midwife is also interesting from an historical perspective as it reflects the scientific knowledge of the time. For example, people appear unaware of the harmful effects of tobacco on foetal development as the pregnant women in the waiting room of the community ante-natal clinic are pictured smoking. It also portrays a number of anachronistic methods and procedures. Both shaving and hot water enemas are no longer performed by midwives during labour as they increase the risk of complications but are represented as routine procedures at the time (Rhodes, 1999). Episiotomies, such as the one Jenny performs on her first patient, have likewise fallen out of favour (Rhodes, 1999).
The series also alludes to broader social trends and attitudes related to childbirth. All women give birth at home without pain relief, as was the case up until the 1960s when maternity hospitals became more widely established in Britain (Creaser, 2013). By 2011 just 2.4% of births in England and Wales took place in the home (Creaser, 2013). In the 1950s fathers were not allowed to be in the delivery room to watch their children being born as it was considered improper for a man to see his wife in labour (Rhodes, 1999). Call the Midwife is accurate in this respect as the delivery room is depicted as an exclusively female domain and the nurses express disapproval when a woman’s husband insists on being present at the birth of his son.
Contextually, the episode reflects demographic trends prior to the introduction of the contraceptive pill. Jenny is amazed by the size of the families in the district and attends to a local woman who is giving birth to her 25th child. Sister Evangelina later informs her that 80 to 100 babies are born each month in Poplar. Miriam Creaser (2013) supports this figure and suggests that after oral contraception became widely available, local delivery rates dropped to around 4 births per month by 1963.
Despite the social changes and medical advancements that have transformed childbirth since the 1950s, many aspects of Call the Midwife are recognisable to a modern audience. It doesn’t shy away from unpleasant bodily functions and includes graphic yet realistic birthing scenes. A normal labour is shown progressing through stages – with waters breaking, contractions spaced 5 minutes apart, “crowning” (when the top of the baby’s head becomes visible), delivery of the afterbirth, and clamping of the umbilical cord.
It shows how in many ways the management of maternal health remain unchanged. Breathing slowly and deeply is a technique contemporary midwives instruct their patients to use (Rhodes, 1999). The Pinard horn, used in multiple scenes to monitor the heartbeat of the foetus, is a medical tool still widely used in obstetrics today (Rhodes, 1999). Creaser (2103) identifies that the mother who goes against against medical advice to keep her premature baby at home rather than sending it to the hospital is essentially using an early form of “kangaroo care”. By keeping him close to her skin and feeing him breast milk from a dropper, he manages to put on weight. The nurse is delighted because just as it is today, breastfeeding babies to improve their weight gain was recognised in the 1950s as important in the treatment of pre-term babies.
Although technology may have improved since the period that the programme is set, the essential approaches to diagnosis and treatment are little changed. Jenny explains that swollen ankles are a symptom of pre-eclampsia and uses a basic diagnostic test to check for signs of protein in the urine by heating a test tube over a Bunsen burner. A mother who undergoes extensive bleeding and goes into shock after labour is given a blood transfusion and antibiotics (Rhodes, 1999). A woman with a syphilitic chancre is treated with an injection of penicillin in the same manner used to treat primary stage syphilis in the present (Rhodes, 1999). Her husband is also treated in an example of the “contact tracing” still used in the management of STIs (Rhodes, 1999).
Overall, Call the Midwife presents an accurate portrayal of midwifery during the 1950s in a format that makes for informative and enjoyable viewing. Watching just a single episode provided a wealth of information about experiences of childbirth in the past that are partly relevant today. Well written and with commanding performances from the cast, the series does not appear to sacrifice scientific facts or detail for dramatic tension.
Have you seen Call the Midwife? Feel free to leave a comment below.
Creaser, M. (2013). Call the midwife: a true story of the East End in the 1950s. Infant Observation: International Journal of Infant Observation and Its Applications, 16(3), 286-289.
Rhodes, M. (1999). “You worked on your own, making your own decisions and coping on your own”: midwifery knowledge, practice and independence in the workplace in Britain, 1936 to the early 1950s. Dynamis, 19, 119-214.