Early in the 20th century, Margaret Louise Sanger became a leader of the modern birth-control movement after working as a maternity nurse in Manhattan's Lower East Side. In this chapter from her autobiography, Sanger relates how her social conscience was awakened by the plight of poverty-stricken young women who endured--and often eventually died from--the "chronic condition" of pregnancy.
The Turbid Ebb and Flow of Misery
by Margaret Sanger (1879-1966)
During these years in New York trained nurses were in great demand. Few people wanted to enter hospitals; they were afraid they might be "practiced" upon, and consented to go only in desperate emergencies. Sentiment was especially vehement in the matter of having babies. A woman's own bedroom, no matter how inconveniently arranged, was the usual place for her lying-in. I was not sufficiently free from domestic duties to be a general nurse, but I could ordinarily manage obstetrical cases because I was notified far enough ahead to plan my schedule. And after serving my two weeks I could get home again.
Sometimes I was summoned to small apartments occupied by young clerks, insurance salesmen, or lawyers, just starting out, most of them under thirty and whose wives were having their first or second baby. They were always eager to know the best and latest method in infant care and feeding. In particular, Jewish patients, whose lives centered around the family, welcomed advice and followed it implicitly.
But more and more my calls began to come from the Lower East Side, as though I were being magnetically drawn there by some force outside my control. I hated the wretchedness and hopelessness of the poor, and never experienced that satisfaction in working among them that so many noble women have found. My concern for my patients was now quite different from my earlier hospital attitude. I could see that much was wrong with them which did not appear in the physiological or medical diagnosis. A woman in childbirth was not merely a woman in childbirth. My expanded outlook included a view of her background, her potentialities as a human being, the kind of children she was bearing, and what was going to happen to them.
The wives of small shopkeepers were my most frequent cases, but I had carpenters, truck drivers, dishwashers, and pushcart vendors. I admired intensely the consideration most of these people had for their own. Money to pay doctor and nurse had been carefully saved months in advance--parents-in-law, grandfathers, grandmothers, all contributing.
As soon as the neighbors learned that a nurse was in the building they came in a friendly way to visit, often carrying fruit, jellies, or gefüllter fish made after a cherished recipe. It was infinitely pathetic to me that they, so poor themselves, should bring me food. Later they drifted in again with the excuse of getting the plate, and sat down for a nice talk; there was no hurry. Always back of the little gift was the question, "I am pregnant (or my daughter, or my sister is). Tell me something to keep from having another baby. We cannot afford another yet."
I tried to explain the only two methods I had ever heard among the middle classes, both of which were invariably brushed aside as unacceptable. They were of no certain avail to the wife because they placed the burden of responsibility solely upon the husband--a burden which he seldom assumed. What she was seeking was self-protection she could herself use, and there was none.
Below this stratum of society was one in truly desperate circumstances. The men were sullen and unskilled, picking up odd jobs now and then, but more often unemployed, lounging in and out of the house at all hours of the day and night. The women seemed to slink on their way to market and were without neighborliness.
These submerged, untouched classes were beyond the scope of organized charity or religion. No labor union, no church, not even the Salvation Army reached them. They were apprehensive of everyone and rejected help of any kind, ordering all intruders to keep out; both birth and death they considered their own business. Social agents, who were just beginning to appear, were profoundly mistrusted because they pried into homes and lives, asking questions about wages, how many were in the family, had any of them ever been in jail. Often two or three had been there or were now under suspicion of prostitution, shoplifting, purse snatching, petty thievery, and, in consequence, passed furtively by the big blue uniforms on the corner.
The utmost depression came over me as I approached this surreptitious region. Below Fourteenth Street I seemed to be breathing a different air, to be in another world and country where the people had habits and customs alien to anything I had ever heard about.
There were then approximately ten thousand apartments in New York into which no sun ray penetrated directly; such windows as they had opened only on a narrow court from which rose fetid odors. It was seldom cleaned, though garbage and refuse often went down into it. All these dwellings were pervaded by the foul breath of poverty, that moldy, indefinable, indescribable smell which cannot be fumigated out, sickening to me but apparently unnoticed by those who lived there. When I set to work with antiseptics, their pungent sting, at least temporarily, obscured the stench.
I remember one confinement case to which I was called by the doctor of an insurance company. I climbed up the five flights and entered the airless rooms, but the baby had come with too great speed. A boy of ten had been the only assistant. Five flights was a long way; he had wrapped the placenta in a piece of newspaper and dropped it out the window and into the court.
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