“Louder,” someone yelled from the back.
Nora’s face blazed and she lost her voice altogether. She gave a conciliatory smile to hide the nerves and inhaled as deeply as she dared. “I’m honored to be here,” she nearly shouted. She’d give anything at the moment for one of those effortless, booming voices. Hers sounded reedy and thin. Horace made it look so easy. Had he been yelling his lectures all these years?
She continued her introduction. It wasn’t hard to talk about Italy. Though she saw numerous skeptical frowns, the numbers spoke for themselves. Magdalena and her physician mother had collected ample evidence to prove the advantages of providing rigorous, lifesaving training to the nuns who served as midwives.
“Most of you came here because you have an interest in improving society or to learn of the latest advances in culture and science. The education of midwives addresses both. While families with means choose to consult doctors and accoucheurs, most expectant mothers rely on their local midwife. And while they have their own expertise, there is much to learn from modern medicine. Rigorous training of competent midwives will save the lives of women and children, and provide worthy employment to women practitioners.”
In the front row, a heavy-jowled man thumbed the head of his cane in lethargic boredom, his dismissive attitude so profound that Nora lost her place. The rustle of starched skirts and whispered asides hummed like thunder in her head, making the next sentence even harder to force out.
“There are also skills familiar to practicing midwives that doctors could do well to learn. The records of midwives’ lying-in houses speak for themselves, with rates of puerperal fever many times lower than those in hospitals. When we consider it logically, it makes no sense to house expectant mothers, new mothers, and infants with those who are ill. They aren’t sick. But they do require expert care, and that care should be provided in a way that doesn’t expose them to the risk of infection.”
Across the room, Daniel gave a minute nod, his dark eyes shining in the dim light. Her shoulders loosened slowly as her voice deepened to a richer tenor.
This was what she’d come to say. “Decisions about who can and should be caring for babies and mothers must be focused on what is best for them, and that is doctors and trained midwives working together.” Nora scanned the faces before her. Unsmiling, but attentive.
“Many of you contribute to charities that educate poor women in dressmaking and millinery and domestic service.” Several heads bobbed in the dim light. “What if you also adopted the mission of training impoverished women as midwives? It not only benefits the women; it also frees doctors to attend to other urgent cases, especially in times of epidemic disease. Perhaps helping your own families or servants in their hour of need.”
In the second row, Aunt Wilcox lifted her eyebrow expectantly.
“What of doctors who train for years at great expense and sacrifice? Are they to be replaced by hobbyists and amateurs?” a man with a billowing mustache who Nora didn’t recognizecalled out from the midst of the crowd, followed by rumbles of agreement.
“You haven’t been listening if you think that is what I’m advocating,” Nora said, pressing her hands against the lectern. “A doctor might have extensive training, and many patients generally assume that he does. But the truth is, in obstetrics particularly, only two lectures are necessary to be licensed. A man might not have attended a single birth before he is allowed to go out collecting payment from women patients.”
A portly man jumped to his feet. “I’ve delivered hundreds of children in my career.”
She fumbled for his name, snatching it at the last second. “And I hear great things of your abilities, Dr. Gordon. But how many children had you delivered when you first received your license?”
He huffed and sat down, silenced, which Horace took as a cue to guffaw, his amusement audible to everyone in the room.
“I do not disparage doctors. Do not forget, I am one,” Nora said. “I mean to point out that midwives have had their own children, so they know from experience the hardships of labor. They have also attended dozens of births before practicing alone.”
“Lies!” a man thundered. “What of Caroline Jepson in Surrey?”
“A tragedy and a crime,” Nora agreed. “But if a man had pretended to be a doctor and killed a patient, we would not attempt to ban the entire profession outright. We’d insist on requiring licenses and stricter proofs of ability, and that is what I propose. Education and certification that prove a midwife’s knowledge and skill.” Nora’s eyes strayed to the three midwives. Mrs. Bailey’slips were pressed so tightly she might have bitten them off. “Some midwives I’ve worked with have managed to successfully deliver babies that I was taught were impossible to bring through.”
Nora turned the page of her notes, but before she could continue, a man rose from his chair in the back of the room.
“That’s all well and good, Mrs. Gibson. But are trained physicians to share their knowledge and fees with meddling women simply because they want it?” Dr. Adams stood near the back on her right side, blocking the light of a flaming gas lamp. An expectant hush fell as his shadow loomed across the wall, towering all the way to the skylights. “I’ve invested time, money, and years of my working life perfecting my use of short forceps. It has come at great personal sacrifice.”
The gentlemen beside him nodded, and someone shouted, “Hear, hear!”
“You would not expect a virtuoso musician or a celebrated portrait painter to simply teach his technique to all and sundry,” he finished.
Nora’s swallowed against the heat climbing her chest. “I would say we must share our knowledge, not because midwives want it for nothing—and I don’t advocate it should come free of charge—but because the mothers of England need it.”
Someone clapped, but the sound was too far off for Nora to see who.
Adams stroked his beard, pretending to be thoughtful. “I see. It is now my duty to find every woman in the boroughs and villages who helps fetch water for a birth and force them all to go to medical school.” He won several laughs.
Nora bit her teeth together, grinding through her dislikeof this man. “You bring up another compelling point,” she said, wishing he’d retake his seat. This was not his lecture. “As you all know, cholera has appeared in several neighborhoods the last two months, with devastating results. We’ve suffered thousands of deaths. The mortality rate is currently fifty percent. We lose half of everyone who contracts the disease.”
“I didn’t bring up that subject at all,” Adams argued.
The crowd shifted, disturbed by the sudden shift in topic. “In an oblique way. You scoffed at the idea of women being trained in medicine. Which made me think—St. Bart’s recently lost two medical students to cholera. District doctors are seeing far more patients than they can manage. Death is only kept at bay by meticulous, continuous tending—something overworked physicians have no time to provide.”
Adams squinted in suspicion, unsure where this new tack was steering them.
“At my hospital on Great Queen Street, I’ve trained midwives to help nurse cholera patients, to great effect.”
