Content warning: pregnancy complications


Chapter 28: Of Babies and their Mothers


Uncle Dave and Aunt Katherine wrote in December with the sad news that Miss Elizabeth Russell had gone to her final rest.

"She was laughing on her deathbed," Uncle Dave wrote. He enclosed a tiny, sealed note:

Dear Mr. Blythe,
XXX
Here are three kisses from me. They are my last; don't let them be yours.
With all my love,
Miss E. Russell

Uncle Dave and Aunt Katherine invited the Blythes to Glen St. Mary for Christmas again that year, but Gilbert refused. He wanted to go home to Avonlea and meet Small Anne Cordelia Wright, just to prove he could.

Did they have to name her that?

Of course they did, you clod.

Gilbert realized that Phil might have a daughter as well, and if she did, the chances were very good that she would be an Anne as well. Perhaps they would call her something else for a nickname. Nancy? Nan?

Or perhaps he would just be surrounded by little girls named Anne for the rest of his life.

Better keep practicing that smile, Blythe.


Gilbert had planned the trip carefully, arranging to arrive at Carmody on the late train on Christmas Eve. That would give him as little opportunity as possible to excuse himself for a walk and find himself wandering down the Birch Path toward the schoolhouse. He didn't know whether he'd rather live inside forever or burn the place down.

It was a green Christmas — a nasty, gray-and-brown Christmas, she would have corrected him. Gilbert slogged through the mud to Lone Willow Farm on Christmas Day, bearing gifts.

"You had to get him a whistle?" Fred asked as his namesake toddled around the sitting room, alternately blowing ear-splitting blasts and shrieking with delight at his gift from Uncle Gil.

Gilbert shrugged. "I'll buy him books when he's older."

Small Anne Cordelia was a delectable bundle of pink and white topped with silky black curls and lashes so long they reached halfway down her cheeks. Gilbert even held her. When young Fred screamed from the kitchen in a way that sent both his parents racing from the sitting room, Gilbert kissed her on the top of her velvet head and told her he was glad to meet her.

He did not stay long. Not at the Wrights', and not in Avonlea. He visited Davy and Dora on Boxing Day, but left the next morning. His parents were not overjoyed, but they did not try to prevent his going. Perhaps next year he could stay longer.


On the first Sunday of the new year, Gilbert was surprised to find Jonas Blake waiting for him on the steps of the dormitory.

"Jo! I was just heading over for dinner. Is everything alright?"

"I thought perhaps we could find somewhere to eat around here. Phil isn't feeling well and I didn't want to ask her to cook. She's home in bed."

"Go on home, Jo. I can get a bite in Commons. You should be with her."

Jo forced a smile. "No, actually, she insisted. Says it makes her feel worse to have me hover over her."

Gilbert squinted. "Phil? Not wanting attendants?"

"I think she's feeling pretty miserable and just wants to hide herself away. Ladies from the church have been visiting with food and advice, and she's ready to knock heads together. I understand. It must be wretched to spend all day every day nauseous."

"Still?"

"Unfortunately, yes."

Gilbert did some quick mental arithmetic. "She must be well into the fourth month by now."

"Nearly the fifth."

"And she's still sick? Often?"

"Half a dozen times a day. Sometimes more."

Gilbert felt a queasy bolt pass through his own gut. "Jo, that isn't good. What does her doctor say?"

"He says she'll get over it. Says women are always overly dramatic when they're expecting. Looking for attention."

Their eyes met and Gilbert saw a flash of the fear that Jo had worked so hard to conceal.

"Come on, Jo," he said, grabbing his friend's arm. "We're going to your house."*


They found Phil in bed, riding another endless bout of nausea. Her cheeks, normally so rosy and plump, were the color of boiled cabbage. Sweat stood out in beads on her forehead and her hair straggled over her shoulders in lank clumps.

"Ohhhh, no," she moaned, covering her face with a pillow as Jo led Gilbert into the room.

At first sight of her, Gilbert felt every muscle in his body recoil. Huge eyes staring up from drifts of blankets, the oppressive smell of sickness, and the onrushing sound of something huge . . .

With an enormous effort, he focused his attention on the pattern of the quilt that covered her legs. Circle and star, circle and star, circle and star. By the time he recognized Rachel Lynde's apple leaf pattern, the worst of the panic had passed, leaving only a vague nausea in its wake. He could work with that.

"Mrs. Blake!" he said in tones of mock affront. "Just what have you done to yourself now?"

She smiled weakly. "Don't tease, Gil. I feel positively dreadful."

He crossed the room and sat lightly on the chair beside the bed. "You look it, too."

"Well that's a pretty compliment from a man who goes barging into ladies' bedrooms."

Gilbert took her hand gently. "How are you, Phil? I may not be a real doctor yet, but it doesn't take one to see you're in bad shape."

Phil blew a raspberry. "I suppose Jo will have told you the essentials. I'm just . . . just having a rather rough go of it."

"Have you talked to anyone about it?"

"Oh, I've seen the doctor, of course," Phil rolled her eyes. "And a lot of help he is. He's mother's physician and about as sympathetic as a hangman. I've tried to talk to mother a bit, too, but she doesn't like to discuss such things. She said that one pregnancy was more than enough for her and left it at that. I suppose I must take after her. Diana has been a dear, though, sending me ginger candies and peppermint tea."

"Have you been eating?"

Phil wrinkled he nose. "When I can manage some bread, I do."

"Phil," Gilbert pressed her hand in his. "You must eat. For yourself and for the baby."

"I know," she said, her eyes filling with tears. "But I can't. The smell of food makes me violently ill and if I manage a bite of anything it's even odds whether it stays down. I've tried. And I know it's not good for either of us, but I just keep hoping that it will pass."

Gilbert nodded, struggling to keep his face impassive. "You've done all you can. And Jo as well. But it sounds to me like this is more than the normal sickness you might expect. You need a doctor, and not that pompous old gasbag. I'll talk to some of the professors at the hospital, see if they don't know anyone better. Maybe there's a treatment out there for cases like yours."

Phil's eyes were shining with both tears and relief.

"You're a good friend, Gil," she said, reaching for a handkerchief.

There was no trace of teasing in his wistful smile. "You've taken such good care of me this past year and a half. I can only hope to return the favor."

Phil hiccuped. The earnest mood dissolved into laughter, punctuated at intervals by her squeaks.

"I'll tell you the truth," said Phil between hiccups. "I've often resented my mother for making me an only child. But I've quite forgiven her now."

Jo stood beside the bed, smiling fondly at his wife. "Strange how we grow kinder toward our parents once we begin to see them as people like ourselves."

"My mother always said you can't truly appreciate your own parents until your own children pay you back cent for cent for all the mischief you caused in your own childhood," Gilbert said.

"Oh dear!" Phil exclaimed, shaking her head. "If that's the case, we certainly are in for it. Poor Jo. I was a dreadfully headstrong child."

"I gave little Fred Wright a whistle for Christmas," Gilbert offered. "Perhaps I'll get Baby Blake a drum next year."

"Gil, that's diabolical! Think of his poor parents!"

"Only doing my part to help him pay back his debt," Gilbert winked. "The trouble we caused poor Mrs. Wright . . ."

"Well, this one is certainly starting out strong," Phil grimaced.

Gilbert patted her arm. "Try to rest, Phil. Keep drinking fluids, and eat anything you can stand. I'll see what I can find."


Gilbert sat up late into the night, textbooks piled high around him. Luckily, he had ordered all of the supplementary books recommended by the course catalogue, not just the core texts.

He had started with William Lusk's The Science and Art of Midwifery, the textbook for the introductory course in obstetrics. It was no Tennyson, but it would would keep him lying awake that night just the same.

It is necessary not to forget the neurotic character of the stomach sickness in many pregnant women. The complete cessation of the vomiting, deemed uncontrollable as the result of mental impressions, has been often noted by clinical observers. In one instance, owing to extreme exhaustion of the patient due to continued vomiting, I decided to induce abortion. As I was making preparations to that end, the patient, somewhat unexpectedly to myself, announced her determined opposition to the proposed plan of treatment. I endeavored to show her that it was necessary, to save her life. She asked me to hand her a cup of boullion. As she swallowed it I told her there would be no occasion to induce abortion, if she kept it on her stomach. This she did seemingly without difficulty, and from that moment to the end of the pregnancy there was no recurrence of stomach sickness. A similar history is related by Kaltenbach. In a paper on the excessive vomiting of pregnancy, Kaltenbach urges that in all cases especial stress should be laid upon the underlying disturbance of the nervous system . . . 'The more authoritatively the physician carries out his plans of treatment,' he says, 'the more rarely will he be driven to seek a cure in artificial abortion.**

That was it? Lusk thought that Phil was just hysterical, and Kaltenbach agreed? They thought that she could just choose to eat if she were threatened with . . .

Gilbert closed the textbook with a vicious snap. He ran a hand through his hair until he had worried his curls to frizz. However many times he did it, he could not unsee the words "necessary to save her life."


Over the next week, Gilbert devoted much of his time to Phil's case. He read every obstetrical textbook he could find and begged more off of Edgar. The pair could often be found in Commons after supper, poring over medical journals right up until the clock chased them toward their evening dissection session.

Nothing they read did anything to lessen Gilbert's alarm. Dr. Hirst's Textbook of Obstetrics was less condescending than Dr. Lusk's, but it contained statistics that liquefied Gilbert's intestines.***

The mortality of the pernicious vomiting of pregnancy is high. Of 239 cases, 95 died; of 57 cases treated by the usual means, 28 died; of 36 cases treated by the induction of abortion, 9 died. I have induced abortion for hyperemesis twelve times. Two patients died. In one case I was called to see the woman in consultation when she was almost moribund. The induction of abortion proved too great a shock to her, easy and simple as the operation is. In the other case the religious scruples of the family prevented the termination of the pregnancy when I first advised it. Ten days later, the patient being obviously at death's door, the operation was demanded.

"Come on, Blythe," Edgar said, alarmed by Gilbert's expression. "Let's go hunt up Dr. Forbes."

Dr. Forbes was the chief of obstetrics at Kingsport Hospital. A round, genial man with a white fringe ringing his bald head, he had a broad smile and a quick laugh. Edgar had become a pet of his by lingering after obstetrics lectures to ask probing or clarifying questions.

"Edgar, my lad! What can I do for you?" Dr. Forbes asked, clapping his young protégé on the back.

Edgar introduced Gilbert and went over the outline of Phil's case.

Dr. Forbes shook his head.

"It's hyperemesis gravidarum, sure enough. Nasty complication. There are degrees, of course, and most women make it through. Miserable, but they recover after the delivery. But sometimes . . . well, I've seen some very bad cases. Even lost a mother once."

Gilbert swallowed hard. "I read a bit about it in Lusk's Midwifery. He mentions that it is sometimes necessary to . . . induce abortion. Do you agree?"

Dr. Forbes met his gaze frankly. "I've done it. It shouldn't be done except in the most extreme cases. But in those cases, yes."

"What can be done to avoid getting to that point?"

Dr. Forbes was thoughtful. "The real trick is to keep the mother hydrated and fed as much as possible. If she can maintain her weight, or only lose a little, she should pull through just fine. The bad outcomes happen when we see mothers losing an excessive amount of weight. Find something she can stomach and impress upon her the medical necessity of eating. If she can drink, try broths instead of tea — anything to get some nourishment into her."

"What if she can't keep anything down?"

Dr. Forbes crossed his office to a bookshelf and pulled down a handwritten ledger of case notes. "Have you tried giving her menthol?"

"Yes. And peppermint and ginger. All of the kitchen remedies."

Dr. Forbes ran a finger down the page. "What about subnitrate of bismuth? Hydrobromate of hyoscin?"

Gilbert pulled a notebook and pencil from his satchel and scribbled furiously.

"Try those," Forbes was saying. "I've also had some success with cocaine. The nervous sedatives — chloral and opium — work as well, though they have their own problems. But if the case is as bad as you suspect, they're worth a try."****

"Thank you, sir," said Gilbert, barely waiting to shake Dr. Forbes's hand before rushing out the door for the apothecary.


*LMMontgomery's canon does not give copious details regarding Phil Blake's adult life. We know that she had at least two children because "both the Rev. Jo's boys" served in World War I. This subplot is largely based on Phil's comment that she had "got fearfully thin since the babies came" in Anne's House of Dreams.

**This paragraph is a direct quotation from The Science and Art of Midwifery by William Thompson Lusk, which was the assigned obstetrics textbook for the University of Pennsylvania Medical School class of 1889.

***Textbook of Obstetrics by Barton Cooke Hirst was one of the supplementary textbooks recommended to the University of Pennsylvania Medical School class of 1889. This paragraph is a direct quotation.

****All of these treatments are suggested in Hirst's Textbook of Obstetrics.