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Perinatal Bereavement Rituals and Practices Among U. S. Cultural Groups 1st Edition Erin M. Denney-Koelsch
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Perinatal Palliative Care A Clinical Guide Erin M. Denney-Koelsch
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Foreword
The book opens with these words: “Perinatal loss is a ubiquitous experience across human existence” (see Denney-Koelsch, introduction). Ubiquitous, meaning present or found everywhere, perfectly describes why this book was written. As a oneof-a-kind reference, the book’s authors take us on a journey that explores meaning, which is woven into the human experience of loss. If one uses the metaphor of a quilt, the chapters are like quilt pieces intended to be sewn together into one. Each chapter could stand on its own like a quilt square, yet the real beauty engages us as we see the whole. The quilt’s background is often where the most perfect patterns come alive, uniting the individual stories of each square, much like this book does. Books come in many shapes, sizes, and lengths. There are books that stand out solely on their exemplary content. This is one of those. Dr. Denney-Koelsch and the author experts produced a publication that will be a contribution to the healthcare feld for years to come. I have learned that one can often judge a book by its frst (in this case, second) and fnal chapters. In Chap. 2 Foundations and Meanings of Death Rituals—the authors describe van Gennep’s stages that provide the reader a deep understanding of the developing concept of ritual. These include separation (e.g., a baby’s death), the waiting period (liminality, the space between; perhaps the time between death and some type of ceremony), and a fnal transformation (e.g., a ritual designed to represent change or something new). I found this chapter to be a thorough grounding in the art and practice of ritual. In the last Chap. 13, titled How to Plan and Support Families Through Rituals and Memory-Making, the authors discuss multiple options for memory-making, the how tos (e.g., photography), and sensitivity in connecting with parents regarding their preferences.
Dr. Denney-Koelsch’s vision to create a new and different look at ritual began as an ethnographic research project and led her to people and materials that inform the smallest details of the writing. She took an overarching view of history, religion, and death rituals for everyone, not just babies. In these times when healthcare equity and inclusion have rightfully taken center stage, the editor and authors have written a key resource for anyone associated with bereavement and end-of-life care across cultures. The editor and contributing authors have created a masterpiece that focuses on understanding why different cultural groups and religions respond to perinatal
loss the way they do. She explores when life begins, when someone becomes a person with a soul or spirit, and what happens after we die, done across cultural and religious groups.
This book is descriptive, not prescriptive. In a contemporary communication strategy of bullet points, Perinatal Bereavement Rituals and Practices Across U.S. Cultural Groups is the opposite. Rich description, a facet of ethnographic research, provides the reader with cultural background, flling in numerous details that would be left out of a less-nuanced presentation. Why is this signifcant? To care for those whose lives have been different from our own, we are obligated to do our best to engage and be with those we care for. When the authors explore, for example, the question of when life begins across religions and cultures, not surprisingly, there are numerous answers to that question. That leads the reader to a focus on social construction, essentially that meanings grow out of a context. Knowing the context helps us know the individual.
As noted throughout the book, rituals are imbued with meaning, used to ease transitions and mark milestones. In Chap. 4, the Jewish Halakha may be used as a guide for ritual for a baby, yet the individual nature of grief leads to this mother’s quotation in Liam’s story:
I knew right away that even if it was against traditional Jewish values, it was imperative to me that we give him a name and honor the hope that he had brought to our lives. We decided to name our son "Menachem-Mendel," after my husband's brother who had only lived for two weeks. Just being able to give our son a name provided great comfort for us at the most diffcult time in our life.
Each of these stories of diverse beliefs, values, and practices has commonalities. Getting through the night, living another day, accepting help from others, living with the pain of unintended hurt caused by the voice of another, choosing to do something in honor and memory. In all of these experiences that happen when a baby dies or a pregnancy ends, one can hear the meaning of relationship, central to human grief, intricately woven into childbearing loss. And with that grief often comes the desire to remember.
In conclusion, this book has a broad audience, especially those involved in healthcare teams and community support networks. The desire to develop and sustain an exemplary practice is in all of us. It seems appropriate to close this foreword to such a stellar book with a reminder about what constitutes stellar practice. From DJ’s mother (Chap. 5):
I did have a nurse that I thought was phenomenal. I think she was a God-send for me in that moment. And I just wish that everybody could have an experience like that because everything is so fnite. You only get to do it once. Each moment matters.
This book can help you as a clinician and human to be there in that fnite moment of the family’s one chance.
Resolve Through Sharing® Rana Limbo Gundersen Medical Foundation La Crosse, WI, USA
Preface
This book has been a true labor of love and a spiritual journey. It represents my work of a number of years searching to understand the ways we humans cope with death. It began as a 6-month sabbatical project in 2021–2022. In my work as a palliative care physician for people from pregnancy to geriatrics, I have walked alongside many patients and their families who are facing death and loss of a loved one.
During my palliative care fellowship, my career took me to the niche of perinatal palliative care, caring for families who in the past have not received the attention they deserve. Usually, they have very suddenly received a lethal fetal diagnosis for their unborn baby, who is faced with a serious fetal condition that may result in prolonged complex medical needs or death. I see the love these parents have for their babies, and their dreams of the future are dramatically altered by this news.
When parents are faced with serious fetal conditions, they must make heart wrenching decisions in the midst of grief and the loss of their future dreams. They need expert support to address suffering, hopes, and fears. Working with families when birth and death collide inevitably elicits questions about what is life and what happens after death. One of my colleagues describes the moments between birth and death as the time “where heaven and earth touch.” It is truly sacred work.
A few years ago, one of my dear friends from my college years delivered an unexpected full-term stillborn, named Lysander. As Eva and her husband processed this loss, I wondered in what ways her religious background as a Mormon (married to a non-Mormon) infuenced their decisions about death rituals as they coped with Lysander’s death. She shared that in the Mormon church, babies are considered inherently innocent. She chose a hospital cremation so Lysander could “be with the other little babies.” His only photographs were taken several days after death, and
Eva regretted not having photos taken right after Lysander was born, so she could remember him as she wanted. About 6 months later, she took the photographs to the beach on a cold winter night, built a bonfre on the beach, and burned the photographs along with white roses. She describes,
I felt like that was a good ritual and helped process my grief a little bit. I was really grateful to…invent something because I didn’t feel like that I had done enough. There’s a lot of comfort in a ritual. I just didn’t feel any closure for a while but that really helped… I think it was a combination of different past rituals…a lot of cultures have burning things and having the solitude of the stars and a clear night and have it be an unusual outside of time experience... The white fowers do symbolize a feeling of innocence and purity because since he died before he could even experience the world, it makes it doubly innocent…I felt after that, not that I hadn’t appreciated it before, but the world is such a beautiful and sad place that he never got to see. I feel like I have to experience it all the more fully. It crystallized my appreciation of the beauty that we have.
–Eva, Lysander’s mother
As I was writing this book, Eva and Lysander’s story resonated with me. It illustrates how many families create their own rituals. Eva, like many of the parents you will hear, invented her own ritual by doing what gave her the most meaning at the time.
Through this ethnographic study, I sought to understand the role of culture in how people use rituals after death or perinatal loss. Knowing that pregnancy and infant loss lie on a spectrum of experience, I sought in this work to understand how parents experience any type of perinatal loss—miscarriage, stillbirth, or infant death—and how their understanding and feelings were infuenced by their culture and/or religion.
Studying how an individual responds to a personal crisis is inherently deeply complex. They describe contributions from their cultural stories, history, family, individual personalities, religion and spiritual beliefs, ways of thinking, and lived experiences. Focusing on the question of cultural infuences on perinatal loss has allowed me to meet and hear the stories of women from many backgrounds, cultures, religions, and then go back to the literature, seeking context, history, and other stories to corroborate or dispute what I thought I learned. The journey has been profound.
In exploring other’s cultures, I think it’s important to address my own. I come from a culture of European ancestors who emigrated to the U.S. at least 200 years ago. They were a mix of farmers, ministers, teachers, and highly educated academics. Several of my great and great-great grandparents were Protestant ministers and missionaries, with more recent generations, including myself, veering into Unitarian Universalism (UU). I usually worship through nature, music, and time with family. While I worked extremely hard to get where I am, I had innumerable opportunities put in front of me by parents who always prioritized education and have supported me in a thousand ways. I have always recognized and been grateful for this life of privilege. My pregnancy journey has also been privileged. Thanks to birth control, good medical care, and a lot of luck, I have had two planned pregnancies and two healthy children. While my daughter came 6 weeks early and was in the NICU, and my son
threatened to do the same, they are both healthy and thriving. These experiences were diffcult at the time, but I have never experienced the terrible grief and loss that the women in this book have lived through. I do, however, understand the almost painful intensity of love a mother feels for her child, even a dreamed of ficker of a child. I can certainly imagine the exquisite pain of extended infertility, sudden and traumatic loss of a desired pregnancy or baby, and the daunting challenges of welcoming a baby who if they survive, will be seriously ill.
To acknowledge our privilege, it has been my family’s goal to educate ourselves about history, to understand others’ life stories, and to put ourselves in the shoes of others. So, part of the drive for this research was my own personal cultural and religious exploration. I have grieved and struggled with my country’s challenging history as I toured a Jewish funeral home, experienced the shock of an Amish cemetery containing more than 50% baby’s graves, explored the American Museum of African American History, attended a Black funeral for the frst time, and read more about the atrocities of early colonists toward Native Americans.
In my work as a physician, I have cared for families from all of the cultures represented in this book, walked with them on their medical journeys and even up until death. One of the essential components of palliative care assessment is learning the person’s life story, where they come from, who their psychosocial and spiritual supports are, and understanding their values and beliefs. We typically ask about religion and spiritual beliefs, but often don’t know how to respond to these responses other than to call the chaplain for assistance.
Also, my experience with families usually does not extend beyond the frst hours or days after death. I am usually not present for the bereavement of the families of my patients. After they leave the hospital, what happens? What is the funeral like? What is their mourning process? How do these rituals help them in their grief? What are the small, seemingly minor moments or tasks that hold great meaning because of their loss? So, in this exploration of culture, I also wanted to understand and help others understand a number of spectrums: the spectrum of pregnancy and infant loss, the spectrum of cultural and religious rituals and practices, and the arc of each family’s story of loss.
Part I of the book introduces perinatal loss, the theoretical background for understanding pregnancy and infant loss, perinatal bereavement, and role of rituals in death and dying. This part defnes different types of perinatal loss, including a section on those who have chosen termination of pregnancy for life-limiting fetal conditions. Their stories have many similarities to other losses in this book, with parents feeling shock, grief, and making incredibly hard decisions out of love. Part I also addresses perspectives on fetal personhood, which intimately infuence how cultures approach rituals surrounding pregnancy and infant loss.
Part II covers the Major U.S. Ethnic and Religious groups, categorized by Racial and Ethnic groups identifed by the U.S. Census. The world’s major religions (and some minor ones) are discussed within these Census groups, even though there is sometimes overlap between them. In this part, individual family stories provide the voices of parents themselves, sharing how they personally coped with their loss and how their culture helped (or did not help) them in their bereavement. Death rituals
of older persons (child and adult) are also discussed, as it is impossible to discuss what is unique about pregnancy or infant death rituals without knowing the rituals of an older person’s death. The fnal chapter in this part is on Special Populations who span the other racial and religious groups, but whose bereavement experiences are unique. Infertility is a common story for many of our loss parents. Those who have never conceived experience grief in the form of their lost future as parents. The LGBTQ+ community also has unique fertility and reproductive needs, often requiring reproductive assistance, and therefore their losses are felt very keenly.
Part III covers the healthcare team and supportive services in the community. We overview the interdisciplinary healthcare team, and community supports such as funeral homes, cemeteries, and support groups. The fnal chapter is a practical “How to” guide for supporting families through memory making and co-creation of rituals of all kinds, from hospital to home to community memorial events. This fnal part was a group effort; many authors contributed sections on their expertise and from their discipline’s perspective.
The book attempts to cover the most critical concepts that should inform caregivers about common cultural and religious beliefs and practices, using real people’s stories. When we discuss how a baby’s short life is honored through ritual in a particular culture, it inevitably leads to questions of when does life begin? When does a person become a person? When does the soul or spirit enter the body? What happens after we die? These fundamental spiritual questions of life and death have been asked since the beginning of humankind. The widely varied perspectives on these questions among the cultural groups described here demonstrate the wealth of ideas on this topic, as well as the lack of any consensus.
The stories in this book include the voices of many parents whose personal needs in bereavement were not suffciently addressed by their own cultural or religious group. They sought support elsewhere, often fnding other bereaved parents to share ideas on how to honor their baby’s life. Whatever their cultural or religious background, each parents’ unique needs and wishes must be addressed by listening, caring, being open-minded, nonjudgmental, and sensitive. Ultimately, the parents know best what will help them, and we are all here to support them in making the most of their baby’s short life.
Rochester, NY, USA
Acknowledgments
First and foremost, I must thank my husband, Matthew Koelsch. He holds everything together at home while I work (a lot), teach, do research, and do crazy things like taking spiritual journeys and writing books. He is the most extraordinary caregiver for our 2 kids, 2 dogs, and 22 chickens on our small homestead in Western New York. Our kids (Cora, 13 and Evan, 10) don’t fnd it odd at all to discuss death rituals at the dinner table. You guys are my everything and I couldn’t do it without you!
I deeply thank two of my research colleagues and dear friends. Dr. Denise CôtéArsenault served as my mentor in ethnographic methods and analysis. She is also coauthor on several chapters as an expert in pregnancy loss, nursing, and Catholicism. And I thank Dr. Katie Kobler, who has such a great mind for making complex concepts seem obvious and has such a beautiful way with words. Her expertise on perinatal loss rituals and interdisciplinary teamwork was invaluable.
I want to thank all of my coauthors. Many have had personal losses as well as professional expertise. Your stories and your knowledge of working with families and culture and religious perspectives, beliefs, and practices have brought this entire book to fruition.
I also deeply thank Dr. Constance Baldwin (Professor of Pediatrics, my personal scientifc editor, and also my mother) who has helped edit most of the book using her masterful wordsmithing and organizational expertise. And to my father Dr. Richard Denney and stepmother Karen Denney, who have been staunch supporters of my career and work from my childhood on. Your pride in me always brings me such joy.
To Eva, for your bravery, beauty, and courage and to baby Lysander’s memory. To all the mothers, fathers, grandparents, siblings, friends, and families who have grieved and found solace in all the churches, synagogues, temples, mosques, longhouses, gardens, and beaches described in this book: Your beautiful, heartbreaking, poignant, and sweet stories have made this book come alive.
10 Unique Experiences of Family Building and Perinatal Loss Using Assisted Reproductive Technologies with Heterosexual and LGBTQ+ People
Lindsay J. Sycz, Adam T. Evans, and Erin M. Denney-Koelsch
Part III Planning and Supporting Families Through Perinatal Death Rituals
11 The Interdisciplinary Health Care Team in the Setting of Pregnancy Loss and Infant Death .
Erin M. Denney-Koelsch, Chris Tryon, Darryl Owens, Elise Marcello, Elaine Kong, Katherine Hyde-Hensley, Elizabeth Conrow, Kathie Kobler, and Melanie Chichester
12 Community Supports for Parents with Perinatal Loss and Bereavement
Erin M. Denney-Koelsch, Alyssa Gupton, Amy Degro, Nora Doebrich, Katherine Hyde-Hensley, Melanie Chichester, Jennifer Sternal-Johnson, Amy Kuebelbeck, Debra Cochran, and Denise Côté -Arsenault
13 How to Support Families through Rituals and Memory-Making . . .
Erin M. Denney-Koelsch, Kathie Kobler, Melanie Chichester, Katherine Hyde-Hensley, Chris Tryon, Jennifer Sternal-Johnson, Denise Côté-Arsenault, Debra Cochran, Amy Kuebelbeck, Rachel Diamond, Barbra Murante, and Elise Marcello
Index
Part I
Overview
of Perinatal Death Rituals
Chapter 1
A Spectrum of Loss: Introduction to Perinatal
Loss and Bereavement
Erin M. Denney-Koelsch and Ponnila Marinescu
A fower and not a fower; Of mist yet not of mist; At midnight she was there; She went as daylight shone. She came, and for a little while Was like a dream of spring. And then, As morning clouds that vanish traceless, She was gone.
—Po Chu
From Mothers of Thyme: Customs and Rituals of Infertility and Miscarriage by Janet L. Sha
Author’s Note: Dr. Denney-Koelsch is a palliative care physician who specializes in perinatal palliative care and is the primary researcher for the entire book. When the text describes methods using the frst person, it is her voice. Dr. Marinescu is a maternal-fetal medicine physician who specializes in perinatal loss and terminations for life-limiting fetal conditions.
E. M. Denney-Koelsch (*)
Division of Palliative Care, University of Rochester, Rochester, NY, USA
e-mail: erin_denney@urmc.rochester.edu
P. Marinescu
Division of Maternal-Fetal Medicine, University of Rochester Medical Center, Rochester, NY, USA
E. M. Denney-Koelsch (ed.), Perinatal Bereavement Rituals and Practices Among U. S. Cultural Groups, https://doi.org/10.1007/978-3-031-47203-9_1
E. M. Denney-Koelsch and P. Marinescu
Introduction to Perinatal Loss
Perinatal loss is ubiquitous across human existence. Pregnancy and infant loss, a term interchangeable with perinatal loss, refers to miscarriage, stillbirth, and death of liveborn infants in the frst year of life. This book arose out of an ethnographic research study that sought to explore the cultural and religious aspects of perinatal loss in the many and varied groups within the USA. Many people are affected by pregnancy and infant loss: not only the parents and family members, but also all those who support parents in their grief from the medical professionals to community support services.
Society’s failure to acknowledge the profound experience of perinatal loss has meant that parents often have to invent their own rituals and search out their own supports to overcome their grief. These approaches are highly infuenced by parents’ personal views and needs; their social context, religious beliefs, family culture and beliefs, and surrounding support network; and the views of society at large. When a family’s own cultural or religious community fails to provide adequate support, meaning or structure after a perinatal loss, they must seek out their own “loss community” to receive needed support and understanding, often through support groups or social media. Ultimately, many of the parents interviewed for this book had to fnd their own rituals and mourning practices to meet their own needs.
The intended audience for this book is broad: anyone who is experiencing, has experienced or is working with someone who has experienced a perinatal loss. The authors come from a wide-ranging group of interdisciplinary clinicians (nurses, physicians, social workers, child-life specialists, and doulas); therapists in bereavement, music and art; and clergy and chaplains. It is designed to be a reference for any of these care providers, or others who interface with parents who are undergoing the trauma of losing a fetus or infant, whether in the hospital or in the community.
This project initially arose when one author (EDK) was writing and editing an earlier book called Perinatal Palliative Care: A Clinical Guide (Denney-Koelsch and Côté-Arsenault 2020). When I asked a chaplain for resources on how different religions approach pregnancy and infant loss and what rituals they might use, he replied that he did not think such a resource existed. He came up with a brief description of some common birth and death rituals, but I realized that this was only a beginning. This book represents the frst comprehensive resource on U.S. cultural and religious beliefs, perspectives, practices and rituals related to perinatal loss. Because the USA is a proverbial melting pot of cultures, the book covers a wide range of racial, ethnic and religious groups from across the world. We interpret these traditions within the context of U.S. society and healthcare system.
In order to understand rituals and practices around the death of a fetus or infant, one must understand human beliefs about the soul or spirit and the afterlife, and cultural practices for the deaths of adults and older children. We have, therefore, taken a broad cultural view of pregnancy and infant loss in this book. We cover a brief history of each cultural group and religion, common death practices for adults, and the unique practices that apply to fetuses and infants. There cannot be a discussion of culture without stories, and the richest part of the book are the words of
parents themselves. No single story can represent all people, but the richness of the parents’ own experiences can help us to ground theoretical and theological concepts in real, gritty life. Fundamental questions of life, death, and the search for meaning in death are the essence of this work.
Ethnographic Methodology
Ethnography, which is often conducted by anthropologists or social scientists, entails describing a culture by understanding life from the native point of view (Spradley 1980). An important component of ethnography is understanding the meaning of specifc actions and events, such as the death of a baby. People may express this meaning through words and actions. Spradley writes that:
… in every society, people make constant use of these complex meaning systems to organize their behavior, to understand themselves and others, and to make sense out of the world in which they live. These systems of meaning constitute their culture; ethnography always implies a theory of culture. (Spradley 1980, p. 5)
Culture is described by Spradley as “acquired knowledge” that is learned by humans from their surrounding infuences. These infuences can include their immediate and distant family, the neighborhood, city or country in which they currently live or where they were raised, their religious teachings or beliefs, and more. Part of culture is that “human beings act toward things on the basis of the meanings that the things have for them” (Spradley 1980, p. 8), and those meanings are infuenced by their culture. For example, the way in which a parent defnes the meaning of a pregnancy at any particular gestational age, or identifes a newborn baby in the context of their own family, has enormous implications for how they will respond if that fetus or baby dies. To understand culture, we must seek to understand cultural behavior (actions prior to, during and after the death of a baby), cultural knowledge (their understanding of religious beliefs or practices in their group(s)), and cultural artifacts (keepsakes, gravestones, urns, etc.). From the observation of these behaviors, artifacts, and speech messages, the ethnographer can come to understand the informant’s cultural knowledge.
This ethnographic study is unusual because I wanted to understand not just one culture, but the phenomenon of death rituals seen through the lens of the very specifc circumstance of perinatal loss. I frst defned the cultural and religious groups I should explore, and for this purpose we used the major demographic groups defned by the U.S. Census and the World’s Major Religions (Christianity, Judaism, Islam, Hinduism, and Buddhism). It was important to include cultures and racial/ ethnic groups that are unique to the USA, in particular Native Americans and smaller religious groups such as the Amish and Mennonites, Church of Jesus Christ of Latter Day Saints (Mormons), Jehovah’s Witnesses, and others. It is important for health care workers and community support caregivers to understand the cultural context and beliefs of the wide variety of patients they see.
The Institutional Review Board at the author’s institution reviewed the study and approved it as having minimal risk. An information sheet for participants stated the
E. M. Denney-Koelsch and P. Marinescu
purpose of the study, that participation was voluntary, and that interviews would be audio-video recorded for research purposes. It stated that the results were going into a book for health care providers who care for families after perinatal loss. It was also expected to contribute to health care education and potential future publications. When personal stories were shared, we asked each informant to state whether they would prefer that we use real or simulated names for them and their baby in the book. Virtually all gave permission for use of real names, wanting their story and their baby’s life to be shared.
This work was supported by the University of Rochester Academic Leave Program, which allowed the author 6 months of protected time to conduct research, assemble a qualifed set of chapter authors and contributors, and write and edit the book. Funding for professional transcriptions came from the University of Rochester Center for Palliative Care Research. Denise Côté-Arsenault served as primary mentor for this project, providing extensive guidance on ethnographic methodology, design, and data analysis. Kathie Kobler has also provided substantial advice, mentorship, and conceptual guidance throughout.
Because this ethnography covers many cultures, not an immersion within a single culture, trustworthiness and validity of the fndings were increased by using extensive interviews with key informants who identifed with the cultural and religious groups listed above. By purposive sampling from across U.S. cultures, I frst found key informants to be interviewed from the many cultural groups, identifed through their unique personal and professional expertise. I interviewed 46 individuals or groups. Because of their unique expertise, many of the co-authors for the book were identifed through these interviews. Each persons’ stories and perspectives were compared with existing literature to make sense of their perspectives. To add credibility, An Author’s Note is added at the beginning of each chapter explaining their own background (cultural and religious), and their personal or professional experience with perinatal loss and bereavement. Denise Côté-Arsenault and Kathie Kobler both provided additional mentorship in interpretation of the data. Each story shared is its own unique experience but the commonalities and differences are highlighted to increase transferability of the fndings.
In preparation for this project, an extensive literature search identifed books, manuscripts from medical and sociological journals, bereavement and perinatal loss websites, and support groups. Search terms included death rituals, perinatal loss, pregnancy loss, infant loss, infant mortality, mourning practices, and specifc cultural terms like African American, Jewish, etc. While a substantial literature on death rituals was identifed, most sources failed to mention infant death and even fewer mentioned fetal death. There was no source that resembled this book, with the exception of one ethnography, the Mothers of Thyme: Customs and Rituals of Infertility and Miscarriage by Janet L. Sha from 1990. This exceptional text does not cover stillbirth or infant loss, but it is rich with global stories that I have referenced often in the book, including the wonderful poem at the start of this chapter.
Data collection was conducted using multiple methods. The individual interviews were our primary and initial focus, but we also collected and documented artifacts that could be included in the book to deepen our understanding of cultures, rituals, and religious beliefs. These include texts, testimonials, and photographs of
parents with their dying or deceased babies, as well as photographs of memorial artifacts: cemeteries, head stones, unique family-chosen memorials, memory box items, and infant footprints and handprints.
Ethnographic interviews, using the methods of Spradley (1979), were guided by three elements: (1) the explicit ethnographic purpose of the interview (to understand cultural and religious beliefs, practices and rituals after perinatal loss), (2) the ethnographic explanations (such as “I’m interested in your role as a clergy in pregnant loss. What would you say to a parishioner who comes to you after a loss”), and (3) ethnographic questions (e.g. “When they told you there wasn’t a heartbeat, what did you do frst...second...”). I also asked contrast questions, such as “How would this be different if it were an older child or an adult?”
Interview informants came from three major groups:
1. Bereaved parents from all the major demographic and religious groups in the USA with a goal of at least 2 from each group
2. Hospital-based interdisciplinary team members (physicians, nurses, social work, child-life specialists, music therapists, chaplains, bereavement specialists, hospital funeral director)
3. Community support service members (e.g., clergy, funeral directors and employees, cemetery directors, support groups)
Network sampling methods were used so that initial participant contacts suggested others who might be informative. In total, 47 interviews were done: 7 interdisciplinary health care team members, 7 clergy or chaplains, a Jewish funeral director, a cemetery director, 27 bereaved parents (some of whom overlapped with the previous groups). I observed 2 support groups and interviewed the leaders of 4 others. The interviews were all conducted on Zoom (due COVID-19 pandemic requirements and geographic distance); they were recorded and professionally transcribed. While this approach did not allow the researcher to be “in the feld” and study the living context of informants as much as she would have liked, she found that Zoom worked well and was convenient for the informants. The vast majority of the interviews were done by the author/editor (EDK), but some chapter authors also wanted to enhance their understanding of the topic by doing some independent interviews, particularly in the Jewish, Asian, and Latino chapters. These interviews did not necessarily follow the same interview guide as those done by EDK, but their stories and experiences are rich with information.
Detailed feld notes were written. I often typed throughout the Zoom visits, or jotted hand-written notes when in the feld, typing up notes and impressions immediately afterwards. A running spreadsheet of contacts recorded their cultural identifcation, religious background, and occupation or professional discipline. A spreadsheet of memos allowed tracking of commonly repeated themes and concepts, ideas for further exploration, and suggested new informants or resources. Refective and analytical memos were kept, including cultural symbols (such as “fetal soul” and “the afterlife”) and the relationships between those symbols. A comparative grid of religious perspectives was created that included the fve World religions and the Native American Haudenosaunee Nation, recording information
E. M. Denney-Koelsch and P. Marinescu
on the afterlife, the timing of fetal personhood, and basic death rituals. A discussion of these data can be found in the Introduction to Part II.
Beginning close to home in Western New York, I frst interviewed all members of my own institution’s interdisciplinary health care team in palliative care, obstetrics, maternal-fetal medicine, and neonatology. These were doctors, perinatal loss bereavement nurses, bedside nurses, child-life specialists, chaplains, bereavement educators, and music therapists. Each was asked for suggestions on resources they would recommend or others whom we should interview (using network sampling method). Next, additional informants were recruited through several national listservs of perinatal loss and perinatal hospice groups. We sought health care team members, community support, and bereaved parents from different cultural and religious backgrounds with the goal of learning from people with as many diverse perspectives as possible.
To enhance my historical understanding, I took a tour of the American Museum of African American History and Culture and the Museum of the American Indian in Washington, D.C. My tours of multiple cemeteries across the country were also very fruitful. I also toured a local funeral home, the “memory room” of our hospital (where perinatal loss photos and memory boxes are created), and an Angel of Hope infant memorial in St. Louis, Missouri. Photos were taken where allowed and appropriate. I attended two funerals of adult family members of informants. A remarkable opportunity arose to visit the homes of bereaved Amish parents in Pennsylvania with a palliative care nurse who works with these families.
Because this book seeks to understand a narrow topic (pregnancy and infant loss rituals) in the context of many cultures, we were limited in our depth of understanding of any particular culture. However, through my interviews and tours, I identifed an amazing set of co-authors who have made this ethnographic study come alive. Some speak for themselves, and some speak for others whom they know well. While I sought to understand the cultures and religions as much as possible, my coauthors are the real experts on the subject matter of the subsequent chapters. Because there is so little published on this topic, the book’s rigor and richness comes from the expertise of the co-authors who are interpreting and describing the lived experiences and words of bereaved parents. In most chapters, these parents are invited to speak for themselves. We have made every effort to recreate for readers the intense reality of perinatal loss and grief.
A Brief History of Pregnancy and Infant Loss
Theories about the causes of miscarriage abound in the historical literature, and often the woman is blamed or feared. In ancient India, people believed that the blood of a miscarried fetus contained a demon which could be spread to other women, so the cloth containing the blood from the miscarriage was discarded (Cox 2020). Women who miscarry in Eskimo culture were blamed for having broken
taboos, bringing impending evil that could contaminate others from a vapor rising from her (Sha 1990).
Cox (2020) writes that “In the European Middle Ages, an increasingly pious culture placed more blame and restrictions on mothers during pregnancy, requiring bed rest and confnement. Fright, blaspheming, strong emotions, sneezing, riding in a carriage, heavy lifting, and being conceived under bad planetary alignment were all thought to cause miscarriage.” Blame of the mother was commonplace in many societies, with accusations of her having committed adultery, lifting something, breaking some other taboo, engaging in witchcraft, or having been cursed by someone (Sha 1990). Women who were “nervous” or “of delicate form” were felt to be most likely to miscarry. Too much intercourse could cause miscarriage, as could reaching for a pitcher over her head, taking a warm bath, etc. (Sha 1990).
While most cultures did accept that miscarriage is a natural event, many women continued to feel isolated, blamed, and stigmatized for their losses. They would go to great lengths to take herbal treatments or charms that might help, avoid certain foods, odors, tasks or positions, and perform rituals such as making an offering or sacrifce to a god to drive off evil (Sha 1990). In ancient Egypt, Isis (the God of pregnancy and fertility), “was believed to have inserted rolled papyrus in the shape of a knot into her vagina acting as a plug to prevent miscarriage of Horus, her son. Pregnant women would mimic this act to keep their pregnancies safe. Uterine magic was commonly practiced; the uterus was believed to be a separate entity within the body and magic attempted to control its unpredictable behavior. Primarily spells and prayer were used to control the timely opening and closing of the uterus, thus preventing miscarriage” (Cox 2020). The Anglo-Saxons had a series of rituals for women who have had a miscarriage to prevent a future one. She would step over the grave of a dead man three times, asking to prevent another “hateful misbirth” (Sha 1990, p. 97). When she conceived again she would step over a living man asking for this baby to live, and if she reached quickening (fourth month), she would approach the altar at her church and proclaim “To Christ I have declared this child announced” (Sha 1990, p. 98).
In Victorian society, pregnancies were hidden with corsets attempting to conceal the condition as much as possible (Sha 1990). Only the outcomes of successful pregnancies (healthy babies) were recognized, so it was “no wonder that miscarriage was considered a nonevent in our society—for everyone but the parents” (Sha 1990, p. 63).
In Colonial America, Friedenfelds writes that:
Women experienced pregnancy in an era when life was always uncertain, the faithful were expected to trust God and submit to fate, and women were celebrated and respected for the bounty of their wombs. Childbearing could be exhausting and diffcult, but children came when they came, and the process was largely regarded as inevitable and simply part of the natural and religious order of things. Early and abrupt endings, too, were part of the Godgiven order. Pregnancies came frequently and were regarded as tenuous until late in gestation. In an era when families frequently lost infants and children to infectious disease, early pregnancy losses received little attention (Freidenfelds 2020).
E. M. Denney-Koelsch and P. Marinescu
For enslaved women in America, pregnancies were often forced and even those who had desired pregnancies dreaded knowing that their children would also become property of their slaveowners (who were often their fathers). More than half of the pregnancies of slave women ended in stillbirth, infant mortality or death in early childhood (Morgan 2004), twice the frequency of such outcomes for their white slaveowners. After importation of slaves was banned, but prior to abolition, slave women, like cattle, became the sole commodity for augmenting the chattel wealth of their slaveholders through “their increase” (babies) (Morgan 2004).
For much of human history, losing a pregnancy or a baby was commonplace, and many of the beliefs, practices, and rituals described in this book likely arose out of pragmatic needs. It was not feasible for most women to observe a prolonged period of mourning after an infant death when her daily tasks were required for survival of the remaining children. However, the frequency of perinatal loss and the practicalities that may have led to minimizing mourning requirements do not indicate that the mothers did not feel grief. It is possible that in the past, infectious concerns as much as spiritual demands led to the extensive bathing of the deceased’s body and subsequent ablution of the washers that is practiced in Judaism, Islam, and other religions. While pregnancy loss was common, Sha explains:
Some people think that, because so many babies were lost to illness, miscarriage was considered a trivial event in the past. This is not true. Although people in the past were more attuned to the cycles of life and were better prepared to handle death than we are today, parents have always grieved over losing a wanted child during a known pregnancy, even when they had many children. And there have always been women who had no live births, only miscarriages. These women did not pass off their miscarriages as trivial, or fail to notice that they had occurred (Sha 1990, p. 71).
At the turn of the twentieth century, nearly 10% of American infants died in the frst year of life, and 0.6% of mothers died. With improved obstetrical and neonatal care, infant mortality between 1900 and 1997 fell 90% (to 6/1000) and maternal mortality fell 99% (to 0.1/1000 year). This dramatic decline is the result of improvements in sanitation and hygiene, nutrition, widespread availability of antibiotics and improved medical care, as well as declining fertility rates. Regrettably, preventable deaths still occur, as demonstrated by the wide disparities in infant and maternal mortality between people of color and whites, with Black mothers and babies most at risk. Black infants are over twice as likely to die as their white counterparts (10.6/1000 vs 4.5/1000) and Black women are more than 3 times as likely to die in childbirth. In the USA, the lowest infant mortality rates are in Non-Hispanic Asians at 3.4/1000 (cdc.gov) (Achievements in Public Health 2023).
Despite lower rates over the past century, it is still common for women and their families to experience pregnancy and infant loss. About 15–24% of US pregnancies will end in miscarriage and 5/1000 women will lose an infant in the frst year of life. The defnitions of different types of perinatal loss and rates are given in Table 1.1.
1 A Spectrum of Loss: Introduction to Perinatal Loss and Bereavement
Table 1.1 Defnitions and rates of types of perinatal loss in the USA
Term
Miscarriage or spontaneous abortion
Stillbirth or intrauterine fetal demise (IUFD)
Perinatal death
Age at the time of death Notes U.S. rate
<20 weeks gestation
Early (<12 weeks) Late (12–20 weeks)
20 weeks gestation through full term
28 weeks gestation through 1 week after birth
Neonatal death
Termination of pregnancy for fetal anomalies (TOPFA)
Infant mortality
Birth to <28 days of life
Any gestational age
Between live birth and 1 year of life
Range of experience from a heavy period to an experience of labor with delivery of a fully-formed, small fetus
Fetus found not to have a heartrate during pregnancy and/or does not take a breath at birth
Dies either in utero at >28 weeks gestation or <1 week after birth
Born alive, dies within 28 days of life
Rates vary by severity of anomaly and location of study
10–15% of known pregnancies 1–5% are late
1% (24,000/year)
5.69 perinatal deaths/1000 live births and late fetal deaths
3.49/1000 live births
37–78% of pregnancies with severe fetal anomaliesa
5.4/1000 live births
Rates from Pregnancy and Infant Loss (2022); Infant Mortality (2022) cdc.gov/2022 a Schechtman et al. (2002)
Types and Rates of Perinatal Loss
The most common causes of pregnancy loss are chromosomal anomalies (particularly too few or too many chromosomes, not compatible with survival), followed by toxins; problems with the placenta, cervix or uterus; and problems with the sperm (NICHD.gov). Risks of miscarriage increase with maternal age, presence of health problems, and prior obstetrical history.
The most common causes of infant death are: (1) birth defects, (2) preterm birth and low birth weight, (3) sudden infant death syndrome, (4) injuries, and (5) maternal pregnancy complications such as placental abruption. Table 1.1 describes the types of perinatal losses and their defnitions and rates. The terminology can sometimes overlap.
E. M. Denney-Koelsch and P. Marinescu
A Note on Respectful Terminology
We have attempted throughout the book to use terminology that fts with the parent’s own words. We have usually chosen to use “baby” rather than “fetus” except when talking about medical conditions. We have most often used the terms “mother” and “father.” The vast majority of the parents interviewed for this study were cisgender, heterosexual couples, so we have used the terms that they preferred. In cases where the pregnant person did not identify as female or as mother, we have used the terminology the person preferred such as “birthing parent.” Respectful terminology for LGBTQ+ parents is discussed in Chap. 10
Parent Experiences of Perinatal Loss
In many ways, this topic covers the entire book. The parents’ words speak volumes more than we can describe as observers. As with all types of human losses and bereavement, the experience is highly individual, based on circumstances and the personal meaning of the loss. Perinatal loss can be understood on several parallel spectra: a 9-month spectrum of gestational age at the time of loss, a spectrum of degrees of effort invested in conception, a spectrum of the value placed on that individual pregnancy by parents, a spectrum of experiences of delivery, and a spectrum of levels of support. There are certainly people for whom a miscarriage is just “a missed period” or “something that was not meant to be.” For others, a miscarriage can be a devastating experience of lost hopes, a painful medical ordeal, and a lifechanging event. While there is clearly a difference between a sudden, unexpected infant loss and one in which a known serious condition was expected to lead to the baby’s death, parents in both circumstances experience grief for the loss of that baby and of the entire future with that child.
A Support Group as a Microcosm
When I observed a pregnancy and infant loss support group, the women described wide differences in their personal loss experiences, but still talked about many common themes. One had two miscarriages in the frst 6–8 weeks of pregnancy, and because these were her frst pregnancies and were highly desired, the mother was intensely sad. Another mom had lost a baby to stillbirth 12 years prior to this very frst attendance at a support group. Another mom had multiple living children as well as multiple miscarriages, and she had a Catholic mass and burial for all of them. Another mom’s baby had been induced at 23 weeks gestation because of the mom’s critical health problems, and did not survive. One had fnally conceived after multiple rounds of IVF only to have a placental hematoma and delivery of a
stillborn at 24 weeks. Another had twins, one with congenital heart disease who lived 90 min. His brother is now old enough to understand that he lost a brother.
Despite these varied loss events, the women all had many similarities in their experiences. They all struggled to answer the question of “how many kids do you have?” They all talked about the importance of talking about their baby, using his or her name, and honoring the infant on important dates and birthdays. All of those who buried their baby periodically visited their gravesites. All of those who kept the ashes chose cremation to make their baby’s remains portable when they moved and put them in a special place. One kept the ashes in a necklace.
They all talked about the importance of having “tangibles:” specifc items that signify the memory of their baby, such as ultrasound photos, items the baby wore at the hospital, or ID tags from the hospital. If there were no tangibles, they created them, e.g., jewelry with the baby’s name, ornaments, and tattoos. One of the mothers stated, “I needed my babies to be with me all the time.”
All of the women who experienced miscarriages described the fallacy of the common description of it being “just a heavy period.” Several of them did not pass all of the fetal and placental tissue and required dilation and evacuation (D&E). Several of them attempted to catch the fetal remains intact using a kitchen strainer in order to be able to bury the baby’s body. Several had to deliver in the hospital and they had no idea that they would have to deliver an intact body. “No one talks about delivering dead babies.” They described how surreal it was when “they put my dead baby on my stomach.” They were surprised that the bereavement photographer was so comfortable with it.
Mothers whose babies lived a short time after birth were incredibly grateful for the time they had, although they also felt that their pregnancies were extremely diffcult when they knew that their baby would not survive. They had to make diffcult medical decisions about their baby’s care, such as should we attempt to resuscitate if the infant is not breathing?
Several of the mothers talked about guilt over feeling that their “body couldn’t do it.” While they didn’t receive blame in the way that historical women did, they still questioned whether they had done something, or not done something, that might have caused the baby to die. Those who previously experienced infertility felt even more distraught at having failed to carry this one baby to safety, and worried they would never have another one. Those who had carried pregnancies after a prior loss all worried throughout the pregnancy that the same would happen again.
Considerations for LGBTQ+ Parents
Parents who identifed as LGBTQ+ face unique challenges in starting a family, often needing fertility assistance to conceive, either through sperm donation, a surrogate, or hormonal treatments to allow a transgender man who still has a uterus to conceive. The important and sensitive experiences of these parents are explored in greater depth in Chap. 10. 1 A Spectrum of Loss:
E. M. Denney-Koelsch and P. Marinescu
Need for Community
Janet Sha says that “women and men who experience infertility and miscarriage belong to a tremendously large and ancient fellowship” (Sha 1990, p. 113). Many parents found that stigmatization of their “taboo losses” was incredibly isolating, and they sought others who had been through something similar. Many of the parents interviewed for this book described the experience of “joining a club you never wanted to join.” Support groups, social media, and therapists who specialize in perinatal loss were incredibly valuable and validating; they reassured these mothers that they were not alone and their feelings were completely acceptable. Many parents interviewed talked about their “loss community” or “one of my loss friends.” These connections with others who have been through something similar were extremely important.
Standard Medical Care for People Experiencing Pregnancy Loss
Most women who have a fetal death experience symptoms of pelvic or abdominal cramping, lower back pain, bleeding, white or pink vaginal discharge, and the passage of tissue. Half of women experiencing miscarriages will completely expel all the fetal and placental tissue without intervention. However, if there is retained tissue, the mothers will require treatment or risk serious infection (see below). Miscarriages at later gestational ages require passing a recognizable sac of tissue or a small fetus, and mothers describe the experience as similar to labor. Other mothers have no symptoms and only fnd out about their baby’s death when a scheduled ultrasound fails to fnd a heartbeat. Fetal death can occur late in gestation, often with no warning, and thus lead to stillbirth. These late term infant losses can occur because of previously known fetal conditions or anomalies, or unexpectedly due to delivery complications such as birth asphyxia. Sometimes undiagnosed conditions lead to infant death in the neonatal period. Many parents never know the cause of their baby’s death.
Medical Treatment for Miscarriage (Fetal Loss <20 Weeks Gestation)
In the event of an incomplete miscarriage or the determination of no heartbeat on an ultrasound without sign of labor, the pregnant woman will have to make decisions about whether to wait for natural labor or to be induced. In the frst trimester, most women are offered expectant management, i.e., waiting to see if they pass the fetus naturally. Most women will pass the fetus, though it make take multiple weeks. If
they do not, they need to undergo a procedure to remove the remaining tissue. Misoprostol, a prostaglandin analog, can also be used to help the mother to pass intrauterine contents, and most will not require uterine curettage. If they fail to pass all the remaining tissue, there is a risk of severe infection. Most women will choose a D&C (dilation and curettage), which involves cervical dilation and aspiration of the uterine contents with a curette, usually a suction cannula Dilation and Curettage (D&C) (2023). At >14 weeks, a similar procedure is referred to as a D&E (dilation and evacuation). Here the cervix is dilated and all material is removed using a combination of forceps and suction.
Medical Treatment for Stillbirth (Fetal Death >20 Weeks Gestation)
A stillbirth, or fetal demise, happens when a fetal death occurs between 20 weeks gestation and birth. Some women notice a lack of movement and seek evaluation, which confrms an absent heartbeat. For others, the fetus dies during labor or delivery. Almost half of late fetal deaths occur in uncomplicated pregnancies, so without warning, parents may be in shock and distress (UptoDate.com). If the mother is not in labor and she is at <24 weeks gestation, she can undergo a D&E. Later, she will usually be offered induction with misoprostol and mifepristone, though spontaneous labor occurs in the majority of cases in the 1–2 weeks after the fetal death. A vaginal birth is preferred, but the mother’s health is the priority in decision-making. In the event of placenta previa or previous cesarean births, a cesarean may be required or preferred.
Standard Care of Parents with Life-Limiting Fetal Diagnoses (LLFDs)
The previous scenarios of miscarriage and stillbirth usually happen with little warning, and parents are often shocked and flled with intense grief. With advances in fetal monitoring and genetic testing, however, parents can fnd out, in early months of pregnancy, whether there is an increased risk for chromosomal or structural differences and/or a clearly observed fetal condition. About 3% of fetuses are found to have congenital birth differences, with 2% being life-threatening (cdc.gov). Because these parents have many months of pregnancy ahead, and know to expect a serious condition, they are faced with shock and grief at the time of diagnosis, with less surprise, although no less grief, after birth. They are asked to make a series of sometimes heart wrenching medical decisions, and experience a prolonged period of time during which they are anticipating the birth and possible death of their child (DCA and EDK 2016). This time period, while stressful, also presents an opportunity for providing increased support.
E. M. Denney-Koelsch and P. Marinescu
Pregnancy care in the setting of life-limiting fetal diagnoses (LLFDs) is tailored to the fetal condition with careful watching for complications. Monitoring of the fetus can be individualized. Most parents want to know the baby’s status, even if the prognosis is poor. Parents will typically meet with the pediatric or neonatal teams to learn about the baby’s condition, prognosis, and treatment options. Parents in this circumstance are faced with whether to continue the pregnancy. When they choose to continue or are outside of local limits for termination, they may work with the team to develop a birth plan that addresses the type of care they would want for labor, delivery, infant care at birth, and can plan special memory-making activities.
Perinatal Palliative Care
Perinatal palliative care (PPC) arose out of both the perinatal bereavement and the pediatric palliative care communities. Both identifed the benefts to building a relationship with parents during pregnancy, without waiting until after the birth to offer support. Another commonly used term is perinatal hospice, which refers to the care of parents who have chosen a purely comfort-oriented approach to care of their newborn. The perinatal palliative care team may counsel families about their choices, including feasible life-sustaining treatments for the baby after birth and the option of comfort care. The team may follow those babies who survive through long hospitalizations and even into childhood, in some cases. When a comfort care approach is chosen by the family, perinatal hospice (which falls under the umbrella of palliative care) can support babies and families through the dying process.
The PPC feld has grown exponentially in recent years, with increasing availability of teams, the growth of telehealth, a growing body of research, and representation of PPC providers on national pediatrics organizations (EDK and DCA book, 2020). ACOG recommends (Perinatal palliative care 2019) palliative care in a number of opinions (ACOG opinion 786 and 587) with this language:
• “Health care providers are encouraged to model effective, compassionate communication that respects patient cultural beliefs and values and to promote shared decision making with patients” (ACOG Committee Opinion 587 2014).
• “Although specifc offerings may vary between institutions, some care components are generally advisable across perinatal palliative comfort care programs: a formal prenatal consultation; development of a birth plan; access to other neonatal and pediatric specialties, as needed; and support and care during the prenatal, birth, and postnatal periods, including bereavement counseling” (ACOG Committee Opinion 587 2014).
Perinatal palliative care for parents typically involves a prenatal consultation (often interdisciplinary) with the family during which the team discusses the fetal diagnosis, prognosis, treatment options—if applicable, and expectations throughout pregnancy and after birth. They assess parents understanding of the circumstances, their need for information, and their goals, values and preferences around decisions surrounding birth and possibly death. Working in collaboration with the parents and
the obstetrical and neonatal teams, the PPC team can assist the parents in creating a birth plan that honors their goals and wishes.
PPC teams are interdisciplinary, with physicians, advanced practice providers (APPs), nurses, chaplains, social workers, child-life specialists, and therapists (Wool et al. 2015). They provide emotional, psychosocial, and spiritual support to families throughout the pregnancy and neonatal period.
The PPC team may be instrumental in memory-making and helping families to consider rituals described throughout the book. This work may be done by anyone on the interdisciplinary PPC team, but most commonly it is the bedside nurse, palliative care nurse, child life-specialists, chaplain or possibly a social worker. Part III will describe in detail the types of work done by all of the team members.
Offering perinatal palliative care to pregnant patients should be seen as an opportunity to further their autonomy and promote benefcent care during incredibly challenging circumstances. Families should be supported in a shared decision-making process that honors individual autonomy and respects the complex network of family relations and emotional infuences in their lives (ACOG Committee Opinion 501). Recognizing the characteristics of grief that may be unique to these circumstances of loss is important, so providers can build trust and possibly guide a patient through family building in the future.
Termination of Pregnancy Because of Fetal Anomalies (TOPFA) or Maternal Health Risk
Chromosomal and structural differences account for 20% of both fetal and neonatal demise (Heron 2018). Many of these chromosomal and structural differences constitute life-limiting conditions. They may be lethal fetal conditions, or conditions for which prospects of long-term ex-utero survival are limited, or when severe morbidity or poor quality of life is likely if the baby should survive. Parents in these circumstances have to face the extremely stressful decision of whether to terminate or continue the pregnancy.
Termination may also be indicated in pregnancy if the mother’s health may place at risk her life or that of her fetus. Such parental co-morbidities include the modifed World Health Organization Class IV cardiac pathology—Marfan’s Syndrome with an aortic root diameter >4.5 cm, Eisenmenger’s Syndrome, and prior history of peripartum cardiomyopathy with unrecovered systolic heart function, among others. Pregnancy is contraindicated for those patients who meet this class of criteria, given that the risk of occurrence of a critical cardiac event, including death, is 40–100% (Regitz-Zagrosek et al. 2011).
The rates of pregnancy termination for fetal anomalies vary signifcantly across studies and there is a paucity of recent data. Rates of termination increase with the severity of the anomaly; a 2002 study in St. Louis, MO showed rates as high as 78% for the most lethal anomalies (anencephaly and bilateral renal agenesis). The choice
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Then gang wi’ me to Scotland, dear, We ne’er again will roam, And with thy smile sae bonny, cheer My native Highland home.
For blithsome is the breath of day, And sweet’s the bonny broom, And pure the dimpling rills that play Around my Highland home
Such, during several months, was their almost unvaried mode of life. On the 12th of March 1826, Clapperton was seized with dysentery; and the intense heat of the weather as well as the feverish state of the patient rendered it necessary that he should be almost constantly fanned; a female slave was employed to perform this office, but she found it too irksome, and soon abandoned her post and ran away. He grew daily worse, while Lander was oppressed with anxiety on account of the calamities which had befallen him, and exhausted with the exertion required in the performance of the various duties which devolved upon him. As he had a great regard for his master, we see no reason to doubt the accuracy of his account, that he was unremitting in his attentions to him during his last illness, which Clapperton himself attributed to the following instance of imprudence. “Early in February,” said he one day to Lander, “after walking a whole day exposed to the scorching rays of the sun, I was fatigued, and lay down under the branch of a tree. The soil on that occasion was soft and wet, and from that hour to the present I have not been free from cold. This has brought on my present disorder, from which I believe I shall never recover.” A couch was made for him on the outside of his hut, and during the space of twenty days he gradually declined, till at last all hope of recovery was extinguished. In these dismal moments, says his faithful attendant, he derived consolation and support from the exercises of religion. Lander read the scriptures to him daily. No stranger visited him during his illness, except an Arab of Fezzan, who intruded himself one day into the hut, and wished to be allowed
to read some of the Mahometan prayers, but he was ordered to quit his presence. Pasko who had left his service, and had married and settled in the city, was taken back, and relieved Lander of a portion of his heavy tasks. During his illness Clapperton talked much of his country and his friends. By the advice of Maddie, a native of Bornou, he swallowed a decoction of green bark from the butter tree, and speedily afterwards became worse, so that he could get no repose. On the next day he said to Lander, “I feel myself dying. Take care of my journal and papers after my decease; and when you arrive in London, go immediately to my agents and send for my uncle who will accompany you to the colonial office, and see you deposit them with the secretary. Borrow money, and go home by Fezzan in the train of the Arab merchants. From Mourzuk send to Mr. Warrington, our consul at Tripoli, for money, and wait till it comes. Do not lumber yourself with my books. Leave also the barometer and every cumbersome article. You may give them to Mallem Mudey. Remark what towns and villages you pass through, and put on paper whatever remarkable thing the chiefs of the different places may say to you.”
On the 11th of April, he was shaved, and rallied a little, but soon became worse, and died on the 13th. By order of Bello he was buried in an open place about five miles from the city of Soccatoo, and Lander read over him the service of the church of England for the “burial of the dead,” as Clapperton had himself formerly done for Dr. Oudney and some other of his companions. Next day Lander returned to the spot, and with the assistance of some of the natives a shed was erected over the grave.
MEMOIR OF MAJOR ALEXANDER LAING, THE AFRICAN TRAVELLER.
MEMOIR OF MAJOR ALEX. GORDON LAING, THE
AFRICAN TRAVELLER.
M A G L , another of those adventurous spirits who met with their common fate, in the attempt to explore the interior of Africa, was born at Edinburgh on the 27th December 1794, and was the eldest son of Mr. William Laing, A.M., one of the most popular classical teachers of his day. In his academy, in the New Town of Edinburgh, young Laing received nearly the whole of his education, at least all that was necessary to prepare him for the university Possessing a quick intuitive perception, and an ardent thirst for classical knowledge, his progress was in proportion; and at the early age of thirteen, he entered the university of Edinburgh. Here his attainments became still more marked, and Professor Christison, who then occupied the humanity chair, observing his literary taste, used to point him out in the public class as worthy the imitation of his fellow-students, though few might hope to surpass him.
When about fifteen, Laing went to Newcastle, where for six months he filled the situation of assistant to Mr. Bruce, a teacher in that city; he then returned to Edinburgh, and entered upon a similar duty under his father, a situation for which he was singularly qualified.
It appears strange that a young man, quietly, and, at the same time, eagerly, pursuing the laborious profession of a schoolmaster,
should have afterwards adopted another line of life forming a perfect contrast to that in which he had been previously employed. The change of his tastes is wholly to be attributed to his connexion with the volunteers. At a time when volunteering was very general, Alexander Laing entered one of the corps then forming; and in 1810 was made an ensign in the Prince of Wales’s Edinburgh Volunteers, then being in his seventeenth year. Captivated with the specimen he there had of a military life, he desired earnestly to be a soldier. He could no longer submit to the restraints and routine of school discipline; and at the end of the second year, he finally gave up the now to him irksome duties of teaching, to the disappointment of his parents and relatives, who were very desirous that he should not change his profession. Being, however, bent upon the military service, he, in the year 1811, went out to Barbadoes, where his maternal uncle, Colonel, afterwards General Gabriel Gordon, then was, with whom he remained a short time till he obtained an ensigncy in the York Light Infantry, which regiment he immediately joined at Antigua, and in two years thereafter he was promoted to a lieutenancy in the same corps—a situation which he held till the regiment was reduced, when he was then placed upon half pay.
But anxious for occupation, he exchanged, as speedily as the affair could be negotiated, into the second West India regiment, which he joined at Jamaica. While there, he had to discharge the duties of deputy quartermaster-general, the exertions of which department brought on a liver complaint, for which his medical advisers recommended a sea voyage. He accordingly sailed to Honduras, by which his complaint was considerably relieved, and the governor, Colonel Arthur, finding him an active, useful, and intelligent officer, appointed him to the office of fort-major, and would not suffer him to return to Jamaica, but had him attached to another division of his regiment then in Honduras, where he remained till a return of his complaint forced him to come home, his frame being so much debilitated, that he was unable to walk, so that it became necessary to carry him on shipboard.
His constitution was very seriously injured by this illness, and in consequence he remained nearly eighteen months with his friends in
Scotland. During this time, however, that half of the second West India regiment to which he was attached was reduced, and he was again placed upon half-pay. In the autumn of 1819, he returned to London, and having been sent for by the late Sir Henry Torrens, then Colonel of his regiment, was familiarly complimented by him on his former services, immediately appointed lieutenant and adjutant, and proceeded to Sierra Leone.
Early in January 1822, Lieutenant Laing was sent by the late governor, Sir Charles M‘Carthy, on an embassy to Kambia and the Mandingo country, to ascertain the political state of those districts, the disposition of the inhabitants to trade, and their sentiments in regard to the abolition of the slave trade. Sir Charles was perfectly satisfied with the manner in which his instructions were executed, and with the information he received on the different heads.
Having fulfilled the purposes of the mission at Kambia, he crossed the river Scarcies, and proceeded on foot to Malacouri, a strongly fortified Mandingo town, situated on the banks of the river Malageea, about twenty miles N. by W. from Kambia, where he learned that Amara had applied to the king of the Soolimas, who had sent a numerous army to his assistance, by whose means he had taken Malageea, the principal town belonging to Sannassee, and had made that chief a prisoner. Here he was also informed, that Amara meant to put Sannassee to death after the performance of several ceremonies. The Soolima force was stated to exceed ten thousand in number, and commanded by Yaradee, a brother of the king, who had acquired some renown as a warrior. Of the Soolimas, little more than the name was known at Sierra Leone: they were reported, however, to be a very powerful nation, residing in the interior, at a distance of three or four hundred miles to the eastward of Sierra Leone.
Sannassee having always been upon the most friendly terms with our government, and the unforgiving disposition of Amara being well known, great alarm was excited for the unfortunate chieftain whom he had in his power; Laing therefore, though suffering under a severe attack of fever and ague, proceeded to the Soolima camp to
mediate between Amara and the captive Sannassee. His account of this expedition is as follows:
“About two miles beyond the river Malageea, which I crossed near its source, I fell in with an outlying picket of the Soolimas, consisting of about fifty men, with sentries regularly posted, to whom I was obliged to explain my purpose before the chief of the guard would permit me to pass: another mile west brought me to a stronger guard of about one hundred and fifty men; and a mile and a-half farther to a large savannah or plain where the whole army was encamped. It was now nearly nine o’clock, and being very faint and feverish, I was glad to take refuge from the rays of the morning sun, which, in this part of Africa is the most oppressive time of the day, under a few bundles of dried grass thrown loosely upon three sticks fixed apart in the ground at equal distances, the tops being drawn together and fastened after the manner of military triangles. These temporary dwellings, when well constructed, form no bad imitation of, or substitute for, bell-tents, possessing this advantage, that they can be erected with little trouble, and no expense, in a short time, whenever an army takes up a position. From this covering I had a view of the whole encampment, which exhibited the appearance and bustle of a well attended fair, rather than the regularity and discipline of military quarters. Tents constructed as above described, were to be seen covering the savannah as far as the trees, windings, and other obstacles, would permit the eye to reach; and the distinguishing flags of the various and numerous tribes were everywhere to be observed waving over the habitations of their respective chiefs. Music, a horrid din of a variety of barbarous instruments broke on the ear from every direction; while parties of men, grotesquely habited in war dresses, were here and there descried, brandishing their cutlasses, and capering with the most extravagant gestures, to the time of the various sounds produced. The novelty of the scene attracted my attention for a while,—but fatigue, arising from the ague of the preceding night, at length overcame my curiosity. About noon I was awoke by one of my followers, who acquainted me that Amara was ready to hold a palaver with me, and desired my immediate attendance. In my way to his tent I visited Satin Lai, a designing Mandingo chief, possessing much power; he had been mainly
instrumental in putting Amara on the throne, and was at this time the only staunch adherent to the king, who, by following too implicitly his advice, had lowered himself considerably in the opinion of his head men, who form the principal strength of an African king. I found Satin Lai, a good-looking man, apparently between sixty and seventy years of age, about five feet ten inches in height, affable in his deportment, with a mild and amiable countenance which is said to be rather at variance with his actions. He was performing the office of a commissary, surrounded by several hundred baskets of white rice, which he was distributing to the different tribes in quantities proportionate to their strength. In one corner of the tent some of his slaves were employed in cooking, in another his horse was feeding, encircled with Moorish trapping, spears, muskets, bows and quivers. On appearing before the tent of Amara, I was directed to seat myself under the shade of a large booth covered with cocoa-nut branches and plantain leaves, capable of containing and sheltering from the rays of the sun upwards of two thousand people; here the king soon joined me, and the war drum being beat, the booth was shortly filled with a motley assemblage of armed men. Booths of corresponding size, erected at right angles, and parallel to the one in which I sat, so as to form a large square, were also soon crowded with hordes of Soolimas, Bennas, Tambaccas, and Sangaras, in all, amounting to about ten thousand men, while the inclosed space was free to such as were desirous of exhibiting in feats of warlike exercises, in dancing, and in music. As the exibitions on this occasion were of the same kind with those which I afterwards saw in the Soolima country on similar occasions, and which will be described hereafter, I shall merely observe that Yaradee, the general of the Soolima army, was particularly conspicuous in exhibiting on horseback the various evolutions of African attack and defence. When their performances were concluded, I had an interview with Yaradee, and obtaining from him an assurance that Sannassee’s life should be preserved, I took my leave, receiving many protestations of friendship. A subsequent conversation with Amara, in which I explained his Excellency’s wishes, terminated my visit to the camp, which I quitted at sunset, and proceeded direct on my return to Sierra Leone, where I did not
arrive till the sixth day, having suffered much inconvenience on the journey, from the effects of increasing illness.”
We have given this account entire, that the reader may understand the kind of natives that he had to deal with in his after intercourse with them. His interference seemed here to have terminated happily for Sannassee, but he was scarcely recovered from his illness, when it was reported that all his efforts had been of no avail; and the governor, still anxious to save the life of his ally, asked Laing again to undertake another embassy for the same object; he complied, again visited the Soolima camp, where he found that Amara had set Sannassee at liberty, after first burning his town, and then plundering his property. Lieutenant Laing did not waste time in a longer palaver than was just sufficient to mark the displeasure of the governor regarding their conduct to Sannassee. He was accompanied on this mission by Mr. Mackie, assistant surgeon, who, together with Lieutenant Laing, were the objects of undisguised astonishment to Yarradee, who scrutinized every article of their dress with great minuteness; and on observing Laing pull off his gloves, “he stared with surprise, covered his widely opened mouth with his hands, and at length he exclaimed, ‘Alla ackbar,’ he has pulled the skin off his hands.” Lieutenant Laing and Mr. Mackie reached Sierra Leone after an absence of six days and a-half during the whole of which time they had not been under shelter for a single hour. While upon this second mission he had observed that many men who accompanied the Soolima army possessed considerable quantities of gold, and having learned that ivory abounded in Soolima, he suggested to the governor the advantage to the colony of opening up an intercourse with these people.
The governor was pleased with the suggestion, and submitted it without delay to a meeting of the council, when it was resolved, that Lieutenant Laing should be permitted to penetrate to the country of the Soolimas, choosing his own road, and the one by which he could most easily communicate his discoveries. He was now in the character of a volunteer traveller, a character which he admirably supported.
This party consisted of Musah Kanta, a native of Foutah Jallon; two soldiers of the second West India regiment, eleven carriers, natives of the Jolof country, and a boy, Mahomed, a native of Sego.
They quitted Sierra Leone in boats on the 16th of April, 1822, and ascending the Rokelle, slept the first night at Mr. M‘Cormick’s factory, who, from his name, seems to have been a countryman of our traveller’s. They took the route through the Timannee country, calling upon the various chieftains and governors who were in their way, from whom they received passes, but often with difficulty, and only on the payment of money, and the presentation of articles, sometimes of considerable value.
While they were upon the point of leaving Rokon, which is in the Timannee country, the king of the place made his appearance in a violent rage, and the cause of his grievance, was a Jolofman, who attended Lieutenant Laing, having had the audacity to dress himself in a new red slop shirt, which the king considering a more splendid habiliment than his own, insisted upon having; this the Jolof obstinately refused; while the king declared it to be the law in his country, (a law made by himself at the moment) “That any man dressed better than himself, especially in red, should forfeit his clothes.” Lieutenant Laing settled this difference by desiring the Jolof to change his shirt, and giving the king a bar of tobacco and a dram of rum. After leaving Rokon, the country for a short time was beautiful and cultivated, and on reaching Nunkaba, they found the female inhabitants busy with their cotton, preparing it for spinning.
On their arrival at Toma, though only sixty miles from Sierra Leone, Lieutenant Laing learned, to his surprise, that “no white man had ever before been seen there.” He says, in his journal, “the first appearance of surprise, that came under my observation was in a woman, who stood fixed like a statue, gazing at the party as they entered the town, and did not stir a muscle till the whole had passed, when she gave a loud halloo of astonishment, and covered her mouth with both her hands.”
This astonishment at their appearance, was sometimes productive of annoyance during the progress of their journey. At
Balanduco they found the women busily employed in separating the juicy saffron-coloured fruit from the palm nut; in squeezing it into wooden mortars, and in beating it into one common mash, in order that the oil might be extracted more easily and more commodiously in boiling. Lieutenant Laing estimated that during the season of the fruit, they manufactured, on an average, from thirty to forty gallons aday.
They now began to feel the fatigues of a long continued journey; they reached Rokanka on the 25th of April, much fatigued, and deprived of water, the inhabitants of the village either being unable or unwilling to supply them with any; and being afraid to enter the woods in search of it, from the whistle of the Purrah being heard in the neighbourhood. The Purrah are a sort of “Robin Hood gang,” who infest the woods, occasionally making an inroad upon some peaceful village, which they invariably plunder; the inhabitants keeping hidden, and never attempting any resistance. They are tatooed in a manner peculiar to themselves, and have gradations of rank in their community. At stated times they hold assemblies, on which occasions, the country is in the greatest alarm, for notices are dispersed abroad concerning them, and the people are obliged to attend; they settle all differences, and inflict capital punishments, according to their pleasure, so that in fact, they are the governors of the country, and Lieutenant Laing says, “that from the nature of their power, and the purposes to which it is applied, they will probably be found a most serious obstacle to its civilization.”
On leaving Rokanka the next day, they came in sight of a stream, after walking about an hour and a quarter, and having suffered so much from thirst, for thirty hours preceding, they were so eager to enjoy it, and indulged so freely in it, that on reaching a town four miles farther, the whole party were attacked with the most violent spasms, Lieutenant Laing suffering particularly, it being six days before he was at all restored to his usual health.
He found some difficulty in procuring permission to depart from Ma-Bung, which was the name of his present residence, being obliged to hold a palaver, as they termed it, with the head men of the place; and it was only after a very long palaver with his interpreter
and them, that he was suffered to depart, upon making presents of tobacco, powder, white baft, and rum.
This custom of presenting gifts at every place, was a serious evil, but it was one without which it was impossible to proceed, and occasionally, his attendants and the inhabitants engaged in a scuffle, sometimes difficult to suppress. It is unnecessary to follow his motions minutely; the reader may find them interestingly and particularly recorded in his travels published in 1825, and edited by his friend Captain Sabine.
It is sufficient to mention that on the 7th of May he reached the last town of the Timmannee country; called Ma-Boom, part of which was inhabited by Koorankos, in which part he took up his residence, as through that country it was now his intention to proceed.
He found very great difficulty in getting away from Ma-Boom, owing to the greediness and treachery of Smeilla, the head man of the place, who laid a plan of assault and robbery upon him and his party, but from which he was preserved by the sagacity of his servant, Musah, and his own decision. With the other inhabitants of Ma-Boom he seemed pleased, particularly the Mandingo families, and the country around, he says, is thickly wooded, and abounds with rich pasturages, well stocked with cattle, sheep, and goats.
The next station was Kooloofa, where they received a kind but noisy welcome, being prevented from sleeping during the night by barbarous music in honour of their visit. “They, one and all,” says Lieutenant Laing, “thanked God for my appearance among them: they said they could not live without trade, and on that account, if for no other, they were glad to see a white man come into the country to open a good road.” He easily received permission to depart from Kooloofa, and left it with the best wishes of a numerous crowd, assembled to witness his departure. After passing through several places, they reached Seemera, where he was as kindly received as at Kooloofa, the king “thanking God that he had seen a white man, and would do any thing to help him, as he was sure he could have no other object in coming to this country than to do good.” While there the place was visited by a tremendous tornado. The house
where Laing slept being badly thatched, the lightning kept it in almost perpetual illumination, and, as he himself expresses it, the holes in the roof gave him the full benefit of a shower bath. He was detained here a short time, partly by the rain, during which time the king sent a company of dancers to dance before him for his diversion. His route, after leaving Seemera, was difficult and dangerous, he and his party having to endure several heavy tornadoes, rough roads, and plots laid to rob him of his baggage. His remarks upon what he observed during this journey must be extremely interesting to a geologist, and, indeed, to any man of science, for which, however, we again refer to his travels.
While at Worrowyah, he was entertained by some female singers, the tenor of whose song, he said, did not please him. They sung “of the white man who had come to their town; the houseful of money which he had; such cloth, such beads, such fine things had never been seen in Kooranko before; if their husbands were men, and wished to see their wives well dressed, they ought to take some of the money from the white man.” He was saved from the effects of this advice by one of his suite called Tamba, who answered them by a counter song. He sung of “Sierra Leone, of houses a mile in length filled with money; that the white man who was here had nothing compared to those in Sierra Leone; if, therefore, they wished to see some of the rich men from that country come into Kooranko, they must not trouble this one; whoever wanted to see a snake’s tail must not strike it on the head.” This song was applauded, and Lieutenant Laing was allowed to keep his money
While at Kamato, which he reached on the 29th of May, Laing had a severe attack of fever, which lasted for several days. As he was recovering from the attack, a messenger arrived from the king of the Soolimas, with a party, and two horses, to convey him to their country, his majesty being very desirous to see him within his territories. Laing was very glad to accept of the invitation, so on the morning of the 5th of June, he mounted one of the horses, and left the Kooranko country for a time. It was not till the 11th that he reached the royal city, having in his way thither received much kindness and hospitality from the native head men of the villages
through which they passed; one head man, says our traveller, “took off his cap, and lifting his aged eyes to heaven, fervently thanked his Creator for having blessed him with the sight of a white man before he died.”
When Lieutenant Laing reached Falaba, which was the residence of the king of the Soolimas, he was saluted with a heavy and irregular discharge of musketry, which he ordered to be returned with three rounds from his party, and then alighting, shook hands with the king, who presented him with two massive gold rings, and made him sit down beside him. The king and the Lieutenant were scarcely seated, when his old friend Yaradee, better dressed than when he last met him, mounted on a fiery charger, crossed the parade at full gallop, followed by about thirty warriors on horseback, and two thousand on foot,—the equestrians returning and performing many evolutions, to the amazement and admiration of the spectators. After which many other spectacles were exhibited for the diversion of his guest by the king of the Soolimas. Yaradee was particularly kind to Lieutenant Laing, saying, “he was a proud man that day, the first day in which a white man had ever been in the Soolima country.”
The different chieftains paid homage to our traveller, when they saw how highly he was thought of by their sovereign, and he was teazed with speeches and remarks addressed to him by a crowd for the pleasure of hearing him speak, and whenever he did so, they would shout, “He speaks, the white man speaks.” He said these marks of attention would have delighted him any other time, but his horse having fallen with him, he had been precipitated into the water of a marsh he was crossing at the time of the accident, which brought on an attack of fever, from which, however, he recovered in about three days. Those who wish to see an account of the fetes and the excursions, designed principally in honour of Lieutenant Laing, must read his travels, in which they will find an interesting account.
Feeling again the intimations of approaching illness, he shortened his interviews, and came to the great business of the mission, free intercourse and trade, and the desire of Sir Charles M‘Carthy to cultivate a good understanding with them; and then producing his presents, which were considerable, every thing was adjusted in the
most amicable manner: but he had scarcely returned to his hut, when the fever was renewed with redoubled violence, and, stretching himself on his mat, he resigned himself to the disease which for nine or ten days prevented him from rising; three days of which he was in a state of delirium. On his consciousness returning he found he had been cupped by one of the country doctors, which had been of great service to him. During this illness his meteorological observations ceased, and it was, as he expresses it, “with a grief bordering on distraction that he thought upon his chronometer, which, as nobody could wind up but himself, had unavoidably gone down.”
It was on the 1st of July that he found himself able to write a few lines to acquaint his friends at Sierra Leone with his arrival at Falaba, and that he hoped soon to be able to go even farther eastward; two natives of Soolima volunteering to be the bearers of his despatches. On the 11th, he was so well as to mount on horseback and take a survey of the adjacent country, but from the delay occasioned by the unwillingness of the king to allow him to depart, it was not till the 17th of September that he finally quitted Falaba in order to return to Sierra Leone; having resided in the Soolima country more than three months. He was on the 9th of September gratified by the return of the messengers he had sent to Sierra Leone; he received the packet they conveyed to him with exquisite delight; but besides the kind letters of his friends, they sent “tobacco, sugar, a little brandy, which soon disappeared among the Soolimas, and, though last not least, two pairs of good shoes, a luxury to which his feet had for some time been unaccustomed. He was also furnished, through the kindness of Dr. Barry, staff-surgeon at Sierra Leone, with a lancet and two glass plates of preserved vaccine virus, with which, on the 13th, he was permitted to inoculate a number of children, commencing with those of the king himself,” who had so much confidence in him, that Laing says “he believed he would have permitted him to have attempted the most extravagant experiment upon any of his own family.” If he had possessed sufficient virus, he continues, “I might have inoculated all the children in Falaba: the yard was absolutely crowded with old men and women, holding young children in their arms, and forming a group worthy of the pencil of a West or a
Rubens.” He very naturally remarks upon it as an interesting fact, “that a nation so far in the interior of Africa, should have so readily submitted, at the instigation of a white man, who was almost a stranger to them, to an operation against which so much prejudice existed for so many years in the most enlightened and civilized countries in Europe. When the general prevalence of superstitious fear from greegrees and fetishes is duly considered, this fact presents a strong proof of the confidence which the natives of Western Africa repose in the measures of white people to benefit them; and affords a no less strong presumption, that their other superstitious notions might soon be found to give way, in like manner, to the labours of the missionary: and their present barbarous habits of obtaining slaves for trade by force of arms, to the more rational proceeding of cultivating the soil for articles of commercial exchange.”
The day that he quitted Falaba, which, as has been already stated, was on the 17th of September, the natives in great numbers accompanied him for a considerable distance, the females making most extravagant demonstrations of grief; the king accompanied him a little farther, when a parting took place, which we shall insert in Captain Laing’s own words, (for while at Falaba, he had received intelligence of his promotion to the rank of captain). “At length the old man stopped and said, he was now to see me for the last time. The tears were in his eyes, and the power of utterance seemed to have forsaken him for a while. Holding my hand still fast, he said ‘white man, think of Falaba, for Falaba will always think of you: the men laughed when you came among us, the women and children feared and hid themselves: they all sit now with their heads in their hands, and with tears in their eyes because you leave us. I shall remember all you have said to me; you have told me what is good, and I know that it will make my country great; I shall make no more slaves.’ Then squeezing me affectionately by the hand, and turning away his head, he gently loosened his grasp, and saying, ‘Go, and return to see us,’ he covered his face with his hands. I felt as if I had parted from a father Such remembrances impress themselves too deeply in the heart to be effaced by time or distance, and establish a permanent interest in the welfare of a country, which may have a
material influence on the after life of the individual who entertains them.”
The route of Captain Laing and his party back to Sierra Leone was much the same with that which they had gone when they set out; most of the head men expressing surprise at seeing him again, they in general supposing that he had been killed in the interior, and on the 28th of October, he had the pleasure of being welcomed by his friends at Sierra Leone, “so many of whom, so much esteemed, and so highly valued, are now, alas, no more!”
On Captain Laing’s arrival at Sierra Leone, he received an order to join his regiment on the Gold Coast, without delay, in consequence of the hostilities which had commenced between the British government and the king of the Ashantees.
On his arrival on the Gold Coast, he was employed in the organization and command of a very considerable native force, designed to be auxiliary to a small British detachment, which was then expected from England. During the greater part of the year 1823, this native force was stationed on the frontier of the Fantee and Ashantee countries, and was frequently engaged, and always successfully, with detachments of the Ashantee army.
On the fall of Sir Charles M‘Carthy, which took place early in 1824, Captain Sabine, who edits the Travels, and writes the preface from which we quote, says, “that Lieutenant-Colonel Chisholm, on whom the command of the Gold Coast devolved, deemed it expedient to send Captain Laing to England, for the purpose of acquainting government, more fully than could be done by despatch, with the existing circumstances of the command. Soon after his arrival in England, which took place in August, he obtained a short leave of absence to visit Scotland for the recovery of his health, which had been seriously affected by so many months of such constant and extreme exposure in Africa, as it is probable few constitutions would have supported.”
He returned to London in October of the same year, where an opportunity now presented itself which he had long anxiously desired, of proceeding under the auspices of government, on an
expedition to discover the course and termination of the Niger He was now promoted to the rank of major, and departed from London on that enterprise early in February 1825, with the intention of leaving Tripoli, for Timbuctoo, in the course of the summer of that year. He touched at Malta on his way to Tripoli, where he was shown every attention by the late Marquis of Hastings, at whose table he repeatedly dined.
While at Tripoli, he became acquainted with the British Consul, Mr. Warrington, his business with him producing an intimacy of the closest nature, which was farther cemented by Major Laing’s marrying his daughter, Emma Maria Warrington, an event which took place on the 14th of July 1825. But he had no time to spend in domestic life: two days after marriage he set out for those vallies of death where every preceding traveller had found a grave.
It was on the 17th of July that Major Laing left Tripoli in company of the Sheik Babani, a highly respectable man who had resided in Timbuctoo twenty-two years, and whose wife and children were there still. This Sheik engaged to conduct our traveller thither in two months and a half; and there, or at his neighbouring residence, to deliver him over to the great Marabout Mooktar, by whose influence he would be able to proceed farther in any direction that might be required, according to information received as to the course of the river. This Babani is stated by the Consul of Tripoli, to be “one of the finest fellows, with the best tempered and most prepossessing countenance that he ever beheld; Laing, in all his letters, speaks of him in the highest terms of respect and approbation. As the Gharan mountains were rendered impassable by the defection of a rebellious chief of the Bashaw, who had taken possession of all the passes, the small koffila of Babani took the route of Beneoleed. On the 21st of August they reached Shaté, and, on the 13th of September, arrived safely at Ghadamis, after a “tedious and circuitous journey of nearly a thousand miles.” In the course of this journey, Laing reports the destruction of all his instruments from the heat of the weather, and the jolting of the camels; his barometers broken; his hygrometers rendered useless from the evaporation of the ether; the tubes of most of his thermometers snapt by the warping of the ivory; the glass
of the artificial horizon so dimmed by the friction of sand which insinuated itself everywhere, as to render an observation difficult and troublesome; his chronometer stopt, owing, he says, to the extremes of heat and cold, but more probably to the jolting, or the insinuation of sandy particles; and to wind up the catalogue of his misfortunes, the stock of his rifle broken by the great gouty foot of a camel treading upon it. The range of the thermometer in the desert, was from 120° about the middle of the day, to 75°-68°, and once or twice to 62° an hour or two before sunrise, at which time was observable a great incrustation of nitre on the ground, which is the common appearance on the surface of all the known deserts of Africa, from Tripoli to the Cape of Good Hope.
When Major Laing reached Ghadamis, he discovered that his companion, the Sheik Babani, was governor of the town. He considered him a person of sterling worth, with a quiet, inoffensive, unobtrusive character, though at the same time not deficient in decision, but never once suspected him to be a person of so much importance and influence as he all at once discovered him to be. The Sheik immediately lodged him in one of his own houses, with a large garden, and yard for his camels, which were fed at the expense of the governor. Ghadamis is a place of considerable trade; all the koffilas to and from Soudan passing through it. The citizens pay tribute to the Tuaric who inhabit the great Sahara or desert on the western side of Africa for permission to their koffilas to pass without being subjected to plunder. The town contains six or seven thousand inhabitants.
Major Laing left Ghadamis on the 27th of October, and arrived at Ensala on the 3d of December Ensala is the most eastern town in the province of Tuat, and belongs to the Tuaric: it is considered to be thirty-five days journey distant from Timbuctoo. As he approached this city, some thousands of people, of all ages, came out to meet this Christian traveller. Nothing could exceed the kindness and hospitality with which they received him, and Major Laing returned it, by patiently listening to their complaints, and administering medicine to their diseases to the best of his ability.
The koffila left Ensala on the 10th of January 1826, and on the 26th of the same month entered upon the desert of Tenezarof, about twenty journies from Timbuctoo, a mere desert of sand, perfectly flat, and quite destitute of all verdure. Major Laing, at this time was still an enthusiast in his expedition, and, possessed of good health and spirits, experiencing everywhere, from every person, nothing but good will, kindness, and hospitality. He particularly mentions the services of Hatteta, the Tuaric who had accompanied him thither; he also speaks of the sheik Babani, who, he says, continued “to watch over him with the solicitude of a father.” Shortly after the arrival of a letter with these accounts from Tenezarof, reports reached Tripoli, that the koffila had been attacked by robbers; that the Major’s servant, as well as some others, had been killed, and he himself wounded; at the same time adding, that he had effected his escape to the Marabout Mooktar, who usually resided at a spot only five days journey distant from Timbuctoo. These reports, though they created some uneasiness, were not believed, till a letter was received at Tripoli by Mrs. Laing, indirectly tending to confirm them. She received it on the 20th of September 1826: it was written from the desert of Tenezarof. The following extract is what appears to refer to the circumstances which raised the reports.
“I take the advantage of a Tuaric going to Tuat, to acquaint you, that I am safe and in perfect health, and completely recovered from the trifling indisposition which annoyed me on leaving that place. If it pleases God I shall be in Timbuctoo in less than twenty days, and in two months afterwards I hope to find my way to some part of the coast. I have met with much annoyance from the Tuaric; few, very few of whom are like Hatteta, and are not, as the consul anticipated, our friends. You shall know all particulars from me on my arrival at Timbuctoo, from whence I shall lose no time in addressing you. I have stopped in the sun to write; pray excuse it, for I am in great haste, and I write with only a thumb and a finger, having a very severe cut on my fore finger.”
This cut probably refers to the wounds he had received, but which he did not wish to mention in a more serious manner.
