After arranging her notepad and pen on a small desk, Alice interviewed a woman who was convinced that her daughter’s knitted woollen knickers had caused a particularly nasty outbreak of intimate sores. ‘Well, what else could it be?’ the woman asked Alice earnestly, her overweight daughter cringing behind a curtain of long greasy hair beside her. The almoner suggested that the woman should return home, then discreetly booked her daughter into the VD clinic.
Her next interviewee was a charlady who was more in need of something to wear on her feet than medical treatment. When Alice told the woman that she would source some charitable funds to buy her a pair of shoes, she was rewarded by a wide, gap-toothed smile. The almoner glanced up and narrowed her eyes between interviews, checking on the comings and goings beyond the screens.
One of the most enjoyable and rewarding aspects of an almoner’s work was being able to witness the benefit of their interventions. When Alice presented her next visitor – an elderly watchman suffering with eczema whose sore hands had blistered after spending several cold nights in the watchman’s shelter – with a pair of cotton gloves, he danced a little jig in delight, drawing applause from the patients waiting on the other side of the screen.
The day passed productively; four full financial assessments completed, several patients booked in with the relevant doctors and one fraudulent claimant given his marching orders.
At a little before 4 p.m., after securing the patient files in a tall cabinet, Alice ventured out into the main reception area.
‘Hello again,’ she said with a nod to the elderly couple who were sitting together and holding hands in the far corner of the outpatients department waiting area. Ted and Hetty Woods had spent almost every day of the last week huddled side by side in the same spot, their few belongings stowed in a dog-eared bag at Ted’s feet.
‘Hullo, Miss,’ Ted said as his pale-blue eyes fixed on Alice’s face. Mrs Woods, a plump woman with hair of faded copper, gave her a tired but cheerful smile. The lines on her face were deep, the upward edges of her mouth suggesting a character that was determined to remain hopeful, despite all the difficulties that were thrown her way.
‘We spoke about you both perhaps spending a day or two at home, didn’t we?’ Alice said, crouching down in front of them and resting a gloved hand on Ted’s knee. She was due to meet with Dr Peter Harland, the physician who had treated little Henry Redbourne’s bad chest, at the end of his shift. Their meeting had been arranged to exchange notes on other chest clinic patients, but the list of questions pinned to the front of the file in the almoners’ office reflected Alice’s hope of steering the conversation towards the Redbourne family.
The young woman, Charlotte, had said little during their welfare check on the family, but working closely with families had honed Alice’s intuition. Quickly, she had learned to distinguish between the troubles that blighted most families from time to time and those rising from something more sinister; it was a sort of occupational sixth sense.
‘We’re all at sixes and sevens at home, love. We’re alright here, if it’s all the same to you.’ Ted doffed his cloth cap, but anxiety lay beneath the civility. The skin on his face was chapped and his lips were pale and translucent, but his thin hair had been carefully combed and his clothes were clean and well pressed. Mrs Woods was similarly well groomed and yet, despite the rose water she was dabbing on her wrists and her well-scrubbed pink skin, a peculiar smell rose from beneath her clothes.
‘And you, Mrs Woods? How are you?’
‘Fine, duck. Lovely, thank you.’ Alice’s eyes lingered on the elderly woman, her brow furrowed. She had visited the couple at home months earlier after Ted’s treatment for a severe leg ulcer. With a single room in a three-storey boarding house, they were better off than some, but the mould on the walls and lack of running water meant that it was far from comfortable.
Alice sighed, glancing across the large atrium. Two doctors wearing white laboratory coats stood whispering near a set of fabric screens, nurses bustling past them into the anterooms. A few feet away, another nurse stood in front of a plump elderly woman, trying to help her onto her feet.
An unpleasant musty smell prevailed in the department, overlaid with a hint of carbolic soap; a consequence of every available space being filled with the poor. Numerous ill-clad elderly locals huddled together with threadbare blankets draped over their knees, several in the grip of severe coughing fits. It was likely that more than half of those filling the space weren’t interested in seeing a doctor. If there was a chill in the air it wasn’t unusual for the almoners to find the outpatients department thronging with people like Ted and Hetty, hopeful of passing the time in a place that was warmer and less dreary than their homes.
Alice reached into her handbag and pressed a coin into Ted’s frail hand. She had learned in training and keenly felt that it was her duty to remember the person behind the illness. She had been taught that there was little point in administering medicine to the sick only to discharge them back to a life of near destitution. Sometimes the smallest of interventions was all that was needed to relieve hardship and change lives.
‘I think perhaps –’ Alice began, but broke off at the sound of a shout. Several patients started and turned their heads towards a heavily pregnant woman who was standing by one of the curtained examination cubicles and yelling at a stocky man wearing labourer’s scruffs.
Angling herself sideways on so that she could reach him around her considerable bump, the woman landed a punch on the man’s chest and another on the side of his head. Spots of blood glistened from the resulting scratch on his cheek, and another just above his lip. ‘Will you leave off me, woman!’ the man yelled breathlessly, doing his best to dodge her blows while coughing explosively.
Alice gave Ted’s leg a quick pat and rose to her feet. She wove purposefully around the packed rows of wooden benches, the pregnant woman gesticulating and shouting as she made her way over. ‘I swear you’ve done it now, Jimmy!’ the woman screamed.
‘Excuse me,’ Alice said firmly, seizing the scruffy man’s arm. ‘Nurse,’ she called out, angling her head towards the treatment area. Several patients stared at the smartly dressed woman who had suddenly appeared, their mouths open in hushed, awed silence.
‘Sit down, please,’ she ordered the man, who was still coughing and frantically gasping for air. She motioned him away with a tiny flick of her head, her expression stern. Obediently, he backed away and collapsed onto a nearby seat.
A nurse emerged from one of the cubicles. Her eyes flicked from Alice to the pregnant woman, who was still trying to attack the heavy-set man, and then she hurried over to help. ‘Stay outta this, Miss,’ the expectant mother shouted to Alice. ‘Someone needs to sort ’im out, once and for all.’
‘No one is sorting anyone out, thank you,’ Alice said, her voice carrying across the hall. ‘I’ll deal with this.’
‘He’s a filthy lying hound!’ the woman yelled, spittle spilling out from the edges of her mouth.
‘Be that as it may, he’s now our patient,’ Alice returned, her voice low and steady. Behind her, the nurse handed the man, who was now coughing up blood, a handkerchief. ‘If you want to come back and see me later today, I’m happy to talk things through with you. But for now, please, I’d like you to leave.’
‘You’ll pay for this, Jimmy!’ the woman screamed over Alice’s shoulder, as the nurse led him away. ‘I hope you cough up your guts and strangle yourself with ’em,’ she added, before turning on her heel and waddling to the door.
Alice pulled down the cuffs of her blouse, straightened her hat and gave several still-gawping patients a reassuring smile. The almoner often needed to draw on every ounce of diplomacy she could muster to deal with the loud confrontations that sometimes broke out in the outpatients department.
The man was still coughing when Alice joined him in the watching room. ‘She’s agitated ’cos I’m not earning what I-I used to on account of this cough,’ he told Alice in a th
ick Irish accent. ‘And what with the baby soon to join us –’
Alice opened a new file and jotted down some notes while Jimmy spoke. A thirty-five-year-old labourer, Jimmy had sailed for England from Ireland a year earlier looking for work. He managed to find employment on the Wembley Park site, where work was under way preparing the ground for a new restaurant to be built near the planned new sports stadium, but had not yet managed to save enough to cover the cost of a deposit on his own lodgings.
Alice managed to elicit that he had spent most nights sleeping with three other workmen in a small shed on site, while his pregnant wife camped out on her parents’ sofa. Waking in the same damp clothes he had worked in the previous day, his health had worsened through the winter. ‘’Tis a fine place here though,’ Jimmy said, when Alice confirmed that his meagre earnings and imminent dependant qualified him for entirely free treatment at the hospital. ‘And you’re a fine woman, so you are,’ he gasped, after she told him that he’d been booked into the chest clinic. A deep hacking cough issued from his lungs. He rubbed his red-rimmed eyes, watery with the strain of coughing, and said: ‘Too fine to be wasting your time helping a vagrant like me.’
As the almoner made her way back across the atrium, Hetty Woods nudged her husband with her elbow. When she neared, Ted signalled to her. ‘We was wondering, Miss Alice. Do you think you might have the opportunity to visit our daughter, Tilda? She’s expecting but her husband won’t let us near the place. He’s got some sort of hold over her, I think. We haven’t seen her for months. But my Hetty thinks that if anyone can sort them out, you can.’
Alice glanced over to the double doors, where another line of people were waiting to file inside. When temperatures plummeted, as they had in London in the last twenty-four hours, it was difficult to impose some order on the chaos reigning in outpatients. The doctors found the crowded conditions near impossible to work in, but the worsening storm and poor visibility at least provided her with an excuse to grant the most destitute a temporary reprieve.
‘I will see what I can do in the next few days,’ Alice told the couple, after noting down their daughter’s address.
‘Don’t go after six though, duck,’ Hetty said warningly. ‘That’s when our son-in-law gets home.’
The almoner nodded. ‘I cannot promise anything, but I will try.’
Ted and Hetty watched Alice as she headed off for her meeting with Dr Harland, their rheumy eyes watery with gratitude.
Chapter Three
The almoner is a general practitioner in social healing. It is the almoner whose job it is to deal with the personal difficulties and troubles of the patient … the constructive side of the social work done by the almoner seems to know no limits.
(The Scotsman, 1937)
From its earliest days as an apothecary, doctors from the Royal Free went out into the community to treat patients who were too ill to leave their homes, or rose in the early hours to meet them at the hospital. ‘As there were no telephones,’ explained Dr Grace de Courcy, a medical student in 1894, ‘if an emergency arose at night and the resident required assistance he would go into the street and take a hansom cab or a growler to the house of the surgeon or physician in charge of the ward to bring him back.’
Dedicated to their patients and uncomfortable with the idea of their private lives being examined, medical staff at the Royal Free had initially been reluctant to share any information with the almoners. For some, the whole idea of conducting financial assessments on the sick was repugnant. Sir E. H. Currie complained to a reporter for the London Daily News in 1904 that vetting patients using ‘special detectives’ was ‘a scandal’. Currie ‘strongly condemned’ the use of inquisitorial methods to ‘denounce’ well-off patients. ‘What possible good can one woman investigator do?’ he argued. ‘It is ridiculous.’
Mr Rogers, a secretary from the London Hospital, defended the appointment of an almoner who was to ‘watch in the receiving rooms for cases of imposition’. The secretary stated that local doctors running private practices had accused the hospital of ‘robbing their profession’ by treating patients who ‘they had personally seen … driving to hospital in their own carriages’.
Like his predecessors, Dr Peter Harland was another of those people who subscribed to the view that any sort of surveillance of the private lives of others was a disagreeable pastime. He was waiting at the top of the stairs leading to the almoners’ basement office when Alice arrived. ‘I’m so sorry, doctor. Have you been waiting long?’
‘A minute or so.’ There was no reproof in his voice, but his features were strained.
Alice led the way down the dimly lit stairs, stopping before a sturdy-looking oak door inset at eye-level with a small barred window. Dr Harland waited silently as she opened the door to the office, where arrow-slit windows high up across one wall overlooked the sodden grey pavement of Gray’s Inn Road. The window sills provided neat cubby holes for reference books and medical journals, the heavy tomes blocking much of the natural light.
Before the fires were lit by the caretaker each morning, the almoners’ office lay silent, the stillness broken only by the rumble of underground trains beneath them. Now, the room was bustling with activity. Frank was seated at the nearest desk, taking ledgers one by one from a small pile and checking them against a list of the hospital’s assets. Alexander was kneeling on the floor beside a solid leather trunk and setting a trap for the mice that emerged at night to nibble the edges of his financial reports. He fumbled with the steel mechanism with a harried air, his handsome features twisted and pink with annoyance. In the far corner, Winnie sat behind her typewriter, her habitual anguished frown in place.
At the opposite end of the office, the Lady Almoner, Bess Campbell, was busy preparing lists for a post-New Year party; a get-together for those acquaintances who had missed out on the New Year’s celebration that had taken place in her considerable residence in Kensington. Miss Campbell, a woman with a flair for combining dynamic guests with those of a quieter nature so that everyone felt at ease, had a calendar packed with social events, dances and dinner parties.
She was a slim woman in her late forties, with greying shoulder-length hair and sharp but pleasant features. An accomplished and formidable character, she had a love of fine clothes and an air of authority, but she was also possessed of a natural humility, an essential quality in someone working so closely with the poor.
Like the majority of her colleagues, she had been selected from a class superior to those she served, the appointing committee believing that only someone gifted with eloquence could suitably advocate for the working class, who were generally less able to express themselves.
Each member of staff glanced up as Alice entered. At the appearance of Dr Harland, Alexander got to his feet and brushed down his trouser legs. Puffing absently on his pipe, Frank merely jutted out his chin. Miss Campbell beamed. ‘Peter, my dear, how are you?’
‘Too busy to be here. And you?’ The doctor’s expression settled as far into solicitousness as it ever went, though his face, all blunt lines and irregular angles, retained its slightly grumpy expression. About six inches taller than Alice, at just under five feet eleven, he was a tall man, sturdy and strong. In his mid-thirties, his square face was framed by a crop of thick curly black hair, his jaw displaying the hint of a beard.
‘Well, it’s most generous of you to spare some time for us, isn’t it, Alice? And I’m splendid, thank you.’ Miss Campbell ran the office with a regimen as strict as the fiercest sisters on the wards above her, but there were times when her staff caught a glimpse of the compassion she usually reserved for patients. When Alice had returned to the office after discovering the bodies of Molly and her infant son, Miss Campbell had been the first to her feet, steering Alice with tenderness towards her chair. Within minutes she had pressed a hot, disturbingly sweet cup of tea into one hand and a vinaigrette of smelling salts into the other. Alice was to take her final exam in social work the next day, but after what
had happened, she told her boss that she was tempted to withdraw. ‘I’m not suited to this sort of work,’ she told Miss Campbell mournfully, after everyone else had gone home.
Miss Campbell had reached across the desk and taken Alice’s hand in her own. ‘If you’re not suited to it, my dear, I don’t think any of us are.’
‘If only I’d acted sooner,’ Alice had burst out, pulling her hands away to cover her cheeks. She shook her head. ‘I knew something wasn’t right. I should never have left Molly alone for so long.’
Miss Campbell scoffed gently. ‘Would not the world be a finer place if only we were all possessed with blessed foresight?’ She paused. Alice dropped her hands and looked at her. The Lady Almoner levelled her gaze. ‘Alice, you need to accept that we all have limitations, and that includes you. You’re not responsible for every vulnerable waif and stray in London, you know. But you have more empathy and intuition than almost anyone else I know. So you’ll go tomorrow and take your exam and then you’ll return here to carry on with your work.’
Alice’s eyes pooled with tears. ‘But I’ll fail, just like I failed Molly.’
‘Then you shall take it again,’ Miss Campbell had said with a note of finality and a short sharp squeeze of Alice’s hand.
At her desk, Alice removed her hat and gloves and tucked them into a drawer. ‘Would you like a cup of tea before we get started, doctor?’
Dr Harland nodded as he drew up a chair and sat at the end of her desk. From across the office, Frank began to cough theatrically. ‘I take it you would like one too, Frank,’ Alice said, moving towards the boiler with weary amusement.
‘I am parched, now you mention it.’
Winnie got to her feet and made efforts to convince Miss Campbell, who had declined Alice’s offer, that it would be wise to keep hydrated. She then hovered behind Alice and warned her of the perils inherent in carrying out any activity involving boiling water. ‘I have everything under control, Winnie, thank you,’ Alice said with impatience.
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