About two-thirds across the space she turned down one of the aisles and picked out another file. The corners were dog-eared with damp, the front marked ‘MOLLY RAINHAM, DOB 02/04/1900’. Alice flicked through the short medical history. Apart from a short stay in the hospital as a teenager for treatment on a tubercular bone, the deceased had had no other contact with hospital staff prior to her death, according to the file.
The almoner’s file relating to Molly in their basement office held records of Alice’s post-partum visits to the young mother, as well as a copy of the post-mortem report from the Coroner’s Office, which confirmed that Molly had been four months pregnant on her death. An open verdict had been recorded; the suspicion being that Molly had died from shock as a result of a severe haemorrhage after an illegal attempt had been made to remove the foetus.
Back in the almoners’ office, Winnie glanced up as Alice walked in and she stared at her over the top of her glasses. ‘Well?’ she said, restoring the key to the pot on her desk.
‘What?’
‘Did you find what you were looking for?’
‘Yes, thank you.’ Alice extinguished the oil lamp, sat behind her desk and chewed her lip. When Winnie’s attention returned to her work, Alice slipped the report she had written into the filing cabinet beside her desk.
Charlotte had given birth only a few hours earlier, but the almoner already had several unanswered questions that needed to be resolved. After a quick glance around the room, Alice withdrew a tiny key from the pocket of her skirt and secured the lock.
Chapter Eight
It is heartrending to refuse help to a woman in her confinement because her husband is a drunkard or a loafer … But if the husband is able-bodied and can work, it is clearly inadvisable to remove the impetus that might rouse him in his duty, and if a man spends half his earnings in the public house, it is clearly wrong to support his wife and thus remove the responsibility from his shoulders.
(St Thomas’s Hospital Almoner, Anne Cummins)
Besides keeping their own files and financial reports updated, the almoners devoted some of their time to helping patients who were illiterate or out of practice when it came to writing. They regularly found themselves filling in forms, responding to official letters, even sometimes writing to patients’ loved ones. One of Alice’s tasks on the afternoon of 4 January 1922, just over twenty-four hours after Charlotte Redbourne had been admitted into Banstead Hospital, was to assist a soldier in making an application for extended leave so that he could care for his children while his wife came into the hospital for an operation.
Alice sent off the relevant forms to the Ministry of Defence and then embarked on one of the most challenging tasks she faced as almoner; convincing a room full of East End housewives that beans and pulses were a delicious alternative to one of the staples of their diet: bread and dripping.
The war had highlighted in stark terms the impact of deprivation on health and the almoners were expected to play their part in educating the public on the benefits of eating well.
Twelve women in all had been cajoled into observing Alice’s cooking demonstration in one of the side rooms of the outpatients department. Her audience’s initial suspicion, she later recorded in her notes, turned to interest as they watched her weighing out and mixing the unfamiliar ingredients, though she added that when she had handed each of them a bowl of fresh lentil soup and assured them their husbands would find the dish wholly satisfying, she was met with shrieks of baying laughter.
After handing out small samples of haricot beans for the women to take home, Alice made the short walk from Gray’s Inn Road to Chancery Lane station. There she paid the 2 d. fare and rode the tube to Liverpool Street, arriving at the home of Tilda Simpkins, daughter of Ted and Hetty Woods, the couple who had made outpatients their temporary home, at just after 4 p.m.
Two horses were tethered to an iron ring at the end of the street, their heads dipped over a drinking trough. One of them lifted its head as Alice passed by, its soft whinny accompanying the tapping sound as she knocked on the door of a narrow house at the end of a row of terraces.
A harassed-looking pregnant woman with a young baby balanced on her hip answered the door. The bruise on the delicate skin below the woman’s right eye and the crusted gash on her chin gave clues as to the nature of her home life. ‘Tilda? I’m Alice Hudson, an almoner from the Royal Free Hospital. May I come in?’
The woman claimed that she was too busy catching up with laundry left over from the previous day. Alice persisted, telling her that it was her duty to ensure that all parents of children under the age of one were furnished with the latest recommended feeding advice.
Armed with the knowledge that nourishing food, fresh air and sanitary living conditions could improve overall health, social reformers hoped to make a rapid difference in the health of their patients in the years following the war by going out into the community and educating them.
Besides harnessing goodwill and linking arms with the socially minded, proactive clergy, Alice worked hard to try and improve the nutrition of babies and young children. The Maternal and Child Welfare Act of 1918 saw the arrival of mother and baby clinics around the country, but with word spreading that staff in the centres were on the lookout for cases of neglect and abuse, they were not utilised by those who were most in need. The almoners regularly picked up the slack, visiting mothers in the most deprived areas of the capital and offering leaflets, encouragement and advice. It was a convenient ruse to use if they wanted to check on particular children they held concerns about.
The woman peered over Alice’s shoulder onto the street. ‘We’ll have to be quick.’
Alice followed Tilda down a narrow hallway and into a small scullery at the rear of the house, where most of the bare stone floor was taken up by tubs of soapy grey water and piles of clothes. Wash day was almost universally on a Monday in the pre-washing machine era, with ironing of the almost-dry clothes usually swallowing up most of the next day.
A boy of around ten years old was sitting at a pock-marked table on the far side of the kitchen, his grubby flannel shorts revealing dirty knees and calves that were far too thin. His face was almost as grey as the water at his feet. ‘This is Billy,’ Tilda said, pulling out another of the chairs. The wicker seat was almost entirely missing. She pushed it hastily back, pulling out another for Alice to sit down.
Tilda lowered the baby she was holding, a boy of around nine months, to the stone tiles and gave him a pair of wooden tongs to hold. He grinned, sucked on the metal tip then banged the soggy end on the floor with a loud babble. ‘You wouldn’t usually find us in such a mess,’ Tilda said, holding the back of one hand to her forehead. She blew stray mousy tendrils of hair from her eyes and related how she had been unable to get through all the washing yesterday on account of Billy being poorly. Slight of build and thin in the face, it appeared as if her bulging stomach didn’t belong to her body, but had been fastened on. She spoke wearily, as if all her vitality had been drained away.
‘Is it your chest, Billy?’ Alice asked the older boy.
He nodded breathlessly, his shoulders hunched in the pose of a suffering asthmatic.
‘Has he seen a doctor, Tilda?’
‘Heavens, no! We can’t afford that.’
‘Well, you may qualify for free treatment,’ Alice said, her eyes still resting on the young boy. ‘We can complete an assessment straight away, if you’d like?’
There was hesitancy in Tilda’s stance. ‘I-I’m not sure. I think he’s over the worst. It’s always bad in the damp.’
After a pause, Alice enquired whether the baby was getting all the milk he needed. Tilda returned her attention to her washing. ‘I try, but it’s so expensive,’ she said, heaving a heavy sheet from one of the buckets and wringing it out. The cost of a quart of milk was only around 5d. in 1922, but it was still unaffordable for some families. Common alternatives used at the time – weak tea, vegetable stock thickened with cornflour, or co
ndensed and evaporated milk – were low in calcium and other nutrients, and children in poorer families were in constant danger of wasting away.
‘He really needs cow’s milk, if you’re not feeding him yourself, Tilda. We can go through an assessment if you would like, and see if we can get you some relief. There is assistance available in some circumstances, for milk and extra nutrition, as well as medical attention.’ She looked at her. ‘What does your husband do?’
Out of breath, Tilda draped the still-dripping sheet over the back of one of the chairs and dried her reddened hands on her apron. ‘He’s a labourer.’
‘And how much does he bring home?’
Billy gripped the table, his knuckles a pale white. Tilda hesitated and then said: ‘I wouldn’t like to say.’
‘You would rather not say, or you do not know?’
‘I don’t know.’
‘Can you find out?’
Tilda folded her arms and ran her hands up and down her arms. ‘It’s not my place to ask.’
Alice pulled a notepad and a pencil from her bag. ‘Well, I would estimate a reasonable wage for building work. What are you paying in rent? We can help you find cheaper lodgings if you would like, to make things a little easier.’ The almoners encouraged thrift wherever possible and often suggested ways of cutting outgoings to help struggling families to make ends meet.
‘Rich won’t want nothing smaller.’
Alice’s pencil hovered over the pad. ‘But your little one’s needs must come first, Tilda, and milk is a necessity if he is to stay well.’
‘We’re doing alright, really. Now, I got to get this lot cleared away before Rich comes home or –’
Alice lowered the pencil to the table and gave the woman a keen look. Tilda stiffened and turned away. As she did so, the pocket of her apron caught the handle of a pot balanced on the stove. Alice lunged to prevent the spinning pan from clattering down onto the baby’s head, and Tilda, a woman primed for the unexpected, gasped and threw her arms up to her face in defence. Alice stilled with the pot in her hand, her eyes on Tilda, then turned and placed it slowly back on the stove. Billy’s eyes, the size of saucers, flicked between the almoner and his mother.
‘Tilda,’ Alice said quietly, taking a step towards the young mother. Tilda made a noise of acknowledgement in her throat but turned and busied herself with the washing. She transferred some small vests from a sink full of soap suds to a pot of clean water, keeping her face angled away. ‘We’re here to help. If you’re having some difficulties …’
Tilda took a deep breath, patted her hands on her apron again and then sank into a nearby chair. Alice sat beside her and anchored the woman with her eyes. ‘I know that Ted and Hetty would love to offer a hand, if you’d let them.’
‘You know my parents?’
‘We are acquainted.’
Tilda’s shoulders sagged and her bottom lip trembled. ‘I know. I miss them so much, but Rich thinks they interfere too much. They exchanged words a few months back and now he won’t let them anywhere near. He made me swear not to contact them. He wants us to make a clean breast of it, just me and the kids.’
‘And what about you? What do you want?’
One of Tilda’s hands skittered to her hair. She opened her mouth to speak, but a noise in the hallway stilled her. She was off her seat within a second. Billy’s hands fell away from the table and shrank back into his chair.
A tall man with a flattened nose and stocky shoulders walked into the kitchen. His infant son lowered the tongs he was holding to the floor and peered up at him silently. ‘What’s all this?’
‘Oh, this is Miss Hudson, Rich,’ Tilda said with a note of hysteria creeping into her tone. ‘She reckons Billy might qualify to see a doctor. Wouldn’t necessarily cost us nothing either.’
Her husband scoffed a laugh. ‘Oh she does, does she?’ he said in a mocking tone. ‘She thinks we’re a case for charity then?’
‘Not charity, no,’ Alice began in an emollient tone. She angled herself around in her chair, turning her full attention to him. ‘It’s a case of everyone contributing according to their means, Mr Simpkins. Naturally, those with the broadest shoulders bear the greatest responsibility. It’s the fairest way.’ She got to her feet. ‘Perhaps you would care to come along to our information evening for expectant fathers at the Royal Free? They run every fortnight on a Tuesday evening, and while you are with us we could explain a little more about who qualifies for free treatment.’
‘Why would I wanna do that?’ The man’s eyes were shiny, his voice slightly slurred. Perhaps responding to a sharpening of the air in the room, Billy’s chest began to heave rapidly, a whistle accompanying each of his breaths.
Alice glanced in the boy’s direction. ‘We should discuss this another time, when the children are not around. For now I think it is a priority for Billy to get the treatment he needs.’
‘Oh, a priority is it?’ Richard Simpkins sneered, before turning to his son. ‘Come here,’ he said quietly. Billy flushed but didn’t move. His father grabbed him by the ear and hauled him to his feet. The boy screwed up his face in pain and bit his lip to stop himself from crying out. ‘Leave us to it, laddie, so the nice lady can say what she must.’ The young boy took advantage of the opportunity to escape and scuttled from the room.
Alice gave the labourer a cold glance. The sights and sounds of the battlefield still resonated with her, but back at home it was the viciousness towards children she had encountered since becoming an almoner that was most disturbing to her. This was a war utterly without cause or justification.
The physical punishment of children was commonplace at the time, expected even. Great store was placed in the Bible’s warning ‘spare the rod, spoil the child’, and few households with children in them were without the customary strap or poker handy to keep them in line. Hearsay told of the punishments being doled out by nuns in some of the local children’s homes – the flagrant beatings, the punitive bathing of youngsters in scalding water, the use of hot pokers to ‘imprint’ the importance of Bible study in their minds. But what was most shocking of all was the deliberate and callous abuse meted out by those who were supposed to love children most: their own parents.
In the last few months alone a newborn baby had been abandoned in a ditch, a toddler had been poisoned with two pennyworth of salt and a child of three months had been thrust head first into a pail of water by its own mother. Had it not been for the speedy actions of a concerned neighbour, who rushed in and revived the blue-faced infant, she might have drowned.
‘Perhaps it would be better if I returned another time,’ Alice said, levelling her gaze. ‘When you’re sober.’
Mr Simpkins’ face flooded with colour, his chin stiffening. Perhaps realising that it wasn’t wise to expose his family to further scrutiny, he took a breath and moderated his attitude. ‘We don’t need any more calls or advice from outsiders.’ He thumped his own chest with a closed fist. ‘My family is my business,’ he said quietly. ‘And nothing to do with no one else.’
The almoners regularly issued stern warnings to heavy drinkers, and Alice was no less forthright when she told Richard Simpkins that the welfare of his children was, as a matter of fact, her concern. And then, with no trace of judgement or condemnation in her tone, she said: ‘But we can only give our help to those who do their utmost to help themselves.’
Alice and her colleagues’ commitment to social change would eventually lead to the creation of the welfare state, but like many reformers they strongly believed that people should be encouraged to help themselves. The provision of charity was not to be regarded as a permanent arrangement, as far as Alice and her colleagues were concerned. The motto ‘heaven helps those who help themselves’ was one well used in the almoners’ office. It was strongly felt that material assistance could corrupt and encourage those with a tendency towards vice to indulge themselves more.
‘We don’t need nothing from you, thanks very much.’
; If the ice in Mr Simpkins’ tone had been intended to intimidate Alice, then he had certainly failed, but his wife whipped her youngest son up from the floor and shrank back against the furthest wall. Alice’s gaze lingered on the man’s face and then she dipped her head. ‘Very well. Tilda, it was nice talking to you,’ she said, keeping her eyes on Tilda’s husband. ‘If your son’s condition deteriorates any further, it’s imperative that you bring him to the hospital without delay. Good day, Mr Simpkins.’
Outside, Alice made note of Tilda’s nervous disposition and the condition of her ashen-faced son – Tilda Simpkins, battered wife? Richard Simpkins, drunkard, not suitable for material assistance. Billy Simpkins, asthmatic. Will return with further words of advice. She heaved a sigh, closed the pad and slipped it into her bag.
Unless Tilda took the decision to take a stand against her husband, there was little that Alice would be permitted to do. Until then, the woman was in the dangerous position of being at the mercy of a violent husband. And if there was one thing the almoners learned early on in their careers, it was that some people were capable of anything.
Alice’s shift officially ended at 5 p.m., but it was almost quarter past six by the time she descended the stairs to the basement. The sound of lowered voices could be heard outside the office, but they fell abruptly silent when she opened the door.
‘Ah, Alice,’ Bess Campbell said, a frozen smile on her face. ‘I didn’t expect you back so late.’ Frank, who had been seated opposite the Lady Almoner with his elbows resting on her desk, got to his feet. There was a pause, and then Bess cleared her throat. ‘But now you’re here, I’d like to talk to you about the upcoming medical social work conference at High Leigh.’
Alice took the seat that Frank had just vacated. ‘We’re to make a presentation on the benefits of social intervention in improving overall health,’ Bess continued, ‘and I need you to sort out some cases that best highlight our success.’
Letters from Alice Page 9