Letters from Alice: Part 1 of 3: A tale of hardship and hope. A search for the truth.

Alice picked up pace, the bells of Southwark Cathedral jangling in time with her steps. As they neared Whitechapel, walking the same streets stalked by Jack the Ripper a few decades earlier, they passed several tenements, silent but for the distant yowls of a stray dog. With shoeless children using stones for marbles on the icy pavements and coatless beggars huddling against crumbling walls, it was an area well known to the almoners.

Hurrying past the destitute with nothing to offer but a concerned smile must have been demoralising for a committed social reformer like Alice, but the almoners soon learned the difficult and humbling lesson that all social workers through the ages come to accept: you can’t help everyone.

Frank slowed as they neared a warren of three-storied houses with overhanging eaves. The smoke rising from chimneys all along Dock Street would likely worsen the weather conditions, but at least offered the promise of a room warmed by a log fire.

Alice reached Frank a few doors away from their destination. The trail of acrid smoke he left in his wake caught in her throat and she gave a sudden cough. Frank stopped mid-pace, draped the handle of his umbrella over the crook of one arm and held out his other hand to take possession of the briefcase. ‘May I?’ he asked, pipe dangling from between his teeth. With a slow roll of her eyes, Alice relinquished the suitcase. Frank immediately stood aside, gesturing for her to take the lead with a flourish of his brolly.

The Redbournes’ rickety wooden gate gave a resentful moan on opening, the yard empty but for a skinny cat curled up inside an old cardboard box. Lifting its head, the creature eyed them sorrowfully and then gave a mournful yowl. Alice crouched down, stroked its cold, velvety ears and whispered a soft hello.

The rug appeared out of the door without warning, just as Frank reached the front step. With a pitiful yelp he dropped both briefcase and brolly and staggered backwards to the gate, flapping his hands madly at his hair and face. Seemingly oblivious to her visitors, the woman brandishing the rug continued with the task, shaking it violently, eyes and mouth pinched tight against the spiralling dust.

It was only when Alice rose to her feet that Mrs Redbourne noticed them.

‘Oh,’ she said, staring at them agog. Frank, doubled over and gasping as he clutched at the fence post for support, looked for all the world as if he’d just left the battlefield. Alice’s mouth twitched as if stifling a giggle. A movement of the curtain at next door’s window, and the appearance of an elderly woman with curly grey hair on the other side of the glass, was a reminder of the need for discretion.

‘I am sorry to trouble you, Mrs Redbourne,’ Alice said softly. The cat raised itself and coiled her ankles in a figure of eight, disappearing beneath the hem of her skirt and reappearing at intervals. A passer-by stopped outside the house. Hat in hand, the elderly gentleman stared unabashedly at their small party. Alice lowered her voice still further. ‘We are from the Royal Free Hospital. Would you mind if we came in?’

Mrs Redbourne gave Alice a long look. The files back at the Royal Free stated that she was in her early forties, but her stern expression made her appear much older. Her hair had been combed into a grid-like pattern, each square grey tress curled, secured with pins and kept in place with a dark scarf. The rim of the scarf pulled tightly on the lined skin around her forehead, rendering her pink-rimmed eyes severe. She began to work her mouth as if chewing and then she said: ‘We’re in the middle of things just now.’

‘We shan’t take much of your time. We would like to check a few facts with you, and leave you with some information about our subscription scheme.’

The woman’s face contorted further. ‘That won’t be necessary. We have all the information we need, thank you very much.’ Steadfastly blocking their entrance with her wide girth, she folded the rug against the apron she wore like a shield, her lips stretched into a thin line.

Alice opened her mouth to speak. Before she managed to say a word, however, Frank, recomposed, grabbed his umbrella and nudged it against her skirt, half-pointing, half-thrusting it into the hall. ‘If you’d be so kind, Madam,’ he said, easing Alice aside with a fractional movement of his wrist. The expression on Mrs Redbourne’s face suggested that she wasn’t going anywhere, but a few moments later the woman flattened herself against the open door and let them through.

Alice met Frank’s satisfied look with another curt nod. She followed him into the hall, hovering at the open door for a fraction of a second before moving aside to allow Mrs Redbourne to close it behind them.

The almoner ran her eyes around the Redbournes’ hall. It was bright and clear of debris, the floor recently swept. There was a darkened rectangle where a rug must have been, the rest of the space dominated by a large coach pram.

In the front room, several logs glowed brightly in the fireplace. A pot of water bubbled away over the flames, children of varying ages playing close by. The high number of children arriving at hospital with severe burns and scalds meant that Alice frequently offered strong words of advice about the use of fireguards. It was one of the warnings that often fell on deaf ears, probably because finding the money for a guard was low down on the list of priorities for families who were worried about where their next meal might come from.

After eleven months in the post, the almoner was at least well practised in running through all of the necessary checks she needed to ensure that the financial information provided matched the family’s apparent means. She had also been trained to note down any evidence of harm to the children, bruising to the skin and other tell-tale signs of neglect, as well as any other issues that might negatively impact on a patient’s health. The rudimentary medical knowledge she had gained as a nurse with the VAD in a field hospital in Belgium helped her to discriminate between those injuries resulting from natural rough play and those of a more sinister origin.

The British Red Cross, recognising that the VADs had much to offer on their return to England, had offered scholarships to those willing to train as hospital almoners. Sent home after being injured from the fire resulting from the blast of a mortar bomb, and passionate about improving the living standards of the ordinary working people, Alice had jumped at the chance.

Back in 1916, when she had first arrived at the casualty clearing station in Belgium, unqualified and with no medical experience, she had only been allowed to carry out the most menial of chores, like cleaning floors and swilling out bedpans. The qualified nurses from Queen Alexandra’s Imperial Military Nursing Service (QAIMNS), already battling for professional recognition, had resented the onslaught of hundreds of untrained women from middle-class homes. Inevitably, the grottiest of chores were directed towards the new arrivals.

Alice uncomplainingly cleaned up the stinking, putrid dead skin that had been scraped from the feet of soldiers suffering from trench foot. She swept up the discarded fragments of bloodstained uniform that nurses had pulled from infected wounds. She stoically hid her blushes when confronted with her first glimpse of a naked male.

Gradually the qualified staff recognised Alice’s dedication. As their attitude towards her softened and their appreciation grew, she was granted closer contact with injured soldiers. Like many of her contemporaries plunged into the aftermath of battle, she discovered that she possessed a natural ability to console. It wasn’t unheard of for Alice and the other VADs to lower themselves into the trenches to comfort dying soldiers, ignoring the roar of cannon fire and the smell of charred flesh. Mothers back in England found comfort in knowing that someone gentle had held their sons as they passed away.

Alice wrinkled her nose. There was a faint smell of drains, sour nicotine and something like old lard in the air – sometimes the dank smell inside the homes she visited was enough to make her retch – but the house was clean enough. The Redbourne children were whey-faced and snuffly with colds but there was no sign of fever or the dreaded influenza virus that had driven so many people to the Royal Free that winter. All of them were clothed and there was no sign of rickets among them. Neither were any of them possessed of that shrunken, unhealthy appearance that so worried the almoners whenever they came across it.

A small boy lay languidly on his tummy under a wooden clothes horse covered in linen cloth nappies and, incongruously, a white silk chemise. About a year or so old, his appearance was consistent with the description of Henry recorded in the Redbournes’ hospital file. Alice’s eyes lingered on his damp, flushed cheeks. With his head on his forearms, he looked close to dropping off, but healthy enough otherwise.

An older girl of around twelve years old was kneeling nearby, trying to field off blows from another young boy who was standing behind her. Around four years old, he alternated between slapping the top of her head and grabbing handfuls of her hair. He giggled when she pulled him over her shoulder and onto her lap, but then lashed out, slapping her in the eye when she tickled his midriff.

In light of what was to come, the child’s behaviour might have set some alarm bells ringing. As it was, the overall impression offered was one of need, but not destitution, or something graver. And yet somehow there was enough money left at the end of the week to finance nights out in the West End, and, so it seemed, luxury lingerie.

Alice scanned the room for a second time. In the corner, an older girl was sitting on a small sofa with her face turned towards the window. A sickly-looking toddler was perched on her knee. The conversation between Mrs Redbourne and Frank became increasingly loud and animated. By distracting the homeowner with his extravagant gestures, Frank was offering Alice the opportunity to carry out an inspection unhampered; one of the oft-used subterfuges employed by the almoners.

Even with the dust motes clinging to his beard, Frank looked fantastically conspicuous in the room. Alice and her colleagues had initially been perplexed at the idea of a man turning up whenever he felt like it to observe them at work, but his humour had put them quickly at ease. Beneath his buffoonery lurked a sharp mind and keen intuition, something he appeared keen to keep under wraps.

Quietly, Alice edged past the pair into the room. Frank shifted his weight subtly from one foot to the other to aid her passage. A ripple of interest at the arrival of yet another stranger rolled over the children. The young boy who was in the process of pinching his older sister sprang to his feet and walked over to her. ‘Hello,’ Alice said softly, crouching down in front of him. ‘What’s your name then?’

‘Jack,’ the boy answered and began fiddling with the sleeve of Alice’s cape. ‘You one of them busybodies?’

The almoner smiled then removed her hat and rested it on one knee, instantly softening her features. Some of Alice’s nursing colleagues were beginning to experiment with cosmetics, something that would have been considered vulgar before the war. When readying themselves for a night out, they would cajole her into darkening her lashes with a mixture of crushed charcoal and Vaseline, the more exuberant characters outlining their eyes in a dramatic sweep. Alice generally went make-up free when on duty, taming her long brown curls in a tight chignon at the back of her head. It was a style that gave her square jaw and high forehead prominence over her softest feature: her large, thickly lashed brown eyes. The resulting rather prim look came in useful when dealing with the least cooperative of patients. ‘Erm, I suppose some might say so.’

‘Mummy usually sends you lot packing.’

His older sister shifted around and gave a shake of her head. Alice pressed her lips together, eyes shining. ‘And who is this?’ she asked, kneeling in front of the young boy who was sitting on his older sister’s lap, bare knees dangling beneath a worn blanket. About two years old, the child regarded her shyly and buried his face in his sister’s chest. The latter planted a brief kiss on top of his hair. When she pulled away, her eyes remained downcast. The logs crackled in the grate as Alice stilled, waiting for an answer.

The girl, though wearing a morose expression, was pretty. Her cheeks were plump and prominent despite the thinness of her wrists, her eyes a feline green. After a few moments she met Alice’s gaze. ‘John,’ she mumbled, regarding the almoner with the sort of suspicion that anyone involved in social work quickly becomes accustomed to.

‘Hello, John,’ Alice said, with a brief touch to his knee. She looked up at his sister. ‘And you are?’

‘That’s Charlotte,’ Jack offered, stealing Alice’s hat from her knee and planting it lopsided on his own head. ‘She’s trouble, Mum says. Him’s Henry,’ he added, pointing to the young boy almost asleep on the floor. ‘And Elsa’s over there.’ The young girl sitting next to Henry chewed her lip and regarded Alice from beneath lowered lashes. Charlotte rolled her eyes and glared.

The tell-tale signs of a scabies infestation were visible along John’s forearm. Track-like burrows ran around his wrist where a mite had tunnelled into the skin, the tiny black dots of faecal matter visible around an angry rash. It was something Alice and the other VADs had often seen in the field hospitals; soldiers driven half-mad by the intense, irrepressible itch. The entire family would need to be treated with benzyl benzoate emulsion. ‘Not at school, Charlotte?’ Alice asked, in a precise but friendly tone.

It was a question designed to engage, rather than a genuine enquiry. The almoner had been taught specific interviewing strategies in training that helped her to disguise carefully planned interviews as casual chats, thereby gaining valuable insight into the living conditions of her patients: their relationships, finances, thoughts and fears. By examining individuals in the context of their social setting she was able to identify issues that might be impacting negatively on their health. Practical help honed to individual needs could then be offered, improving outcomes and the chances of a good recovery.

One way to encourage an interviewee to relax was to start a conversation with questions that were most easily answered, in much the same way as the devisers of written exams open with a problem easily solved. Since patients almost universally enjoyed talking about themselves, she learned that a readiness to listen, a keen interest in people and a sincere desire to help were all that was needed to encourage loose tongues.

‘I’m fifteen,’ the girl said, sounding offended. ‘I left ages ago.’

Alice nodded. ‘So are you working outside of the home now?’ The almoners knew it wasn’t unusual for older children to take a job so that they could contribute towards the family purse, even skipping school to do so. The income generated was often kept under wraps by families being assessed. Alice had been taught to be thorough in her questioning to uncover a true picture of a family’s finances.

‘Not really,’ Charlotte answered quickly. Her thin chilblained fingers worked continuously at the blanket on her brother’s lap, as if she had more to say. Alice waited, but the girl’s eyes flicked over to her mother and then her expression suddenly closed down. Her shoulders rounded further away so that the child on her lap wobbled and almost lost balance until she reached out and wrapped her arms around his waist.

Alice pressed her lips together, rescued her hat and rose to her feet. Over by the door, Frank’s charms were working a treat, Mrs Redbourne smiling up at him coyly. She barely seemed to notice when Alice slipped past. Behind her, Charlotte sat quietly, eyes watchful.

In the hallway, Alice hesitated. She stood in solitary silence for a few seconds, head cocked as if listening. After a moment she turned sideways to squeeze past the pram and then moved towards a closed door at the end of the hall. A soft thump stopped her in her tracks. There was a creaking sound, and then the door gave way, a pair of eyes peering through the crack.

After a short pause in which no one moved, the door was opened to reveal a fleshy, puffy-eyed man with a glossy sheen across his forehead. Alice strode towards him, thrust out her hand and smiled, as if a meeting had been planned between them. ‘You must be Mr Redbourne?’ she said. ‘Alice Hudson. Pleased to meet you.’

The man looked down at her and passed his tongue over his lips, then took her proffered hand. ‘You’ll be from the hospital,’ he said in an uncertain voice. ‘The wife could do without the added pressure,’ he added, when Alice confirmed her occupation. ‘We do what we can, but you can’t expect us to give what we don’t have.’

He followed her to the living room, but when his wife caught sight of him she shooed him away with her hand. ‘I thought you were at the market, George? Get going will yer, there’s things we need.’ Mr Redbourne pulled a pack of cigarettes from his pocket, took one into his mouth using his teeth, then, without another word, slipped out of the house.

When the front door clicked to a close, Alice entered the room he had just vacated. The back parlour was a dark room with a single bed in the centre, the wooden base held up by a pile of bricks at each corner. There was a bite to the air, the room colder than the street outside. A dozen shirts hung from a rope stretched diagonally across it, one end caught between the slightly open window and the other wedged between the top of a Welsh dresser and the wall.

Alice closed the door and peered into the nearby kitchen. Through the small window at the end of the room, a partly stone-flagged backyard was visible, a patch of bare earth beyond. An old lean-to housing the lavatory blocked what little winter light there was from entering the kitchen. There was no sign of running water; most working-class families were still filling buckets from a pump at the end of their street. The approaching twilight bathed the small area in shadows, the air fermenting with the smell of old dinners. With so many people living in the house the room was likely a place of much activity but, aside from a few black beetles scurrying across the floor and over the draining board, the overriding air was one of long abandonment.