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

‘Lying dormant for the time being,’ came Alexander’s reply. ‘To re-emerge whenever someone manages to display some wit.’

Stocky office typist Winnie Bertram blew her nose into a hanky and tucked it back into the handbag that rarely left her lap. ‘God rest his soul,’ she said, her reedy, wavering voice momentarily cutting through the office banter.

Alexander glanced up from his work. ‘Are you coping, Winnie?’

Winnie adjusted the black silk shawl she was wearing around her shoulders, the one she had worn religiously since Queen Victoria had been interred next to Prince Albert in Windsor Great Park more than two decades earlier. ‘Not particularly, dear, no,’ she said, straightening her spectacles with a mottled hand.

Winnie could be relied upon to mourn every loss the hospital notched up, even if the first she had heard of the patient was after they’d departed. She too was in the ideal job in that regard, especially with Sidney keeping her abreast of every last gasp, choke and coronary going on above them.

‘You look tired,’ Alexander pressed gently. ‘Perhaps you should consider spending the day at home?’

Winnie patted down her short grey hair and gave Alexander a wan smile. ‘I’ve been tired since 1890, dear. Don’t worry about me, I’ll soldier on.’

Alice rolled her eyes. Witnessing the aftermath of war had left her with a sense of urgency to improve the lives of society’s most unfortunate, as well as a lack of patience for those with a tendency to complain about trifling issues.

She herself recognised her good fortune, having enjoyed a largely happy childhood. Quick intuition made her the ideal student and as she grew older, she delighted in the new opportunities becoming available to women. Influenced by her parents, who were both pacifists and active peace campaigners, Alice became aware of society’s ills at an early age. She and her elder brother, Frederick, sat quietly in the corner of the sofa during the meetings of the National Peace Council – a body coordinating smaller groups dedicated to furthering the cause of non-violent opposition across Britain – that took place in the living room of their Clapham home.

In later years Alice became brave enough to interject, shaping the skills of negotiation and the moral compass that were to guide her as she tended to wounded soldiers on the battlefield, the ear-splitting crack of shell-fire in the distance, plumes of gas looming high above her head.

‘But I don’t understand why they had to invade!’ thirteen-year-old Alice had burst out passionately, in response to an argument about the Austro-Hungarian annexing of Bosnia-Herzegovina.

Her father glanced at her tenderly. ‘The Austrians are flexing their muscles, love. They want to ensure their empire is taken seriously. We’ll see where their flag-waving nationalism gets them soon enough, I suspect.’

‘War, in the Balkans and beyond, you mark my words,’ one of the men, a Quaker, answered hotly, causing a great deal of muttering and concern on the faces of those present.

A hiss of steam from the old boiler caught everyone’s attention. In the lull that followed, Alice asked Frank if he was ready to join her in outpatients. She was scheduled to spend the day conducting assessments on some of those waiting, all the while keeping an eye out for cases of fraud. It was an information-gathering exercise, and the ideal opportunity for Frank to gain a sense of her work.

‘I’ve decided to carry on with my review of the paperwork down here this morning, dear Alice,’ Frank said, checking his pocket watch and slipping it back into his waistcoat. ‘Besides, you females are so much better with the ailing than us men.’

‘But I have juggled everything around, as you asked me to. I haven’t been through the inpatients lists yet, and I need to organise wigs and prosthetics for several patients.’

‘Don’t you worry about that,’ Frank said. There was a hopeful glance from Alice, before he continued. ‘It will still be here when you get back.’

‘That doesn’t sound particularly fair,’ Alexander offered from the other side of the room.

‘No,’ Alice said, turning to him. ‘But then some men believe a woman’s sole purpose is to bend to their every whim. In fact, I suspect that some would prefer it if we didn’t exist at all.’

‘Ha! Not true, if indeed the lady is referring to me,’ Frank said. He stuck out the tip of his tongue, removed a flake of tobacco and planted it back in his pipe. ‘I love the female of the species. Fascinating creatures.’

Alice grimaced, grabbed her notepad and pen, and left the office with a cold glance towards her colleague.

When the first almoner, Mary Stewart, took up her post at the Royal Free in 1895, for which she was paid a modest annual salary of £125, she was allocated a small corner of the outpatients’ department to work from. Visitors to her ‘office’ perched themselves on the edge of a radiator in the dark, airless space, a thin screen partitioning them from the view of the throng of patients waiting to be seen.

Six years later and a few miles away to the south, the first female almoner of St George’s Hospital, Edith Mudd, was to carry out her duties from a screened-off area in the recovery room next to the operating theatre. She got on with the job conscientiously, doing her best to concentrate despite the activity across the room as patients came round after anaesthesia. Since the almoners were used to moving around between London hospitals to cover each other’s shifts and gain wider experience, they quickly learned to adapt to unusual working environments; one of Edith Mudd’s successors at St George’s managed to run a fully functioning almoners’ office from one of the hospital’s bathrooms.

It was in a similarly small space known as the watching room that Alice seated herself in the outpatients department; somewhere from which she could keep an eye on the comings and goings with a degree of discretion. It was just before 9 a.m. but already there were few gaps on the wooden benches that were arranged in tight rows across the large atrium. Incessant rain pelted the small recessed windows of the double doors at the entrance to the building, the wind penetrating the gap beneath the doors with a ferocious whistle.

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.