Read the book: «Letters from Alice: A tale of hardship and hope. A search for the truth.»

Chapter One

The question of the abuse of voluntary hospitals is one of wide knowledge. It has led to the creation of the hospital almoner, and there is a great future in front of her … Students should be between the ages of twenty-five and thirty-five, and the more knowledge of the world and of general interests that they can bring to their training, which lasts at least eighteen months, the better.

(Pall Mall Gazette, 1915)

By the middle of the afternoon on 31 December 1921, Alice Hudson had ticked off almost all of the duties on her weekend list.

It was three degrees Celsius, the sort of weather that prescribed hot drinks and thick blankets, and the almoner might have spent the day huddled in front of the log fire in the nurses’ home instead of trudging across the icy streets of east London, had it not been for the pile of urgent home visits weighing down the desk of her basement office.

Although December 1921 had been generally mild, Londoners shouldered frequent high winds and gales towards the end of the month. Today, Saturday, there was a cloud of sulphur in the air, the sky stretching over the Thames as grey as the sediment lurking at its depths. Conditions were likely to worsen over the next few hours but, all being well, Alice would be back in her room before dark.

The signs were promising. It was 2.30 p.m. and she was already three calls down, with only one to go.

The almoner took hurried, lopsided steps along the pavement overlooking the river, a briefcase full of patient files bumping against her ankle-length cape. In the distance, the faint blue glow from the lamplighter’s pole twinkled reflectively over the surface of the Thames as he worked his way, much earlier than usual, along Tower Bridge. Several children had walked unwittingly through the vapours into the frozen waters during the last terrible smog. The flickering lights glinting over the water offered at least some degree of reassurance for pedestrians.

Fifty-seven years old and possessed of an unruly beard, portly physique and a loud but undeniable charm, Frank Worthington strode ahead, smoking his ever-present pipe. A newly appointed board member of the Charity Organisation Society, or COS, Frank had shadowed Alice in the last fortnight, apparently to report back to the board on the benefits of the almoners’ work.

Besides arranging financial assistance and practical support for patients in times of crisis, or improving their living conditions so that they were able to benefit from their hospital treatment, Alice was expected to identify those families with the means to make a small contribution, thereby increasing the hospital’s income and justifying the cost of her own salary.

Peering beneath the veneer of the family and making judgements about their financial situation while at the same time maintaining a friendly, trusting relationship was a tricky balancing act for the almoners, however, one that could easily swing out of kilter.

Some families fiercely resented the intrusion of home visits, particularly those that were unannounced. Alice quickly learned to brace herself against the inevitable shock on the faces of her subjects, the rising unpredictability that could beset any unannounced visit, the ever-present possibility of violence.

Not that it always helped to be mentally prepared. On one surprise home visit, Alice was pelted from an upstairs window with some foul-smelling, ominously yellow soggy rags. Another time, she lost her thumbnail in a ferociously slammed door.

According to the almoner’s file on the last family they planned to visit, the Redbournes persistently claimed poverty, but were known to frequent several of the newly opened jazz clubs in the West End. While the question mark over their earnings was a matter that required further investigation, however, it wasn’t the almoner’s biggest concern.

The Redbourne family file was marked with an asterisk; a code to indicate to the team that theirs might be a case that warranted closer inspection.

When Alice’s boss, Bess Campbell, had first visited the family in their small house in Dock Street, she later documented that she had found the children home alone. Mrs Redbourne had staggered back arm-in-arm with one of her neighbours singing ‘It’s a Long Way to Tipperary’ at the top of her voice while the Lady Almoner conducted a conversation with one of her youngest through the letterbox.

There were five children in the family, three of whom had received treatment in the outpatients department for dysentery. It was a condition feared by parents across the city: the summer diarrhoea of 1911 claimed the lives of 32,000 babies under the age of one, the plethora of flies attracted by horse manure on the streets speeding up the transmission of disease. The Redbournes’ youngest, a boy of around a year old named Henry, had fallen sick with pneumonia soon after recovering from his bout of dysentery. According to the physician who treated him, he had been lucky to survive.

As a porter on the railways, Mr George Redbourne earned a reasonable wage, one that, according to Miss Campbell, should have been sufficient to allow the family to contribute sixpence a week towards the cost of their medical treatment. A typical wage for someone like Mr Redbourne in the early 1920s was around thirty to forty shillings a week (in old money, there were twelve pennies in a shilling, and twenty shillings to a pound).

The Redbournes insisted that the rest of their income, after the eight shillings and sixpence a week they paid out in rent, was swallowed up by tram fares to and from work, payments to elderly parents and other essentials. So far, not a penny of the costs of the family’s treatment had been recouped.

Trouble with nerves prevented Mrs Redbourne from working, or so she claimed, but she was a reluctant interviewee, and her word was not entirely trusted. The margin of the Redbournes’ file was marked with the letters ‘NF’: the almoners’ code for ‘Not Friendly’. It was a practice taught in training, one that forewarned visiting staff to be on their guard.

Across the river, a barge billowed steam into the air. Frank stopped abruptly as a horse cantered past, its cart loaded with coal. ‘Miss Hudson, you’ve made your point,’ he said, tilting his head towards the briefcase. ‘You’re as capable as any man, I accept it. I just wish you’d give up your desire to become one.’

Alice stopped, resting the briefcase on the ground and shaking her hands to get the blood flowing again. Tentatively, she loosened the silk scarf she was wearing, wincing as she tucked the end inside her cape. A collection of scarves in assorted colours hung in Alice’s wardrobe back in her room. She alternated them throughout the seasons to conceal the burn injury she sustained in the trench fire that had sent her home to England, the rough scars running across her left shoulder, up to the nape of her neck and over the back of her left hand.

‘Don’t worry, Frank,’ came the curt reply. ‘If ever I had such ambition, you are more than enough to contain it.’ Frank chuckled and set off again through the resulting cloud of smoke, unburdened but for the folded umbrella he tapped on the ground in front of him.

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.