Author of" Business Talks to Young Men" "Straight Talks to Employers" etc.

A New and Not Overcrowded Profession - The Growing Necessity for Hospital Almoners - Duties of the Office - An Opening for the Educated Woman - The Training Required - How to Train The Fees Required - Prospects when Trained

The profession of hospital almoner is a comparatively new one, for, although it is now sixteen years since the Royal Free Hospital appointed the first lady to this position, it was not until a few years ago that such appointments became at all general.

The establishment of a Hospital Almoners' Council for the training of candidates, in 1907, gave a great impetus to the movement, and there are now thirteen London hospitals, including some of the largest, such as St. Thomas's and the London, that employ these officials, and several provincial hospitals are following the example.

The hospital almoner has a two-fold duty to perform. She has to protect the interests of the institution by eliminating unsuitable cases and by making those contribute toward the expenses of their treatment who can afford to do so.

The Almoner's Duties

On the other hand, there is her work on behalf of the patients themselves, and it is not too much to say that the attention which she gives to the particular needs and circumstances of each case, apart from its medical aspect, practically doubles the value of the actual treatment.

The abuse of hospital charity has been for a long time a growing evil, and the funds of these institutions have suffered severely in consequence, so that some change in the old system of indiscriminate treatment was greatly needed, and there is no doubt that where an almoner has been appointed, not only has the hospital benefited financially, but it has been able to deal more efficiently with deserving cases, especially those who come to the out-patients' department.

This profession appeals especially to the woman who is interested in social work, as there are few branches of even purely philan-ihropic effort which offer greater opportunities of ameliorating social evils.

The hospital almoner's duties are many and varied, and her work touches the lives of the poor in almost every direction.

Every patient who applies for treatment in the out-patients' department is interviewed by the lady almoner, who makes inquiries both with regard to the means of the applicant and the suitability of the case. Many of those who present themselves at the hospital could be treated equally well at a dispensary, and in such cases the almonei rightly refuses them admission to the over-crowded out-patients' department, and induces them to join their local-dispensary.

The Wealthy Poor

Again, people who could well afford the fees of West End consultants not infrequently attempt to obtain free treatment.

In one case, a man suffering from bronchitis applied for admission to the London Hospital, saying that his doctor had recommended him to do so. The latter statement was untrue, and a very brief inquiry served to show that this applicant for charity was a prosperous coffee-stall keeper, whose average takings were 12 a week.

The almoner visits each of the out-patients in their own homes, in order to see that the treatment prescribed is properly carried out. Under the ordinary system, many of these poor people receive but little benefit from their visits to the hospital. They carry away with them medicine enough, it is true, but there are many ills that medicine will not touch, and the general conditions of their home-life make a cure quite impossible.

Preventable Disease

This is especially noticeable in consumptive cases, which improve in hospital, but at once relapse when they return to their old unhealthy surroundings. These the almoner does her best to improve by promoting cleanliness in the home, and inculcating a knowledge of the virtues of fresh air, while, if the conditions are altogether unsuitable, she orders the patient away to a sanatorium.

Again, the hospital doctor will perhaps, after prescribing, recommend the patient to take a generous diet of milk and eggs. He might just as well order champagne, the patient being as little able to afford one as the other. When there is an almoner attached to the hospital, such haphazard methods are not allowed to exist. If extra nourishment is required as part of the treatment, she orders it. She also provides for home nursing where necessary, and sometimes even for temporary domestic help.

She often has to teach the people of the house how to cook and prepare the invalid's food, and to direct them in the choice of suitable articles of diet, a point upon which the poor often have strange ideas.

In carrying out all that part of her work which relates to hygiene and the improvement of the patient's surroundings, she frequently calls in the assistance of the health visitor and the sanitary inspector, as it is her duty to be in touch with every agency that makes for healthy living.

All applications for surgical instruments and orders for admission into convalescent homes pass through her hands, and in suitable cases she makes grants from the Samaritan Fund, patients being required to contribute, if possible, according to their means.

A hospital almoner's work has, too, even wider scope. It is not merely devoted to relief in sickness, but to removing the conditions which make for sickness and poverty.

She is in touch with charitable organisations of every kind, labour bureaux, emigration and apprenticeship societies, and the friendly societies. Thus, by helping patients to help themselves, and encouraging habits of thrift and industry, she endeavours permanently to improve their condition, and prevent their becoming a constant drain on the resources of the hospitals and other charitable agencies.

A man, say, has been in the hospital for weeks, and has lost his employment. To send him out without any prospect of work often only means his speedy return, and that in a worse state than before. In such a case the almoner communicates with one of the labour bureaux, and work is often found for him as soon as he can take his discharge.