Category: Frimley correspondence

Doctors’ views on gratitude

A few weeks ago I had the opportunity to present some of my work on the gratitude expressed in the Frimley correspondence to GP trainers and trainees from West Middlesex Hospital, whose two days away were delightfully themed around ‘happiness’. It was a nice way to hear some stories of gratitude from the frontline.

We had a lively discussion about whether patients are morally obliged to feel grateful. Lots of the delegates were uncomfortable about the word ‘moral’, although most agreed that patients had lots to be grateful for. The overwhelming majority felt that patients should be grateful for the NHS in general, rather than specific practitioners. This sits uncomfortably with some of the literature (e.g. Simmons, 1979, Moral Principles and Political Obligations) in which it is argued that there are difficulties with expressing gratitude to an institution, especially if the individuals that form it are merely carrying out their duties. Most of those joining in the discussion thought that gratitude was owing to the NHS because patients got a lot more out of it than they put in. Some invoked comparisons with other parts of the world, making the case that access to the NHS is a privilege and definitely something for which to be grateful.

When it came to receiving gratitude, the most memorable gifts or cards came from patients from whom it was unexpected. An example was given of a man that had to be sectioned and was incredibly angry at the time, so a card saying ‘thank you’ a few weeks later was particularly touching. Homemade food as a currency of gratitude was also prominent, especially amongst the Asian community. Receiving gifts was confirmed as a particularly tricky issue for doctors with high potential to cause offence by refusing gifts, but sometimes it’s tricky to tell whether gifts do indeed come with strings attached.

‘Yours gratefully…’: the Frimley Sanatorium correspondence

Frimley Sanatorium, established in 1905, was the country outpost of the Brompton Hospital for Consumption and Diseases of the Chest. Its purpose was to provide a healthy environment for patients who were deemed capable of making a good recovery from TB. After a few years it was realised that follow-up records were vital for understanding the impact of the changing treatment regimes at Frimley. It fell to the Lady Almoner at the Brompton Hospital to persuade patients to keep in touch with the hospital after they were discharged.

Report on the after-histories of patients discharged from the Brompton Hospital Snatorium at Frimley, in Surrey, during the years 1905-1910.
Report on the after-histories of patients discharged from the Brompton Hospital Sanatorium at Frimley, in Surrey, during the years 1905-1910, emphasising the need for follow-up.

Miss Lily Constance Marx, appointed in 1920, took this duty very seriously. She maintained contact with hundreds of patients through the course of her long career. The letters are a testament to the gratitude that many patients felt for the treatment they received at Brompton and Frimley. But the courteous and grateful tone of the correspondence from the almoner, thanking patients for keeping in touch, established a mutual cycle of gratitude. Here is one example, sent by Walter Woollett, writing over 40 years after he had received treatment at Frimley:

I must say Madam it is nice to know, that one knows that someone takes an interest in our old age & again I thank you for all past kindnesses […] If it had not been for Frimley & Brompton I am afraid I should not be acknowledging your kind letter. All good wishes for 1948.

Another example of mutual gratitude is evident from correspondence in 1945 between the almoner and Mr H E Watson, who had been treated in 1906. He sent a £25 donation to the hospital, and received this reply:

Dear Mr Watson

I am writing to thank you most gratefully for your generous donation of £25 for which a formal receipt is enclosed from the Secretary.

May I say how encouraging such an expression of gratitude from old patients can give to the hospital staff, as well as practical support?

I am glad to know you are keeping well and going on at business as usual. Please find the enclosed Annual Report which you wished to see.

Again with many thanks.

Yours truly,

Almoner

These types of letters are typical examples of the expressions of gratitude that abound in the archive of letters. They arose from institutional, yet personalised, correspondence. The correspondence became a lot less personal when the almoner’s letters were replaced by correspondence from ‘the Frimley follow-up department’ in the late 1950s.