<Articles>Commercialization of Charitable Medicine and Medical Scandal Mongering : With Particular Reference to Holloway Sanatorium

This paper examines the commercialization of British charitable medicine between the late-nineteenth century and early-twentieth century. Past historians have argued that the early-twentieth century welfare state replaced charitable activities with state enterprises. However, as shown in the works of Shusaku Kanazawa and Martin Daunton, recent historians have revised the historical meaning of charity, and have argued that it was not a minor social enterprise but represented an idea of "civil society" in Britain. Despite this increasingly powerful revision of the history of charity, charitable medicine has been paid little attention. It has been long understood as an outdated mode of welfare that would be replaced by the National Insurance and National Health Services. However, this paper shows, charitable medicine became increasingly commercialized between the late nineteenth century and the early-twentieth century, and survived into the twentieth century. In the mid-nineteenth century, the state began public health services financed by local taxes, which undermined the legitimacy of medical charities and exacerbated the problem of collecting contributions. The competition with new specialized hospitals such as those devoted to the treatment of the eyes and ears, or exclusively for children, also put traditional charitable hospitals in a disadvantageous position. Hence, many of the medical charities faced financial difficulties in the late-nineteenth century. A key to the survival of charitable hospitals in financial crisis was to accommodate admission-fee-paying patients, that is, to commercialize themselves. This was not difficult for charitable hospitals since there was an increasing demand for them from the late nineteenth century. This demand arose from the middle class that witnessed the progress made in medicine in the mid-nineteenth century. Hence, charitable hospitals increased the number of paying patients until the advent of the National Health Service. However, charitable medicine faced another hardship, the attention of mass media that appeared at that time, The popular newspapers and magazines became the new watchdogs of society, sensationalizing British society. In this light the commercialization of charitable medicine was a suitable target for criticism that involved the disclosure of a number of scandals. Such scandals offer us a hint for understanding the commercialization of charitable medicine in late-nineteenth and early-twentieth century Britain, on which this paper focuses. To examine the commercialization of charitable medicine and scandal mongering, this paper focuses on a scandal that took place in 1895. It concerned the Holloway Sanatorium, a charitable mental hospital established in the late nineteenth century. Prior to examining this institution, this paper outlines in section 1 how charitable medicine was commercialized and how it was problematized in the press. Section 2 introduces preliminary information about English mental health services in the late nineteenth century, and section 3 argues the significance of the Holloway Sanatorium and the 1895 scandal. In so doing, this paper uses archival documents, the Holloway Sanatorium Papers, held by the Surrey History Centre, and Truth, one of the most famous scandal-mongering presses of the late nineteenth century. In particular, this paper argues that as the Holloway Sanatorium had been started later than other institutions and was born in the age of financial hardship for charitable bodies of medicine, it pursued a policy of maximizing income and minimizing costs. The 1895 scandal exposed just such a scheme. Until 1895, the Holloway Sanatorium increased the percentage of paying patients compared with charitable patients, thereby increasing its profits. On the other hand, it pursued low-cost management. For example, the medical staff often failed to watch over patients who were mechanically constrained. As this profit-seeking management arose as a