<論説>慈善医療の商業化とスキャンダリズム : ホロウェイ・サナトリアム精神病院を中心に

Abstract

本稿は一九世紀末から二〇世紀初頭の英国における慈善医療の商業化を検討するものである。近代英国における慈善は福祉国家の前段階として評価されがちであった。しかし近年再検討が進み、慈善は近代英国が標榜する民間公共社会を象徴する社会的事業であったことが理解されつつある。しかし慈善医療については、一九世紀末になると国家医療の登場、慈善資金の減少、中産階級向けの病院施設の欠如、医療の専門分化などが背景となり、徐々にその篤志的性格を変え商業化の一途をたどろうとしていた。そして、大衆的ジャーナリズムが勃興する時代において、この慈善医療の商業化はスキャンダルとして扱われていったのである。その事例として、本稿はホロウェイ・サナトリアム精神病院における一八九五年のスキャンダルを検討し、慈善医療が商業的性格を強めつつ医療布場で生き残りを模索する様相に迫ることによって、一九世紀末から二〇世紀前半における慈善医療の歴史的特質を論じる。

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 It has been long understood as an outdated mode of welfare that would be replaced by the National Insurance and National Health Services.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 result of the deficiency of charitable contributions and increasing demands from the middle-class, the 1895 scandal of the Holloway Sanatorium provides us a representative case of the commercialization of charitable medicine, which had just started in the late-nineteenth century and were to continue beneath the surface of history thereafter.