In 1894, Mrs. Mary Gray suffered “torture” through medical “experiments [that] nearly took her life” at the Chelsea Hospital for Women in London.Footnote 1 Mrs. Gray survived the experience, unlike the thirty-six mostly young and healthy women who died at the hospital after being operated on for similar gynecological conditions. Historians have examined this controversy in the context of experiments on womenFootnote 2; but Gray was not just any woman. A Poor Law guardian and Social Democrat, she joined a coalition of trade unionists, socialists, and animal-rights advocates who demanded the democratic control of hospitals, for “those institutions are open to great abuses affecting the health and bodies of the suffering poor and the personal rights of patients.”Footnote 3
The Chelsea Hospital scandal followed a long history of working-class hostility to compulsory medical treatment, such as incarceration in fever hospitals and vaccinations, both seen by some as a violation of the personal right to bodily integrity. Hospitals were biopolitical institutions that were supposed to manage the health of populations, but like other biopolitical institutions, such as schools, orphanages, and workhouses, they were also organized to discipline inmates. As in these other institutions, patients were sometimes referred to by number and ranked in serried rows, a system that enabled small numbers of staff to supervise large numbers of inmates. Nurses were both the enforcers of hospital discipline and its subjects; they had to keep infection at bay and maintain order, but they also worked long hours for low pay in dangerous conditions. A scandal in the same period about nursing conditions at the London Hospital also led to demands for democratic or at least municipal control of hospitals.
In Christchurch, New Zealand, in 1895, progressives and socialists also demanded the democratic control of hospitals after a similar hospital scandal. There, no one died. Rather, the problem was rudeness: an inspector charged Nurse Cameron with “general surliness” and scolding patients who soiled their beds. In turn, working-class activists defended the nurse and accused the chief physician, Dr. Murray-Aynsley, of brusquely turning patients away and cruelly rebuking patients’ pleas for treatment.Footnote 4 Which was worse: the rudeness of doctors or the rudeness of nurses? Rudeness can affect medical outcomes, and patients also experience it as a violation of their right to bodily integrity.Footnote 5 Rudeness also has profound political implications, for to treat someone rudely is to imply that they are unworthy of respect or politeness. These activists demanded the democratic control of hospitals as a right of citizenship; they also felt they deserved respect.
Hospitals were not primarily disciplinary institutions; their purpose was to provide necessary medical care that working-class patients sought out. Nurses wanted better conditions not just for themselves: they believed the poor deserved the same. By complaining of commonplace rudeness from doctors and nurses, bad food, and long waiting times, patients implied that they expected decent care and respect even if they were receiving free medical services. Eventually, they would expand the personal right to bodily integrity to include the right to health care.
The demand for democratic control of hospitals was part of a larger move to democratize municipal government. Women activists, trade unionists, and socialists wanted more representation on school boards, poor law boards, and city councils, demanding that cities provide services such as water, gas, trams, laundries, baths, and even hospitals. New Zealand was especially known for its progressive policies such as national railways, government insurance, and old-age pensions; there, the goal of democratic control of hospitals was enshrined in the country's legislation by 1909. Yet municipalization could mean control by local philanthropists, experts, or elite politicians. Social reformers and medical experts certainly wrote a great deal about hospital management in specialized journals and policy forums, but they focused on how to make medical care more efficient and economical. While some have suggested that ideas of municipal or democratic control were marginal to these debates, the call for democratic control of hospitals is interesting precisely for that reason: based on the rights of patients and workers, and publicized in popular newspapers and pamphlets, it was part of a different debate about direct democracy and personal rights in the 1890s.Footnote 6
The Hospital System
In the 1890s, Britain's hospitals were a patchwork of institutions based on disparate models of funding, governance, and treatment. Most middle-class and wealthy people received medical treatment, including surgery, at home; they almost never went to hospitals and then only to private hospitals. Charity hospitals, like the Chelsea Hospital for Women and the London Hospital, termed “voluntary” hospitals, were funded and governed by wealthy donors; they were intended to help the poor and those down on their luck. For instance, the Chelsea Hospital for Women “catered for gentlewomen in reduced circumstances and respectable poor women” such as Mary Gray, who was the wife of a stonemason.Footnote 7 The Charity Organisation Society provided some oversight by investigating each London hospital's finances, but the society was more concerned with financial probity than patient care.Footnote 8 Local boards of guardians governed the workhouse infirmaries and hospitals, and until 1883 also controlled the fever hospitals intended to provide care to prevent epidemics. After that date, municipalities such as London's Metropolitan Asylum Board ran fever hospitals. In New Zealand, cities built their own hospitals combining charitable, municipal, and eventually central government funds, controlled by indirectly elected local councils but surveilled by central government inspectors.
In Britain, admission to a voluntary hospital originally required a letter of recommendation from a donor or local notable, but by the mid-nineteenth century, doctors controlled admissions and opened hospital outpatient clinics to the poor. The Charity Organisation Society believed that too many prosperous working people took advantage of this arrangement and tried to get hospitals to enforce payment.Footnote 9 In New Zealand, hospitals were intended for the white poor; the most destitute received free treatment, but other patients were required to pay what they could.Footnote 10 In Britain, the poor law administration deliberately deterred people from seeking free help in workhouse infirmaries and hospitals by making them as unpleasant and bare-bones as possible, with minimal medical care and untrained staff. Indeed, until 1883, those who received treatment in municipal fever hospitals were deprived of the parliamentary franchise, and after that date still could not vote for boards of guardians; poor law medical relief still disqualified people from voting. Municipal medical officers pressured poor people found to be infected to go into fever hospitals in order to prevent the spread of epidemics, but until the mid-1880s the bleakness of these hospitals was also intended to deter them from taking advantage of free treatment. Historian Matthew Newsom Kerr has found that by the late 1880s and 1890s, response to scandals and the removal of the fever hospitals from the poor law system made fever hospitals less unpopular.Footnote 11
Leaders in medicine and nursing wanted to organize the governance of hospitals to make treatment more efficacious and efficient. Florence Nightingale and others concentrated on designing and running hospitals to prevent infection and cure disease most efficiently, with a small number of trained staff overseeing large numbers of patients. On one hand, they were motivated to provide the best possible medical care: by the 1890s nurses and physicians, as well as the public, pressured workhouse hospitals to provide efficacious and kind care even to the poor. On the other hand, the strict organization could be a form of “moral discipline” over patients and nurses.Footnote 12
Medical students and physicians were also eager to invent new medical treatments to cure disease, and to do so, they needed the “clinical material” provided by the inpatient and outpatient wards of voluntary hospitals. These patients were expected to submit quietly to the demands of doctors and nurses. As Michael Worboys writes, “Hospital patients were often treated by doctors as mere bodies”—or even parts of bodies, as disease came to be understood as localized within specific organs or tissues.Footnote 13 In outpatient wards, doctors had to see hundreds of patients a day, and according to Dr. Harry Roberts, sometimes treated them with “great insolence” and subjected them to “bullying cross examinations.”Footnote 14 Doctors examined patients within earshot of the waiting room, violating their privacy and exposing others to their screams as they were poked and prodded.Footnote 15 Although waiting rooms had improved by the 1890s, problems remained.Footnote 16 Indeed, Mary Gray witnessed harrowing scenes as she waited at Chelsea Hospital.Footnote 17
Not all patients passively submitted to hospital discipline. Marjorie Levine-Clark found that in the early nineteenth century, patients sometimes refused treatment—or demanded more.Footnote 18 The London Hospital minute books reveal that patients took their complaints about waiting times and rude doctors and nurses to local clergymen, employers, and newspapers.Footnote 19 One physician at Chelsea Hospital, Dr. W. H. Fenton, was the subject of a number of complaints about rudeness and poor treatment of patients when he was a medical student at the London Hospital.Footnote 20 Hospitals took these complaints seriously and investigated, even if they did not provide recompense to patients, and the House of Lords enquiry into metropolitan hospitals in 1892 asked about patient complaints.Footnote 21 Newspaper scandals about fever hospitals’ terrible food and inadequate medical care inspired some to resist treatment there until they improved in the 1890s.Footnote 22
Hostility to hospital treatment stemmed as well from the anti-vaccination and anti-vivisection movements. The smallpox vaccine had been made compulsory in 1853, and for the poor, vaccines were administered through the hated workhouse system. The issue of vivisection also linked opposition to vaccination to fears of experiments in humans: vaccines were derived from experiments on animals, and vivisection involved experiments on live animals. Many activists objected to both on the same grounds of animal rights; furthermore, as Nadja Durbach writes, the poor often felt that they were being treated like animals in vaccination campaigns.Footnote 23
The struggle against the Contagious Diseases Acts also shaped the fears of some female activists that doctors were coercing and experimenting on women. They depicted the forcible pelvic examinations of sex workers mandated by the acts as government-sanctioned “instrumental violation.”Footnote 24 The leader of the movement against the act, Josephine Butler, founded the Vigilance Association for the Defence of Personal Rights to broaden out this campaign to defend the personal right to bodily integrity of women, the poor, and the abject—unlike the conventional notion of individual rights based on a middle-class man's control of his household and property. Although Butler split off from the association and it became a small pressure group, it continued to provide legal help for those objecting to vaccination and compulsory incarceration of children in fever hospitals and plague camps in India, based on a libertarian notion of the personal right to bodily integrity.Footnote 25
Activists had long claimed that animal vivisection would lead to experiments on human hospital patients.Footnote 26 The term “human vivisection” came into occasional use in the 1870s when advocates for a law to limit animal vivisection maintained that it was all too easy for physicians to experiment on humans if they had already experimented on animals.Footnote 27 This anxiety fed into working-class fears that they would be dissected if they died penniless in a workhouse or hospital, as the 1832 Anatomy Act allowed.Footnote 28 In 1888, former medical student Edward Berdoe published St. Bernard's, a lurid novel depicting the savage Dr. Malthus Crowe who secretly hoarded animals to vivisect, experimented on patients, and poisoned his wife.Footnote 29 By the late 1880s, more pamphlets and letters to the editor alleging human vivisection began to appear.Footnote 30
The Chelsea Hospital for Women
The Chelsea Hospital for Women was facing an outcry over high death rates at the same time as a new Pasteur Institute was being built in the same neighborhood to invent new vaccines for terrible diseases, first testing them on animals before trying them on humans.Footnote 31 Opponents linked the two, claiming that Chelsea doctors were experimenting on women, citing as proof a high death rate for optional operations. Outraged citizens wrote to newspapers claiming that so-called “human vivisection” was not a problem only at Chelsea but part of a larger phenomenon of medical experimentation on women and animals. The Daily Chronicle printed a series of articles and letters on the issue, asserting that doctors were turning “houses of charity into butchers’ shops” and that people needed an intermediary between “patients and scientific explorers armed to the teeth with scalpels and forceps.”Footnote 32 Woman's Signal, the journal of feminist Mrs. Fenwick-Miller, lauded the Chronicle for revealing “the wrongs of women helpless in the grasp of too enthusiastic surgical science”; Fenwick-Miller then echoed this sentiment in a letter to the Illustrated London News.Footnote 33
Were doctors really performing surgical experiments on patients at Chelsea and other hospitals? British doctors were much less likely to carry out medical experiments than their French and German counterparts; lacking the full-time research positions available on the continent, British doctors in this period were so busy consulting in hospitals, teaching, and treating private patients that they had little time for medical experiments.Footnote 34 But as historian Clare Brock writes, British physicians took “a distinctively experimental surgical approach” of learning by mistakes. During the 1880s and 1890s, doctors became much more eager to operate because antisepsis and anesthesia made surgery much safer, although still somewhat risky.Footnote 35 Ovariotomy, or removal of the ovaries, became popular as an operation notoriously carried out to treat not only fibroids and tumors but also “hysteria.”Footnote 36 In the early nineteenth century, Dr. James Blundell developed his technique using experiments on living animals, and Dr. Ephraim McDowell practiced ovariotomy on enslaved women. The death rate ranged from 44 percent to 90 percent until the introduction of antiseptics and asepsis brought mortality down to around 6 percent for most operations in the 1890s.Footnote 37
As the death rate mounted, the local governing body of Chelsea, the vestry, instructed its medical officer of health, Dr. Louis Parkes, to investigate. He found that at Chelsea the death rate for ovariotomy was 19.3 percent, double that of other London hospitals for the same operation.Footnote 38 Furthermore, Chelsea doctors opened up women for diagnostic purposes; even more shocking, “in 5 of 8 exploratory operations cases no disease was found, in 44.4% of these operations the women died.”Footnote 39 Dr. Parkes claimed that too many operations were done not to save lives but to correct deformities or relieve pain. While the British Medical Journal defended the Chelsea doctors, arguing that “operative practice can only be made by trying new methods,” the Lancet questioned why Chelsea's doctors were carrying out such optional operations when the death rate was so high, whatever the cause.Footnote 40
Dr. Parkes had a rather negative attitude toward doctors and medical students: in May 1894, the Daily Chronicle quoted him as saying that medical students “carouse in the West End, knock people off the pavement, break old men's glasses, then go and on operate.” Doctors did not think of patients as people, he declared, but “as an interesting composition of flesh bones and blood.”Footnote 41 Dr. Parkes also received letters from patients and their husbands claiming they had been operated on without their consent.Footnote 42 Although medical ethics were as yet undeveloped, doctors and surgeons generally accepted the necessity of obtaining consent for operations, although sometimes with heavy persuasion, and hospitals expected doctors to gain consent from patients and increasingly to document it.Footnote 43 Yet the Chelsea Hospital's own records reveal that even in 1895 some of its surgeons continued to fail to document or obtain patients’ consent to some operations.Footnote 44 The Chelsea Hospital case was just the most spectacular of several in which patients complained that doctors did not gain their full consent for operations.Footnote 45
The real problem with Chelsea was not experimentation but a struggle over documentation that would ensure that doctors were accountable for their actions.Footnote 46 The vestry twice asked Asquith, then home secretary, and the Local Government Board to investigate, but both denied it was under their jurisdiction.Footnote 47 So Dr. Parkes wrote his own report. As a local medical officer of health very concerned with sanitation, he examined not only the statistics of medical practice but also the architecture of plumbing; he discovered that the cause of the high death rate was bad drains and infection spread by overcrowding and advocated new management for the hospital. In turn, the vestry appointed eminences such as Lord Sandhurst and Charles Dilke to write an independent report. The medical staff submitted their resignations, and new management was instituted.Footnote 48
Sandhurst wrote privately to Asquith acknowledging that the Chelsea Hospital record keeping was a “shambles,” remarking that “such operations” required “the most careful watching.”Footnote 49 Good record keeping was an essential part of the new experimental approach to surgery, for operations needed to be recorded to assess success or mortality rates.Footnote 50 Typically, voluntary hospitals instituted accountability through house committees that met weekly to assess medical matters, respond to any internal or external complaints, and conduct quotidian business of contracts and supplies. Indeed, the Chelsea Hospital House Medical Committee minutes before the scandal were notable (in contrast with other hospitals) for their cursory and sloppy notes.Footnote 51 Even after the scandal, in 1896 a surgeon refused to “recognize the authority of the rules” and failed to record the death of patient Kate Wellman on the operating table.Footnote 52 Within hospitals, some doctors followed individualistic paths of experimenting with new treatments and surgeries on their own, while others wanted treatments and surgeries to be approved and documented.Footnote 53
For local activists, the problem was not record keeping but a failure to be accountable to the public. In the summer of 1894, a coalition of trade unionists, feminists, and animal-rights and antivivisection activists mounted a large demonstration at the World's End pub in Chelsea, among them Jesse Craigen, an activist in the suffrage, anti-Contagious Diseases Act, and trade union causes.Footnote 54 Outraged by the problems of the hospital and the Pasteur Institute, equating both with experiments on women and animals, they rejected the Sandhurst inquiry, it was reported, “seeing that the working classes, who were chiefly affected, were not represented on it.”Footnote 55 The Daily Chronicle reported that the coalition had passed a resolution “protesting against the existing management of hospitals, whereby those institutions are open to great abuses affecting the health and bodies of the suffering poor and the personal rights of patients,” and quoted a speaker at the demonstration as saying that he thought “the time had arrived when the Government should have some control over public institutions.” Another meeting at Pimlico called “upon all men and women in the land never to rest satisfied with the management of this or any other hospital until popular control of hospitals is conceded and Vivisection abolished.”Footnote 56 A poem on a placard proclaimed, “Too long have our wives been slain,” demanding “death to the vile vivisection” and warning that the “pillars of tyranny would tremble.”Footnote 57 In 1896, after the death of Kate Wellman, the agitation revived with another public meeting, where, it was reported, Mary Gray, the poor law guardian, recounted the horrors she had experienced at Chelsea, and Mr. Marsh made a “strong argument for the municipalization of our hospital system, so that its administration should be under the control of a properly elected body.”Footnote 58
Democratic Control of Hospitals
These demands for democratic control of hospitals based on the experiences of patients were quite different from other movements for hospital reform in the 1880s and 1890s generated by middle-class philanthropists and medical experts. Philanthropists and social reformers began to debate how to make Britain's collection of charity, municipal, and poor law hospitals into a more efficient, economical, and coordinated system. In the 1880s, the possibility of a state-run medical system was raised, only to be dismissed.Footnote 59 In response, the Charity Organisation Society, an influential organization based on strict political economy principles, tried to counter these ideas by advocating for a central board to coordinate hospitals in London.Footnote 60 Between 1890 and 1892, a Lords Commission investigated this possibility, but the voluntary hospitals resisted this threat to their autonomy. At the same time, the Charity Organisation Society mounted a campaign for hospital reform. They believed that too many working people who could afford to pay doctors sought free care at voluntary hospitals and workhouse infirmaries, and so demanded that all patients be means-tested and charged if they could pay.Footnote 61
At the same time, advocates for voluntary hospitals tried to argue that charity infused these institutions with a kindly, benevolent air that would be missing in a more mechanical, state-run institution. The Libertarian Alfred Hake argued that in “voluntary hospitals patients are received and looked after with a tenderness and care . . . They are not there as subjects for scientific experiment.”Footnote 62 Indeed, shortly after the second wave of the Chelsea Hospital scandal, fund-raising began for the Battersea Anti-Vivisection Hospital, which promised no experimentation on humans or animals.Footnote 63 The New Hospital for Women was founded to allow women to be treated by women physicians and surgeons, although, as Claire Brock notes, it experienced its own controversies over surgical death rates.Footnote 64 However, this idealized view of philanthropically run hospitals came under criticism. Honnor Morten, an advocate for democratic control of hospitals, acerbically wrote, “The provision for the sick . . . should not be left to the haphazard of voluntary contributions, nor to the management of irresponsible committees composed of benevolent busybodies and seekers after an entrance to ‘society.’”Footnote 65
Philanthropists also encouraged working men to donate substantial amounts to hospitals through the Hospital Saturday Fund drives as their duty as citizens and to ensure that hospital care would be available to them in case of accidents, while insisting that their donations did not imply that hospitals owed any care to them. In response, organized working men demanded seats on board of governors and free treatment for their members; some hospitals slowly complied during the 1890s.Footnote 66 The Hospital Saturday Funds also sent representatives to hospitals to investigate working men and women's complaints about treatment.Footnote 67 For instance, it temporarily withheld its grant to the Chelsea Hospital for Women until needed reforms were carried out.Footnote 68 The demand for working men to serve on the boards of governors, however, was still based on the notion that donors should have control over hospitals.
In the late 1880s and 1890s, socialists, Progressives, and even some conventional Liberals and Liberal Unionists became interested in municipalization, the idea that cities should run gas and water systems and town trams, and even hospitals. Rejecting his former Charity Organization Society allies, the settlement house philanthropist Canon Samuel Barnett called for the municipalization of hospitals in his 1895 book Practicable Socialism.Footnote 69 Going even further, socialists began to advocate for state-funded hospitals as early as 1888.Footnote 70 By 1891–92, the Fabian socialists and others were calling for the municipalization or even nationalization of hospitals.Footnote 71 But municipalization could still mean that local elites and experts ran institutions, with indirect control from elected bodies. Historians Logie Barrow and Ian Bullock point out that, while the Fabian socialists and many London Progressives wanted a “representative system with administrative experts,” more radical socialists focused on direct democracy.Footnote 72 During this time, trade unionists and female activists (such as Mary Gray) were seeking representation on municipal bodies such as school boards and on hospital boards.
Three Fabian socialists wrote tracts demanding the democratic control of hospitals that drew on this idea of direct democracy. Havelock Ellis was a doctor, a Fabian, and sexologist; Harry Roberts was a doctor who served the poor at a Stepney practice and became a member of the Mile End Board of Guardians.Footnote 73 Honnor Morten, a “new woman” who wore “barbaric jewelry” and smoked, was a nurse, school board member, and Hoxton settlement worker.Footnote 74 Ellis published The Nationalization of Health in 1892; Roberts published his tract in 1895 as a Humanitarian League pamphlet, and in 1896, Morten was planning her 1897 Fabian Society lectures on the municipalization of hospitals.Footnote 75 All three wanted state or locally funded and popularly controlled health care. Ellis advocated for the nationalization of health care under popular control.Footnote 76 Morten liked this scheme but advocated the gradual takeover of the voluntary system and the poor law hospitals, to be folded into one system run by municipal councils. Roberts declared that hospitals must be taken out of “the hands of the present governing bodies and placing directly in the hands of the people's representatives.”Footnote 77
Ellis, Roberts, and Morten all belonged to the more utopian and bohemian wing of the Fabian Society, sympathizing with such issues as birth control (Ellis and Roberts) and animal rights (Roberts and Morten). Ellis had belonged to the Fellowship of the New Life, and Roberts and Morten were involved with the Humanitarian League. The two organizations focused much more than the main Fabian group on individuality and individual rights, especially the individual right to bodily integrity, but they differed from the anti-socialist Personal Rights Association's defense of bodily integrity rooted in a hostility to government control. Indeed, in 1895, the year after the Chelsea scandal, the annual meeting of the National Humanitarian Conference passed a resolution advocating the municipal control of hospitals to prevent experimentation on patients.Footnote 78
All three believed that “popular control” of hospitals would allay fears of experimentation. Ellis, however, dismissed the fears of the “credulous” about the alleged “cruelties and inhumanities” in hospitals.Footnote 79 In contrast, Morten and Roberts, as medical professionals, sympathized with those who feared animal and human experimentation and wanted to ensure public trust in hospitals. Roberts defended the profession against those who portrayed doctors as “a sort of disease-spreading devil” and refuted rumors of “human vivisection,” but he feared that doctors were experimenting on poor patients by administering drugs and trying new surgeries. To ensure the people's willingness to go to the hospital, he argued, the people's representatives, not the medical profession, should control hospitals.Footnote 80 Morten explicitly referred to the Chelsea scandal and operations on women in an article, “Hospital Chaos,” for she was more anxious about surgical experiments. She declared, “Doctors look on hospitals as built for them, and the patients as so much material for their use,” and decried the “mania for different kind of ovarian and uterine operations.” The accountability of statistics was not the solution: experts in medicine should be under “some control.” Morten opposed the “domination of professionalism, which puts the patient entirely in the hands of the expert.”Footnote 81
Sympathizing with the Humanitarian League, both Morten and Roberts linked animal rights and human rights.Footnote 82 The league's manifesto declared, “It is iniquitous to inflict suffering, directly or indirectly, on any sentient being, except when self-defence or absolute necessity can be justly pleaded.”Footnote 83 Capitalism had speeded up the slaughterhouses that imposed pain on animals, just as it had speeded up the factories where workers labored on assembly lines. Morten and Roberts, as with many other activists in the Humanitarian League, saw schools, prisons, and hospitals as part of a larger carceral archipelago that squelched the souls of those confined in these drab, cheerless institutions that relied on force to abuse their inmates; for instance, Morten campaigned against beating in schools. As a nurse, she herself experienced the alienating discipline of hospital life. In her nursing reminiscences, she wrote, “What a brutal thing custom is; I have fallen into the routine here till I am becoming a mere machine, and losing all perception of the spiritual. Soon my patients will be ‘cases.’”Footnote 84
Nursing and the Democratic Control of Hospitals
Eva Luckes, the famed matron of the London Hospital, wrote that the human body was like a machine, and so was the hospital ward: “If a sister looks upon the wards as a clock and herself as the key, after seeing that the works are in good order she will wind it up regularly and be able to leave it for a time in confidence that it will go well.”Footnote 85 On one hand, Luckes, like her mentor Florence Nightingale, emphasized that poor patients in voluntary hospitals deserved the comfort and good medical care provided by nurses and that nurses’ organizational skills helped prevent infection.Footnote 86 On the other hand, Nightingale and her followers imposed a quasi-military discipline on nurses that resembled the general discipline of other institutions such as schools, camps, and workhouses, where a few staff had to control large numbers of inmates through rigid schedules and rules. Nurses both directed the hospital regimentation that left patients feeling like cogs in a machine and were subjected themselves to this discipline, for they were expected to give “unquestioning obedience” to matrons and doctors.Footnote 87 To implement this system, Nightingale and her followers wanted to replace older nurses, who were originally domestic servants trained informally on the job, with new, highly educated hospital nurses who often came from middle-class or even upper-class backgrounds, although many were lower-middle or upper-working class.Footnote 88 When the young Eva Luckes became matron at the London Hospital in 1880, she rebuked nurses for rudeness and privately admonished them “to shew all possible kindness of manner to patients.”Footnote 89 If they did not respond, she fired many of the older nurses for treating patients harshly, drinking, and disobedience.Footnote 90 Their rudeness was seen as symptomatic of arbitrary, capricious, and personal treatment of patients, whereas the new method was supposed to be systematic, consistent, and kind.
Not surprisingly, the replacement of older nurses with newly trained nurses could lead to controversy over patient treatment, as at Guy's Hospital in 1880. An ancient institution endowed for the poor, Guy's wanted highly trained nurses to complement its new medical school. Nurse Margaret Lonsdale wrote that the presence of self-sacrificing female nurses would prevent doctors and medical students from indulging in “practices and experiments” on charity patients that they would not attempt on private patients.Footnote 91 While the doctors resented the class superiority of the new nurses, they mobilized public opinion by claiming that the nurses’ strict discipline harmed the patients, most egregiously when a nurse left a consumptive woman in a cold bath, leading to her death.Footnote 92 Local authorities and newspapers also complained about the rigid schedules favored by nursing authorities, a common issue. For instance, Dr. Iliff told the St. Saviour's Poor Law guardians that Guy's nurses woke patients at 5:00 a.m. when they cleaned the wards, and the poor had to wait too long for medical care.Footnote 93 One guardian declared that this charitable institution was now controlled by the “rich” and a “nursing aristocracy.”Footnote 94 For the populist Reynolds's Newspaper and the South London Press, such rigid schedules made the hospital uncomfortably close to the dehumanizing discipline of the asylum, the workhouse, and the prison. “Bill Blades” denounced the “cruel tyranny” of prisons, workhouses, and hospitals, while the South London Press said that Guy's was “no longer a Hospital—it is a Reformatory—we had almost written a Penitentiary.”Footnote 95
By 1889 and especially in the early 1890s, new scandals about nursing reversed the hostility to nurses evident in the Guy's scandal, instead linking nurses and working-class patients as allies in a common cause against an oppressive hospital administration. Nurses, after all, were also workers; despite their education, they wore caps and uniforms like maids, often had to scrub, worked long hours, and had little time off each week. The New Unionism was drawing previously unorganized workers like dockers and match girls into trade unions and strikes. The movement also recognized that these workers could not attain all their goals through organization and strikes; they needed government help to limit their hours and pass legislation to ensure safe working conditions. Some domestic servants and nurses tried to join this movement through organizations that functioned as both unions and cooperatives.Footnote 96 Honnor Morten, for instance, organized a nurses’ trade union and cooperative that succeeded for years.Footnote 97 Although nurses differed in their opinions about organization, registration, or even unionization, many of them protested that their long hours (up to fourteen hours a day on the ward), inadequate food, and suffocating discipline harmed their own health and that of patients.Footnote 98
Newspapers published exposés of nurses’ dangerous conditions. The Pall Mall Gazette claimed that nurses experienced “white slavery,” echoing its earlier “white slave” scandal about child prostitution but also depicting nurses as sweated workers.Footnote 99 The 1892 series “Nurses’ Bitter Cry” in the Morning Leader evoked the famed book on London poverty, The Bitter Cry of Outcast London.Footnote 100 The House of Lords also investigated nurses’ plight as part of a larger inquiry into hospital administration.Footnote 101
Nurses made common cause with patients in seeing themselves as trapped in a cold mechanism of discipline. The muckraking Pall Mall Gazette began a series claiming that “in a hospital, everyone is cared for except a nurse, who is considered simply as a machine wound up by an imaginative enthusiasm, and expected to work night and day until the spring breaks and life is useless.”Footnote 102 One nurse described herself as “a mere automaton, the merest tool in a matter-of-fact sick-repairing business.”Footnote 103 A philanthropist wrote that he had thought hospitals were doing great humanitarian work, but now “I see not that goodly Samaritanism, but a gigantic mechanism, an automatous body-mending factory, hard and unemotional.”Footnote 104
The London Hospital became the target of the most criticism as the largest voluntary hospital in London, located in Whitechapel and serving the poor. Mrs. Robert Hunter, wife of the solicitor general of the Post Office, became a governor of the hospital in order to protest that thirteen nurses had died within three years while serving at the London Hospital.Footnote 105 Furthermore, her allies noted, when probationers were put in charge of wards and sent out for private nursing, their unfinished training endangered patients’ health. Nurse Yatman, the daughter of a wealthy landowner, testified to the House of Lords committee that the rigid conditions had damaged both her health and her ability to care for patients. As a night nurse she had looked after fifty-three ill children, waking them up at 4:00 a.m. to wash them. In addition, she had to wash all the mugs or jugs used by children, polish six lamps and six inkstands, keep up four fires, clean a bath and two lavatories with turpentine, comb the hair of all the children, and cut their nails. She did not have time to comfort them; for instance, she could not console a wailing child whose eye had been removed, even though his tears endangered the remaining eye. The adults, too, were woken very early, but she noted that most did not complain, except for “ladies.”Footnote 106 Patients also claimed that as they recovered, they were woken up early to sweep and scrub the wards to relieve the overworked nurses.Footnote 107
Critics denounced hospital matrons for their “despotic” rule that put nurses and patients in danger. Matron Eva Luckes of the London Hospital found herself under attack. In her testimony to the House of Lords, she depicted Miss Yatman as a bad, “selfish” nurse. But newspaper letter writers attacked Luckes and other matrons “as a race of petticoated martinets who exercise their disciplinary powers with the unbending severity of a German officer.”Footnote 108 To be sure, some of these criticisms may have derived from internal power struggles among governors, doctors, and nursing matrons, but they also reflected tensions between nurses and their supervisors. A correspondent complained that in response to their “self-denying labors,” nurses got “iron-bound rules and vexatious repression” in an “autocratic system of hospital management.”Footnote 109
The outcome of these scandals was a sense that both “nurses and the sick poor have rights which should not be ignored.”Footnote 110 Sydney Holland, a businessman who was chairman of the Poplar Hospital for Accidents and then the London Hospital, promulgated a Charter of Liberty for nurses in 1895, promising fewer hours and time off. He told the Nursing subcommittee of the London Hospital, “All of us must agree that the more the Patients are individuals to the Nurses, and not mere numbers, the better the nursing.” Privately, Luckes admitted that the nurses’ working hours were too long, and she herself had complained about the poor food and living conditions but did not want to state this publicly for fear of undermining discipline.Footnote 111
The nursing scandal also fed into the demand for municipal control of hospitals. One letter writer from Leytonstone, an East London suburb, declared, “Had the hospitals of the country been under municipal superintendence the probability is that you would have had no nurses’ bitter cry.”Footnote 112 Another writer complained that doctors and nurses “become querulous, captious and tyrannous” when they take charge, for “they are without the restraint of representative authority.”Footnote 113 The Morning Leader declared that the London Hospital was “capable—by means of a system of proper representative control—of being developed in the direction which is indicated by metropolitan necessities.”Footnote 114 “A Municipal Socialist” wanted a board “elected by the people triennially, and having the same power to draw on the rates as the School Board has.”Footnote 115
Morten and Roberts presented detailed arguments on this topic, suggesting that hospitals should be run by councils, either democratically elected or staffed by representatives from democratic municipal councils. In her lectures, Morten pointed out that New Zealanders already had some municipal control over their hospitals, regarding that island country, as did many Fabians, as a beacon of social progress.Footnote 116 But did New Zealanders really control their own hospitals?
The 1895 Christchurch Hospital Scandal
In the 1890s, New Zealand was known as the social laboratory of the world. In 1891, a Liberal government was elected by white manhood suffrage, and in 1893 women won the vote. (Maori voted for their own members of Parliament but faced discrimination in the general electorate.)Footnote 117 The Liberal government went further than Britain with government-run railroads, insurance, and eventually old-age pensions. These ideas influenced the Fabian Society, especially through the person of William Pember Reeves, the New Zealand high commissioner in London. Yet historians have pointed out that New Zealand's politicians did not enact these policies to usher in socialism but to forestall it. In earlier years, New Zealand's social provision had been quite bare-bones, but an economic downturn in the 1880s led to intense labor strife; to fend off socialism, politicians instituted welfare policies. Experts inspecting for health and safety and conciliating labor and management would make New Zealand more efficient, they thought, and would also head off the threat of revolution.Footnote 118 Yet tensions remained; New Zealanders saw the state as the embodiment of the people, yet they also wanted more local democracy.Footnote 119
New Zealand's social laboratory was also built on whiteness and the alienation of Maori land.Footnote 120 In the first years of settlement, Governor Gray promised hospitals to the Maori in exchange for the sale of their land, and many responded enthusiastically, even donating land themselves for such projects for both whites and Maori.Footnote 121 Later, they complained bitterly that the government reneged on these promises.Footnote 122 By the late nineteenth century, most Maori lived away from the cities and had little access to medical care except for that provided by their own practitioners.Footnote 123
The New Zealand state started the first hospitals as white settlement accelerated in the 1840s. Philanthropists gave money to build hospitals in the burgeoning city but never gave enough, so the cities and national government had to fund them. As a result, New Zealand lacked the large voluntary or charity hospitals of Britain; health care was provided instead by municipal and private hospitals.Footnote 124 By 1885, the Hospitals and Charitable Aid Act mandated that municipal hospitals be governed by local boards consisting of representatives from city councils and other municipal bodies, but the local franchise was still based on property in the 1890s, so boards were dominated by local elites. The act also empowered an inspectorate general of hospitals, who were supposed to ensure that the ratepayers’ money was not being squandered. Yet New Zealanders began to think of hospital care as a right, not as charity.Footnote 125 As early as 1880, a politician declared there was an implicit right to medical treatment, even a “right of every man woman and child to live and if possible enjoy life.”Footnote 126
Anglican elites and Scottish settlers founded Christchurch to emulate a British country town, naming its picturesque river the Avon and building a gothic cathedral, a university college, and a local hospital out of the profits made from trade and large sheep farms built on land appropriated from the Maori. But they never quite donated enough: in the 1880s, Christchurch Hospital was a ramshackle if “picturesque old gabled two-story erection, in wood, dark and ill-ventilated, and full of odd corners and corridors,” with bad sanitation and dead birds stuck in chimneys.Footnote 127
Nonetheless, Christchurch doctors usually trained in Britain and saw hospitals as places to practice the latest medical techniques. Dr. McBean Stewart, a gruff, bearded Scotsman trained by Samuel Lister, boasted, “I was the first to do ovariotomy . . . and I think I introduced a freer and bolder and more scientific treatment.” In 1885, when one of his patients died after an experimental operation, the local press fulminated “that the unfortunate victim, was first subjected to untold tortures . . . violence and butchery.” Further, since “the ratepayers had themselves to pay for the maintenance of hospitals, [they should] look sharply into these things, and see that these abuses did not occur again.”Footnote 128
Indeed, Christchurch ratepayers did look into the matter, and determined to improve the hospital by replacing the former domestic servants and wardsmen with better-trained nurses.Footnote 129 Like their British counterparts, the Christchurch board members believed that nursing should be a profession for “refined ladies” of culture and education—“good women who will be nurses for the pure love of it”—and built a new nurses’ home to attract them, providing a piano for evening soirees.Footnote 130 However, doctors and nurses apparently socialized rather too vigorously together; nurses became pregnant, and the police secretly investigated a rumor that a doctor had botched an abortion on one nurse.Footnote 131
In 1892, a new hospital superintendent, Dr. J. H. Murray-Aynsley arrived, the scion of a wealthy Christchurch family distantly related to the English aristocracy.Footnote 132 London educated, he kept up with the latest medical knowledge, indeed publishing in medical journals.Footnote 133 Murray-Aynsley insisted on strict hospital discipline and insisted that nurses stand when he entered a ward, alienating the old nurses from working-class backgrounds.Footnote 134 One nurse complained, “It seems to me that a good, decent, regular, working, eight hour nursing automaton . . . to be wound up every Sunday morning, is the only perfect machine likely to please the susceptibilities of this very particular doctor.”Footnote 135 Dr. McBean Stewart hated Murray-Aynsley, and cozied up to the old nurses. In an incendiary anonymous letter to the newspaper, he protested that “patients and nurses [were] treated as if they were menials, and once they cross the portals, if they expect to get along comfortably and smoothly, they have to leave their souls and minds behind them.” He further alleged that Murray-Aynsley treated patients rudely and turned away terribly ill people.Footnote 136
The newspapers pressured the Christchurch Hospital Board to investigate.Footnote 137 Traditionally, the board was composed of local notables from the Anglican elite, but by 1895 it included firebrand C. M. Gray, a “rebel against conformity” who appealed to the national hospital inspector Duncan Macgregor; in turn Macgregor appointed his new deputy, Grace Neill to investigate.Footnote 138 Like Dr. Murray-Aynsley, she was from an aristocratic background, but she was alienated from her family and had made her own way as a nurse and then matron in London, emigrating to New Zealand while in her forties.Footnote 139 On a surprise visit to Christchurch Hospital, Neill found “general untidiness and slovenliness” on the wards, and interviews revealed that the older nurses formed a cabal to block new modern methods. Most notably, Neill accused an old nurse named Cameron of cruelty, neglect, and “roughness” to patients, of failing to change bandages or give them adequate food, and using crude language and “undue familiarity” with a patient. Cameron refused to give patients drinks at night, and when one patient wanted his poultice changed, she yelled at him to do it himself and hurled the bandage at him. The board followed Neill's recommendation to transfer four older nurses and fire Nurse Cameron.Footnote 140
Placards were posted around town, letters to the newspaper protested Cameron's dismissal, and a broad coalition of progressives mounted a protest meeting.Footnote 141 From the late 1880s into the 1890s, the city bubbled over with radical discussions: Christchurch was the home of a Brotherhood Church and a Fabian Society, the Knights of Labor, temperance activists, dress reformers, a tailoresses’ union, a Workers’ Political association advocating for old-age pensions and state industries, birth control advocates, a Progressive Liberal Association, and a utopian commune.Footnote 142 A failed strike in 1890 caused unrest, and the middle-class suffrage advocates and female trade unionists disagreed on tactics. For these people, it was not enough to allow experts to run things more efficiently; workers were pressing for a more representative local suffrage.Footnote 143
Politicians declared that the dismissal of Nurse Cameron “meant that we, as a democracy, had no gratitude to those who had given us faithful service.” Working-class journalist G. W. Russell thundered, “God help the poor people who were sent there as patients.” Hot-tempered temperance activist Tommy Taylor pointed out that “the well-to-do classes could afford to nurse their own sick, but the classes who were the poorest and had the fewest friends had to use the hospital, and for that reason it was the duty of the public to see that it was managed in the best possible way.”Footnote 144
Christchurch people felt that the reforms blocked nursing as an occupation for working-class girls who were eager to escape domestic service and found factory work unpleasant.Footnote 145 One accused the “gentlemen” who wanted work for their “refined and educated and cultured” daughters of kicking out “the common women who had done the work for nine or ten years.” At this, the audience cried, “Shame!”Footnote 146 Aileen Garmson, a fiery seaman's union activist, asked, “Why should the daughters of the poor man be handicapped while those who have influence to back them up have a big start given them. We want to see fair play to each according to her merits.”Footnote 147 “Father of a Family” indignantly pointed out that Christchurch Hospital was a “public institution in which there should be no distinction of class.”Footnote 148
Yet why did letter writers and attendees at the public meeting defend Nurse Cameron so vigorously when she had been accused of cruelty to patients? The answer may lie in the expectations of respect between nurses, doctors, and patients. As nursing medical anthropologists note, nurses handle patients’ everyday needs, such as eating and bathing, that are familiar from daily life, if structured in very different ways.Footnote 149 Working-class patients may have shared common assumptions about how to behave that may have been looser and rougher than a middle-class etiquette; they were used to fending for themselves, for instance, bandaging their own wounds. The “familiarity” and “broad language” that Grace Neill saw as counts against Nurse Cameron were just ordinary behavior for a working-class woman. The rudeness of a nurse would just be an individual peccadillo.
In contrast, the rudeness of a doctor represented an alien new way of doing things concerned with strange matters of life and death. In the inquiry, patients also testified that Dr. Murray-Aynsley treated them “roughly,” and Grace Neill concluded that he had acted with “discourtesy” to them. The hospital regulations had long mandated expulsion for patients found playing cards or drinking, but the doctor was particularly strict, expecting them to submit silently to his will.Footnote 150 As recorded in the report on the inquiry into the hospital, Murray-Aynsley punished patients who talked when he examined them with a diet of bread and water, including one small boy who whispered to his sister while the doctor poked and prodded him. Murray-Aynsley also squirted water in the face of crying children to quiet them down.Footnote 151 As reported by the Lyttelton Herald, he abruptly told a woman who had been in the hospital for three weeks, “We want your bed.” After a failed operation on a domestic servant for curvature of the spine, he brusquely refused to operate further, for he could only “patch her up.”Footnote 152 According to the report on the inquiry, when a relative wanted an operation on a woman with advanced breast cancer, the doctor said the best thing he could do was to go to the rope-makers, get a rope, and hang her.Footnote 153 As reported in the Lyttelton Times, when Mrs. Grimsby complained that she had to wait for months to see the doctor after he had trepanned her son's skull, Murray-Aynsley was “very insulting” and told her “it was just such people as her who made all the trouble.” She replied, “If it was not for her troubles and other people's like her, he would not be required there.”Footnote 154 Mrs. Grimsby did not expect to defer to the doctor but saw him as a servant of the people. Nonetheless, the inquiry exonerated Murray-Aynsley, although he lost his position as hospital superintendent.
The scandal triggered a debate among Christchurch citizens over the governance of hospitals: should they be guided by the local elite, chosen by mayors and councils? By doctors? Or should ordinary citizens control hospital boards? As one of the Christchurch reformers declared, “The public, represented by the Government and the Hospital Board, were the proprietors of this institution,” not the doctor.Footnote 155 But, as reported by the Christchurch Star, the Rev. E. C. M. Watson proclaimed that the present system prevented “the will of the people from being carried into effect.”Footnote 156 For the radicals, the franchise reforms had not gone far enough, for only the parliamentary vote was available to all; local government bodies still required property qualification for vote. The public meeting moved that “all boards of public institutions should be elected by ratepayer vote or adult suffrage.”Footnote 157 The Christchurch Hospital agitation was part of a larger effort to develop municipal democracy in New Zealand.Footnote 158 In 1901, the Christchurch Socialist Church demanded free health care and municipal control of hospitals, and the National Council of Women heard demands for an expanded franchise and women's representations on hospital boards in 1901.Footnote 159
Eventually, these efforts succeeded when the Liberal government set up the direct election of hospital boards in 1909. The Gisborne Times was excited about the “democratic promise” of these boards, “for indirect representation is always more or less sluggish in obeying popular mandate.”Footnote 160 Yet the 1909 Hospital and Charitable Institutions Act kept the ratepayers’ franchise, biased toward property, whereas the parliamentary franchise was more democratic, and the Liberal Government may have been trying to fend off a Labour Party challenge for a more thoroughgoing reform of the ratepayer franchise.Footnote 161 Furthermore, Tommy Taylor, active in the Christchurch controversy, demanded a more democratic suffrage, but he wanted to tax Maori land for hospitals even though almost no hospitals were built in those areas.Footnote 162 In 1903, a congress of Maori councils petitioned the government to build hospitals in Maori regions, but only one was built, supported by local fund-raising.Footnote 163
The hospital boards did not always fulfill their democratic promise. Labor and trade unions often ran candidates for these boards in the cities and occasionally succeeded, especially with women who were seen as able to represent both the working class and children.Footnote 164 Most of their hospital board candidates lost, and the boards were dominated by businessmen who wanted to cut taxes rather than improve health care.Footnote 165 The central government strengthened its oversight over the municipal hospitals, since it paid an increasing proportion of their funds, so these hospitals become a key part of New Zealand's welfare state.Footnote 166
Publicly Controlled Hospitals?
Back in Britain, one set of British hospitals was popularly controlled by 1894 when the election of poor law guardians became more democratic. Women ratepayers could now vote and serve as guardians, the franchise was much wider, those who received medical relief could vote, and guardians did not need a property qualification to serve.Footnote 167 In turn, these guardians oversaw the workhouse infirmaries and hospitals. In the 1890s, some workhouse infirmaries became modern, efficient institutions, but most were still bleak, originating as they did in a deterrent philosophy that care at the public expense could only be provided at a bare minimum. A British Medical Journal investigation in 1895 found that most workhouse sick wards were crowded, badly ventilated, and dirty, staffed only by untrained pauper nurses; patients were tied down at night, ridden with lice, and clothed in dirty workhouse uniforms.Footnote 168 Medical students were not allowed in the wards, which may have spared patients their brusque attentions but also meant that medical officers were not up-to-date on the latest medical innovations.Footnote 169 In response, nursing advocates asserted that the poor deserved “the attention of the most highly-trained Nurses that exist.”Footnote 170 In 1895, the poor law inspectors sent a circular to guardians declaring that “humanity and economy” dictated that paupers should get as good medical care in workhouses as in general hospitals and cottage hospitals and strongly advising that trained nurses replace pauper nurses.Footnote 171
Democratic control was not necessarily a panacea for the ills of workhouse hospitals. First, guardians sometimes resisted the introduction of trained nurses. For instance, St. Olave's board of guardians in London, serving the poor area of Rotherhithe, faced divisions over attempts to appoint trained lady nurses instead of promoting long-serving domestic servants. For some new Progressive guardians, the authority of the matron threatened their own authority over the hospital and the wishes of the ratepayer, but for the matron, their actions undermined her ability to supervise skilled nurses.Footnote 172
These guardians joined the wider hostility to the use of a new diphtheria anti-toxin treatment in workhouse infirmaries and fever hospitals.Footnote 173 As Newsom Kerr points out, Londoners demanded that the fever hospitals provide more beds for children suffering from the dread disease that coated children's throats with a leathery membrane—yet they feared the new treatment.Footnote 174 The Echo newspaper denounced the anti-toxin and vivisection together, declaring, “Hospitals do not belong to a few rich men but to the many poor.”Footnote 175 In response, a London surgeon's wife wrote, “To such a point has the mania for experimenting upon living animals” reached among doctors that “it is no longer safe to put helpless human subjects in their power”; instead, she argued, we need a “safeguard of public control” over the “medical monopoly.”Footnote 176 Most guardians, however, welcomed the new diphtheria treatment that saved the lives of children.Footnote 177
Instead of seeing medical care as an alien imposition, working people began to see health care as a right. By providing free care, the voluntary hospital outpatient wards had inadvertently encouraged this idea. An article in the London Evening News Post reports a hospital reformer as explaining that working people refused to see themselves as paupers if they availed themselves of the services of poor law infirmaries, seeing treatment there as an “inalienable right.”Footnote 178 Many workingmen's organizations and socialists asserted that health care should be a “right of citizenship” because it was the unhealthy conditions of society and economic exploitation that caused disease.Footnote 179 For instance, in 1890, the Birmingham Trades Council moved that hospitals should recognize ‘that many of the complaints and diseases treated at such institutions are attributable to the long hours, bad pay, and insanitary conditions under which the people so treated work and exist.”Footnote 180 In 1900, the Fabians declared, “the community must bestow on its incapacitated members, freely as a right, those means of ‘cure’ which have been made necessary by its failure to employ to the fullest extent the more satisfactory methods of prevention.”Footnote 181 As early as 1890, Liberal MP (and vaccination skeptic) B. Walter Foster argued that public hospitals should be and could be “bright and cheerful:” when “the collective provision for the sick is made a public duty, many hospital abuses will be cured by the municipalization of our hospitals.”Footnote 182 For the Women's Labour League in 1908, the municipalization of hospitals was part of a larger set of demands including the abolition of the poor law, the provision of work for the unemployed, and old-age pensions.Footnote 183
Advocates of a nationalized public health service, however, sometimes stressed the necessity to control disease through prevention, inspection, and compulsion as well as the individual right to health care. Sidney and Beatrice Webb called for a unified public health service that could surveil and inspect the poor in hospitals and workhouses and even their homes. For them, personal responsibility was not about forcing people into substandard care in the workhouses but about instilling an ethic that they had a duty to themselves and others to have “physical self-control” and practice hygiene. But the Webbs did not want to do away with the voluntary hospitals, because they thought that “prosperous working men” could pay for their own care. They declared, “Beneficiaries [of the health service] must be compelled to obedience, alike in their own and in the public interest. And the officers who are placed in direct charge of the beneficiaries must themselves be subject to supervision and discipline.”Footnote 184 Similarly, Benjamin Moore, a Liverpool biochemist who founded the State Medical Service Association in 1912, declared that for a “fit virile healthy nation,” a state medical service must teach good healthy habits, “making the reverse a crime.”Footnote 185
Havelock Ellis proposed nationalization rather than municipalization of hospitals in 1892, but this position was not widely advocated until 1909, when the Labour Party at its annual meetings called for the “nationalization” of hospitals.Footnote 186 The Women's Labour League signed on to this idea in 1911.Footnote 187 Benjamin Moore advocated for national rather than municipal control, because he believed this would be more efficient in recognizing the merit and facilitating the advancement of excellent medical men. With municipal control, they would be subject to the wire-pulling and patronage networks of local politicians wanting their own connections promoted and their own businesses given contracts. Despite all these radical ideas, the voluntary hospitals withstood this challenge to their existence until 1945, often positing workers’ participation through Saturday Funds as contributing to community control without government control.Footnote 188 The new National Health Service did not incorporate the idea of democratic control of hospitals.Footnote 189
Nonetheless, scandals about the mistreatment of patients and nurses could lead to some change, as hospital experts realized that to improve the health of populations, hospitals had to be less deterrent and a little more comfortable for patients. Newsom Kerr observes that by the 1890s, local governments improved conditions at fever hospitals to help control epidemics, and as result even middle-class people sometimes sought treatment there.Footnote 190 By providing free care, the charity hospitals also encouraged people to think of health care as a right.
While the idea of the democratic control of hospitals did not succeed, the fact that it was raised could be seen as the first step in a lengthy and persisting struggle to make health care more people centered. In the long term, the allied notion of a right to health care did become enshrined in the British welfare state, and patients’ right to bodily integrity eventually became a part of modern medical ethics.
