Book excerpt: This electronic version has been made available under a Creative Commons (BY-NC-ND) open access license. This book is available as an open access ebook under a CC-BY-NC-ND licence. At a time when payment is claiming a greater place than ever before within the NHS, this book provides the first in-depth investigation of the workings, scale and meaning of payment in British hospitals before the NHS. There were only three decades in British history when it was the norm for patients to pay the hospital; those between the end of the First World War and the establishment of the National Health Service in 1948. Payment played an important part in redefining rather than abandoning medical philanthropy, based on class divisions and the notion of financial contribution as a civic duty. With new insights on the scope of private medicine and the workings of the means test in the hospital, as well as the civic, consumer and charitable meanings associated with paying the hospital, Gosling offers a fresh perspective on healthcare before the NHS and welfare before the welfare state.