Dating back to the work of Sigerist and Rosen,1 the hospital and associated medical charities have come to be labelled as social institutions, embodying social policies and ambitions. Indeed the medical aspects of hospital development remain shadowy; ‘the medicine is often ignored in histories of hospitals’,2 a result in part of the bias towards social and economic issues in nineteenth-century hospital archives. Morris Vogel, for example, has claimed that for much of the nineteenth century the American hospital was ‘a largely undifferentiated welfare institution’, rather than a medical environment.3 It has been argued that the setting up of hospitals was frequently unrelated to medical needs; it cannot be ‘assumed that infirmaries were created, expanded and adapted in accordance with the needs of local communities, or even that the advocates of modest medical improvements could rely on support from the wealthier classes who traditionally supported medical charities’.4 Much early hospital development had little to do with the demands of population increase and industrialization, or associated health problems; many were founded in small county towns, not centres of rapid growth. Dispensaries to a certain extent came forward to fill this gap, but again were not necessarily set up in areas where need was the greatest,
and they could not offer all the services covered by hospitals. The limits on the funding of voluntary hospitals remained a barrier to expansion throughout the nineteenth century, in-patient facilities often being particularly slow to develop (the empty hospital ward was as symbolic of this period as it is of the 1990s); the limited vision of the lay boards of management was potentially an even greater barrier.