The building of state institutions for one category of deviant was a relatively late development from a trend towards an institutional response to deviance in general. The idea that relief should go only to those who deserved it was not new; the distinction, however, had never been very carefully applied in practice, possibly because the numbers involved were relatively small and, in any case, work could easily be forced from those who did not conform. The construction of institutions at this time and the growing practice of segregating deviants lacked some important features which were later to typify western society’s response to those who failed to conform to its norms. The Royal College of Physicians, formed in 1518, had been for some time engaged in a battle to keep surgeons and apothecaries, who were seeking to improve their status, in an inferior position.