Conflict, consensus and charity: politics and the provincial voluntary hospitals in the eighteenth century

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The voluntary hospitals were amongst the most original and enduring monuments of Georgian England. Financed on the seemingly flimsy basis of voluntary benefactions and annual subscriptions, they nevertheless flourished in the eighteenth century and subsequently became the leading medical institutions of the industrial age. By entitling even the small subscriber to recommend patients, they recruited substantial support amongst the large class of shopkeepers and traders; by weighting this power in proportion to the size of the contribution, they nevertheless preserved the pre-eminence of local magnates. By making subscription open to men and women of all confessions, they worked for the hegemony and unity of property against the threat of religious divisions; by enlisting subscribers as governors, they rewarded the act of giving with a share of power. Managed by honorary committees elected annually from the subscribers themselves, they enabled the shopkeeper to join the grandee in a common enterprise; by restricting committee membership to male subscribers, they kept within bounds the participation of 'the sex'. Through the annual publication of the financial accounts, the subscribers' names, and the numbers of patients `cured' and `relieved', they ensured probity of management, gave publicity to the subscribers great and small, and assured those subscribers that their money had been well spent. With their strong local roots, they promoted a sense of civic identity; by bringing together local medical men as honorary consultants, they helped to forge a professional medical community; by constructing a new context for medicine, they led to innovations in medical practice and teaching. And by making charity dependent upon the channel of personal recommendation, they exacted a political tribute from the sick poor who sought the benefit of their facilities. To each individual patient the hospitals made available a massive though brief donation of help in a time of need. To the poor collectively they offered a profound and highly visible subordination, translating the practice and rhetoric of personal dependence into an institutional setting).