Charity and the London hospitals, 1850–1898

Despite recognizing their importance, hospital historians have traditionally been less interested in the administrative and financial aspects of institutions under study, although paradoxically this documentation has survived much better than clinical records. We tend easily to forget that most hospitals periodically teetered on the brink of insolvency even though many had been initially launched with generous endowments provided by pious donors. Saddled with the somewhat fixed expenses of providing shelter, food, and care, hospital income remained highly dependent on the fickle generosity of individual patrons, the uncertain revenues from investments, and the greed of corrupt administrators. Waddington's work, focused on Victorian voluntary institutions in London, thus fills an important gap in our understanding of nineteenth-century British hospitals. Instead of depicting the "great" metropolitan establishments as heroic arenas for medical and surgical triumphs, the author allows us to see them as administratively contested and financially precarious establishments, constantly struggling to raise more funds and pay their mounting debts. The book is chronologically divided into three parts. The first discusses in detail the charitable imperative that motivated prospective donors, followed by a close look at their role in the management of institutions thus supported. Readers will readily discover the contours of a private benevolent economy based on philanthropy and voluntarism that was a source of pride in British society. Employing rich published and unpublished hospital sources the author probes the multiple layers of contemporary meaning associated with the concept of charity. A third section looks at the events of 1897 and beyond. Waddington is at his best in penetrating the autocratic world of hospital subscribers and their selfish reasons for giving and then adopting managerial functions to further their business and political careers. Fundraising and social enhancement went hand in hand, with subscription lists printed in annual reports and newspapers. In London, those middle-class governors represented a male elite jealous of its status, a close group of well-to-do gentlemen with enough money and leisure to run their institutions, even successfully protecting their turf against the inroads of an ascendant medical staff. The carefully maintained separate spheres between them led to constant tensions and struggles for control of admissions, patient monitoring, and institutional discharges. By the 1890s, the endemic financial crisis in the metropolis' major hospitals triggered more fears of state intervention, seen as a threat to voluntarism and local control. To no avail, both the creation of a royal sponsored collection, the Prince of Wales Hospital Fund (1897), and a voluntary Central Hospital Council for London (1898) sought to improve finances and avoid the competition and duplication of services. Charity alone could no longer solve social problems, allowing the state to join in a partnership with voluntary efforts that came to shape the health care sector for the first half of the twentieth century. In conclusion, Waddington's account represents an impressive display of scholarship. He has