If you could travel backwards in time to 1800, what would the health care system look like? The first thing to grasp is that it would not look like a system at all. Since 1948, most of us have grown up with a pretty clear idea of what a hospital is, what a doctor is, what a nurse is, and so on. In our lifetime there has been a fair degree of consensus about what is and is not valid and reliable medical knowledge. If you looked at health care in 1800, you would find that none of these assumptions hold true. There was no generally accepted body of medical knowledge so that rival theories circulated freely and competitively. There was no legal definition of a doctor and few restrictions on the practice of healing. The Royal Colleges of Physicians and Surgeons and the Society of Apothecaries all competed to licence suppliers of medical treatment and to protect the privileges of those whom they had admitted. However, they would only have served relatively well-off people living in or near major towns. Elsewhere, medical care would be given by family members, especially women, using treatments handed down in the local community or taken from books of home remedies, or by anybody from the neighbourhood who could build up some reputation as a healer, a bonesetter, a herbalist, or a midwife. These might be ordinary villagers or people with some education like a parson or a squire, or their wives. Even among the elite physicians, only the most successful healers could work full-time and make a living at this trade (Waddington 1985:180-90).
Architecturally, the voluntary hospitals might have looked more familiar, but, of course, some of their buildings are still in use. Wards were large, rectangular rooms holding between fifteen and thirty patients in parallel rows of beds on each side. If you were to examine the patients, however, you might wonder how many of them were sufficiently ill to justify their place. People seldom died