Book excerpt: Between 1890 and 1910 scientific and technological innovation transformed the custodial Victorian charity hospital for the sick poor into the primary source of effective acute medical care for all members of society. For the next half century hospitals coped with relentlessly escalating demands for accessibility by both medical indigents and a new clientele of patients able and willing to pay for hospitalization. With limited statutory revenues and unpredictable voluntary support, hospitals taxed paying patients through ever-increasing user fees, offering in return privacy, comfort, service, and medical attendance in private and semi-private wards that were more appealing to middle-class patients than the stark and grudging service of the public wards.