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.

The Great Depression, however, finally exhausted the average patient's ability to pay and engendered a national health-care crisis. A public hospital insurance scheme was first achieved in Saskatchewan in 1947 and nationally in 1957. Universal accessibility without fear of the financial consequences of hospitalization reflected concern for both the medical health of Canadians unable to pay for hospital care, and the economic health of the paying ‘patient of moderate means' threatened with medical pauperization. It also provided the resources necessary to address the modern epidemic of lifestyle diseases and to accommodate the demands of the post-war therapeutic revolution. Employing the historical records of selected individual hospitals, reports and data from all levels of government, a wide range of professional medical, nursing, hospital, and public health journals, and the international historiography of hospital history, David and Rosemary Gagan describe and account for the invention, rise, decline, and rebirth of the modern Canadian hospital between 1890 and 1950. They pay particular attention to the evolving interdependence of doctors and hospitals in the struggle to legitimate the social and cultural authority of scientific medicine, the evolution of hospital-based nursing, and the experiences of patients.