The full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-prot purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders. Purpose -This paper examines the nature and function of cost accounting at the Newcastle Infirmary, a large voluntary provincial hospital, established in 1751. In particular, the paper adds to the literature on accounting within early voluntary hospitals by identifying the relative contribution of the costing system to planning and controlling the operations, assisting decision-making and holding managers accountable for their performance.Design/methodology/approach -The paper relies primarily on original documents preserved in the archives of the Newcastle Infirmary.Findings -Although evidence was found of sophisticated costing procedures, the findings suggest that the majority of the information was produced ex post by the hospital management to demonstrate good stewardship and to engender financial support. Research limitations/implications