therefore only through investigation at the level of the hospital itself that we can really hope to gain insight into the uncomfortable accommodation between payment and philanthropy that emerged in the early twentieth century. As sites of charity, sites of care and sites of decisionmaking, these institutions were independent, although they did not operate in isolation. Context is important, and this means understanding the local economic, political and social context as well as the health and welfare sector within which the hospital operated.Our case study is the city of Bristol, sitting within the historic county of Gloucestershire, on the border with Somerset, in the South West of England (see figure 2.1). In the mid-eighteenth century this port city, although slightly smaller than Edinburgh and far smaller than London, had been the largest of England's provincial towns and cities, before the rapid growth of manufacturing centres in the Midlands and the North. While the early twentieth century saw Birmingham overtake Liverpool and Manchester to become England's second most populous city behind London, Bristol's steady growth has seen it remain seventh from the mid-nineteenth century behind Leeds and Sheffield; smaller than the major Scottish cities of Glasgow and Edinburgh but larger than nearby Cardiff or any other Welsh city. 2 The importance of Bristol lies less in its role as regional centre George Campbell Gosling -9781526114358 Downloaded from manchesterhive.com at