Introduction: ‘hospitals are a form of philanthropy’Footnote ¹

By the end of the nineteenth century, what was known as Hospital Sunday had become a firmly established, and greatly valued, feature of the Christian calendar in many British cities, towns and even villages. Arguably, it was as well recognized as Christmas, Easter, Whitsun and especially Harvest Festival, with which it shared a number of features, such as the principle of charitable donations. Indeed, Hospital Sunday was in keeping with what had become a common practice of setting aside a number of special Sundays each year for a variety of purposes.Footnote ²

Originating in Birmingham in 1859, Hospital Sunday provided an opportunity for churches and chapels not only to raise essential funds for what was at that time primarily voluntary provision but also to remember the suffering of patients and the contributions made by hospital staff to their care and well-being. From its genesis in Birmingham, the idea quickly spread across England as well as other parts of the United Kingdom, and indeed further afield.Footnote ³ Although attempts were made to ‘nationalize’ it by setting a date for its observance throughout the whole country, it remained essentially a grassroots phenomenon with clergy and civic leaders deciding the most appropriate Sunday for their communities, which organizations should be invited to participate, and the beneficiaries of the funds raised. While several medical journals in the late 1860s agitated for ‘one Sunday to be set apart throughout the Kingdom’, this campaign proved unsuccessful.Footnote ⁴

Through their engagement with Hospital Sunday, places of worship were able to demonstrate their commitment to philanthropy and altruism and what Hugh McLeod has portrayed as ‘the creative role’ of religion with respect to ‘the impetus it gave to humanitarian activity of many kinds’.Footnote ⁵ For evangelicals, in particular, it can also be seen as a means of aligning themselves with, and a manifestation of, certain tenets of the social gospel. David Bebbington contrasts this with the personal gospel by defining it, perhaps contentiously, as ‘an attempt to change human beings by transforming their environment rather than touching their hearts’.Footnote ⁶ In the context of this article, the environment comprises provision for the relief of sickness, not only in hospitals but also in cognate institutions such as dispensaries. Hospital Sunday illustrates the way that physical health was seen as an essential adjunct of spiritual health.

Hospital Sunday also symbolized an element of interdenominational cooperation with most denominations participating, at a time when relations between the established church and the Free Churches could sometimes be fraught. Moreover, Hospital Sunday was an additional means by which churches could engage with the needs and aspirations of the wider community and with charitable organizations, such as friendly societies.

In the academic literature, there is relatively little about Hospital Sunday, beyond that which considers the role of churches and chapels in what may be broadly defined as ‘good works’ and ‘charitable enterprise’. Callum Brown, for example, in his characterization of ‘the faith society, 1900–14’ makes no mention of this widely adopted initiative.Footnote ⁷ Jeremy Morris, in his study of churches in Croydon between 1840 and 1914, does mention Hospital Sunday. As he puts it, churches functioned ‘as fund-raising units for philanthropic work … through the institution of annual hospital sermons … for example, the Croydon general hospital fund could by 1879 raise nearly a quarter of its annual income, which in that year totalled £2,500’ from this source.Footnote ⁸ Nevertheless, as Morris points out, there were both ideological and material limits to voluntary activity of this kind. Likewise, Waddington's study of the Metropolitan Hospital Sunday Fund draws upon the discourse of voluntarism and highlights the friction which arose over what was perceived as a threat to the independence of hospitals.Footnote ⁹ Although he adopts what is essentially a secular perspective, as will be indicated later, certain aspects of the religious dimension are acknowledged. Reference can also be made to Kenneth Brown, who draws attention to the role of many Nonconformist ministers in philanthropic activities, including writing about, financial support for, and participating in ‘welfare movements, temperance, hospitals, libraries’.Footnote ¹⁰

In the work of Stephen Cherry, which focuses primarily on the financing of hospitals in the days before the establishment of the National Health Service, Hospital Sunday is located alongside other sources of finance for voluntary hospitals, such as subscriptions, patient payments, workplace collections and investment income.Footnote ¹¹ Although by 1900 Hospital Sunday ‘only provided between 4 and 7 per cent of hospitals’ ordinary income in England and Wales and slightly less in Scotland by the 1890s’, it was still highly valued.Footnote ¹²

From an essentially religious perspective, Hospital Sunday was a tangible response to the gospel imperative of loving one's neighbour, as exemplified by the parable of the Good Samaritan. Thus, it can be seen as, in the words of David Nash, one of ‘the numerous ways in which members of British society and their local communities embraced the morality and ideals of the “Good Samaritan” story’, which continues to this day.Footnote ¹³ This, he suggests, is one of the ‘stories of belief’ that might replace or at least modify the dominant narrative of secularization.Footnote ¹⁴

That said, religious historians such as Jeffrey Cox have argued that by engaging in welfare provision, churches sowed the seeds of their own demise in the twentieth century, as the state gradually took over this role. Indeed, Hospital Sunday can be seen as a classic example of what Cox characterizes as ‘religious philanthropy’.Footnote ¹⁵ A similar stance is adopted by Frank Prochaska, who has illustrated the extent to which churches were engaged in charitable activities, including those supporting medical and related services, in the nineteenth century.Footnote ¹⁶ Thus Hospital Sunday is indicative of the manner in which, in his words, ‘Christian self-examination predisposed the faithful to charitable conduct and animated piety.’Footnote ¹⁷

In seeking to build on these foundations, this article aims to explore the origins of the Hospital Sunday initiative, to analyse its key attributes, to assess its appeal in blurring the boundary between the sacred and the secular with respect to sickness and medical care, and to indicate some of the issues to which it gave rise. Throughout, it is intended to position Hospital Sunday within the moves by churches and chapels during the nineteenth century to demonstrate their value to the communities in which they were situated by not only addressing the spiritual needs of the population they served but also promoting physical well-being. For primary source material, heavy reliance has been placed on online sources. Although these consist mainly of newspaper reports and journals, such as The Lancet and the British Medical Journal, they have still facilitated the undertaking of an initial exploration and demonstration of the wide-ranging impact of this ‘outward facing’ initiative. The resulting narrative, which charts its development during the Victorian and Edwardian eras, is offered as the basis for further investigation.

Origins: ‘to aid in freeing the General Hospital from its load of debt’Footnote ¹⁸

As Cherry has observed, ‘[t]he preaching of church sermons, usually followed by an appeal or collection, often promoted or marked the establishment of hospitals in the eighteenth century. Although church and chapel hospital collections were regular or periodic, they were first systematized into an annual Sunday event on an area basis in Birmingham in 1859.’Footnote ¹⁹ Thus in determining a launch date for Hospital Sunday, at least as far as England is concerned, a strong case can be made for Tuesday, 23 October 1859. On that day, a group of clergy from all the major denominations in Birmingham convened a meeting to consider a response to a financial crisis facing the city's General Hospital. As it was put formally in the public invitation:

The signatories included clergy from a wide variety of denominations: high and low church Anglicans, Independents, Baptists, Wesleyan and Primitive Methodists, Presbyterians, Swedenborgians, Roman Catholics and Unitarians. There was also a representative of the Jewish faith. One of the signatories was R. W. Dale, at that time assistant minister at the renowned Carrs Lane Independent / (Congregational) Church. In the 1870s and 1880s he was to become one of the foremost exponents of the civic gospel, which required Christians to engage fully with municipal institutions as a means of enhancing the well-being of their fellow citizens. In a sermon preached in 1884 on ‘Political and Municipal Duty’, he made the case for ‘medicine and not the gospel only’ to cure the sick.Footnote ²¹ Among the clergy, a key figure was John C. Miller, the vicar of St Martin in the Bull Ring, Birmingham. Later, however, he was at pains to point out in a letter to The Times, published in 1873, that the idea of a Hospital Sunday had not originated with him. As he explained: ‘It was suggested in the Midland Counties Herald by a good man on the staff of that paper [Thomas Barber Weight] that a simultaneous collection in the churches and chapels would do much to help’ in relieving the very heavy debt burden of the General Hospital.Footnote ²² Thus the press was seen as having a key role in persuading the town to adopt the idea.

From whomever the idea originated, it is clear that it resonated with the clergy of Birmingham, including those of the Jewish faith, and it was agreed to hold the first Hospital Sunday on 13 November 1859. For the Birmingham Journal, ‘On no occasion within our recollection ha[d] any event offered an opportunity for a zealous but friendly rivalry between church and chapel, and church and church.’Footnote ²³ On that Sunday, special sermons were preached in a number of churches, as well as the Roman Catholic cathedral and the synagogue. The total sum raised was £4700 13s 6d.Footnote ²⁴ In the light of this, and the initiative's impact in general, it was claimed that ‘Hospital Sunday … [would] not soon be forgotten by the people of Birmingham.’Footnote ²⁵ This proved to be an accurate prediction and the event became an annual fixture in the life of most places of worship in the town. In 1865, for example, the words of Dr Miller were used by the Birmingham Journal to underline the character of the appeal in its editorial columns:

As a result, for many decades Birmingham's Hospital Sunday served as an exemplar for other communities.

As mentioned earlier, the idea was soon taken up elsewhere. In some instances, what had previously been a piecemeal approach was replaced by a more co-ordinated and extensive one. Indeed, as Waddington points out, although ‘sympathetic clergy had traditionally dedicated church collections to individual hospitals … under a fund these contributions were redirected away from a single institution to an organisation that coordinated sermons, universalised support, and redistributed collections as a solution to the medical charities’ perceived financial difficulties’.Footnote ²⁷ An early adopter was Bristol, which held its first Hospital Sunday on 12 January 1862. A couple of months later, the committee of Bristol's General Hospital praised the initiative:

Whilst the initial enthusiasm proved hard to sustain, in time the idea became firmly established in the area.

During the 1860s hospitals in those communities without a Hospital Sunday often pointed to the example of what was happening elsewhere in making their case for one to be held locally. For example, in December 1864 at a meeting of the Quarterly Court of Governors of Addenbrooke's Hospital in Cambridge, the mayor remarked ‘that in many provincial towns there was what was called a Hospital Sunday – a Sunday in the year in which sermons were preached at all the churches and Dissenting chapels … He was sure that much larger collections would be made by having all the sermons on the same Sunday.’ He went on to argue for a similar event to be held in Cambridge.Footnote ²⁹ However, although 11 June 1865 was suggested it would seem that in Cambridge and district very few churches participated at first, with Hospital Sunday not being formally observed until the summer of 1874.Footnote ³⁰

As a further example, at the annual meeting of the Royal Albert Hospital in Devonport in November 1865 it was explained that:

Evidence as to what happened next is sparse, but it would seem that it was not until 13 November 1870 that a Hospital Sunday was instituted in this part of the country.Footnote ³²

Other towns and cities which held their first Hospital Sunday in this period included Sheffield on 31 January 1869,Footnote ³³ Manchester on 27 February 1870,Footnote ³⁴ Cardiff on 27 April 1873Footnote ³⁵ and Dublin on 15 November 1874.Footnote ³⁶ The situation in Scotland was a little more complicated since, in a letter to The Times published in 1873, it was claimed by William Carnie, treasurer of the Royal Infirmary in Aberdeen, that ‘Hospital Sunday … [had] been a recognised institution in Aberdeen for well nigh a century … the first Sunday of every year … [being] faithfully observed’.Footnote ³⁷ That said, other towns in Scotland appear to have followed the pattern elsewhere in the United Kingdom. For example, Dundee's first Hospital Sunday was held on 28 December 1873Footnote ³⁸ and Greenock's on 4 May 1879.Footnote ³⁹ However, it was not until 1893 that a Hospital Sunday Fund was established in Glasgow.Footnote ⁴⁰

As far as London was concerned, preliminary steps were taken to promote the idea in the early 1870s. Although the case was forcefully made in an article published in The Times on 27 January 1870,Footnote ⁴¹ it was not until November 1872 that ‘a meeting of representatives of many of the unendowed hospitals’ of the metropolis was held to promote the idea. At this, the chairman, Richard Martin, the treasurer of St Mark's Hospital:

In other words, Martin offered reassurance that Hospital Sunday did not undermine other modes of giving in support of voluntary hospitals. He also indicated that the bishop of London, the Rt Revd John Jackson, and the Roman Catholic archbishop of Westminster, Cardinal Manning, ‘had intimated their willingness to co-operate in the scheme’.Footnote ⁴² Indeed, as The Tablet reported, Cardinal Manning ‘spoke strongly in favour’ of it.Footnote ⁴³ Support also came from the lord mayor, who played a key role, and the first Hospital Sunday in the capital was held on 15 June 1873, with further collections on the two subsequent Sundays. Not surprisingly, the sums raised were considerable and for many decades the Metropolitan Hospital Sunday Fund was a major source of income for medical facilities, also receiving support from royalty. For example, King Edward VII and Queen Alexandra attended an afternoon service at St Paul's Cathedral on 7 June 1903, and special Hospital Sunday collections were taken, since they were otherwise engaged on the following Sunday, which had been officially designated for this purpose.Footnote ⁴⁴ The collections that year in London amounted to a record sum of £64,975.Footnote ⁴⁵

By the turn of the twentieth century, the concept of Hospital Sunday was well established and continued to serve as a financial lifeline for voluntary hospitals and dispensaries until the establishment of the National Health Service after the Second World War. It can also be seen as a providential element of Christian witness in a wide variety of communities, both large and small, since it offered churches an additional means of demonstrating their value to wider society. Moreover, such was its impact that at the end of the nineteenth century controversy arose as to whom credit was due for initiating the term ‘Hospital Sunday’. While many considered that Revd J. L. Miller of Birmingham was the originator, others backed the claims of John Henn, rector of St John's Church in Manchester.Footnote ⁴⁶ Whatever the merits of the respective claims of each candidate, the dispute illustrates the sensitivities surrounding this demonstration of philanthropic endeavour.

Attributes: ‘simultaneous Sunday collections’Footnote ⁴⁷

At first sight, Hospital Sunday might be regarded as simply an effective and efficient means of fund-raising for a good cause. This, however, oversimplifies what was, in effect, a multifaceted initiative, incorporating a variety of features that are worthy of further consideration.

The first is the role of the sermon, which was seen as a vehicle both for offering a theological justification for the appeal and for maximizing the sum raised. As it was put by Waddington, ‘the pulpit was co-opted to preach the gospel of hospital funding, systematically publicising medical relief to motivate benevolence’.Footnote ⁴⁸ The comment was made in a British Medical Journal article of 1872 that ‘the sermons on these occasions are generally evidently most carefully prepared, each minister trying to outvie the others in eloquence upon that always eloquent subject “Charity”’.Footnote ⁴⁹ In the early days, the local press frequently reported the title and sometimes the content of sermons, which were regarded as an essential prerequisite for the collection, together with leaflets in the pews. As the basis for what they had to say, preachers used a wide variety of texts, and from these various themes emerge. For many, Christ's example in healing the sick was to the fore. This was reflected in the titles of three sermons preached at various London churches on Hospital Sunday in June 1893. At St Michael's, London Fields, the title was ‘Christ the Healer’; at St Peter's, Greenwich, ‘Christ in the Sick Ward’; and at Holy Trinity, Minories, ‘Christ healing the Man sick of the Palsy’.Footnote ⁵⁰

In the circumstances, it was unsurprising that another pervasive theme was the importance of charity as a marker of neighbourliness, or what was often described, in the terminology of the late nineteenth and early twentieth centuries, as ‘brotherhood’ or ‘brotherly love’. Here the notion of support for the poor and disadvantaged was very much in evidence. Take, for example, a sermon preached by Revd J. Bullen at St Matthew's Church in Southampton in April 1874 and based on the text: “Take care of Him, and whatsoever thou spendest more, when I come again I will repay thee” (Luke 10: 35), from the story of the Good Samaritan. As Bullen explained, the text was:

He went on to argue that ‘no charities were more deserving than those of the Infirmary and the Dispensary’, and that their work could be greatly extended ‘if more funds were forthcoming.’ Moreover, as they ‘were chiefly for the benefit of poor persons, that alone rendered them deserving of support’ and that they should take the words of the second part of the text about paying whatever was necessary ‘literally to themselves’.Footnote ⁵¹

In a similar vein, at Manchester Cathedral in 1890, Revd Canon Davenport Kelly based his sermon on the text ‘He had compassion on him’ (Luke 10: 33). In so doing, ‘he pointed out the way in which the word “compassion” had too often fallen from the meaning it first had of suffering with another, to a transient sentiment of pity’. He went on to argue that in professing to ‘learn Christ’, his congregation ‘should see what suffering with others meant to Him’. He ended by expressing the hope that there would be ‘a marked increase’ in collections.Footnote ⁵²

In their appeals preachers frequently made reference to the role of hospitals in the alleviation of suffering and distress, and the dedication of the medical and nursing staff. For example, in 1889 the vicar of St Giles, Northampton, referred to the town's infirmary as ‘that noble institution in their midst’, in the context of a sermon based on St Paul's exhortation to present our ‘bodies as a “living sacrifice”’.Footnote ⁵³ This, he argued, could be demonstrated by giving up something close to their hearts in order to donate to the hospital. Similarly, in 1895, Revd H. S. Mercer of Christ Church, Coventry, ‘referred to the great blessings derived from the hospital’, by way of encouraging his hearers to assist in the good work it performed.Footnote ⁵⁴ On this occasion, the text is unknown.

The sermons preached on Hospital Sunday served as opportunities to remind congregations of the obligations that their faith imposed. They also reinforced the religious character of the occasion and often gave the impression that hospitals were divinely ordained institutions. Moreover, the message of the sermon was usually underpinned by other features of Hospital Sunday services. As it was put in a report of the first Hospital Sunday celebrations at St Andrew's Church in Cardiff, ‘the arrangement of the service had reference to the special character of the day’.Footnote ⁵⁵ From other accounts it is clear that particular attention was given the choice of hymns and anthems. For example, in 1874, at All Saints, Southampton, ‘hymns commencing “O thou by whom the healing art”, “Divine physician of the soul”, and others … appropriate to the occasion’ were selected.Footnote ⁵⁶ With respect to this aspect of the service, a special piece of choral music, ‘Let not thine Hand be stretched out to receive: An Anthem for Hospital Sunday or any other Occasion of Almsgiving to the Poor’, was composed by John Stainer (1840–1901).Footnote ⁵⁷ Prayers would also have reflected the nature of the occasion.

A second feature was the cross-denominational and inter-faith dimension. This was highlighted in an appeal which appeared in the Sheffield and Rotherham Independent in 1869: ‘Churchman and Dissenter, Protestant and Catholic, Christian and Jew, are alike called upon to help, for this is the cause of the sick and lame poor [who are] “ever with us”, and whose appeal no one will venture to refuse.’Footnote ⁵⁸ Similar remarks were made in respect of Birmingham, where ‘all unite in demonstrating that in the sacred cause of charity distinctions of creed lose their disintegrating character’.Footnote ⁵⁹ Such comments could be applied to many communities and can perhaps be regarded as an antidote to the antipathy which could often sour relations between denominations during the second half of the nineteenth century and into the twentieth, over such controversial issues as the marking in 1862 of the two hundredth anniversary of the Great Ejection, the role of ritual in worship, church governance and the church rate, and the provision of primary education. By comparison, the imperative to care for the sick and suffering was viewed as relatively unproblematic and could function as a unifying force. Through Hospital Sunday, the churches were enabled to present ‘a united front against one of society's more pressing problems’.Footnote ⁶⁰

Although there is little evidence of united services being held in the early years of Hospital Sunday, later, especially in smaller communities, open-air services were organized. One example comes from the Hampshire village of Hook, where ‘Church and Chapel … pulled together for the common good.’ In 1907, an innovation was the ‘free distribution of a tastefully printed “Order of Service” containing all the hymns’. This meant that ‘all were able to follow the service throughout, obviating the difficulty of lending hymn books which usually suffer in their excursion to an open air service’.Footnote ⁶¹

A third attribute was the manner in which the idea spread. In this respect, it can be seen as an example of the ‘diffusion of innovation’. As mentioned in the Introduction, what was essentially a local initiative mushroomed, in part because of the publicity it received from a generally sympathetic press as well as its evident success in monetary terms. Indeed, the British Medical Journal regarded ‘the aid of the press’ as one of the factors ‘necessary for success’.Footnote ⁶² However, Hospital Sunday remained a local phenomenon ‘owned’ by individual communities and focused on their health care institutions. As indicated earlier, attempts to establish one dedicated Sunday in each year for this purpose, to be observed throughout the country, were unsuccessful.

Appeal: ‘greater moral weight’Footnote ⁶³

Apart from the attributes considered above, the appeal of Hospital Sunday for individual churches was that it enabled them to benefit from being part of a more extensive initiative. This was reflected in remarks made by one of the early advocates, the vicar of Leeds, Canon James Woodford, who claimed that by having the collections simultaneously on the same Sunday the town's ministers were ‘relieved of the burden of a coming collection, the date of which might be regulated or postponed by many circumstances – by the presence or absence of some influential person, and by other reasons of a similar nature’. By implication they could concentrate on their message from the pulpit. It also, he claimed, attached ‘greater moral weight’ to the appeal when all the chapels and churches were acting in unison.Footnote ⁶⁴

Also of importance was its role in enabling churches, chapels and synagogues to reach out to the wider community and in particular to secular institutions. Put a little differently, it blurred the boundary between the sacred and the secular. This was evident not only in the raising of money within the context of acts of worship which was to be donated to temporal, albeit charitable, institutions but also through engaging with members of friendly societies and related organizations and inviting them to attend a church service. Thus in many communities church parades gradually became a distinctive component of Hospital Sunday. For example, in 1890 in the small Hampshire town of Alresford, the leading member of the local branch of the Ancient Order of ForestersFootnote ⁶⁵ suggested that since they did not ‘habitually attend divine service on their feast day’ they should do so on Hospital Sunday and invited other societies to join with them in doing so. This received a favourable response and after processing down the main street, Foresters and members of the Hampshire Friendly Society, the Unity Order of Oddfellows, the Hand-Held Friendly Society, the George Club and the Bighton Friendly Society attended a service at the parish church, when Revd A. A. Headley ‘preached a most suitable sermon’.Footnote ⁶⁶

Another example comes from the north Hampshire town of Whitchurch, with its Hospital Sunday attracting many visitors. As reported in 1909, ‘thousands of people crowded into the town from Basingstoke on the one side to Stockbridge on the other. Both railways gave extra facilities in the way of cheap tickets but the majority of the visitors came by road and the various inns and stable yards were more than over-crowded.’Footnote ⁶⁷ In a similar manner to Alresford there was a procession comprising a wide variety of organizations, one of which was the Salvation Army band. There was an open-air service conducted by Revd Thomas Davies, who was ‘in charge of the parish during the vicar's absence’, with the sermon being based on the parable of the Good Samaritan. Throughout ‘the afternoon collecting boxes were carried round, not only by the official collectors of each society, but also by a number of young ladies, whose persuasive appeals were all but irresistible’.Footnote ⁶⁸

The Alresford and Whitchurch examples were by no means exceptional and were replicated in many communities throughout the country. They illustrate how Hospital Sunday had become part of what has been conceptualized as ‘civic ritual’,Footnote ⁶⁹ and in the process could be said to have lost some of its religious significance. In other words, it had become more of a civic festival and less of a religious celebration. This, however, was by no means the only issue which arose for those of a religious disposition with even such an ostensibly benign concept as Hospital Sunday.

Issues: A Sensitive Initiative

An early indication of the problems which could arise was seen in Liverpool. Here in 1870 initial steps to launch a simultaneous collection in all churches and chapels were in danger of being blown off course by what were dubbed as ‘unfair clerical proceedings’.Footnote ⁷⁰ These were steps taken by Church of England clergy to protect their charitable endeavours, which for twenty years had taken the form of collections for a variety of denominational causes, including some non-medical charities. In seeking protection for these, the clergy wanted to ‘ring-fence’ some of the money collected, thereby undermining one of the key principles of Hospital Sunday. As it was put in editorial comment in the Liverpool Daily Courier: ‘The strangest incident in the bitter controversy is that every one is bent on doing good, and that one man differs from his neighbour only in the means of achieving the common end.’Footnote ⁷¹ Thanks to the efforts of the lord mayor, together with a willingness to compromise, agreement was reached and Liverpool's first Hospital Sunday went ahead in early 1871.

In larger towns and cities, such as Liverpool, where health care provision was spread across a number of institutions clergy were given the opportunity to participate in decisions regarding the distribution of funds raised, through membership of committees established to oversee Hospital Sundays. Such involvement, however, was by no means unproblematic. Deciding which institutions should receive financial support could also give rise to disagreements and accusations of unfairness. Thus engagement with the secular world could be a double-edged sword. As Waddington observes, in 1874 the Metropolitan Sunday Hospital Fund was involved in ‘an acrimonious and public debate as those concerned with the position of the specialist hospitals attempted to hijack the movement by imposing their own views on distribution, threatening collections until a compromise was reached’.Footnote ⁷²

Another issue was that of sectarianism, which has been explored by Carmen Mangion, primarily in the context of the institutional culture of voluntary hospitals. She highlights a case from 1885 when an applicant to train as a nurse at University College Hospital (UCH) in London, a supposedly non-sectarian institution, was rejected because she was a Nonconformist. As Mangion observes, in considering the resulting controversy from the perspective of the funding of voluntary hospitals, ‘the Metropolitan Hospital Sunday Fund took the claim of sectarianism seriously[;] they feared it would damage the credibility of all voluntary hospitals and could lead to a decline in donations’.Footnote ⁷³ One of those who took exception to the action of UCH was a Congregational minister and a member of the Metropolitan Hospital Sunday Fund Committee, Henry Allon. In a letter to The Times, he argued for the holding of an inquiry to establish the facts in this case. In so doing he was motivated by what he described as his ‘earnest deprecation of sectarian exclusiveness’.Footnote ⁷⁴ In the end, the fund ‘with the support of the Hospitals Association opted out of defining sectarianism and supported ‘tolerable intolerance’, with respect to nurse-hiring policies in this instance, ‘in order to maintain its role in the funding of voluntary hospitals’.Footnote ⁷⁵ Consequently, when hiring nurses, UCH could continue to discriminate on grounds of denominational affiliation without forfeiting its entitlement to financial support from the Metropolitan Hospital Sunday Fund.

From the perspective of the churches, there were also issues associated with the occasion's becoming too secularized. One manifestation of this was the establishment of a Hospital Saturday to complement Hospital Sunday. Originating in Liverpool in 1870, this was seen as a means of securing contributions from those who would not be in church on Hospital Sunday. Again the concept spread rapidly to other towns. Taking Southampton as an example, in 1874 it was decided that on the Saturday before Hospital Sunday ‘a general collection should be made in the various manufactories and workshops of the town as well as amongst the officers and crew of the steamships in the port’.Footnote ⁷⁶ While such a move undoubtedly increased the amount collected, it could be argued that by extending the scope of the appeal its character as a practical outworking of the Christian gospel was weakened. Thus, although most clergy and their congregations were sympathetic towards, and keen to support the aims of, Hospital Sunday, they could be troubled and constrained by the more ‘worldly’ aspects.

A final issue was associated with a gradual decline in the amount collected in many of the larger centres of population, a frequent cause for concern. This was attributed to a variety of factors. In 1910, for example, the leading Congregationalist and minister of Lyndhurst Road Church in Hampstead, Revd Dr R. F. Horton, drew attention to ‘the fact that the people who used to contribute now go out of town for the weekend. They spent Sunday in the country. The habit of Sunday worship in church was dying out … [in] England.’Footnote ⁷⁷ More prosaically, in some communities bad weather over the weekend Hospital Sunday was held was blamed for a reduction in donations. A 1910 press report from Leeds, which held its Hospital Sunday in February, indicated that for some years ‘congregational collections had been of diminishing quantity’ and although ‘a special effort’ had been made that year ‘unfortunately bad weather interfered with the attendances’.Footnote ⁷⁸ In Sheffield, which also held its Hospital Sunday in the winter, the local paper commented that ‘a stormy Sunday mean(t) empty churches and empty churches mean(t) attenuated collections’.Footnote ⁷⁹ There were, therefore, signs that maintaining the momentum was a particular challenge, with frequent references in the press to a decline in the sums raised and the need for appeals to be more robust and assertive.