Like many of these chapters, this one was conceived in a moment of celebratory inadvertence – as a contribution for a symposium honoring Richard H. Shryock, pioneer historian of American medicine. I used the occasion to explore the rise and fall of the outpatient dispensary, an institution that had been central to the delivery of health care in America's growing cities – but which had been largely ignored by historians of medicine. I had first become aware of the dispensary's centrality – both to the medical profession and to urban working people – when completing research for Chapter 7, on mid-nineteenth-century New York. That essay emphasizes the pivotal interdependence between the internal history of the medical profession and the development of urban social institutions. But my interest remained latent as I worked on a variety of unrelated topics in the late 1960s and early 1970s. The focus of the Shryock symposium on social history provided an ideal incentive – and occasion – to pursue this relationship in another context.

To most mid-twentieth-century physicians, the term dispensary evokes the image of a hectic hospital pharmacy. To their mid-nineteenth-century counterparts, it was both the primary means for providing the urban poor with medical care and a vital link in the prevailing system of medical education. These institutions had an effective life span of roughly a hundred years.