The patient has been much neglected by medical historians: most medical history has been compiled by medically-trained men and published only for medical men. This social history of health and ill-health in Britain is conceived on a wider, more questioning scale than standard medical history. The survey ranges from maternal mortality to the management of the old and infirm, and hinges upon measuring the benefit accruing from the huge investment in the medical profession and sanitary improvement. It is shown, in answer to the cost-benefit question that, apart from vaccination against smallpox, and anesthesia and antisepsis after 1880, medical science had little impact upon the health and life chances of nineteenth-century people. Improved nutrition, better housing and working conditions probably achieved a great deal more. Similarly, despite a large investment in lying-in hospitals and obstetric training for doctors, maternal and infant mortality rates remained at an appallingly high level until the first decade of this century. Sanitary development has also been too readily accepted as lowering the death and morbidity rates. This study shows that piped water and sewerage systems came to wealthy suburbs a generation before they were introduced among the poor. Indeed, the channelling of the refuse of the rich into the rivers which supplied water for the poor may have maintained the high typhoid, cholera, diphtheria and gastro-enteritis rates among the latter.