“Sir,” wrote John Wood of Sittingbourne, Kent, on 28 May 1788, to George Neale, surgeon,

Nineteen years after walking the London's wards, John Wood found that evidence of that experience might “be necessary” for his practice in Kent. His brief request suggests the little ways that hospital training crept into the making of regular medical men in the eighteenth century. In 1769, Wood chose to pay to watch and assist elite surgeons in their charitable work, spending twelve months engaged in an activity hardly required for a surgeon, or surgeon-apothecary, to start treating patients in Britain. Yet it mattered. In 1788 the “Certificate from the Hospital” was valuable. It marked Wood as a practitioner with an appropriate background, whatever he actually learned under Neale and the other surgeons.

For the emergence of hospital teaching in London, Wood's decision to enter the wards evokes part of the story, the demand side, as it were, of institutional change.