This study considers the mixed economy for medical services in Herefordshire between 1770 and 1850. Medical services were an integral part of wider systems of welfare and were provided within a mixed economy that included private practice, state provision, philanthropic activities and mutual societies. Significant resources were spent within the sector and influence over their deployment was of direct interest to parishes, the municipal council, magistrates, philanthropists and individual members of the elite. Four types of medical services are reviewed. These are the provision of personal care by medical practitioners in the private, public and charitable sectors, the establishment of Hereford General Infirmary, changes in institutional services for the insane and developments in public health. Two underlying themes are discussed throughout the thesis. The first of these is the complexity of the mixed economy for medical services. Important changes over the period are identified and the interrelationships between the various sectors investigated. The dominance of public, private or charitable provision shifted in the period as a result of both national and local factors. The second theme explored is the interplay between politics and the systems and institutions providing medical services. The importance of political considerations in shaping local policy towards medical services is demonstrated through detailed case studies. These include examining the link between the launch of the subscription appeal for Hereford Infirmary and the parliamentary election campaign in 1774, approaches taken towards the management of the cholera epidemic of 1832 and the campaign to establish a public lunatic asylum in the late 1830s.