Prior to the reforms, the poor often went without medical treatment, relying instead on dubious - and sometimes dangerous - home remedies or on the charity of doctors who gave their services free to their poorest patients.
Access to a doctor was free to workers, who were on lower pay, but 'national health insurance' often did not extend even to their wives or children.
Hospitals charged for services, and although poor people were reimbursed, they had to pay upfront first to receive treatment.
The need for free healthcare was widely recognised, but it was impossible to achieve without the support or resources of the state.
Throughout the 19th century, philanthropists and social reformers working alone had tried to provide free medical care for the poor, but, without government backing, they were destined merely to scratch the surface of need.
The hospitals established by these pioneers dealt mainly with serious illness.
Other demands, such as care of the elderly and mentally ill, were met - at least partially - by local authorities which often ran local municipal hospitals.
Provision, however, was patchy, and people were often locked away in forbidding institutions, not always for their own benefit, but to save other people from embarrassment.