The creation of a network of county infirmaries was a remarkable achievement in late eighteenth-century Ireland. Supported by grants from parliament and the county grand juries, each hospital was managed by governors whose subscriptions entitled them to appoint the medical staff and decide on the patient population. While the laudable aim of the legislators was that the infirmaries would be ‘a means of restoring the health and preserving the lives of many’, the reality was quite different. In 1788 the prison reformer, John Howard, and the inspector general of prisons, Sir Jeremiah Fitzpatrick, delivered a damning report to parliament on the state of the county infirmaries. They described good care and governance in a minority of institutions, but most were in a very bad state; they noted decayed and broken buildings, dirty or no bedding, poor food, lack of regulation, financial malfeasance, few patients and absent staff. Based on their report, this paper argues that the county infirmaries benefited the governors and the staff considerably, and had little impact on the health of the nation. However, providing a hospital and trained medical professionals in every county was a significant step in the formation of the Irish institutional healthcare system.