New York and Brooklyn community hospitals and dispensaries were organized and run by local church groups, merchants, and other organizations and leaders. These sponsors lent to their institutions the ethnic or religious flavor that made the services unique. Rarely, if ever, were the trustees and governors important on the regional, state, or national level. When the forces of industrial and economic change, commercial development, or demographic reorganization and political upheaval altered the relationships and neighborhoods in which these institutions were located, the hospitals found themselves subjected to pressures well beyond their control. In the face of these growing pressures, smaller institutions sometimes moved away or reorganized, or perhaps went out of existence.

For some Manhattan hospitals, the story was different. Some hospitals were larger, had more political power, and were more secure financially. Their lay governors and trustees often came from older and more prominent New York families who controlled and owned significant portions of the city and provided access to benefactors, legacies, and landholdings. Given the enormous financial and political resources of these institutions and their trustees, it is not surprising to find that when they came into conflict with the forces of urbanization and capitalist development that seriously disrupted smaller facilities, the outcomes were substantially different. Although larger hospitals and institutions were often pressured to move by realtors, they generally had more control over where they moved and how they affected neighborhoods than did community hospitals.