The first members of staff were appointed in September 1871, including medical and surgical staff and a resident surgeon, matron and nurse.

The buildings stood on about three acres of land, forming three sides of a quadrangle with a tower in the middle. The left wing was for male patients, the right wing for female patients. The buildings were lit with gas, and held 60 patients.

The official opening on Wednesday 25th October, 1871 was celebrated throughout the town. Flags were flown, a procession was held, with guests including the Earl and Countess of Dudley. The Countess declared the hospital open and the Earl presented the hospital with £30,000.

It was the Earl who suggested that the hospital should be called 'The Guest Hospital' in recognition of Joseph Guest's endowment.

Joseph Guest and his wife.

The number of patients slowly increased. There were 43 patients in the seventeenth week. There was an average of 32 patients in the hospital at any one time, during the first year.

Until the introduction of the National Health Service, the hospital was funded by voluntary contributions, and local collections, particularly in the local factories. The annual contribution from the Guest Hospital Contributory Association grew to about £30,000 in 1937 with the introduction of the Saturday Fund Committee. The Hospital Sunday Fund began in 1873 and held collections at places of worship. The hospital also received the proceeds of the Dudley Castle Fetes.

 In 1875 a children's ward opened with seven cots for children suffering from various diseases and in 1876 the hospital trustees received £2,350 from the executors of Mr. Alexander Brodie Cochrane, who had died on the 23rd June, 1863 at his home in Stourbridge. Along with family members, he ran Woodside Ironworks and had been closely involved with the hospital since its formation. He had paid-for and had built, Holly Hall School in 1860 and his executors decided that it was no longer necessary to support the school, which was sold for £4,700, half of which was given to the hospital.

In 1879 the hospital received two substantial bequests, £5,000 from the will of Mrs. Elizabeth Bennett and £10,000 from the will of Mrs. Mary Charlton. Both ladies were sisters of Joseph Guest and had taken a great interest in the hospital. In the same year, the hospital's Honorary Surgeon Mr. J. H. Houghton died. He was replaced by his son-in-law, Mr. M. A. Messiter.

1886 saw the formation of the Dudley and District Guest Hospital Football Charity Cup Association, which raised considerable sums of money for the hospital. In 1888 a training scheme for probationary nurses began in which each probationer paid 15 guineas, which was returned at the end of three years training, subject to satisfactory work and conduct.

A detached unit for the treatment of infectious diseases was built in 1890. It consisted of two small wards, a bathroom, a nurses' room, and a kitchen. In the same year another two nurses were added to the staff and from time to time, additional nurses were engaged as required. The number of patients treated each year slowly increased. In 1896 a total of 736 patients were admitted to the hospital, along with 765 patients that were treated as emergencies, but not admitted. Also in 1896 the women's wards were temporarily closed for work to be done on an extension. The new ward, known as the Victoria Ward, was one of the finest female wards in the country. The extension included an operating theatre and two small detached wards known as the Claughton Wards. The new wards were officially opened by Gilbert Claughton on the 22nd June, 1897. New staff included a gardener, an engineer, and a house porter.

Building work continued with the addition of a steam laundry and modernisation of the kitchens. The work was partly paid-for from the proceeds of a grand bazaar in the summer of 1899.

An illustration of the hospital in 1871. From the Dudley Guardian newspaper.

In 1901 the men's operating theatre was completely refurbished thanks to the generosity of Mrs. M. A. Messiter, wife of the hospital's surgeon. Two years later, four honorary consulting officers were appointed to assist and advise the hospital's medical staff. The appointments consisted of an Honorary Consulting Surgeon, an Honorary Consulting Gynaecologist, an Honorary Consulting Ophthalmic Surgeon, and an Honorary Consulting Physician. The appointments were given to gentlemen who held similar posts at large Birmingham hospitals.

Also in 1903, Mr. Hugh Lewis, a wealthy pawnbroker from Sutton Coldfield, gave a large amount of second-hand furniture to the hospital along with a donation of £500. He continued to send gifts until his death in 1908, when he left his whole estate to the the hospital. His widow unsuccessfully disputed the will and over £70,000 was handed to the hospital trustees in two instalments in 1910 and 1911. The trustees generously arranged for Mrs. Lewis to receive a pension of £25 per month, out of the dividends, for the rest of her life.

In 1904 an eye department opened for in-patient cases only, outpatients had to go to the dispensary in Priory Road,  until 1912, when the hospital began to cater for them. In 1905 a new department opened for the treatment of surgical casualties, and a ladies committee was formed to raise funds for the hospital. In 1906 the hospital's library opened, following a generous gift of books from Mr. Hugh Lewis. Two years later the hospital acquired its first X-Ray machine and electric lighting was installed in the wards and operating theatres. By 1910 there were around 1,000 admissions annually and in 1911 a massage department opened.

In 1916 a new central boiler house opened, as did a new children's ward. Mr. Cyril C. Messiter, son of the hospital's surgeon, Mr. M. A, Messiter was appointed as Honorary Surgeon in 1918. Three years later a consulting service opened at the hospital to offer a first-class consultant service to Dudley and the surrounding towns.

The hospital in the 1920s.

By 1925 the hospital had debts of £10,000 and an effort was made to pay this off, by a number of schemes including a six-day bazaar and an Olde English Fayre. The events raised over £14,000, including £6,000 raised through a public appeal, run by Mr. Edwin John Thompson, who became Hospital Chairman before the end of the year. Mr. Thompson and his family generously gave the money for the building of a nurses' home on 6,000 square yards of land, given by Lord Ednam. The home consisted of 40 bedrooms, reading, writing, sitting and recreation rooms and was called the Helen Thompson Nurses' Home.

In 1927 a Sister Tutor was appointed for the nurse training scheme, whose services were shared with Walsall General Hospital.  

The Children's ward in the 1920s.

Between 1929 and 1939 the hospital was entirely rebuilt, in stages, to increase the number of in-patients to 154. New wards included the Messiter Ward, named after Mr. M. A, Messiter, the Sankey Ward, named after the Honorary Surgeon, Mr. J. N. Sankey, the Stretton Theatre Suite, named after the Honorary Surgeon, Mr. J. W. Stretton, the Mallows Children's Ward, named after the Matron, Miss E. M. Mallows, a Physiotherapy Department, Nurses' Lecture and Demonstration Rooms and a boiler house and laundry. There was also an annexe added to the Helen Thompson Nurses Home, with 16 bedrooms. It was built in 1931 and was another gift from Edwin John Thompson, who was given the Freedom of the Borough of Dudley in 1936. 

The project ended in 1940 with the opening of the Administration Block. It consisted of kitchens, a matron's flat, quarters for resident medical staff, dining rooms, committee rooms, administrative offices, a sewing room and a telephone exchange.

In 1938 the management board introduced a superannuation scheme for the hospital staff.

The out-patient department in the 1920s.

In 1943 the hospital accepted an invitation to associate itself with the Royal Hospital in Wolverhampton for the establishment of a rehabilitation unit at Patshull Hall and in 1944 a Social Service Department opened and a second Sister Tutor was appointed. An Orthoptic Department in conjunction with the Eye Department opened and a large number of committees and organisations raised sums of money for the hospital.

The Administration Block.

In 1961 the children's room, built in 1916 was converted into a Day Case Ward with 12 beds and an operating theatre. In the following year the Pathology Department was considerably improved and in 1964 a chapel, a quiet room and a vestry were built in the grounds, off the main corridor. For the first time a tray service was introduced for all meals, giving patients a choice from a menu for all courses. To make this possible, the main kitchen was extended to provide automatic dish washing facilities and a trolley area for the tray service.

Three years later the total number of beds was 177 after the opening of the Woodhouse Ward, built over the Georgina and Sankey Wards. In 1968 two new buildings were erected, one for the Group Engineer's Stores, and one for the General Hospital Stores. The library was also greatly improved and television and radio programmes were available for patients.

The Nurses' Home.

The Guest Hospital remained as one of the most important hospitals in the area until the opening of Russells Hall Hospital in 1983. The accident and emergency department at the Guest Hospital closed in the spring of 1984 and was relocated at Russells Hall. At the time it looked as though the Guest Hospital was on the verge of closing, until a new hydrotherapy pool and physiotherapy department opened there in 1986.

An early view of the Georgina Ward.

The Georgina Ward in about 1970.