The work of the Almoning profession within the medical system of the late nineteenth century has been seriously neglected in historical study. Few references to the occupation have been made in previous studies, which have made no attempt to comprehensively consider the role and importance of the first Almoner in establishing the profession. The first Lady Almoner was Miss Mary Stewart, a member of the Charity Organisation Society appointed at the Royal Free Hospital of London in 1895. The decision to create the office of Almoner came jointly from the Royal Free Hospital and the Charity Organisation Society in response to fears that patients were abusing the system of free medical care provided at the Royal Free. The role of the Almoner was to act as a gatekeeper to the hospital, means-testing patients in order to decide if they were eligible to receive treatment at the Royal Free (and if so, to decide whether they could make a contribution to their care), or whether they were better suited to treatment provided elsewhere. No work to date has been carried out into the developing role of Miss Stewart or into the findings of her investigations. Miss Stewart kept an Almoner’s Record Book containing the fourteen reports she produced between the years of 1895 and 1899, when she retired due to ill health. Each report recalled the work undergone in the previous few months, and was presented to a Weekly Board Meeting at the Royal Free once completed. The book also contains the reports of the subsequent Almoners up until the year 1913. This paper however, is concerned only with the reports of Miss Stewart, in order to address both the initial and perceived role of the original Almoner in relation to the actual day to day activities she undertook. By the time she resigned in 1899, Miss Stewart had interviewed thousands of patients as to their financial standing, made countless visits to people homes in order to check their means and to follow up on their progress, and continually remodelled the classification as to who should be made to pay for medical treatment. The Almoners book is abundant with information as to the occupation, earnings, demographics and living conditions of the thousands of patients interviewed at the Royal Free Hospital. The findings of the Almoner are therefore crucial in understanding the quality of life possessed by those people who attend the Royal Free for medical assistance. Moreover, the Almoner’s reports are also telling as to Miss Stewart’s conception of the patients, and in turn, of her opinion as to the amount of abuse the system suffered at their hands. Overall, this paper will examine the appointment, role, authority, and findings of Miss Stewart in order to create an understanding of the life, work, and legacy of the first hospital Almoner.