The hospital first opened in 1797 as the Belfast Fever Hospital and General Dispensary, located in Factory Row. It then moved to West Street two years later and finally to Frederick Street in 1817. It was originally a four-story building with 128 beds.
The General Hospital was named as such in 1847. It was a four-story building with a capacity for 128 in-patient beds.
During the Irish Famine of the 1840s, health services in Belfast were under severe strain. Many people were suffering from starvation and this made them much more suspectable to disease. Also, Belfast became a centre of migration for many people who moved from the land to the town to find food and work.
In April 1846, an additional shed had to be erected at the General Hospital to accommodate the number of people needing treatment and they reopened the old Cholera Buildings that had been closed for over a decade. By summer that year the hospital was forced to erect tents that accommodated an extra 700 people.
In June 1847, it was reported that there were 1,709 patients in the General Hospital, the majority suffering from fever.
The General Hospital operated as the local emergency room for people in Belfast during much of the 19th century. For example, in October 1854, Mary Short, a worker in Campbells Mill in the Falls Road, was admitted to hospital when her hand got entangled in a machine. She lost three fingers on one hand. There was also a man called Magee, who in July 1871, was admitted into the General Hospital suffering from a severe laceration of the foot he received by coming in contact with a reaping machine at the Model Farm, Dunmurry.
Care was funded charitable donations from philanthropists care for many patients was provided free.
The hospital moved from Frederick Street to its new buildings in the Grosvenor Road site in 1903. The hospital was renamed the Royal Victoria in 1899.
The site of the old General Hospital in Frederick Street is now the site of the Ulster University carpark.