BEDS AND PATIENT NUMBERS were set to increase at all of the Birmingham voluntary hospitals, not just the emerging specialist institutions, in the last decades of the nineteenth century. As a result, much hospital reconstruction would characterise the 1880s and 1890s. Starting with the appearance of the last specialist hospital to be founded in Birmingham in the nineteenth century, this era witnessed the construction of purposebuilt facilities for both the Skin and Ear hospitals. By the last decades of the nineteenth century, as has been argued elsewhere, the battle for the acceptance of specialisation had been fought and won throughout most of continental Europe. A similar victory would soon be claimed by specialists in Britain. Far greater transformations, however, were in store. Not only would ever-greater numbers of Birmingham's inhabitants experience hospital treatment during these years, but many more would become familiar with the escalating costs associated with hospital medicine. For many of the town's inhabitants, health care became more and more closely associated with hospital medicine.

LOWER OPERATING COSTS: THE ORTHOPAEDIC HOSPITAL

By the early 1880s, the Orthopaedic Hospital continued its steady growth and was still the only hospital of its kind outside London. In 1877, the charity had moved into a building vacated by the Institution of Mechanical Engineers which, like many of Birmingham's most eminent doctors, including John Ash, William Bowman and Joseph Hodgson, had abandoned Birmingham for the capital. The new hospital that opened in its place initially had twelve beds, with room for eight more. However, given that most individuals at the institution were children, occasionally twice that number resided at the hospital, staff having frequently allocated two young patients to each bed during this period. The work of the hospital was largely in the hands of Miss Dorrell, the matron, and a dispenser, Mr Rogers, and a member of the Freer family was still to be found on its staff. While Thomas Freer together with Bell Fletcher, another of William Sands Cox's first students, served as honorary surgeons, the appointment of Thomas Heslop to the consulting staff in 1879 considerably improved links between the Orthopaedic and Children's hospitals.