WHILE THE VALUE of specialisation was recognised by many industrialists in nineteenth-century Birmingham, very few medical practitioners expounded on the beneficial effects of a division of labour in these years. Although some specialisation in medicine was occurring at this time, the majority of the medical profession initially responded to this new tendency with open hostility. In general, those who relinquished general practice and devoted themselves to the diseases of a particular organ, such as the eye, risked being ostracised as quacks by their colleagues. Many medical practitioners consequently responded to specialisation unfavourably. Besides being considered unprofessional, most regarded it as threatening for a variety of reasons. For example, it promised to make an already fragmented medical profession, originally divided into physicians, surgeons, apothecaries, then, by the early nineteenth century, into general practitioners and consultants, even more chaotic and complex. It also potentially increased the number of medical instructors who claimed specialist knowledge with whom more orthodox practitioners would potentially have to share medical students’ fees. Similarly, specialist institutions created throughout the Victorian period would face accusations of diverting charitable donations away from general hospitals.

In contrast, the public was anything but hostile, and patronised specialists with enthusiasm, especially since general hospitals had excluded certain diseases and age groups from their remit from their first appearance. On the other hand, medical practitioners, just like those who specialised in manufacture, began to realise that ‘they could often do more good, earn more money and have less arduous work to perform’ by devoting themselves to just one branch of the profession. This was especially true in the provinces, where doctors did not have access to the same concentration of wealthy patrons as existed in a large metropolis, such as London. The emergence of localised pathology in the nineteenth century additionally furnished an intellectual rationale for specialisation, though one that is not accepted by all historians. Numerous other ideas and social forces, however, made specialisation appear natural in these years, not least the emergence of Darwin's theory of evolution. Frequently driven by technological innovation, specialisation also increased knowledge and improved technique. Consequently, opposition to this tendency was doomed to defeat, and specialisation even attained a certain degree of respectability by the second half of the nineteenth century.