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The better management of large urban populations was also achieved through improved systems of classification. 9 It therefore first appeared to emerge in places such as nineteenth-century Austria, France and Germany, countries where inhabitants were long familiar with increased levels of government regulation and control. 10 Immigration to towns, like Birmingham, however, occasionally encouraged the spread of ideas and people and equally 5 S. Sturdy and R.  1870–1950’, History of Science 36, 114 (1998), 427.

Eliot, Middlemarch (London, 1994), 434. Chessher, 9. 23 White, Years of Caring, 16. 24 LeVay, History of Orthopaedics, 88. indb 34 08/09/2009 14:16 Birmingham’s First Specialist Hospitals 35 young patients. 25 Few operations were undertaken by the hospital’s staff until the last quarter of the nineteenth century, when the work of Louis Pasteur and Joseph Lister, among others, transformed surgical procedures altogether. 26 The hospital’s work load does not appear to have increased very rapidly in its first eighteen months, a fact that would undoubtedly have suited Freer, who by this time enjoyed a very healthy private practice.

Treatment in Manchester appears to have been similarly conservative; see J. Pickstone, Medicine and Industrial Society: A History of Hospital Development in Manchester and its Region (Manchester, 1985), 12; see also S. Cherry, ‘The hospitals and population growth, Part 1: The voluntary general hospitals, mortality and local populations in the English provinces in the eighteenth and nineteenth centuries’, Population Studies (1980), 258. 30 BCLA, gh/1/2/5; A. Tomkins, The Experience of Urban Poverty, 1723–82: Parish, Charity and Credit (Manchester, 2006), 121.

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