This paper emerges from a Wellcome-funded, comparative history of five English provincial medical schools between c.1825 and 1939. Among other things, it considers the establishment of the first provincial schools in England, the evolution of the curriculum, as well as the emergence of something that more closely resembles modern medical science. In many ways, the new scientific method in medicine was epitomised by physiology; this paper will therefore examine the rise of physiology and the emergence of provincial research schools of physiology. Given the local setting of this conference, this paper will explore the emergence of academic physiology (c.1870) in Birmingham and its development over approximately half a century. Among other things, it will discuss the first instructors, who were usually clinicians, which goes some way towards explaining the practical nature of the earliest classes. It also follows the development of physiology instruction, including the appointment of full-time professors and research laboratories. While it has been suggested that provincial schools often led those in the metropolis in their willingness to embrace courses such as physiology, they also had considerable difficulties first establishing programmes that would satisfy the demands of existing regulatory bodies.