In 1836, Earl Howe and a number of prominent local men submitted a memorandum to King William IV, and on 22 June a reply communicated His Majesty’s acquiescence to become a Patron of the School to be styled the Royal School of Medicine and Surgery in Birmingham. There was serious need for a new teaching hospital and in 1839 Sands Cox launched an appeal. Sufficient money was raised within a year and the hospital built in 1840–41 was opened in 1841 by Sands Cox.