Royal College of Surgeons of Edinburgh The 1897 stained glass window which features the College's armorial bearings overlooks the College's main staircase Seven years from now, the Royal College of Surgeons of Edinburgh will celebrate its Quincentennial. Having enjoyed a continuous existence as a corporate body since 1505 AD, it may justly claim to be one of the oldest surgical corporations in the world. 1. The first 100 years, the Sixteenth Century and the Barber Surgeons 2. The 1600s : the first permanent meeting place 3. The 1700s : the growth of scientific medicine in Edinburgh 4. The 1800s : a new meeting place, the Playfair Building 5. Into the 20th Century: a period of expansion The first 100 years, the Sixteenth Century and the Barber Surgeons In 1505, the Barber Surgeons of Edinburgh were formally incorporated as a Craft Guild of the city and this recognition is embodied in the Seal of Cause or Charter of Privileges which was granted to the Barber Surgeons by the Town Council of Edinburgh on 1st July 1505. The Seal of Cause is a remarkable document. It clearly established the role of the Incorporation of Barber Surgeons as a body concerned with the maintenance and promotion of the highest standards of surgical practice and this remains the prime purpose of the great international surgical brotherhood of The Royal College which has developed from the Incorporation. The Seal of Cause conferred various privileges upon the Incorporation, including the exclusive right of its members to practise surgery in Edinburgh and surrounding districts, but in return for these privileges, it imposed certain crucially important duties and obligations. The most important of these, which remains entirely appropriate to this day, is stated very clearly in the Seal of Cause. "... that no manner of person occupy or practise any points of our said craft of surgery... unless he be worthy and expert in all points belonging to the said craft, diligently and expertly examined and admitted by the Maisters of the said craft and that he know Anatomy and the nature and complexion of every member of the human body... for every man ocht to know the nature and substance of everything that he works or else he is negligent." From its earliest origins the College has been an examining body principally concerned with the setting and maintenance of professional standards. Another vitally important obligation laid upon the Barber Surgeons was that of ensuring that all who practise the craft should be able to read and write and this literacy requirement is the earliest of any comparable professional body. The Seal of Cause recognised the importance of a thorough knowledge of Anatomy for the practice of surgery and in order that the Incorporation might maintain a high standard of anatomical knowledge amongst its members it was granted the right to have the body of one executed criminal per annum for the purposes of anatomical dissection. Having regard to the very strong religious, cultural and social prejudices against dissection of the human body, this was indeed an extraordinary dispensation. The Seal of Cause was confirmed on the 13th of October 1506 by a Royal Charter granted by King James IV of Scotland, arguably the most interesting and attractive figure of the entire Stuart dynasty. [arjames4.jpg (4377 bytes)] A man of many diverse accomplishments, his long and stable reign was for Scotland a brief golden age. King James was particularly fascinated by medical science and we have clear evidence that he was a skilled and enthusiastic practical surgeon and dentist. During the 16th Century the Incorporation met in the house of its Deacon but meetings were occasionally held in one of the aisles of St. Giles Kirk and because of this the Deacon was sometimes referred to as the `Kirk Maister'. The early records of the Incorporation are somewhat fragmented but the names of most of its early Office Bearers are recorded in minutes of the Town Council. From 1581 onwards, its records are complete. One of the most important landmarks in the early history of the Barber Surgeons is the Royal Charter granted to them by Mary Queen of Scots, the grand-daughter of James IV, on 11th May 1567. This notable document - which is often referred to as the " Barber Surgeons' letter of exemption ", formally relieved members of the Incorporation from the obligation to bear arms in defence of the realm but obliged them to treat sick and wounded soldiers in the Queen's armies - is the first formal statement anywhere of the non-combatant role of the army doctor. Gilbert Primrose, who was elected Deacon of the Barber Surgeons on three separate occasions, was appointed Surgeon to King James VI of Scotland and when the King succeeded to the English throne, in 1603, Primrose went south with him and became Chief Surgeon to the Royal Household in London. Because of Primrose's prestige and the force of his personality, the status of the Incorporation of Barber Surgeons became progressively enhanced and, in 1583, it was formally recognised by the Town Council as the premier craft guild. Several members of the Incorporation gained wide experience of military surgery through service with various European armies during the Thirty Years War and many others later served in the Scottish Covenanting Armies of the 1640's. The 1600's : the first permanent meeting place By the end of the 16th Century, a distinction had developed between the Barbers, who simply cut and shaved hair, and the Barber Surgeons, who also practised the more skilled craft of blood letting and other forms of surgery. The Surgeons gradually abandoned hair cutting and shaving, but frequent disputes arose between the two branches of the Incorporation concerning the rightful scope of their work. In 1647 the Incorporation acquired for the first time a permanent meeting place by renting three rooms of a tenement in Dickson's Close. Later, after joining forces with the Apothecaries, the Incorporation laid out in their grounds at Curriehill the first Edinburgh Physic Garden. In this were grown all kinds of medicinal herbs which enabled the Surgeon/Apothecaries to train their apprentices in the recognition of the plants which formed the basis of Materia Medica at that time. By the end of the 17th Century, an increasing number of Edinburgh Surgeons had acquired a formal academic training in medicine and certain Physicians had begun also to practise surgery. The most notable of these was Archibald Pitcairne, who became Professor of Medicine in the University of Leiden where amongst his students were many Scots. He returned to Edinburgh in 1693 and joined the Incorporation of Barber Surgeons in 1701. The admission of Pitcairne and other `Doctors' to the Incorporation did much to enhance its prestige and to establish surgery clearly as a reputable branch of medicine. In 1695, the Incorporation was granted a new charter by King William III and Queen Mary, which confirmed the jurisdiction of the Surgeon-Apothecaries over the practice of surgery in Edinburgh and the south-east of Scotland. The charter also confirmed the Incorporation's responsibility for anatomical teaching and this prompted it to apply to the Town Council for more bodies for dissection. The Council approved this application on the condition that the Incorporation provided an anatomical theatre. Work on what is now known as " Old Surgeons' Hall " , in High School Yards, was started and by 1697 was completed and occupied. The first public dissections were conducted there in 1703. Old Surgeons' Hall The 1700's : the growth of scientific medicine in Edinburgh The Faculty of Medicine in the University of Edinburgh was established in 1726 and no one did more to achieve this than John Monro, who was Deacon of the Incorporation of Surgeons from 1712 to 1713. Monro's son, Alexander Monro (Primus), became Professor of Anatomy in the University in 1719 and his brilliance as a teacher attracted students from all over the British Isles and even from the North American Colonies. He also played a notable part in the establishment of the Edinburgh Royal Infirmary. The University Faculty of Medicine and The Royal Infirmary were responsible for the rapid development in Edinburgh of systematic medical teaching on a sound scientific basis. Surgery, however, suffered from the effects of a lingering academic prejudice against what was perceived to be a manual craft rather than an intellectual discipline. Formal surgical teaching consisted of only a few lectures grudgingly appended to the University course in Anatomy. These surgical lectures were delivered by two successive Professors of Anatomy, Alexander Monro (Secundus) and Alexander Monro (Tertius), the son and grandson of Alexander Monro (Primus), who were physicians without any surgical training. This was bitterly resented by the Incorporation of Surgeons and prompted certain of its members to exercise their historical right to teach surgery independently within the city. The energy and enthusiasm of these teachers more than compensated for the surgical deficiencies of the University Medical Course and certain of them, most notably Benjamin Bell and the brothers, John and Charles Bell (to whom he was not related) did much to establish Edinburgh's reputation as a centre of surgical teaching. The College agitated strongly for the establishment of a Chair of Clinical Surgery in Edinburgh University and this was eventually approved in 1803. The College also pressed for the establishment of a University Chair of Systematic Surgery and, when this proposal was rejected, a Chair of Surgery within the College was set up in 1804. In 1831, surgical teaching within the academic curriculum was finally separated from Anatomy by the institution in the University of a Chair of Systematic Surgery and, as a result of this, the College Chair of Surgery was allowed to lapse in 1833. On 22nd May 1778, King George III granted a new Charter whereby the Surgeons were incorporated anew under the title " Royal College of Surgeons of the City of Edinburgh " . This did not completely separate the College from its connection with the Town Council. A further Charter, granted by Queen Victoria in 1851, completed the severance of the College from the Town Council and changed its title to its present form. Her Majesty Queen Elizabeth II was graciously pleased in 1979 to grant the College its sixth Royal Charter. The 1800's : a new meeting place, the Playfair Building By the beginning of the 19th Century, the Old Surgeons' Hall had become inadequate for the College and there was an urgent need to provide suitable accommodation for the large collection of anatomical and surgical specimens which had been presented to the College by Dr John Barclay. A site for this was acquired by the purchase of the Riding School in Nicolson Street. William Henry Playfair, 1790-1857, the foremost Scottish architect of that era, was commissioned to design a building containing a meeting hall, Museum, Lecture Room and Library as its principal apartments. The original plans are preserved in the College archives and the handsome furniture, designed by him for the College building, is still in use to this day. Into the 20th Century: a period of expansion In July 1905, the College celebrated the fourth centenary of its Incorporation and the most important occasion was the conferment of the Honorary Fellowship upon 36 of the world's most distinguished surgeons. These included Lord Lister, the acknowledged " Father of Modern Surgery " who had become a Fellow in 1855 and he is the only Fellow of the College ever to be awarded its Honorary Fellowship. In 1955, on the 450th Anniversary of the foundation of the College, the Honorary Fellowship was conferred upon His Royal Highness, the Duke of Edinburgh, who had graciously consented to become Patron of the College earlier in that year. The same year marked the advent of the Journal of the Royal College of Surgeons of Edinburgh, which, under the Editorship of Sir John Bruce, rapidly achieved world-wide recognition. The Annual Clinical Meeting of Fellows has developed into an important scientific occasion, in which distinguished surgeons from all over the world participate. The first College meeting outwith Edinburgh was held in 1960. This has been repeated every year since then. Some years later, certain senior Egyptian Fellows invited the College to visit Egypt and, in 1976, the first full scale College meeting to be held outwith the British Isles took place in Cairo and Alexandria. Further overseas meetings have been held in Jamaica, Sri Lanka, Singapore, Kenya, India and Malaysia and the next overseas meeting is due to take place in Hong Kong in October 1996. During the first two centuries of its existence, the Incorporation of Surgeons admitted to membership those apprentices who had been trained for six years by master surgeons and who had given satisfactory service. A statutory fee had to be paid and the aspiring surgeon was required to produce his `ticket' as a Burgess of the City of Edinburgh, but the most important condition of entry was the passing of an examination, conducted by the senior members of the Incorporation. In 1851, it was decided that admission to the Fellowship of the College should be purely by election. It was not until 1884 that the Fellowship Examination was re-introduced. From its inception, the examination flourished and the recruitment of candidates increased steadily during the early years of the 20th Century. A considerable number of those were from overseas and soon many Fellows of the College were to be found in senior surgical posts in Australia, Canada, New Zealand, South Africa, India and in all other parts of what was then the British Empire. During the 20th Century, the form and content of the Fellowship Examination has been progressively adapted to changes in surgical science and practice and in accordance with changing patterns of surgical training. The College has always been prompt to recognise the need for such adaptation, which it has managed to achieve without any diminution of standards. At the end of the 20th Century, the College has nearly 13,000 Fellows of whom some 6,300 live in the British Isles. The others are to be found in all parts of the world, but whatever their location, the Fellows are concerned to fulfil the prime purpose of the College which is, quite simply, the maintenance and promotion of the highest standards of surgical practice and surgical training. Until very recently, the College has been concerned almost entirely with the setting of standards and the conduct of examinations designed to ensure that these standards are being maintained, but as we approach the 21st Century and our Quincentennial, the College will increasingly be concerned with the provision of surgical education and training in addition to maintaining and enhancing its historic role. Dr Helen Dingwall has commenced work on the production, for the Quincentennial, of a new History of the College and this will be a record of how a local Craft Guild in the capital city of a small, poor nation on the fringe of Europe developed over 500 years into a large international organisation of high repute. It will be a record of notable service to Humanity of which all Fellows of the College can be justly proud.