In 2005 the Royal College of Surgeons of Edinburgh celebrated its quincentenary. There is much to be said for taking this as an opportunity to recount the College's history. Quite apart from celebrating the institution's longevity, there is a deeper historical interest in understanding how it has survived, and how it has responded and adapted to changing circumstances and an evolving cultural context. Helen Dingwall tells that story in a way that will interest and entertain medical historians and the Fellows and Members of the present-day College alike. Central to the College's history is its changing role in the evolving medical economy. The College began life as a trade incorporation, founded to secure and protect the rights and privileges of its members within the complex occupational and political structures of renaissance Edinburgh. By the eighteenth century, as skill in surgery became an increasingly saleable commodity in a burgeoning market economy, the Incorporation had begun to take on an additional educational and examining role, earning a healthy income from the pedagogical reputation of its members and the prestige of its diplomas. By the mid-twentieth century, as medical teaching came to be monopolized by the universities and medical practice by the state, so the College consolidated its activities around the administration of higher examinations, controlling access to consultant status within an increasingly hierarchical health care system. The story of how the College achieved that transformation while maintaining its continuity of identity and tradition is a hugely complex one. The surgeons had constantly to negotiate and redefine their role in relation to many other institutions that made up its social and political environment. Initially, these were mostly local, including the Town Council, the Royal College of Physicians of Edinburgh, the University and the Royal Infirmary. Engagement with national institutions—most importantly Parliament and the Crown—was more sporadic, but became increasingly frequent with the growth of state regulation and state provision of medical care from the nineteenth century onwards. These institutional interactions were further complicated by a host of other contextual factors with which the College had to contend, including the impact of major wars, the incursion of women into the medical profession and—most importantly—the enormous change in the technical capabilities of surgery over the past five centuries. Given these many and diverse strands to the College's history, the deftest of storytellers would struggle to weave them all into a seamless whole. Dingwall opts for a broad five-part periodization, spanning the early years of the Incorporation to 1581, its consolidation to 1726, the growth of commercial medical education to 1830, the period of medical reform up to the establishment of the NHS in 1948, and the globalization of medicine since the Second World War. Within this framework, she occasionally gestures towards a unifying view of the College as a participant in an expanding Habermasian public sphere, but the idea is scarcely developed and does little to resolve the rather episodic nature of her story. Other historical processes such as specialization and professionalization remain unexamined, invoked merely as a shorthand for describing otherwise unexplained events. Meanwhile, certain aspects of the College's history—its role in public health reform, for instance, or the growth of its museum collections—are simply tacked on to the end of larger chronological chapters rather than integrated into the narrative. Consequently, the overall result is often somewhat disjointed and piecemeal, despite Dingwall's clear appreciation of the need for a more integrated evolutionary vision. That said, there is much here for which medical historians should be grateful. Dingwall has made a deliberate and sustained attempt to move beyond the merely celebratory genre to which so many institutional histories belong. Her attention to the economics of institutional survival, and to the politics of professional self-interest as much as public service, are particularly to be welcomed. Likewise, her careful accounting of the College's struggles for control over surgical practice and medical education help to illuminate the development of medicine not just in Edinburgh but more widely. The book itself is beautifully produced and copiously illustrated, and the subscribers whose names are recorded in the opening pages can take pride in having supported a valuable historical study as well as a handsome testament to their College's continuing vitality.
Read full abstract
Nov 8, 2024
Wenhui Xu + 1
Just Published
Open Access