Extramural medical education in Edinburgh

Medical education in Edinburgh is considered to have started in 1505 when the Incorporation of Barber Surgeons gained their Seal of Cause or Charter, which requested that, as was common practice elsewhere in Europe. a condemned man should be dissected each year in order that the surgical apprentices might learn anatomy. The Incorporation appointed James Borthwick as a teacher of anatomy in 1647 and he, with Thomas Kincaid, instructed students in botany and pharmacy at the Incorporation's physic garden at Curryhill House. A Royal Patent to teach anatomy was granted in 1694 and this led to the Incorporation building the first Surgeons Hall on the site of Curryhill House in what is now Surgeons’ Square. Opened in 1697 this included an anatomical theatre where public anatomy dissections were performed. Among those participating in such dissections in the early 18th century were Archibald Pitcairne and Alexander Monteith. == The Faculty of Medicine established ==

The University of Edinburgh, founded in 1582, did not begin to teach medical topics until the early 18th century, with the appointment of Robert Eliot as Professor of Anatomy. John Monro, an Edinburgh surgeon, who had obtained his medical degree at Leiden University in Holland, returned to Edinburgh with a view to setting up a medical school within the university and with an associated teaching hospital on the Leiden model. With the local support of Lord Provost George Drummond, and national support from the Earl of Ilay, Monro saw his ambition fulfilled starting with the appointment of his son, Alexander Monro primus, as Professor of Anatomy in 1719. Monro at first taught extra-murally at Surgeons Hall moving his classes to the university in 1725. The appointment of Leiden medical graduates Drs John Innes, Andrew Plummer, John Rutherford and Andrew Sinclair as university professors in 1726 marked the foundation of the university medical school, which was soon teaching a broad medical curriculum and conferred medical degrees by examination. Until this time the only way to obtain a medical degree in the British Isles was from the Universities of Oxford or Cambridge. Under the terms of the Test Acts these were only open to communicant members of the Church of England. Courses could take up to 12 years and did not include hospital clinical teaching. The Edinburgh medical school was open to all faiths, lectures were in English, bedside teaching was included in the curriculum and it was cheaper than European universities or Oxford or Cambridge. These combined to make Edinburgh popular for those seeking a medical degree, who came initially from within the British Isles but increasingly from the then British Empire. == Extramural teaching in the 18th century ==

Edinburgh's attraction as a medical teaching centre was further enhanced by the growing reputation of Alexander Monro primus. Yet in the first 25 years of the medical faculty an average of only three students per year opted to progress to graduate MD. Many chose to sit for the qualification of Licentiateship of the RCSEd which became available from 1770, while others went into practice with no formal institutional qualification. For all these groups the kudos of having studied at Edinburgh could enhance their status and career progress. From 1779 John Aitken began to teach classes in anatomy, physiology, surgery and midwifery at the Anatomical Theatre in Surgeons' Square, which was probably in Old Surgeons' Hall. The surgeon John Bell taught anatomy in his house in the square from 1787 and was joined then succeeded by his brother Charles Bell, later professor of surgery at the University of London. Their classes attracted large number of students as they taught surgical anatomy in contrast to Alexander Monro secundus, the university professor of anatomy, who was not a practising surgeon. In 1805 John Abercrombie was appointed to the staff and established a large teaching practice there. == Extramural teaching in the 19th century ==

In the first part of the 19th century extramural teaching centred on Surgeons Square. This was bounded on its south side by Old Surgeons' Hall, which was sold to the Royal Infirmary in 1832 and served as a cholera hospital and then a fever hospital before being acquired by the University of Edinburgh. Extramural teaching took place in the large detached houses on the east and west sides of the square. Number one Surgeons' Square on the north side was built as a teaching facility with a lecture theatre. In the latter half of the century teaching also took place in buildings near the university, chiefly in Brown Square, Argyle Square, Chambers Street and the new Surgeons' Hall. Extramural teaching expanded rapidly from 1855 when the university was forced into recognising extramural classes as counting towards its medical degrees. James Syme had written to the Town Council in 1840 requesting such recognition and when the university refused the matter was taken to court and eventually to the House of Lords who found in favour of recognition of extramural classes. This recognition was further expanded in 1858 by the Commissioners appointed as regulators of the university curriculum under the Universities (Scotland) Act, 1858. From 1896 many of these small medical schools were incorporated into the Medical School of the Royal Colleges, which from 1896 became by far the largest teaching establishment in the extramural school. Surgeons' Hall Extramural teaching continued at Surgeons Hall throughout the century. By 1860 a broadly based curriculum of medical subjects was taught and, after the House of Lord's judgement, these were recognised by universities as counting toward the degrees of MB, CM. Despite the fact that these classes took place at Surgeons' Hall, a variety of medical subjects were taught. This was by far the largest of the extramural schools of medicine in Edinburgh. Brown Square Brown Square was built as a residential development in 1763 and demolished in the late nineteenth century. The Brown Square School of Medicine was established by James Syme, later Professor of Surgery in the university. Syme taught anatomy and surgery and was joined in the school by John Macintosh who taught medicine and midwifery and John Argyll Robertson who taught materia medica. When Syme resigned from the school his anatomy class was continued by Alexander Jardine Lizars, later professor of anatomy in the University of Aberdeen. The school closed in 1836 when the teaching was transferred to 11 Argyle Square. Minto House, Chambers Street Minto House, a large town house owned by the Elliot family was bought by James Syme in 1829 and converted into a small surgical teaching hospital with an operating theatre and lecture room. There Syme taught surgery as did his assistants Alexander Peddie, later President of the Royal College of Physicians of Edinburgh and John Brown, whose account of the work of the hospital is described in his novel Rab and his Friends. The hospital closed in 1852. Minto House was demolished in 1873 and 'new' Minto house was built on the site, becoming numbers 18-20 Chambers Street. Number 20 Chambers Chambers Street also housed a medical school. Edinburgh School of Medicine for Women, Surgeons' Square Sophia Jex-Blake, a pioneer of medical education for women, founded the school in 1886. Most of its teaching took place in Surgeons' Square, with clinical teaching at Leith Hospital.as the RIE still continued to refuse access to women students. With competition from the College of Medicine for Women and beset with financial problems, the school closed in 1898. Edinburgh College of Medicine for Women, 30 Chambers Street The Edinburgh College of Medicine for Women was founded in 1989 by The Scottish Association for the Medical Education of Women, one of whose leading members was John Inglis, father of Elsie Inglis. This was at a time when women were not admitted to university medical schools in the UK. Clinical teaching was initially at Glasgow Royal Infirmary as the RIE still did not accept women for clinical teaching in its wards. By July 1892 the college had sufficient funds and sufficient influence to have two wards in the RIE opened to the women medical students. The college moved to new premises in 1908 and merged with the School of Medicine of the Royal Colleges in 1916. Lecturers included: • John W Ballantyne (Midwifery and gynaecology) • William Craig - (Materia medica) • James Hodsdon - (Surgery) went on to be knighted and elected president of the RCSEd. • William Keiller (Anatomy) became Professor of Anatomy at the University of Texas at Galveston.[16] • Harvey Littlejohn (Public Health) became professor of Forensic Medicine at the University of Edinburgh • William Ivison Macadam (Chemistry) • Robert Philip (Medicine) later a pioneer in the treatment of tuberculosis and president of the RCPE • William Russell (Pathology) later Professor of Medicine at the University of Edinburgh and president of the RCPE Queens' College Queen's College was the first association of extramural lecturers and schools. It was known to be active from 1841 to 1842. Classes were held at several different locations, with most at Brown Square and Argyle Square. From 1841 the lectures were recognised by the Universities of London, Oxford, Cambridge, St Andrews and Aberdeen, the Royal Colleges of Surgeons of England, Edinburgh and Ireland, the Apothecaries Hall, London and the Faculty of Physicians and Surgeons of Glasgow. Lecturers included Robert Knox (11 Argyle Square) - anatomy and surgery; William Campbell (11 Argyle Square) -midwifery; James Marr (3 Surgeons' Square) - midwifery David Skae (11 Argyle Square) -medical jurisprudence; George Atkin (23 Brown Square) - botany. == Extramural teaching in the 20th century ==

The School of Medicine of the Royal Colleges of Edinburgh In the last decade of the nineteenth century an Association of Extramural Teachers was formed with a view to consolidating most of the smaller schools into a single institution under the aegis of the two medical Royal Colleges in Edinburgh. Dr (later Sir) Henry Littlejohn was chairman of the association and a leading figure in the formation of this new school. The first Board of Governors was chaired by Alexander Russell Simpson and included John Duncan, Harvey Littlejohn, David Berry Hart, Noel Paton, and Patrick Heron Watson. In 1894 the Scottish universities agreed that university students could attend half of their classes in the new school as counting towards a degree. From 1896 many of the small medical schools were incorporated into the School of Medicine of the Royal Colleges, which from 1896 became by far the largest teaching establishment in the extramural school. While most of the classes were held in Surgeons' Hall, there was teaching on smaller sites including The New School in Bristo Street, Park Place School., Minto House and 27 Nicolson Square. The Goodenough Report published in 1944 recommended that all undergraduate medical education in the UK should be carried out by universities. In the face of this the school closed in 1948. Lecturers included: • Joseph Ryland Whittaker, Richard James Arthur Berry (Anatomy) • Agnes Rose MacGregor, Peter MacCallum, Robert Muir (Pathology) • A Nimmo Smith (Bacteriology) • James Ormiston Affleck, Byrom Bramwell, William Russel, George Alexander Gibson, Robert William Philip, John Comrie, Douglas Chalmers Watson, Andrew Rae Gilchrist, T R R Todd, David Murray Lyon (Medicine) • Alexander Pirie Watson, Montagu Cotterill, Charles Walker Cathcart, William James Stuart, John William Struthers, Henry Wade, G L Chiene, James Methuen Graham, Walter Quarry Wood, Walter Mercer (Surgery) • Robert Johnstone, Benjamin Philip Watson, James Haig Fergusson, Douglas Miller, Clifford Kennedy, Ernest Fahmy (Midwifery/Gynaecology) • Arthur H H Sinclair, Harry Moss Traquair (Ophthalmology) • Douglas Guthrie, Ion Simson Hall, G Ewart Martin (Diseases of Ear, Nose and Throat) • Dawson Turner (Radiology) == Further reading ==