The College Charter

Since its inception in 1681 the College has always been subject to the terms and conditions of the current Royal Charter. Much time and effort had to be expended by our predecessors before the successful award of our first Royal Charter. Foremost among those responsible were George Sibbald and George Purves. Initial approaches were made in 1617 and subsequently in 1621, 1633 and 1656. These efforts were blocked by opposition at different stages from the Bishops, the Corporation of Surgeons, the Town Councils of Edinburgh and Glasgow and the Universities, particularly that of Aberdeen. All of these felt that their rights and privileges would be infringed by the proposed College of Physicians.

Finally Robert Sibbald, nephew of George Sibbald, with the help of the King’s High Commissioner, the Duke of York, and of Sir Charles Scarborough, the King’s First Physician, was received by Charles II, then in Edinburgh, and presented him with the Royal Warrant of James VI dated 1621 concerning the establishment of a College of Physicians in Edinburgh. Sibbald, and James VI’s signature, succeeded where others had failed, and the Charter of Erection was signed by Charles II and the great seal appended on St Andrew’s Day 1681. The following year Robert Sibbald was knighted. His portrait hangs in the Fellows Room.

A Charter of Ratification was granted by the Scottish Parliament in June 1685.

No changes in the original charter were made for nearly two centuries. The Medical Act of 1858 had many implications as far as the Royal Colleges were concerned, and after Amending Acts had been passed in 1860 the College, following considerable debate, agreed on the form of a new Royal Charter which was granted by Queen Victoria and sealed on 31 October 1681.

Changes in medical practice have progressed at such a pace during this century that four supplementary charters have been required between 1920 and 1964 to allow the College to increase its activities beyond the bounds set by the 1861 Charter.

The Report of the Royal Commission on Medical Education led to a further reassessment of the role of the College and in 1968, Dr Christopher Clayson, then President, appointed a committee which subsequently became known as the ‘Croom’ Committee after its chairman Sir John Halliday Croom, who succeeded Dr Clayson as President. The recommendations of this committee are the guidelines for present College development. Included in these was the establishment of Collegiate Membership, the first step to greater involvement of Members in the affairs of the College. In addition, other developments, including the MRCPE (UK) and the establishment of the Faculty of Community Medicine jointly by three Royal Colleges of Physicians in the UK, have necessitated a major revision of the College Laws.

Previously published in the Proceedings of the Royal College of Physicians of Edinburgh (1977), 7: 2
Author: A. J. Keay

The College Dispensary

The seventeenth and eighteenth centuries were, for medicine, notable for their great plurality.  There were all kinds of treatments on offer – healers, quacks, wise women, and itinerant sellers of all manner of cures.  Orthodox medicine, however – practiced by trained and qualified physicians - was largely reserved for the elite.  As hospitals were rare, and often more focused on spiritual wellbeing than medical treatments, wealthy folk were usually treated in their homes – either by a visiting physician, or via correspondence.

Which is partly why the Royal College of Physicians of Edinburgh’s decision, at its very first minuted meeting in 1682, to establish a Dispensary for providing medical services for the poor was so significant.  This was to be the first ever free provision of medical services for the poor of Edinburgh, providing everyone with access to respected medical opinion and treatment. It was also the first free public dispensary in Britain.

Establishing a Dispensary

The College first resolved

‘that att the next meeting of the Colledge some persouns be appointed by the Colledge to be physitians for the poore’

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(Extract from College Minutes)

This determination continued into the next meeting, where it was decided that physicians would be appointed for a period of 12 months each, two at a time, to visit the poor and provide advice and treatment.  It was

‘ordered that Doctors Burnett and Crawfurd shall until the next electione of the College serve the poore of the Cittie and suburbs’

(Extract from College Minutes)

Paying for the poor

The College physicians developed and maintained this service, contributing to the costs of medicines.  This was done in part by the expedient measure of fining any doctors who failed to attend at their prescribed times to ‘the sick poore’.  So any failure to provide a service in person was provided out of their pocket instead.

Later it was decided that fixed contributions to the Dispensary were to be paid by each Fellow on election to the College.  This provided a much more stable and reliable stream of funding to support the service.

Expanding the service

In 1705, when the College moved into more ample premises,  it was decided to provide an on-site rather than home-visit service, allowing them to treat many more patients. 

‘unanimouslie agried…That tue of their number shall attend at their place of meeting every Munday Wedensday and ffryday betwixt thrie and four in the afternoon for givieing advice to the sicke and poore Gratis’

Treatment and cure

The treatment provided by this on-site Dispensary would have looked significantly different from its equivalent today.  An emphasis at this time on bleeding and purging seems unlikely to have always been helpful.  And while notions of the need for clean air and clean surroundings, as well as a healthy diet and lots of exercise, have a definite logic to them – they were perhaps less achievable for many of the poorer patients than for the more well-off clientele.  Newer chemical and herbal remedies coming to the fore were more likely to provide a cure than the older traditional unicorn horns and weapon salve (where treating the weapon which had caused a wound was believed to cure the wound itself).

The new Royal Infirmary

(Site of Edinburgh Royal Infirmary, c.1729)

Later, when the Edinburgh Royal Infirmary was established in 1729, managers advanced a proposal

‘That in place of the Colledge their giveing attendance upon poor patients at their own hall twice a will be pleased in time Coming in their turn to attend the poor out patients at the Infirmary’

The Dispensary moved from the College to the Infirmary, but the principles and system of organising this service for the poor continued.

The College Laboratory

The College decided by the 1880s that as well as focussing on regulation of the profession, they should also pursue a stronger line in research.  By 1887 they had formalised this idea, agreeing to establish a laboratory ‘for the prosecution of Original Research’. 

The laboratory was split into the areas of Bacteriological, Chemical, and Histological and Experimental, and researchers came from a wide variety of institutions, and included veterinary pathologists, chemists and zoologists, as well as physicians.

Medical research

The laboratory was broad in its scope, and eventually drew workers from as far as Lithuania and Hong Kong, received specimens not just from Scotland and England, but from Kansas, Cairo, Legos and Teheran, and collaborated on projects with researchers in America, India and Australia.

They defined their medical remit in the broadest sense – one Superintendent emphasising ‘the rejection of the narrow and utilitarian aspect of research’.  This enabled them to study areas including the workings of the stomach of the narwhal, botanical histology, salmon migration (on behalf of the Scottish Fisheries Board), and the nature of Malayan arrow poisons.

Laboratory equipment. (1890s)

They carried out research into conditions and diseases such as leukemia, anaemia, haemophilia, foetal death, meningitis, cancer, deaf mutism, asthma, insanity, and pneumonia, and also some more unusual conditions such as a small outbreak of epidemic plague in Glasgow in 1900, and a case of leprosy in Edinburgh.

War work

In the First World War the laboratory produced stock vaccines on a large scale for both army and civilians, including anti-typhoid and anti-dysentria.  They carried out naval pathological work, did research on trench frostbite and bacteriology of wounds, and studied methods of combating poisonous gas.

Social medicine

The wider social side of medical research was also not forgotten – the College carrying out work on the poisonous air in coal mines (due to a particular fungus growing on the ceilings of certain mines), and investigations into the diet of the labouring classes of Scotland, purity of city water supplies, and pollution (in terms of toxic deposits found in the Clyde and Tyne rivers).  They also did comparative work on urban and rural mortalities and a detailed comparison of vital statistics between Scotland, England, Wales and Sweden.

The laboratory carried out research on various aspects of industrial disease – ventilation in factories (particularly with regards to benzene poisoning), lead poisoning among ship builders, and blood changes in connection with the trade processes of ‘glazing’.

The College laboratory. (1890s)

Nutrition and health

In the late 19th century the laboratory, like much of Victorian society generally, was interested in nutrition and lifestyle.  They did research into different types of vegetarian diets, studies including one gentleman who was convinced that the less a man ate the stronger he became.  To prove this he confined himself to a diet of bananas and hot water, although after 5 days he ventured that he might actually rather like some bread and butter.

They also studied the diets of students in five different residential halls at the University of Edinburgh (coming to the conclusion, perhaps unsurprisingly, that they were somewhat lacking in a balanced diet).  In 1900 the laboratory carried out some possibly more immediately useful research for the government on the nutritional qualities of ‘Famine Foods’ (uncultivated plants used as food by the Bhils during a recent famine in India).

Diagnosis and reporting

The laboratory was never intended to be just for the use of College fellows, but was to be made available to medical practitioners more widely.  From the outset the investigation of patient specimens was part of their remit, as well as the often more esoteric scientific research.

The reporting side though, particularly as the College did not charge for this service, just kept on growing.  At that time, as there was no National Health Service, the laboratory was often the first port of call for doctors – not just in Scotland, but often for England and Wales too, and even overseas.  In 1890 the laboratory received fifty specimens for examination.  By 1898 the figure was over a thousand, and the figure steadily increased year on year – by 1948 reaching an impressive 30,909.

This was stretching the resources of the laboratory to the limit, and greatly impacted on the amount of actual research that could be carried out.  The only way that seemed practical to reduce this was to instigate charging, but there was understandably a concern that this would result in a service which was effectively only for the rich.  On this, it was emphasised by the College that ‘no limitation be made regarding the facilities for such examination to certain classes of citizens’.

Although unfortunately it was increasingly clear that there was a fairly high level of ‘laboratory abuse’ taking place.  Because the service was completely free, many specimens were sent which any competent practitioner should have been able to deal with themselves, there were other investigations which were requested which were clearly of no practical use, and some where the doctor had bothered to record so little information that any conclusion would be close to useless. 

In order to keep the laboratory running a charge was eventually introduced for local authorities, although a free service for patients and practitioners in need continued.

Closure

The wide ranging work of the laboratory, both in providing patient diagnoses for general practitioners, and carrying out wide ranging medical research, came to a halt in 1950.  The establishment of the National Health Service in 1948 signalled its end – the reporting was to be carried out elsewhere, and the research was not considered sustainable on its own.

The ending of the original research the laboratory carried out was a great loss, with one previous laboratory Superintendent writing:

‘That in the brave new world…no place could be found for an institution so long established, so widely known and with so high a reputation may seem strange to us, and to future generations perhaps inexplicable.’

The College Physic Garden

The Royal College of Physicians of Edinburgh has a rich history of development and support for the city's physic gardens, dating back to the seventeenth century. Sir Robert Sibbald not only founded the Royal College of Physicians of Edinburgh, but by co-founding the physic garden at Holyrood Abbey in 1670 he also became the founder of what is now the Royal Botanic Garden Edinburgh.

It seems fitting, therefore, that this close link between the two institutions should be celebrated by creating a new physic garden. In 1993, plans were made for a collaboration between the two institutions to convert a hidden courtyard of the Royal College of Physicians at 9 Queen Street into a “jewel”; into a “small, but exquisite garden”.

David R. Mitchell, leading horticulturist and garden designer for the Royal Botanic Garden Edinburgh, was entrusted with creating this historically symbolic space. The available courtyard space was confined and the light levels (being surrounded by tall buildings) would pose a challenge to many plants. A traditional sundial as the focal point of the garden was not feasible without a clear view of the horizon, so a bust of Sibbald was, very fittingly, chosen instead. The design takes a modern interpretation, which reflects the importance of plants to mankind throughout the ages.

This new physic garden revives medical, botanical and institutional histories. It is a showcase not only for medicinal plants, but for the scientists and publications associated with them.

The Beds in the Physic Garden

Bed One: The Early Herbalists, features plants included in the writings of the Roman and Greek herbalists Pliny, Theopharastus and Dioscorides. Other plants were selected from the writings of the Emperor Charlemagne, who decreed that medicinal plants should be cultivated throughout the land to aid his troops.

Bed Two: The 16th & 17th Centuries, focuses on the rise of herbalism in Great Britain from the late 15th to the 17th century, with the work of the well known herbalist and botanist William Turner, considered to be the father of English botany after the publication of his book A New Herball, between 1551 and 1561.

Bed Three: The 18th & 19th Centuries, celebrates the contribution made by Philip Miller and Elizabeth Blackwell, as well as the discoveries of new plant treatments from the Americas.

Bed Four: The 20th & 21st Centuries, celebrates the use of plants in medicine today and looks into the future with research into the use of new plant compounds.

You can find out more about the contents of the physic garden here.

You can also discover more about the history of Edinburgh's physic gardens here.

John Thomson

(15 March 1765 – 11 October 1846)
College Role: 
President

Biography

John Thomas was born at Paisley on 15 March 1765 to Joseph Thomas, a silk weaver, to whom he was apprenticed at the age of eleven for seven years. Thomson, however, wished to study medicine and in 1785 apprenticed with Dr White of Paisley. In 1788, Thomson entered the University of Glasgow and moved to Edinburgh the following year. He was appointed assistant apothecary at the Royal Infirmary in September 1790 and became house surgeon a year later. Thomson became a member of the Medical Society in 1790 and the following year was elected one of its presidents. In 1792, he moved to London where he studied anatomy at John Hunter’s school of medicine.

In London, Thomson made many valuable contacts before returning to Edinburgh in 1793. He married Margaret Crawford that same year, though only one of their three children together survived. Also in 1793, Thomson became a surgeon at the Royal Infirmary. From 1799 to 1800 Thomson’s interest in chemistry led him to conduct classes at his house, at which he made the acquaintance of the Earl of Lauderdale. In 1800 he began teaching surgery at the Royal Infirmary as well as lecturing on the nature and treatment of injuries and disease familiar to military surgeons.

In 1804, the College of Surgeons of Edinburgh established a professorship of surgery and Thomson was the first to be appointed to this post. In 1806 he was appointed regius professor of military surgery at the University of Edinburgh. Thomson’s first wife died in 1804 and in 1806 he remarried. Two of their children survived to adulthood. Thomson obtained his MD from the University and King’s College of Aberdeen in 1808. In 1814 Thomson travelled around Europe to various medical schools to examine the different methods employed. In 1815, he was instrumental in the founding of Edinburgh’s New Town Dispensary.

Thomson’s classes on military surgery were incredibly popular and by this period he had reached the peak of his career. However, Thomson began to contemplate becoming a physician. Thomson studied smallpox and lectured on the diseases of the eye in 1819 and was instrumental in founding the first eye infirmary in Edinburgh in 1824. From 1822 to 1826 he studied general pathology. In 1832 Thomson was appointed professor of general pathology at the University of Edinburgh.

After 1835, repeated bouts of illness caused Thomson to suspend his practice and resign his professorship in 1841. He died in his home in Edinburgh on 11 October 1846. He was spoken of as one of the most learned physicians in Scotland of his time.

Notable Achievements

Thomson became a fellow of the Royal College of Surgeons of Edinburgh in 1793.

In 1806 George III made Thomson the first Professor of Military Surgery.

From 1834 to 1836 Thomson was President of the Royal College of Physicians of Edinburgh.

Key Publications

•    Elements of Chemistry and Natural History (1798-1800)
•    Observations on Lithotomy, with a New Manner of Cutting for the Stone (1808; with appendix, 1810)
•    Lectures on Inflammation: a View of the General Doctrines of Medical Surgery (1813)

Stuart Threipland

(1716-1805)
College Role: 
President

Biography

Here is a College president honoured as a physician but also remembered for his colourful past. In a sense his name said it all: Stuart, spelt in that way rather than ‘Stewart’, was a mark of his family’s devotion to the Jacobite cause – having a Catholic monarch back on the throne.

The Threipland family originated in the Borders, but around 1600 they moved to Perthshire, buying the Fingask estate and its castle in the foothills of the Highlands, between Perth and Kinross. When the 1715 Jacobite Rebellion started Sir David Threipland immediately joined the Earl of Mar and his men, hoping to reinstall a Stuart on the throne. He was captured by government troops but escaped into exile (although some have claimed that he died in captivity). In 1716 his wife had a premature son whom, not surprisingly, they called Stuart. Soon after, the family were permitted to return, not as owners but as humble tenants of their old home.

Stuart Threipland eventually entered the University of Edinburgh to study medicine. In 1737, he helped to found the student organisation later known as the Royal Medical Society and later served as its president. In 1778 the society was granted a Royal Charter, the only student body ever to be so honoured. After qualifying Stuart started a practice in Edinburgh.

The year 1745 saw Prince Charles Edward Stuart, the son of the 1715 rebellion’s leader, raise his standard in another attempt to regain the throne for a Stuart. Threipland and his elder brother, David, immediately joined the Jacobite army. David soon lost his life in the battle of Prestonpans, while Stuart became the senior medical officer throughout the campaign, which spanned as far south as Derby and then back to the disaster of Culloden in 1746.

Together Threipland and Prince Charles managed to escape and make their way to Badenoch where they hid in a cave. Here Threipland also cared for the clan chieftain Cameron of Lochiel who had serious ankle injuries. Dressed as a Presbyterian minister (although in fact he was an Episcopalian), Threipland reached Edinburgh where he changed his dress to that of a bookseller’s apprentice. He eventually reached France about the time Prince Charles returned to exile there.

The 1747 amnesty allowed Threipland to return to Scotland, although his fellow medical officer at Culloden, Archibald Cameron, did not fare so well and was, in spite of the pleadings of Professor Alexander Monro primus, hanged at Tyburn in London.

Threipland married and made his new home in Edinburgh’s Fountain Close where the Royal College of Physicians of Edinburgh had its first home. His practice thrived and within a few years he moved to Bishop’s Land in the High Street, where he was attended by a butler, a footman, a coachman and his boy and several maids. He lived in Edinburgh during the glorious years of the Enlightenment and the flowering of our College, of which he was President from 1766 to 1770. 

As he approached retirement Threipland repurchased the Fingask estate, his family’s old home, and restored it to its former glory before he died aged 89. The estate exists to this day and is again owned by the Threipland family. Threipland’s devotion to the Stuarts never faltered, demonstrated by his continuing to toast ‘the King across the water’.

The College still has Threipland's medicine chest, used at the Battle of Culloden, in its collections. You can discover more about this chest in the following articles:

Sir Stuart Threipland’s medicine chest

The contents of Sir Stuart Threipland’s medicine chest: list 1

The contents of Sir Stuart Threipland’s medicine chest: list 2

Notable Achievements

Threipland helped found what would later be known as the Royal Medical Society in 1737.

He was president of the Royal College of Physicians of Edinburgh from 1766 to 1770.

 

Previously published in the Journal of the Royal College of Physicians of Edinburgh (2010), 40: 378
Author: Derek Doyle.