The Extramural School of Medicine of the Royal Colleges (1895-1948) was a body consisting of lecturers recognised by the Royal College of Physicians of Edinburgh and the Royal College of Surgeons of Edinburgh, with its remit to assist in the provision of extra academical instruction in all branches of medicine and surgery. The School effectively consolidated and formalised the ad hoc arrangements for extramural medical education in Edinburgh; from the late eighteenth century extramural teaching activity flourished, with a considerable number of lecturers and private anatomy schools operating throughout the city by the nineteenth century.
Medical education began in Edinburgh in 1505 when the Incorporation of Barber Surgeons applied for their Charter and requested at the same time the body of a condemned man, once a year, for teaching purposes. In 1694, King William and Queen Mary granted the Incorporation of Chirurgians a Gift and Patent, enabling them to teach anatomy. As a result, the Incorporation built what is now known as Old Surgeons' Hall with a teaching theatre in 1697. When Edinburgh University founded its Faculty of Medicine in 1726, the Incorporation maintained its medical teaching independently, enabling many lecturers who did not teach at the university to rent rooms for teaching students, often at a lower cost. Clinical instruction of surgery and dentistry was undertaken at the city's Royal Infirmary.
In the historical record, few cities have surpassed Edinburgh’s influence and international reputation as one of the most desired locations for medical study. From the late eighteenth century through the nineteenth century an explosion of teaching activity took place in Edinburgh. This was a consequence of a number of factors, including the fact that students felt daunted by study in Paris, given the political instability in France, and indeed throughout Europe. Moreover, Leiden became a less favourable location to study medicine after the death of Dutch physician Herman Boerhaave, although importantly, many Edinburgh lecturers had studied under him which undoubtedly enticed new students to Scotland. In addition, increased educational opportunities for students from the less wealthy classes made extramural study Edinburgh an attractive option.
For the most part, anatomy and surgery had been the subjects taught in the extra-mural environment but a wider field was provided by physiology, microscopic anatomy, chemistry, medical jurisprudence, diseases of the eye, the history of medicine, gynaecology, midwifery, mental diseases, tropical diseases, ear, nose and throat diseases, histology, pathology, and the diseases of children. These classes were offered in a number of extramural schools and anatomy rooms, which had been established in various Edinburgh localities. Notable lecturers associated with extramural teaching in the eighteenth and nineteenth centuries include John Bell, Joseph Bell, John Barclay, William Cullen, Daniel Rutherford Haldane, Peter Handyside, John Lizars, Robert Knox (Knox’s anatomy classes were regarded as the largest ever held in Britain), Noel Paton, Grainger Stewart and Patrick Heron Watson.
From the late nineteenth century, a number of extramural lecturers throughout the city came together and formed the Association of Lecturers. In 1894 a Petition for a Charter was addressed to the Queen for formal recognition of a School of Medicine (the same year the Scottish Universities agreed to recognise that a University student was permitted to attend half of his classes with extra mural lecturers). This trend towards greater unity between lecturers was finally formalised in 1895 with the opening of the School of Medicine of the Royal Colleges of Edinburgh. Thereafter, intramural and extramural medical teaching in Edinburgh continued to develop side-by-side, and while lecturers were at times considered rivals (before and after 1895) and sometimes involved in quite open dispute, this nevertheless gave rise to a healthy, albeit competitive, medical teaching marketplace. Contemporaries noted the “increase in efficiency of the teaching in both sides” as a result.
The School of Medicine’s doors were open to male and female students (who for varied reasons did not attend university) to train and qualify in medical and surgical practice. This was normally achieved by following a course of study leading to the Triple Qualification (an alternative to the academic MD), which was offered by the two Edinburgh Royal Colleges and also the Royal Faculty of Physicians and Surgeons of Glasgow. Students from the University of Edinburgh were also permitted to attend extramural lectures provided by the School, in order to complement and enhance their learning. This was advantageous to many students; with classes at the University noted by contemporaries -and historians since- as being less than adequate by comparison to those offered in the extramural environment.
From the School’s inception, the lecturers were made up from those whom the Royal Colleges recognised and granted licenses to teach either qualifying or non-qualifying subjects of medical study. Supervision of the School was placed in the hands of the Governing Board (representing both Edinburgh Royal Colleges), who determined the general policy of the School. The first Governing Board, chaired by Alexander Russell Simpson included, amongst others, John Duncan, Sir Henry Littlejohn, David Berry Hart, Noel Paton, and Patrick Heron Watson. The general business of the School was managed by the lecturers (Board of Management), the Business Committee and Education Committee. The School’s administrative base was at Surgeons’ Hall for the most part. Classes were offered at a number of locations, including Surgeons’ Hall, Minto House, Forrest Road, New School (Bristo Street), Nicolson Square and Surgeon Square. Clinical teaching was also provided at various institutions including the Royal Infirmary of Edinburgh, Leith Hospital, New Town Dispensary and the Sick Children’s Hospital. Dental instruction was offered at the Incorporated Dental Hospital and School.
The School of Medicine closed its doors in 1948, principally as a result of the Goodenough Report of 1944, which effectively concluded that universities should be the main entry portal for medical students (and thus single-location study). The Report consequently set the wheels in motion that would bring extra-academical undergraduate education in medical schools to an end. As such, the three Scottish medical corporations were remodelled into being providers of higher medical and surgical education only. The Goodenough Report also recommended that the numbers of university-appointed medical teaching staff should be increased.
Compiled from the following sources:
- Helen Dingwall, ‘The Triple Qualification examination of the Scottish medical and surgical colleges, 1884-1993’, Journal of the Royal College of Physicians of Edinburgh, Vol. 40 (Sep 2010).
- Douglas Guthrie, Extramural Medical Education in Edinburgh and the School of Medicine of the Royal Colleges (E & S Livingstone, Edinburgh and London, 1965).
- Matthew H. Kaufman, Medical Teaching in Edinburgh during the 18th and 19th centuries (Royal College of Surgeons of Edinburgh, 2003).
- Papers of the Extramural School of Medicine of the Royal Colleges, Royal College of Surgeons of Edinburgh