Physicians and Society: A History of the Royal College of Physicians of Edinburgh (review)

“All professions are conspiracies against the laity.” Bernard Shaw’s accusation is not the mere quip it is often assumed to be, but I doubt whether this book’s author would agree. The main title of his new history of the Royal College of Physicians of Edinburgh (RCPE) is “Physicians and Society,” with Dr. Morrice McCrae, a former Glasgow pediatrician, emphasizing its role in securing and maintaining the health of the Scottish people, rather than in education or research.

Is, then, such emphasis justified? To be sure, at its very start (1681) the College set up a free dispensary serving the poor, and fifty years later opened an enlarged infirmary, with a second dispensary after another seventy years. Nevertheless, much of its early days centered on maintaining its dignity and pomp, and resolving both internal and external squabbles—especially over the “new science” and the pharmacopoeia and the early plans for its own school of medicine. And, with the French Revolution, some public health schemes were delayed because of the fear of sedition by the working classes.

McCrae documents the early evolution of the College with necessary but to my mind over-extensive accounts of Scottish history and excessively long quotations. His book justifies its title, however, from around page 100, with the problems arising from an emerging industrial society. As in England, cholera was the touchstone; surfacing at Sunderland in 1831 with widespread outbreaks, particularly in the towns, and further epidemics in later years. But the responses in the two countries were very different. Crucially, McCrae shows, Scotland was prepared for the threat: established two weeks before cholera arrived there at Haddington in December, the twenty-seven-man Edinburgh Cholera Board of Health contained some fifteen medical members, six of them Fellows of the RCPE, and three with experience of treating cholera in India. Besides restricting movement in the city, it set up soup kitchens, four special hospitals, and ten quarantine houses, justifying such measures with posters displayed throughout the city.

The RCPE was fortunate in its then President, though for somebody so seminal in the Scottish health movement, surprisingly William Pulteney Alison (1790–1859) is all but forgotten today. Thus he does not feature in works such as W. F. Bynum’s Science and the Practice of Medicine in the Nineteenth Century (Cambridge, MA: Cambridge University Press, 1994), or Roy Porter’s The Greatest Benefit to Mankind: A Medical History of Humanity (New York: Norton, 1998), while the Dictionary of National Biography (Oxford and New York: Oxford University Press, 2007) has only a respectful, lackluster account. Yet it was Alison who put the long-discussed concept of a “medical police” service for health in Scotland into major practice. His teacher, Andrew Duncan, another College President, had been impressed by the ideas of the Viennese physician Johann Peter Frank, but had had to wait for ten years to get an Edinburgh chair established, and then only in the Law Faculty. Born into a wealthy family, and having also studied philosophy, Alison had absorbed Duncan’s ideas and had investigated the living conditions of various populations on his Grand Tours, helping to found the new and more wide-ranging Edinburgh Dispensary in 1815. Two years later he wrote the influential College report that led to setting up Edinburgh’s Fever Board—the model he later used in persuading the authorities to establish the Cholera Board of Health.

Contrast this forward planning in Edinburgh with the disagreements and dithering in London, where eventually the Privy Council retained the London College representatives only as advisors to a reconstituted cholera board. Not surprisingly, then, given the experience of no advice from London, both the authorities and the Edinburgh College insisted that future public health services in Scotland be controlled in Edinburgh and not London. Thus the regimen in the Scottish poor houses was never as harsh as in the English workhouses. And the...