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J R Soc Med. 2007 September; 100(9): 397.
PMCID: PMC1963395

The Royal College of Surgeons

I was delighted by the paper by Maynard and Ayalew on the Royal Colleges of Medicine and Surgery and its up-to-date list of the Colleges (JRSM 2007;100:306-308).1 But there is one mistake in the list; a mistake so trivial that it I mention it only because it conceals an interesting story. The Royal College of Surgeons founded in 1800 was the Royal College of Surgeons of London, not the Royal College of Surgeons of England.

With the rapid growth of hospitals in the second half of the eighteenth century, the contribution of the physicians in treating medical diseases was very slight. But the surgeons provided a genuinely helpful surgical service, based largely on the treatment of accidents. For this reason, the status of surgery rose very rapidly and the London hospital surgeons saw themselves as the ‘top dogs’—hence the foundation of the Royal College of Surgeons in 1800 and the right to put ‘MRCS’ after their names.

Fifteen years later, newly qualified general practitioners had to obtain the Licence of the Society of Apothecaries and earned the right to put LSA after their name; but a majority also took the MRCS, so that the hallmark of the typical general practitioner was the possession of the MRCS and the LSA, colloquially known as ‘College and Hall’. That is where the trouble began.

The last thing the hospital surgeons wanted was to be confused with the general practitioners, whom they heartily despised. Sharing the MRCS was out of the question, so the hospital surgeons obtained a charter in 1843 which enabled them to introduce the Fellowship (FRCS) as the hallmark of the ‘pure surgeon’. Fellows of the College of Surgeons refused to have any involvement in midwifery and pharmacy, because both played a large part in general practice, and insisted that only Fellows could use the front door of the London College; general practitioners had to go round the back. For the first few years after 1843 fellowships were handed out, without any examination, to the surgeons chosen by Council. Nepotism was rife. As an additional display of their superiority they expanded their territory, renaming their College as the Royal College of Surgeons of England. This is where and when the routine denigration of general practice by hospital consultants began.


Competing interests None declared.


1. Maynard A, Ayalew Y. Performance management and the Royal Colleges of Medicine and Surgery. J R Soc Med 2007;100: 306-8 [PMC free article] [PubMed]

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