J R Soc Med 2001;94:355-357
© 2001 Royal Society of Medicine
The flowering of London pride: finding a name for it
Arthur Crisp MD FRCPsych 1
David Innes Williams FRCS 2
Robin Price MA 3
1
Formerly Dean, Faculty of Medicine, University of London, member of the ‘Flowers
Working Party’
2
Formerly director, British Postgraduate Medical Federation
3
President, British Society for the History of Medicine
Correspondence to: Professor AH Crisp, 113 Copse Hill, London SW20 ONT,
UK
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INTRODUCTION
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In the 1970s, university funding, which had risen progressively
over the
preceding years, began to plateau. The University of
London was especially
afflicted. There was a need to rationalize
resources and the vice-chancellor
of the day, Lord Annan (previously
provost of University College London), saw
opportunity and advantage
in tackling medicine first. At the time the Faculty
of Medicine
comprised 12 so-called undergraduate medical schools, 13
exclusively
postgraduate medical institutes, 5 dental schools, 2 schools
of
pharmacy and the school of veterinary medicine. Its excellence
was not much in
dispute. In the main, these schools were academically,
geographically and
financially separate from the University
multifaculty institutions. London
academic medicine attracted
postgraduate students from around the world much
in the way
that Vienna had a century before. But its academic foundations
were
becoming less secure in that the schools were often divorced
from mainstream
sciences within the University at large. With
financial imperatives in mind it
was also apparent that maintenance
of a large number of adjacent but
administratively separate
and small medical schools was especially expensive.
Hidden agendas
may have included ideas surfacing in two of the major
multifaculty
institutes, ultimately to break away from the federal University
and
take segments of academic medicine with them. It was also felt
that, if
London academic medicine could be rationalized, the
process might serve as a
model for dealing with other Faculties.
At this time the Faculty of Medicine
within the University was
an active body, largely in the hands of clinical
academics,
determining academic standards and coming to involve individual
medical
schools somewhat more robustly. A working party was set up with
Sir
Brian Flowers (rector of Imperial College and subsequently
Lord Flowers) as
its chairman.
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FLOWERS
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The working party saw its task as securing the long-term excellence
of
London academic medicine. It dealt exclusively with University
matters and its
concerns with clinical services were restricted
to ensuring that they were, or
shortly would become, good enough
to sustain clinical teaching into the
foreseeable future. Such
teaching had often been vested historically in one or
other
adjacent and famously named ‘teaching hospital’
which had
given that name to the related medical school. It
soon became apparent, with
recent population shifts and more
academic emphasis on social and community
aspects of medical
education, that some excellent central London schools in
particular
were at risk of asphyxiation.
The Flowers
Report1, published
in 1980, provoked a stormy reaction. It had proposed the consolidation of the
12 undergraduate schools into five blocks, with four of these embedded
respectively in multifaculty colleges—namely, Imperial College, King's
College, Queen Mary College and University College. The postgraduate medical
schools and schools of dentistry were also woven into this fabric. The
exception was St George's Hospital Medical School which was too geographically
isolated to be easily absorbed, having recently moved from central London to a
densely populated part of outer London. Lively discussions persisted through
the following year and only slowly did things change.
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PRIDE AND PREJUDICE
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Mergers and loss of independence are seen as threatening in
many walks of
life even when logic demonstrates their advantages,
and proud names carry a
treasured sense of identity even when
the implied self-sufficiency is long
lost. At stake for the
London Medical Schools was that valuable asset an
established
sense of community, linking both staff and students in a common
enterprise.
Theirs was a long tradition and for a Barts man or a Guy's man,
for
instance, the primary loyalty was to the hospital and its medical
school;
even if they took its degrees London University was
often seen as in essence
an examining body. In the mergers the
coupling between hospital and medical
school was often to be
lost; the hospital name would of course be kept, but
with pooling
of staff, and students attending many different centres, some
new
focus of loyalty would be required. It could be that the
huge multifaculty
college of which they were to be part would
seem as remote as the University
itself had been.
For the institutes of the British Postgraduate Medical Federation the
situation was rather different. They had grown from London's ‘special
hospitals’, which, though originally despised by the medical
establishment, had over the course of a century achieved high international
reputations. These were still regarded with disfavour by many in the general
medical schools, accused of creaming off the resources, staff and clinical
material which should properly have been devoted to undergraduate education.
The institutes feared that they were to be engulfed by these envious giants
and would lose the integrated approach to their special interests built up
over so many years. The special hospitals were still of vital importance to
them and talk of incorporating these in larger new general hospitals was
frightening; but, if the hospital survived, at least the institute would
remain coupled to it and retain its old loyalties. In the event, this was the
outcome for some but not all of the institutes.
Indeed, 23 years later, the new pattern, in terms of the Faculty's
undergraduate and postgraduate institutions, is now almost exactly as
‘Flowers’ recommended. The new medical schools, as part of more
powerful academic blocks and also because of their internal academic
evolution, now largely run their own courses and examinations on a looser
rein, though still with ultimate central university governance. The degrees
for the moment remain those of the University of London.
There is one aspect of the Flowers Report which has sunk without a trace.
The working party, foreseeing the possible implementation of its
recommendations, suggested that new academic identities would emerge and that
new names for the schools might come to be welcome. This was ‘one bridge
too far’. Schools were not accepting of the reassurance that the old
teaching hospital names would often survive and remain linked to them,
unaffected by the renaming of the medical school. They wished to preserve them
in their own titles. But, in the event, many of the old medical school names
have now been submerged beneath new descriptive titles that reflect the new
linkages. These names, linked though they also are, in four instances, to the
distinguished names of their respective multifaculty colleges, are not always
totally meaningful and agreeable in themselves.
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ROOTS
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Relationships between medical education and universities can
be especially
complex. Universities without a medical faculty
often crave one. Those with
such a faculty sometimes bemoan
its cost and troublesomeness. London has been
no exception.
The University of London, as we now know it, was created in
1836.
Before this (apart from University College, which had claimed
the title
in 1826) London was very unusual amongst the leading
European cities in not
having a formalized university. But medical
education had been going on in
London for centuries. Following
the foundation of St Bartholomew's Hospital in
1123, Fitz-Stephen
felt able to
comment
2 that, in
the 1170s, there were several
‘famous schools’ in medieval London.
Subsequently,
within the
text
3 celebrating in
1986 its 150 years of existence,
the University acknowledged that
‘Antedating the University
was a range of preexisting institutions, some
of them important
enough for it to be plausibly held that there already
existed
an unformed university of London. The longest roots of the University
of
London in its twentieth-century form are to be sought not so
much in the
teaching of law in London as in the teaching of
medicine’. Indeed, in
1923, Gordon Wilson
4
had been unable
to resist the comment that such learned instruction had been
part
of the London scene ‘when Oxford was an obscure Saxon
village and
Cambridge noted only for eels’.
But the medical schools remained reluctant bedfellows. As
Logan5 pointed out,
it was only in 1900, when the University was reconstituted, that formally they
became part of it. The Faculty of Medicine of the University, destined rapidly
to become the largest in the English-speaking world, was thus born. However,
the schools' aloofness persisted, even after the creation of the University
Court in 1929, which thereafter came to channel their funding. In 1944 the
influential Goodenough
Report6 recommended
that the medical schools should ‘take all possible steps to make their
associations closer, more active and more mutually advantageous’. The
National Health Service Act of
19467 had the effect
of disconnecting the governance of the medical schools from their parent
teaching hospitals and entrusting it to the University. By the late 1940s, all
medical students were required to take a centrally prescribed course of study
and usually to qualify with a university governed degree. In 1968 the Royal
Commission on Medical Education made further
recommendations8
regarding integration and laid the foundation for the Flowers Working
Party.
Swept along by this tide, the medical schools continued to cherish their
traditions. It had not required the University to kindle their pride. They had
long been aware that they owed their existence largely to the vision and
philanthropy of individuals, based as they still were on the hospitals that
had conferred their names upon them. The foundations of some went back many
centuries (not only Barts but also St Thomas's, which was accustomed to
claiming origins in the first millennium). In the absence of a formal
multifaculty university, teaching of medicine had for long assumed a bedside
apprenticeship form (which finds its present expression in the emphasis still
given in the UK and Eire to undergraduate clinical training). This approach
had been formalized by the Apothecaries Act of
18159, which
required attendance at specific courses as well as six months' attendance at a
hospital. From the beginning of the seventeenth to the end of the nineteenth
century such teaching, sometimes led by physicians, surgeons and obstetricians
of great professional stature and lasting fame, provided the basis of medical
education in London. Despite this, standards of medical practice as
experienced by the public at large became an increasing source of public
concern. This culminated in the 1858 Medical
Act10 and formation
of the General Medical Council and its Education Committee, destined to
determine the standards and hence the form and content of undergraduate
medical education thereafter. Thus such education became ever more
standardized, thereby possibly ensuring that the schools up and down the
country, and perhaps especially in London, did everything else possible to
retain their individual identities. Most recently the Education Committee of
the GMC, first having spelled out in considerable
detail11 what
attributes it requires of the present day fully trained doctor, has
recommended12 that
henceforth there can be a greater degree of freedom in the undergraduate
curriculum within a generally accepted examinable framework. This once again,
after more than a century of increasing constraint, allows greater
individuality to schools—particularly in respect of elective special
study modules, which invite student initiatives and draw upon the particular
strengths of each school.
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A NEW FLOWERING
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There may be a special message here for the reorganized and
sometimes
bruised medical schools in London. It is perhaps an
opportunity to build on
tradition in an accessible way. And
what better than to identify a name from
the past which communicates
that intangible sense of identity and discovery,
expressing
at once continuity and an intellectual and clinical adventure?
‘Flowers’ had the temerity to make some suggestions at the
time. It proposed that, over the centuries, London medicine had spawned people
whose contributions to the field were huge, pivotal to new understanding and
thus enduring. Names that were respected worldwide. Did the Viennese schools
now regret not having named their schools and institutes after their own great
pathologists, clinicians and others? ‘Flowers’ put such names as
Harvey, Jenner, Lister and Fleming into the arena. Others abound.
Naming some of the new school combinations after such locally appropriate
historical medical giants could have several advantages. If the name were well
chosen it would add a halo to the institution that could endure and
consolidate. The institutional profile of London medical education could once
again be rooted in its traditions. Medicine, in its study and practice, is
inseparable from its history and from the historical process applied daily
within the clinical consultation. Aspirants to medical studies and London
medical students of all ages might thus be inspired and their academic
curiosity aroused by such associations. Part of our major medical heritage in
London would also be enshrined for the public at large.
We wished to resurrect this idea from the past, at this time of change.
Others may be thinking about it anew.
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Acknowledgments
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We thank David Eames, secretary and registrar for Medicine in
the
University of London and the archival staff of the University
of London
Library for their help. We also wish to acknowledge
the extent to which we
have drawn upon the text of Negley Harte's
The University of London
1836-1986, Ref 3.
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REFERENCES
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|---|
-
Lord Flowers (Chairman). London Medical
Education—a New Framework. Report of a Working Party on Medical and
Dental Teaching Resources, 1980
-
Fitz-Stephen W. A description of London (trans RHE Butler). In:
Stenton FM. Norman London 1934:28
-
Harte N. The University of London
1836-1986. London: Athlone Press, 1986
-
Gordon Wilson S. The University of London and its
Colleges: ‘constituting the most wonderful aggregation of institutions
to be found anywhere in the world’. London: University
Tutorial Press, 1923: 108
-
Logan, D. The University of London. London:
Athlone Press, 1971
-
Goodenough (Chairman). Report of the Interdepartmental
Committee of Medical Schools. ULL ST2/2/61, SM1042,1944
-
The National Health Service Act. London:
HMSO, 1946: Chap 81
-
Lord Todd (Chairman). Report of the Royal Commission on
Medical Education 1965-68. London: HMSO,1968
-
The Practice of Apothecaries Act. London,1815
: Chap 194
-
The Qualifications of Practitioners in Medicine and
Surgery, (The Medical Act). London: 1858: Chap
90
-
General Medical Council Education Committee.
Recommendations on the Training of Specialists.
London: GMC, 1987
-
General Medical Council Education Committee. Tomorrow's
Doctors. London: GMC, 1993
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INTRODUCTION
FLOWERS
