Dr John Wallace looks at the influence of Scottish medical schools on medical education in Ireland
Founded in 1413, St Andrews is Scotland’s oldest university. The other ancient Scottish universities are Glasgow (1451), Aberdeen (1495), and Edinburgh (1583).The town of St Andrews was founded by St Rule who came from Greece in the fourth century. Saint Rule brought with him the bones of St Andrew, and the town quickly became a place of pilgrimage and later a major ecclesiastical centre.
The impressive cathedral was founded in 1160. However, when a number of Protestant reformers were executed in 1545, the Catholic clergyman, Cardinal Beaton, was murdered in retaliation. The cathedral was subsequently pillaged during the Reformation. Just a few of its architectural features, silhouetted against sea and sky, remain today.
St Andrews was raised to university status by Pope Benedict XIII in return for Scottish loyalty. The Pope’s authorisation took five months to reach the small group of clergy in St Andrews who had been driven from the universities of Paris, Oxford, and Cambridge. James I of Scotland confirmed the university’s charter in 1432.
The seaside university is small and had just three colleges: St Mary’s college was essentially founded in 1418, with St Salvator’s established in 1450, and St Leonard’s in 1511. It was initially intended that St Mary’s would teach medicine. However, when Scotland formally split from the Papacy in 1560, its role was restricted to Theology. Medicine was later introduced as a subject at St Salvator’s College.
School of Medicine
The school of medicine at St Andrews is the oldest in Scotland. The faculty is more recently associated with James Black, developer of beta blockers and H2 antagonists. Formerly called the Bute Medical school, St Andrews alumni also include Edward Jenner of vaccine fame and James MaCartney, innovator at the school of medicine in Trinity College Dublin.
Historically, medical qualifications tended to be vague. Nevertheless, the first MD was conferred by St Andrews in 1696. Over 150 years, a stream of MDs were awarded by the stately university. As the St Andrews doctorate did not require a residential placement, it was popular. The degree was awarded if a testimonial was issued by a supervisor, and the doctor was awarded the MD if they were already well-versed in medical practice.
Civil and religious disturbance
Despite the establishment of a medical chair at St Andrews in 1721, there was often a lack of resources for the teaching of medicine. Like Trinity College Dublin, the colleges were also frequently beset by both religious and civil disturbances. By 1773, St Andrews had fewer than one-hundred students. Poverty and civil disturbance in Scotland, as in Ireland, meant that resources were scare.
In the early nineteenth-century, exams were introduced at St Andrews and candidates had to present themselves in person in order to undertake them. Surprisingly, there was still no medical instruction at the University.
In 1825 the examinations of the University are believed to have developed to a reasonable standard. By 1862, St Andrews had granted 3,375 medical doctorates. Some prestigious candidates sought the qualification. Edward Jenner was awarded an MD in 1792. The anatomist, James MaCartney of TCD took the degree of MD at St Andrews University in 1813.
In 1897, the medical school was joined by a new academic centre in nearby populous Dundee, and a regular medical school was built at St Andrews, helped by a gift from the philanthropist Andrew Carnegie.
In 1889, women were formally admitted to St Andrews on a footing equal to men. Agnes Blackadder was the first woman to graduate in 1895.
A medical school that taught and examined students had developed by the end of the nineteenth century. Pre-clinical teaching expanded from about this time.
The St Andrews medical faculty and the hospitals associated with the Dundee school formed a conjoint medical school. Pre-clinical training was undertaken in St Andrews, with clinical training being completed in Dundee. The degrees MB and ChB were awarded by St Andrews University.
Trinity College Dublin
Trinity College Dublin had been founded in 1592. Unlike St Andrews, which by then had three constituent colleges, Trinity was the sole college of the University of Dublin.
By 1692, the College of Physicians in Dublin provided some instruction in medicine and also examined candidates. It then made a recommendation to the governing Board of Trinity who decided on the granting of a medical degree.
Patrick Dun, a physician from Marischal College, Aberdeen, had already encouraged TCD to take a greater interest in its medical school. By 1700, Edinburgh University had devoted considerable resources to medical teaching. However, the University of Dublin had made no such investment until the Dublin Philosophical Society provided a school of medicine within the high walls of Trinity College Dublin in 1710.
Unlike Edinburgh, the curriculum at Trinity emphasised social and moral standing, rather than applied diagnostic or therapeutic skills. By 1794, the Trinity school had fallen into a state of ‘feebleness and disorganisation’. By 1800, the school appeared to be moribund.
James MaCartney was appointed professor of anatomy and surgery at Trinity College Dublin in 1813, after he had been awarded an MD from St Andrews.
However, the governing board of Trinity College Dublin was uncomfortable with MaCartney’s increasing emphasis on chemical experimentation, anatomical dissection, and practical bedside medicine. The Board disliked doctors getting their hands dirty.
Trinity did not embrace detailed clinical study, especially when it was no longer book-based or taught through Latin. Consequently, James MaCartney faced considerable academic and administrative challenges.
Robert Graves and William Stokes
Robert Graves had travelled to medical schools in Germany and Edinburgh. By 1827 he had become a conduit for a number of external influences, such as bedside teaching. William Stokes joined Robert Graves in Dublin having studied in Glasgow and Edinburgh.
In Dublin, James MaCartney, Robert Graves, and William Stokes imported the systematic, applied clinical approaches developed in Edinburgh, London and also at continental universities. After many false starts, Trinity College later developed its own hospital, Sir Patrick Dun’s, before establishing St James’s as a major centre for clinical teaching.
University of Dundee
In 1969, Dundee became a separate university, retaining the medical school associated with St Andrews. St Andrews now had no clinical medical school or hospital, and lost its capacity to award degrees in medicine.
However, St Andrews later developed a number of partnerships with other medical schools, including with that of Manchester University. More recently, the right to award the postgraduate research degree, the MD, has been restored.
In 2009, the Irish political scientist, Louise Richardson, moved from Harvard to became vice-Chancellor at St Andrews.
The survival of a medical school is not assured. Success requires constant adaptation and an openness to new developments. Like Trinity College Dublin, St Andrews initially preferred classical subjects.
The Scottish medical school, like Trinity, was subject to much social and religious upheaval. The school also experienced many barriers to the type of preclinical and clinical teaching that it could offer. Transformation, when it did occur at both medical schools, was hard-won. Change was not linear, neat, or inevitable.
Dr John Wallace, MSt (Cantab), DPhil (Oxoin) is researching the history of evidence-based medicine.