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Book Review: Physicians and society: a history of the Royal College of Physicians of Edinburgh.

This book promises much. The press release which accompanied its launch described it as a “remarkable social history” and the preface claimed that the founding members resolved to “take the lead” in providing free medical care to the poor of Edinburgh and that the College remained the “chief agency in promoting measures to secure and maintain the health of the people of Scotland” for the two centuries following its foundation in 1681. The volume fails to support these initial claims, despite the author’s mastery of his sources and a deft touch in telling his story. 
 
The early chapters eloquently chart the impact upon the College of the political and religious upheavals of the late seventeenth and early eighteenth centuries before turning to more familiar territory, with sections on the emergence of the Edinburgh Faculty of Medicine and the Royal Infirmary. Many of the subsequent chapters are crafted around the contributions of individual physicians, with extended biographies. Chapter 5, for example, examines William Cullen’s contribution to the medical curriculum, and chapter 6 is headed ‘The invention of medical ethics: the legacy of John Gregory’. Chapter 8—‘Certain measures for the public good’—is a detailed account of the deliberations of the six committees set up in 1791 at the instigation of Andrew Duncan to report on inoculation, asylums, apothecary shops, sea bathing, and vapour baths; the focus of the sixth committee is not revealed. The author admits that their recommendations were not implemented because of a lack of good will on the part of a “tiny and corrupt ruling elite” (p. 127). 
 
The author pinpoints the plight of the urban poor as the great social problem of the mid-nineteenth century and asserts that the College “played the leading role in ensuring that relevant legislation conformed to the problems as they existed in Scotland” (p. 133). It is clear, however, that the College enjoyed very limited success in its attempts to influence public health measures. McCrae offers no evidence to support his claim that its attempts to improve the medical provisions of the 1845 Poor Law Amendment Act bore fruit (p. 161); one offshoot, the 1852 College report on medical aid in the Highlands and Islands, had no obvious impact, and another sixty years elapsed before the creation of a Highlands and Islands Medical Scheme. A similar outcome befell College attempts to influence the deliberations of the General Board of Health during the 1848 cholera epidemic, medical registration (chapter 12) and mid-nineteenth century legislation dealing with mental health (chapter 14). When the College was involved, it often had equal representation with the Royal College of Surgeons of Edinburgh. The one area where the College did claim priority was in the establishment in 1887 of what is stated to be Britain’s first medical research laboratory. 
 
The final sentence of the last chapter—a miscellany which includes accounts of the Scottish triple qualification, the school of medicine of the two Edinburgh colleges, and a perfunctory summary of the Edinburgh School of Medicine for Women—asserts that “at the end of the nineteenth century the Royal College of Physicians of Edinburgh was already playing a leading part in preparing for the medicine of the twentieth century” (p. 260). This is a disappointing ending to a book whose cover notes claimed it would provide a social history of the College from the foundation in 1681 until 1918.