British Journal of Obstetrics and Gynaecology Vol 86 No. 9

NEW SERIES

SEPTEMBER 1979

THE ROYAL COLLEGE OF OBSTETRICIANS AND GYNAECOLOGISTS, 1929 TO 1979 BY

SIRJOHN PEEL,K.C.V.O. ROYALColleges have an important role in British medicine. Within recent years they have proliferated and earlier had been established in the Dominions of the old British Empire and in the United States. The idea of a college as a mechanism for the organisation of a branch of learning is a very ancient one. In Europe many colleges or corporations of physicians were founded in the early Middle Ages, and they were active and influential over a long period. Their function was to exercise surveillance over those who wished to practise medicine. They had three-fold responsibilities : academic (teaching, examining and issuing certificates of licence to practice), administrative (supervising the practice of those who had received such certificates, and exercising a disciplinary control over them) and medico-political (advising government authorities on medical matters). These colleges were local in their spheres of influence and were established in Rome, Geneva, Brussels and Lyons to name but a few centres. The development of faculties within the universities created rivalry, threatening the colleges on many occasions. In Europe the faculties flourished and the colleges were suppressed. Faculties as the sole organisers of medicine tended to create a more formal and didactic character in teaching, and to develop a hierarchical system of administration, and this can be seen in many European universities today. But there is more in medicine than the teaching of academic principles and research. There is also practice, and the development of colleges and faculties side by side has proved to be a factor of great benefit to British medicine. Until 50 years ago the Royal Colleges of Physicians and the Royal Colleges of Surgeons

represented all areas of medical practice. Although during this long period many of the most illustrious men in British obstetrics and gynaecology practised and taught, normal obstetrics belonged to the midwives and the abnormal to the men-midwives whose influence grew steadily, although they failed to gain proper recognition with the older colleges. Gynaecology was but one branch of surgery. It was not until the Medical Act 1886 that midwifery was added to medicine and surgery, as a compulsory subject which students had to be taught and be examined in before admission to the Medical Register. Two years before this, the Conjoint Board had been established by the two London Colleges, and had decided to include midwifery as one of its three basic subjects. The fact that midwifery was singled out in this way as a third part of the final examination must have strengthened the belief of many obstetricians of that era that some formal organisation of obstetricians and gynaecologists ought to be created with a view to improving the standards of practice in this specialty. In 1876, J. H. Aveling wrote very forcefully about the poor facilities available for the teaching of obstetrics to undergraduates. He further deplored the lack of representation of obstetricians on the General Medical Council (GMC) and called for the formation of colleges in obstetrics. Included in his suggestions was also the proposal to establish a special obstetric corporate body to examine and license midwives. He visualised a single body empowered to license and control both obstetricians and midwives, but in the event two quite separate bodies came into existence. Munro Kerr, writing to Blair Bell in 1933, recalls how he had on many occasions early in the century 673

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discussed with Sir William Sinclair, founder of the Journal of Obstetrics and Gynaecology of the British Empire, the idea of establishing a College of Obstetricians and Gynaecologists. It seems clear, therefore, that the concept of founding a College was not completely original to Fletcher Shaw, but to him must go the credit for first taking practical action. By far the most important first step was to enlist the support of Blair Bell and here Fletcher Shaw showed shrewd judgement because there was no one else at that time who could have achieved the foundation of a College in such a relatively short period. Both men were members of the Gynaecological Visiting Society which Blair Bell had founded in 1911. We rightly honour these two as co-fmnders, and they were a perfect foil to one another-Blair Bell the restless, ruthless, intolerant but dynamic torch-bearer, Fletcher Shaw the composed, urbane diplomat who had to pour much oil on the troubled waters of negotiations.

The facts surrounding the early discussions within the Gynaecological Visiting Society from 1924 onwards, and the subsequent events which led to the ultimate incorporation of the College by the Board of Trade in 1929 have been recorded in Fletcher Shaw’s book “Twenty-five Years. The story of the Royal College of Obstetricians and Gynaecologists, 1929-1954”. However, it should be mentioned that in 1934 Blair Bell himself committed to writing his own account of these events and those of the first Presidency. This account was not in a form suitable for publication, and has remained a private document. I have had the opportunity to read some of the material contained in it and to discuss with Miss Mallon many of the details of the events that took place at that time. Miss Mallon was Fletcher Shaw’s private secretary before the foundation of the College and she became the first secretary of the College. She has been most helpful in recalling for my benefit

Photographs by F. E. Loefler

WILLIAM FLETCHER SHAW WILLIAM BLAIR BELL Bronze reliefs from plaque in entrance hall of Royal College of Obstetricians and Gynaecologists commemorating the two founders of the College.

THE ROYAL COLLEGE OF OBSTETRICIANS AND GYNAECOLOGISTS,

much of the history of the early days of the College. There are a number of interesting points which emerge from Blair Bell’s account, which are either avoided or passed over very lightly in Fletcher Shaw’s history. Although a great many of the London gynaecologists welcomed the idea of creating some form of association of obstetricians and gynaecologists in the United Kingdom, they were extremely opposed to the idea that the proposed College should be an examining body. Doubtless allegiance to the two older colleges in London was the basis of this point of view. Curiously, neither Blair Bell nor Fletcher Shaw make any reference to the attitude of the Scottish Colleges. The Edinburgh College of Surgeons granted a Fellowship by examination with obstetrics and gynaecology as a special subject. It is probable that indifference rather than outright opposition accounted for their apparent silence. The acrimony engendered by the proposals concerning examinations are reflected forcefully in Blair Bell’s writing. He records that the implacable opposition of the President of the Royal College of Surgeons was only removed at the last moment by the direct intervention of the Minister of Health, Neville Chamberlain. There was at that time a great deal of public concern about maternal mortality which had not changed for more than 30 years and was at the level of 4 . 3 per 1000 live births. It even became an issue in the 1929 General Election. Mrs Baldwin, wife of the Prime Minister, had taken an active interest in the maternity services and together with Lady Rhys-Williams founded the National Birthday Trust Fund. Public concern was aroused by the poor showing of the general practitioner in relation to these statistics and the Government saw in the foundation of a new College the creation of an informed and expert body to which its Ministry could turn for advice about the changes needed to improve the maternity services. Indeed after the foundation, the College was asked to produce a Report on a National Maternity Service. The question of examination was the rock on which the proposed College nearly foundered. For the existing Colleges it was a matter of both prestige and finance. Many students qualified at that time by taking the Conjoint Diploma.

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They could do this after a shorter period of training than that required for a University Degree. Hence, the Conjoint Board had a valuable source of income. There can be no doubt that Blair Bell was absolutely correct to insist that the right to hold examinations and grant diplomas should be written into the Articles of Association. Without such a right, the ability of the new College to raise the standards of practice of obstetrics and gynaecology would have been very limited. The logical thing was, of course, that the new College when founded should participate equally with the other two Colleges in the Conjoint Diploma Examination, and this was almost an obsession with Blair Bell. After months of acrimonious wrangling he did, however, compromise, and accepted that the new College would be allowed to participate in the final Conjoint Examination as an equal partner only if invited so to do by the other two Colleges. Without this compromise, it is doubtful if the Board of Trade would ever have granted Registration in face of the opposition of the two established Colleges. It is interesting that this invitation has never been extended even to this day. The declining importance of the Conjoint Diploma for British graduates has made the Council of the Royal College of Obstetricians and Gynaecologists (RCOG) reluctant to stir up this particular hornet’s nest. The question of a postgraduate diploma was a very different matter. Blair Bell himself was convinced that in this unhappy atmosphere the Conjoint Board’s decision in 1929 to establish a postgraduate diploma of its own in obstetrics and gynaecology was taken deliberately to spike the guns of the proposed new College. The decision misfired badly. The examination was held only once, and by the time the second examination was due the new British College was established and becoming rapidly acknowledged. The young postgraduates themselves decided that membership by examination of the new College would be a more important accolade for them in their future careers than a Diploma of the Conjoint Board. The importance of formal ceremonial procedures, which he felt added greatly to the dignity of any institution, was very dear to the heart of Blair Bell. From the very start he took a personal and active part in designing a College

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Coat of Arms, the Presidential Badge of Office and the gowns of the Fellows and Members. There was much opposition from some of his colleagues who felt that such paraphernalia was too pretentious for a newly established institution. He was, however, undeterred and went further in laying down details for the procedures to be followed at Council meetings, Annual General Meetings, and Admission Ceremonies. The wording of the Oaths to be taken by newlyadmitted Fellows and Members was carefully thought out. This determination to overcome all opposition, in this as well as in other objectives, has been proved correct in every respect by the subsequent evolution of the College. He was not a modest man and recorded quite frankly that he thought the success or failure of the whole enterprise rested in all important issues upon himself. It was the accepted thing at that time that a postgraduate aspiring to specialist status later should pass a higher examination of one of the Royal Colleges before being accepted for training in a registrar appointment. The new College introduced an entirely new concept, namely, that a specified period of training undertaken in hospital appointments, specifically recognised by the College, must be completed before acceptance to sit the examination. Today this concept is so universally accepted that it is difficult to appreciate that it was new in 1929. 58, QUEENANNESTREET Throughout most of Blair Bell’s Presidency, the College had no home. Office work was done in Fletcher Shaw’s consulting rooms in Manchester; Council Meetings were held in borrowed premises in different centres in the British Isles. Everybody agreed, however, that a ’permanent headquarters in London was absolutely essential. The original Memorandum and Articles of Association were drawn up by a Committee consisting of Fletcher Shaw, Blair Bell and three other members. Each contributed E20. Blair Bell gave considerable thought to both the immediate and long-term need for strong financial support. He wrote “Let us hope that those who follow after us, to whom the baton will be passed, will never forget that the wealthier our College is the

richer will be the gifts on the community bestowed”. An early decision was that Fellows and Members should each pay a Registration Fee upon election, and it was decided not to spend this income on immediate maintenance, but to invest it with a view toestablishing an endowment fund. This Capital Fund had grown to E95000 by 1962, after which it was found necessary to use the income from investments for maintenance purposes. The introduction of an annual subscription was also a new departure from the principles of the older Colleges which did not levy an annual subscription at that time. An income of over E1000 was thereby ensured in the first full year. The need to enlist the interest and financial support of potential benefactors was important, and the fact that the Fellows and Members of the College were themselves contributing substantially has always been a powerful lever in attracting benefactions. The first big gift from outside came from Lord Riddell whose portrait hangs in the College. He was a wealthy newspaper proprietor and Chairman of the Royal Free Hospital, and well known to a number of senior gynaecologists. He gave E1000 and at the same time signed a Covenant for E600 a year for seven years. He later increased this by a further E600, when the College had acquired the lease of 58, Queen Anne Street. This house was actually bought by Blair Bell himself, He gave it to the ColIege on condition that during his own lifetime he should receive the interest on the capital involved (E310. 15s. Od.). On his death the house was to become the property of the College. With considerable forethought he realised that as the College expanded it would inevitably require larger premises which would demand a larger income for maintenance. Hence, he insisted that if and when 58, Queen Anne Street were to be sold, a special fund should be established with the capital from the sale, the interest from which should be used for maintenance. In 1960, the Florence Blair Bell Memorial Fund was therefore established with a capital of approximately E30 000. Older Fellows and Members will remember 58, Queen Anne Street but for those who have joined the College after 1960 a few details are recorded here. As soon as the house was purchased, Blair Bell revealed further his

THE ROYAL COLLEGE OF OBSTETRICIANSAND GYNAECOLOGISTS, 1929 TO

College House, 58, Queen Anne Street: from the drawing by Henry Rushbury, R.A.

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capacity for attention to detail. The lay-out of every room and its precise usage received his attention-Council Chamber, President’s Room, Library, Museum, secretarial accommodation and even cloakrooms and lavatories. He stipulated the exact type of furniture and decorations necessary, and paid special attention to the President’s Room. It was to be a room “Furnished gradually with good antique furniture, good prints and pictures and with valuable relics and silver which may be given to the College. Such a room would be an inspiration to intending donors”. He was anxious to have a resident librarian “A librarian and his wife (the very people who would bring their own furniture) should be engaged and the whole of the second floor would be required for their accommodation”. Miss Mallon tells me that she thinks the real motive behind this was his desire to have a man rather than a woman in charge. She had already been appointed Secretary, before the College took over the Queen Anne Street premises. When the Finance and Executive Committee finally vetoed his plan, he became so incensed that he altered his will. He inserted a clause stating that the College was not to receive his major financial bequest until after the death of the last surviving member of that Committee, and even then not unless a resident librarian had been appointed. Council therefore found it necessary after his death to appoint such a resident librarian in 1937. It was not a very happy appointment and when war broke out in September, 1939, the library became temporarily out of action, the librarian moved to the country and ill health caused his early retirement. No further appointment of a resident librarian has ever been made, but the letter of the law had been respected. But the College had to wait until the demise of the last surviving member of that Committee in 1967, before it could benefit from Blair Bell’s major financial bequest. The sum involved in 1936 was approximately 630 000, but having lain idle for more than 30 years, the total had accumulated to well over ElOOOOO. The income from this money must be used for purposes of research, and Blair Bell’s attention to detail is revealed by the number of stipulations with which those distributing the research grants must comply. An interesting sideline to his character is shown by the bequest that a sum

of E1500 was to be set aside and invested and the income derived was to be used to purchase articles designed to beautify the College. The immediate benefits from his will which came to the College were the monies necessary to establish the Blair Bell Memorial Lectureshp Fund and the furniture taken from his own consulting room and library to furnish the President’s Room. Carlyle wrote that history consists of the biographies of great men. Whether Blair Bell deserves the title ‘great’ is a matter of opinion. But there can He no possible doubt that he was a very remarkable person and that his material benefactions to the College were quite unique and outstandingly generous. Lord Dawson, President of the Royal College of Physicians, described him as “The restless, loveable torchbearer, who never forgot-or allowed anyone else to forget-that he was bearing a torch”. Lord Moynihan, President of the Royal College of Surgeons, writing to him in June 1932 said “I got the feeling about you that Lloyd George feels about de Valera. As a negotiator you are unique, but I love you none the less”. The story of the early years of the College is so much the story of its joint Founders, but in what follows I shall try to avoid reference to individuals as far as possible. It has been a feature of the College that so many Fellows and Members have actively participated and given loyal service. This applies not only to those practising in the United Kingdom but also those in Commonwealth countries, and more recently in countries outside the Commonwealth in which an ever increasing number of Fellows and Members are living and working. Those who have held office have contributed in their differing styles, and the influence and effectiveness of the College has steadily advanced. Some years ago I compiled ‘The Lives of the Fellows’ and in my introduction I wrote “In studying their careers, I have been impressed, and I am sure the reader will be too, by the intellectual stature, professional dedication and single-minded determination that characterised so much of what they did”. Much of what they did was for the College. What follows records the achievements of the College rather than those of its individual members. It must have been daunting to move into a

THE ROYAL COLLEGE OF OBSTETRICIANS AND GYNAECOLOGISTS,

house without a stick of furniture and to face the necessity of furnishing, in a style appropriate to its status, with such limited funds. Miss Mallon recalls how she and the second President spent many days visiting antique shops, cabinet makers and even junk shops to acquire suitable furniture. Happily, with an impending Royal Opening, gifts poured in from all directions. A special gift book was presented by Mrs Fletcher Shaw in order to record all gifts. At every Council Meeting it has been a pleasant experience to hear from the Honorary Secretary about the gifts that have been received since the last Meeting. They have come from all parts of the world and have contributed greatly to beautifying the College and making it such a warm and welcoming building. The years between the official opening by The Duke and Duchess of York on December 5th 1932 and the outbreak of war were years of consolidation, the laying down of acceptable training programmes, the recognition of hospital appointments, and the establishment of examination procedures. Although the right to use the title ‘Royal’ was granted on December 3rd 1938, the acquisition of a Royal Charter had to wait until March 1947 because the application with all the necessary signatures failed to reach the Privy Council before the granting of all Royal Charters was suspended for the duration of the war. Immediately after the cessation of hostilities, the medical profession became involved in negotiations with Government about the introduction of a National Health Service. These negotiations were often stormy and at one stage a substantial part of the profession became totally opposed to any renewal of discussions with the Government. It was then that the Presidents of the three Royal Colleges intervened by writing an open letter to the Minister of Health which was published in The Times on January 2nd, 1947. It was designed to’ avoid the impasse that seemed inevitable, and was variously received by the profession with acclamation or disapproval according to the differing points of view. It was, however, a crucial turning point in the negotiations and forced a reply from the Minister. This fact underlines the important role that the Royal .Colleges have to play in the affairs of State concerned with the practice of medicine.

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The College was fast expanding. The need for a larger building became obvious, but it required appropriate funds. The first of a series of appeals was therefore launched in 1947. It took five years at a difficult period to raise E60 000 but in spite of this serious short-fall from the original target, Council took the bold decision to look for a suitable site, and when one was found to re-open the appeal. The Silver Jubilee was celebrated in 1954 and by that time negotiations for a lease of the site in Regent’s Park (Sussex Lodge) with the Crown Estate Commissioners were well advanced. LieutenantGeneral The Lord Weeks agreed to Chair an Appeal Committee, and a brochure was printed containing the architect’s drawing of the proposed new College. The plans had to be modified later for financial reasons, but the original concepts were retained. There was considerable hestiation about the wisdom of such a bold project, not merely because of the difficulty in raising the money to build, but because of subsequent maintenance costs. Some Members of Council were luke-warm, but the decisive turning point came when a cheque for E75000 was received from Lord Nuffield and E50 000 from the Nuffield Provincial Hospitals Trust. By modern standards these sums may not seem impressive but in 1955they were munificent. The Silver Jubilee Appeal raised E280 OOO but even this was not enough and a further appeal was launched for funds to equip and furnish the new building. A sum of &30000 was received from the Wellcome Trust, E10000 from the Simon Marks Trust, and a great many smaller amounts from businesses, trusts, and Fellows and Members themselves. The tragic death in office of the President (Sir Charles Read) shortly before the Foundation Stone of the new building was to be laid created a constitutional crisis within the College. There was no provision in the Charter to meet such an eventuality and it seemed that the election of a new President could not take place until the following year. However, Council took the decision to elect a new President and to inform the Privy Council afterwards, and risk its displeasure. To have amended the Charter would have meant delaying the election until after the date of the laying of the Foundation Stone. In the event, the Foundation Stone was

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Her Majesty Queen Elizabeth, the Queen Mother, laying the Foundation Stone, 6th November, 1957.

THE ROYAL COLLEGE OF OBSTETRICIANS AND GYNAECOLOGISTS,

duly laid on November 6th, 1957 by the Patron, The Queen Mother in the presence of a newlyelected President. THENEWCOLLEGE Once started, the building was completed in good time and occupied in April, 1960. The official opening by The Queen took place on July 13th. The ceremony attracted many visitors from abroad as well as representatives from important organisations within the United Kingdom. The Great Hall, thereafter named the Nuffield Hall, was filled to capacity and a permanent record of the occasion was created by a painting by Terence Cuneo. This hangs on the staircase leading from the entrance hall. Within the Nuffield Hall itself hangs a portrait of Lord Nuffield, benefactor and Honorary Fellow. It was soon apparent that the maintenance costs of the new building would rise steeply. A further appeal launched in 1964 aimed at E500000. Lord Weir acted as Chairman of a strong Committee. Once again Fellows and Members throughout the United Kingdom, admirably supported by their wives, were active and responsible for raising nearly E100000. A feature of this appeal was that while half the money raised was ‘free’ money many donations were given specifically for academic purposes. The Edgar Travelling Fellowship was created and donations from Ethicon and Roche established travelling funds which have been added to later, enabling the College, for example, to meet the expenses of bringing overseas examiners to London to take part in the final Membership (MRCOG) examination and also to fund visitations in reverse. This was the beginning of the establishment of two special funds-Scholarship and Lectureship Fund and Research Fund which by 1979 have reached a capital value of approximately half a million. It was soon realised that it would be necessary to provide a working library and that this would mean an extension to the building. Fortunately, space was available to extend the existing library at ground floor level and to create a room above it which was made to connect with the back of the Nuffield Hall to accommodate smaller scientific meetings which were increasing rapidly in number. The cost of this extension was

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met by a donation from a Lancashire business man, Mr T. H. Markland. The library is now named the Markland Library, Council Chamber and Committee Room 1 have a commemorative plaque ‘The Simon Marks Rooms’ and the Museum is known as the ‘Wellcome Museum’. The top floor of the administrative block was left temporarily empty except for the flats for the President and the caretaker. Later a donation from the Drapers’ Company enabled a selfcontained flatlet to be created and furnished, and later a Canadian flatlet was constructed and paid for by Canadian Fellows and Members. These rooms have been put to excellent use by succeeding Presidents who have been able to extend College hospitality, not only to visitors from abroad but also to Honorary Officers or Lecturers coming from provincial centres. Even after the construction of these two guest suites, considerable space remained. This was put to good use later on to create more office accommodation and was made available to the secretariat of the Council for Postgraduate Medical Education during its first nine months before its permanent quarters became available, later still the office was occupied by Birthright. The College began with one secretary and a caretaker. Today there is a staff of over 40 and each major department is headed by an administrator responsible for the day-to-day working, subject to the overall control of the Secretary. In Queen Anne Street and for a year after the move to Regent’s Park, Miss Winefrede Mallon as Secretary played a part, the importance of which cannot be overemphasised. For most of the time she had to operate on a shoe-string budget with serious staff shortages. This often necessitated the extension of normal working hours well into the evening for both herself and her willing assistants. Her ability to keep control of everything that went on was outstanding, and she was able to pass on to succeeding Honorary Officers and Chairmen of Committees the knowledge and experience about the workings of the College. When Miss Mallon retired in 1961, Council demonstrated its appreciation for her long years of service by arranging for her portrait to be painted, and this now hangs in the College. The Casey family also deserve special mention. Mr and Mrs Casey occupied the basement flat in Queen Anne Street and they

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stayed with the College as caretakers until Mr Casey’s retirement in 1972. Throughout this time Mr Casey became so well known by Fellows and Members as to be almost an institution. He was delighted when, having acted as Macebearer on all ceremonial occasions, Council agreed to award him the title of Bedelus. Space does not allow mention of all the other members of the staff who have given such loyal and devoted service to the College and contributed so much to its efficiency. The atmosphere has always been a happy and friendly one even when the pressures were on. TRAINING AND EXAMINATIONS At first membership of the College consisted of invited Foundation Fellows and Members, numbering 126 and 121 respectively by January 1932, when the procedure ceased. Thereafter, membership became possible only after successfully passing the MRCOG examination. There are of course Honorary Fellows and Fellows ad eundem. However, the history of the Diploma, has been more complex. Initially it was expected that the new College would participate as an equal partner in conducting the final examination and awarding the triple Conjoint Diploma. When this prospect collapsed, the question of awarding a Diploma was re-examined. After much discussion it was decided to introduce a postgraduate Diploma in obstetrics for general practitioners. There was some anxiety that awarding such a Diploma might create a group of second class specialists. In the United Kingdom this has never been a problem but in some of the older Commonwealth countries there were a few Diplomates who posed as specialists in gynaecology as well as obstetrics. However, although the content of the Diploma examination has often been a subject for debate within the College, there is no doubt that as a qualification it has been a success and has contributed greatly to improving the standards of practice of obstetrics by general practitioners. The need for every candidate to have completed a six-months appointment in a hospital recognised by the College has ensured adequate training. The College has always believed that general practitioners have a very important role in the maternity services of this country. Inevitably,

there has not always been agreement about that exact role because other organisations, especially the British Medical Association (BMA) and the Royal College of General Practitioners (RCGP), have an equal interest in obstetrics as part of general practice. In all its reports on the maternity services, the College has always insisted that only those general practitioners who have had postgraduate training should be accepted for inclusion on the Obstetric List which was introduced soon after the National Health Service came into being. This recommendation has unfortunately never been fully accepted in practice, and the Obstetric List is still not entirely satisfactory from the point of view of the College. The popularity of the Diploma has grown steadily and the number of entrants to the examination now exceeds 1000 annually. Diplomates are represented by an invited Visitor to Council Meetings. With the changing pattern of maternity care, there has been a change in the emphasis on both the training for, and the examination content of, the Diploma. In 1945, the letters DRCOG were changed by Council to D (Obst) RCOG in order to emphasise the predominance of obstetrics. In 1976 there was a reversion to the original letters because of the decreasing involvement of general practitioners in abnormal obstetrics and an increase in their involvement in non-surgical gynaecology and family planning. After the National Health Service took over the responsibility for family planning, the National Association of Family Planning Doctors was founded in 1973. This independent association now has its administrative headquarters within the College, and a joint certificate in family planning is issued to those doctors who have completed a specified training course but without examination. Initially, the MRCOG examination consisted simply of a clinical and a viva voce, but in 1936 formal written papers were included. A novel feature of the examination was the prior submission of the ‘Book’ recording a specified number of cases managed and treated personally by the candidate. In addition, two commentaries were required, designed to show that the candidate could give a selective review of the literature, write good English to express his views, and reach logical conclusions. In the

THE ROYAL COLLEGE OF OBSTETRICIANSAND GYNAECOLOGISTS, 1929 TO

interests of maximum objectivity, the ‘Book’ is assessed by a separate panel of assessors. A sophisticated and well thought out system of marking throughout the examination secures a degree of fairness that has not always been matched by other examining bodies. Until comparatively recently, postgraduates intending to specialise in obstetrics and gynaecology tended to spend more than the minimum time required by the regulations for Membership in gaining experience in general medicine and surgery, and in most cases taking the Fellowship of one of the Royal Surgical Colleges. With a view to broadening the scope of the MRCOG examination, a third paper was introduced in 1950 to encourage greater attention to the need to study the basic sciences as they apply to obstetrics and gynaecology. This was only partially successful in achieving its objective. And so, Council in 1964 set up a special Committee to draw up a Report on all aspects of the training of obstetricians and gynaecologists in Britain, and matters related to them (Macafee Report, 1966). Apart from a number of wideranging recommendations on many aspects of obstetrics and gynaecology, there were two of particular importance within the context of training and examination. Firstly, it was suggested that the examination should be divided into two parts. The first part was to consist of a written examination only, and to cover basic scientific principles as applied to obstetrics and gynaecology. Secondly, it was suggested that the period of training for the second part of the examination should be extended to three years after registration. The idea was that this extra year should be an elective one, optional in timing and content. It was envisaged that in most cases the year would be spent in gaining experience in such disciplines as pathology, anatomy, physiology, biochemistry or in research. With such a comprehensive change in both training and examination it was strongly urged that potential consultants should not spend further time in seeking additional Diplomas but that continuing education should be by way of supervised clinical work and research. The Report was debated at considerable length, and eventually the whole of the Report was accepted in principle. It was decided that the Part 1 examination should consist of a multiple

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choice question paper and an essay. A special Standing Committee was established ‘The Multiple Choice Question Subcommittee’. Recently, the essay part of the examination has been abandoned. With a properly supervised training programme and adequate primary selection, the pass rate for the final examination should be high. This has happened in the case of United Kingdom graduates, and those coming from the older Dominions. Unfortunately, the overall pass rate has been considerably depressed because there are still many candidates who, although they have passed the Part 1, have had most of their training abroad under conditions which have not been as good as they should have been, and it has not been possible for adequate visitations to be arranged by the Hospital Recognition Committee. The College has from time to time been under pressure to hold the examinations outside London, but there would be difficulties in maintaining complete uniformity in standards if such a practice were to become widespread. Apart from the special arrangements made immediately post-war, for the benefit of Australians and Canadians whose training had been interrupted by war service, to hold the examination in Australia and Canada, the examinations have remained located within the British Isles. However, the pressure to relax this ruling has grown, and over the last decade the final MRCOG examination has been held regularly in Australia. The introduction of Part 1 made it inevitable that this part of the examination would have to be held in many different parts of the world. In 1978 it was in fact held in the following countries : United Kingdom, Eire, Australia, Canada, Egypt, Ghana, Hong Kong, Iraq, Kuwait, Libya, New Zealand, Singapore, Sri Lanka, and the West Indies. The Part 2 examination was held in London, Manchester, Australia and Singapore. CONTINUING EDUCATION Continuing education in medicine, though better than in many other professions, used to be somewhat haphazard, and left largely to the initiative of individual doctors. The setting up of a Royal Commission on Medical Education in 1965 was an expression of a national awareness

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of serious deficiencies, particularly in view of the very rapid advances in scientific and technical aspects of medicine that had occurred in the post-war era, In previous generations, a doctor, regardless of the area in which he practised, was able to keep himself up-to-date with new developments by reading journals, attending Society Meetings, and periodic refresher courses. The Royal Commission made it clear that in its view this was no longer enough, and that a more formalised postgraduate and continuing education was necessary for all practising doctors. The College had not been slow in responding to these trends. There had always been a few endowed eponymous lectures and travelling scholarships, but these benefited only a few. The improved facilities in the new College made possible quite rapid expansion of activities in the area of postgraduate education. The Scientific Advisory Committee began to arrange regular Meetings at the College for consultants and general practitioners. Whole-day meetings covering specific topics and organised by the staffs of different medical schools throughout the United Kingdom became a regular feature. Some of these meetings took place in provincial centres after 1967, when the first one was held in Newcastle. A House Dinner in the evening created an informal social spin-off. Later still, separate courses for consultants and registrars lasting a whole week were arranged. The year 1967 saw the appointment of the first Director of Postgraduate Studies and this was soon followed by the setting up of a Postgraduate Education Committee and the appointment of advisers in each of the National Health Service Regions. The Postgraduate Education Committee invited representatives from the Committee of Postgraduate Deans, a senior registrar and an observer from the Department of Health and Social Security (DHSS). The Director of Postgraduate Studies acts also as adviser to overseas students. All these developments over the last two decades have been of great benefit to all concerned, and have extended the influence for good of the College. Following the establishment of a small informal discussion group consisting of College Presidents, Deans of Medical Schools and representatives of the BMA chaired by the late Professor Robson, Vice-Chancellor of Sheffield

University, the Government-sponsored Council for Postgraduate Medical Education was created. It was given the responsibility of controlling and directing postgraduate teaching, nationally and on a regional basis. Postgraduate centres came into existence in most district hospitals and regional tutors were appointed. About the same time, the possibility of Britain joining the Common Market gave rise to some anxieties in relation to medical practice. Specialist training and recognition on the continent is somewhat different from that in Britain. The existence of a Specialist Register in those countries has long been established, but has never been thought necessary in the British Isles. The Colleges requested the GMC to look into this problem. From the point of view of the College, there was anxiety that if the responsibility for postgraduate education were to be controlled by a Postgraduate Council and a Specialist Register established and controlled by the GMC, the status and authority of the individual Royal Colleges might be undermined. After much discussion within the profession, often very heated, the Merrison Committee was set up by Government to look into all aspects of the control and organisation of the medical profession. It has become obvious that the roles of the GMC, the Central Council for Postgraduate Medical Education and the Royal Colleges, though complementary, are essentially different. The Colleges retain their fundamental right to recognise the suitability of appointments in hospitals for training and to set the standards for the examinations for their Fellows and Members. The fact that the RCOG was able to offer hospitality to the Central Council for nearly a year until its headquarters became available soon created an atmosphere of willing cooperation. The successful passage of the MRCOG examination has never entitled the candidate to claim that he is a fully trained specialist. In many overseas countries the training programmes cover a five-year period with an examination at the end. It has often been debated in Council whether the College might adopt this principle, but in fact experience has led Council to take a more flexible view. If a trainee spends five years before he can take an examination, which he may fail even after several

THE ROYAL COLLEGE OF OBSTETRICIANS AND GYNAECOLOGISTS,

attempts, a great deal of time has inevitably been wasted by the trainee who is no longer fitted for entry to general practice, and the opportunities for a different career with a background of specialist training are very limited. Current thinking is that the second part of the MRCOG examination should come slightly more than half way through the whole training programme. After taking the Membership, candidates are now encouraged to spend a further three years concentrating on broadening their experience, developing a specialised interest, or carrying out research. At the end of this time the College issues a Certificate of Accreditation as a fully trained specialist. Accreditation has an applicability within the United Kingdom, but it represents more than is required for entry to a Specialist Register in overseas countries and yet the MRCOG by itself represents something less. This leaves a somewhat untidy situation for that minority of specialists who may wish to practise outside the British Isles. THECOLLEGE AND OUTSIDE BODIES AIthough the College has always had a good relationship with the DHSS and professional organisations, its views on the maternity services have never been completely accepted. This is perhaps not surprising, when one considers the political and social implications and also the separate interests of other bodies such as the BMA, the Central Midwives Board (CMB) and the RCGP. A Departmental Committee was set up in 1926 on maternal mortality, followed by a second one to-consider the workings of the Midwives Act. The Reports of these Committees were, however, rejected by Parliament and the College was asked to draw up a memorandum not only on maternal mortality but also to prepare a scheme for a national maternity service. This scheme was also found unacceptable largely because it recommended that all midwives should be State Registered Nurses. The College, however, never ceased in its efforts to get a greater degree of unification of all maternity services. A third Report produced in 1954 wanted to see the establishment of a Standing Obstetric Advisory Committee of the Central Health Services Council with executive powers to administer the service. When in 1968

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the Standing Maternity and Midwifery Advisory Committee set up a special subcommittee to study the problems created by the rapidly diminishing domiciliary midwifery service, that Committee, not by any means dominated by consultant obstetricians, expressed the view that most of the problems “Stem largely from evidence related to the divided structure of the National Health Service in which the maternity services operate. We see unification of the maternity services as the ultimate goal”. This goal remains unattained. However in spite of this, maternal and perinatal mortality has steadily improved over the last 50 years, and the College has made some important contributions towards this achievement. It has been given representation on all the standing and ad hoc committees of enquiry established by the DHSS. One of the most important of these has been the dual sponsorship of the Confidential Enquiries into Maternal Deaths in England and Wales which has operated since 1952. Successive Presidents have had close association with the Chief Medical Officer of Health and have never been denied access to the Secretary of State when necessary. The strength of the advice that the College can give is due not only to the fact that such advice is based on expert knowledge and experience, but also to the fact that it is forbidden by its Charter from becoming involved in financial matters affecting its members and, most important, it is completely independent of Government. Financial and political considerations inevitably influence departmental policy so that advice given by the College has not always been acceptable. This position was expressed very clearly by the Secretary of State after my first interview with him when I became President. On parting he said “I promise always to ask your advice, but I won’t promise always to take it”. The last two decades have seen a steady stream of topics in which the College has been involved in consultation : abortion and family planning, the organisation of postgraduate training, facilities for clinical cytology, the Rhesus immunisation programme, the use of the fetus in research, the re-organisation of the GMC, the re-organisation of the National Health Service and the declining standards within it, the Royal Commission on Civil Liberties and the Law Society’s proposals

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on compensation. This list is by no means exhaustive, but it does indicate the steady growth of work and responsibility that is falling on the President and Council. Moreover the College is entering into Joint Study Groups and Working Parties with other specialist groups concerned with problems closely related to its own. The recent discussion document on the improvement of infant care during the perinatal period produced by a joint British Paediatric Association and RCOG Liaison Committee has received wide publicity and led to the establishment of a National Perinatal Epidemiology Unit with the collaboration of the DHSS. The fear, which existed in 1929, that there would be a proliferation of Colleges has of course materialised in recent years. The wheel has come full circle and the view once again expressed is that the profession needs a single voice to speak for medicine in the broadest sense. The BMA has become progressively less able to fulfil this role since becoming a registered Trade Union. The idea of an Academy of Medicine though launched a few years ago is not a practical proposition. However, a Conference of Colleges and the Faculties has emerged and this is a most important development. The inclusion of the Scottish Colleges in this new Conference has created a body which should prove of great practical importance not only in negotiations with Government but also because it will be able to speak with one voice on behalf of the profession and to debate within itself important matters of principle. Whether in the future there will be a need for some administrative set-up remains to be seen. The costs of administration are a growing concern to all Colleges and some pooling of resources may well have to be considered. OVERSEAS RELATIONS The older Royal Medical Colleges evolved from Corporations with a geographically limited sphere of influence. The founders of the RCOG had a broader vision, so that it was from the beginning a College embracing not only the whole of the United Kingdom and Eire, but also the Dominions and Colonies. Australia had independent Colleges of Physicians and Surgeons, in neither of which obstetricians and gynaecologists had any $articular identity. In Canada,

the Royal College of Physicians and Surgeons was founded in 1929 and the position of the gynaecologists was more clearly defined as an identifiable entity. There were no medical colleges in New Zealand or South Africa at that time. However, all four Dominions and India welcomed the idea of becoming part of the newly founded British College, and Reference Committees were set up to facilitate communications. Thereafter, the development of specialist training programmes have followed somewhat different lines in the different countries. The strongest support for the new College came from Australasia, and the Australian Reference Committee became a Regional Council in 1947, and that of New Zealand in 1952. They were both formally inaugurated by the President. They were empowered to elect their own Councils and Honorary Officers and when succeeding Presidents paid official visits, they have been most impressed by the way in which the formalities of Council proceedings as practised in London have been adhered to by these Regional Councils. The Australians' were able to acquire a delightfully situated College House in Melbourne in 1952 and have built up considerable capital funds. The major part of annual subscriptions from their Fellows and Members, which have been collected in London, have been returned to them as a contribution towards their administrative expenses. The powers delegated to these Councils have steadily increased without interfering with the ties with the parent body in London. The Sims Black Travelling Fellowship was established in 1952, thanks to a generous benefaction from the late Sir Arthur Sims and his daughter Mrs Lewis Black. This helped to forge close links not only with Australasia but later with other countries of the Commonwealth. It has been obvious for some years that the time would inevitably come when the Australians would wish to found their own College. Opinion in Australia itself has not always been unanimous, and Council's hands have been tied by reason of clauses in the original Charter and Bye-Laws. It has needed a great deal of negotiation and diplomacy to reach a final decision but, following a Referendum amongst the Fellows and Members of the College in Australia, that decision has now been reached and an

THE ROYAL COLLEGE OF OBSTETRICIANSAND GYNAECOLOGISTS, 1929 TO

independent Australian College has come into being. The transformation has been brought about in a most amicable way. The close association between the two countries which has existed throughout the College history has been of great mutual benefit. Postgraduates from Australasia have occupied senior training posts in this country and have maintained extremely high standards both in the quality of their work and in the examination. These ties will, I am sure, continue in the future and there will always be close collaboration. New Zealand being so much smaller has a different problem, and in the future it will be necessary to reach a decision whether the relationship with the College in London stays the same or whether closer ties are to be established with the new College in Australia. The position in Canada is different yet again. After long discussions within the profession, the Canadian Medical Association decided in 1942 to ask the Royal College of Physicians and Surgeons of Canada to undertake the responsibility of certification and registration of specialists throughout Canada. Since 1946, the College has laid down specified training programmes and carried out examinations for certification in different centres covering the whole of Canada. As certification and registration after examination became a necessity for those intending to specialise in obstetrics and gynaecology in Canada, many of whom went on to a further examination for the Fellowship of their College, the acquisition of yet another diploma, the MRCOG, became a less attractive proposition. Hence, only those Canadian postgraduates who had elected to do all or most of their training in the United Kingdom have tended to take the MRCOG. The proximity of Canada to the United States makes it very much easier for postgraduates wishing to go abroad for part of their training to go there rather than to Great Britain. Hence the number of Canadian postgraduates coming to this country has always been relatively small, although close links remain with those Canadian gynaecologists who are Members of the parent College. South Africa too has presented a different problem. When she left the Commonwealth a technical constitutional crisis was created within the College, because according to

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the Charter, College activities were limited to Commonwealth countries. The Privy Council fortunately agreed that no action need be taken and so the South African Regional Council which was inaugurated in 1956 has continued ever since. That country now has a College of Medicine embracing all specialties and general practice. The requirements for training for the Fellowship in Obstetrics and Gynaecology are very close to those required for the MRCOG so that reciprocal acceptance of training has often been a satisfactory solution for South African postgraduates wishing to take the MRCOG examination later. The largest numerical contingent of postgraduates to this country has come from the Indian sub-continent. The acquisition of the MRCOG has been a popular ambition of doctors from that part of the world intending to specialise. During their period of training they have of course contributed greatly to the National Health Service by filling many junior hospital appointments. However, the difficulties for the Hospital Recognition Committee in dealing with individual applications to sit the examination have been considerable, when a large part of the candidate’s training has been completed in his or her country of origin. Uncertainties about the acceptability of training posts in spite of the existence of six Reference Committees have sometimes been almost impossible to resolve equitably. Formal visitations have not been possible, even by Fellows of the College practising in those countries. With the amendment of the Charter, Ordinances and Bye-laws, which were introduced in 1977, the necessity for a candidate for Membership of the College to hold a qualification recognised by the GMC under Sections 18 and 20 of the Medical Act of 1956 before being admitted no longer applies. It is now accepted that a candidate should be recognised as a medical practitioner by the appropriate authority of that country in which he or she resides. Council has in the past waived the earlier regulation in very special cases, but the alteration to the Charter became necessary because of the steady increase in the number of candidates from countries outside the Commonwealth applying to sit the examination. This number looks like growing still further and while, from the point

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of view of the College, there is great satisfaction in having its members in so many different parts of the world, it does create some very obvious problems. Reference Committees have multiplied in the last decade and there are now 12. There must remain a question mark over their effectiveness and ability to provide the College with accurate information about the quality of training for many of their potential candidates for the Membership examination. Should these Reference Committees be allowed to proliferate ? In all the developing countries, new training programmes and examinations are being established nationally. They are quite rightly designed to meet the particular needs of the countries concerned. Therefore, the College may find it necessary to consider alternative ways and means for communications other than those which can be exercised by Reference Committees. The entry of Great Britain into the European Economic Community (EEC) has introduced a new dimension, there being no counterpart to Colleges in European countries. A tri-partite Advisory Committee on Medical Training has been established in Brussels. This has representatives from the profession (BMA) the DHSS and the Universities. The Royal Colleges are not directly represented although by a ‘gentleman’s agreement’ one of the university representatives has College interests. The role of the Colleges in Europe remains problematical. At the present time the College sends representatives to the professional organisations representing obstetricians and gynaecologists in Europe, and currently one of the senior Fellows is President of the International Professional Union of Gynaecologists and Obstetricians (UPIGO).

THELIBRARY Today the College library combines a unique collection of books of historical interest with a modern up-to-date working library. The original plan was for an historical library only, partly for financial reasons and lack of accommodation, but partly because the Queen Anne Street house was so close to the Royal Society of Medicine (RSM) with its comprehensive library service. The march of events has shaped the development of the library differently. The opportunity arose

in 1938 to buy for the comparatively small sum of E500 a magnificient collection of historical books from Roy Dobbin-a Foundation Fellow. His professional life was spent in Cairo and collecting medical books was his hobby. The sum of E500 had been collected in a special fund in memory of Sir Henry Simson specifically for the use of the library. The Dobbin collection has been augmented by many donations and the discreet purchases as funds became available. A catalogue of the historical works published before 1851 was compiled in 1956 and the Consultant Librarian wrote in the preface “The Dobbin Library included amongst its treasures fine copies of the early editions of Vesalius and William Harvey, and was remarkable for the number of rare Servetus items which it contained”. A second edition of the catalogue was published in 1968 bringing the record up-to-date. The decision to make the library a working one was made after the move to Regent’s Park, and with the approval of the RSM whose services were becoming over-extended. A donation of E6000 from the Wellcome Trustees enabled current books and journals to be purchased. After the decision to extend the service, it soon became obvious that further accommodation would be necessary. Fortunately, there was space available adjacent to the library and as already mentioned a two-storey block was constructed. This decision has been amply justified by the steadily increasing use which is made of the library facilities. Requests for photo copies of articles reached over 1000 in 1978. The display cabinets in the passage outside the library invariably attract the attention of passers-by and add greatly to the adornment of the College.

THEJOURNAL An account of obstetric and gynaecological journals can be found in the ‘Historical Review of British Obstetrics and Gynaecology 18001950’ published in 1954, and in an article by H. Taylor in Obstetrical and Gynecological Survey 1965. Medical journals only came into existence in the second half of the 19th century and took off in a big way. Commenting on the fact that in the USA in 1879 there were only 71 survivors out of a total of 364 journals which had been started in the previous decade, Billings wrote “It is as useless to advise a man

THE ROYAL COLLEGE OF OBSTETRICIANS AND GYNAECOLOGISTS,

not to start a journal, as it is to advise him not to commit suicide”. The history of the British Journal begins in 1902 when it was founded as the Journal of Obstetrics and Gynaecology of the British Empire. Its early progress was not promising, having five different editors in its first 17 years by which time it was heavily in debt. After the first World War it received a new lease of life and in the next 60 years it has gone from strength to strength, both in scientific status and financial success under only four different editors. First published by a Manchester firm (Sherratt and Hughes), it remained with them until 1952. The management of the Journal had been taken over by the College in 1951 and an Editorial Committee established. A year later the College took over as Publishers. Although it was a thriving Journal of very high standing in the academic world, the association with the College has undoubtedly produced benefits to both. The name of the Journal has been changed on a number of occasions, Empire becoming Commonwealth, and more recently, because there are a number of other Commonwealth journals, it has taken the title of British Journal of Obstetrics and Gynaecology. On a number of occasions the suggestion has been made that the Journal should be made available to all Fellows and Members, and the cost covered by increasing the annual subscription. This is a common practice in many organisations, but such journals usually include a wide range of information material and a correspondence section, which is inappropriate for a journal not only of high academic standing but with a wide circulation in foreign countries especially in North America. Although the Journal has about 5000 subscribers at present, less than 2000 of these are Fellows and Members of the College. However, a combined subscription would be attractive from the administrative point of view. THEMUSEUM The establishment of a Museum was mooted in the early days of the College history, but lack of accommodation in Queen Anne Street was a limiting factor. A Rare Tumour Registry was established and arrangements were made with the Chelsea Hospital for a technician to be made available there for the care of specimens and the preparation of slides. The move to Regent’s Park

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made the formation and rapid expansion of the Museum possible. An ear-marked donation from the Wellcome Foundation was of immense value in developing the Museum facilities. The Museum today contains enough specimens of a wide variety which postgraduates can study and which can be used in the viva voce examinations; museum demonstrations can also be held. The College was fortunate to acquire from the RSM the original Chamberlen forceps which are housed in a handsome case. In addition, a fine collection of obstetrical instruments of historical interest is being accumulated under the guidance of an Honorary Curator of Instruments.

RESEARCH The extent to which the College should become involved in academic research has often been discussed. It is unlikely that in the foreseeable future it will make any attempt to establish laboratory facilities for carrying out basic scientific research. However, its interest in research of all kinds relating to obstetrics and gynaecology and its practice is pronounced. It has developed a close association with two organisations which are given accommodation within the College. The Blair Bell Research Society, a forum where research workers can meet and exchange their experiences, holds regular meetings in the College and it also promotes symposia in conjunction with other biological societies. The Blair Bell Research Society has a membership of over 400, and the President of the College in Office has always been its President since its foundation in 1962. About the same time the Childbirth Research Centre was founded at University College Hospital with a Representative Council, a Finance and Executive Committee with the task of administration and fund raising, and a Scientific Committee to allocate grants. Funds were slowly accumulated, but it soon&became obvious that a body, whose function was to raise funds for research on a national basis, should be associated with the College as a National Institution rather than with a single university department. The name was changed from Childbirth Research Centre to a National Fund for Childbirth Research, and later to Birthright. Birthright’s Council includes paedi-

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atricians and midwives as well as laymen and after its formal incorporation within the College, alterations were made to the original Charter so that the College representatives have a majority position on the Council. The President of the College is also the President of Birthright, and the Chairman of that Council must be a layman. Lord Shawcross has been an active and effective Chairman and funds are steadily accumulating. Birthright will inevitably become a more important section of College activities in the future. Incidentally, the College benefits financially from this and other organisations housed within its building. It is also an excellent thing that the College premises should be more fully occupied by allowing organisations, whose activities are closely associated with its own, to occupy part of the building.

INTERNATIONAL FEDERATION OF OBSTETRICS AND GYNAECOLOGY (FIGO) In 1954 after prliminary meetings in the United States FIGO came into existence with headquarters in Geneva. Its purpose was to organise triennial Congresses in different parts of the world, designed to bring together obstetricians and gynaeco€ogistsfrom different countries and to set up working groups to study problems of international concern in the field of obstetrics and gynaecology. It has always worked closely with the World Health Organisation and other international bodies. It is currently supported by 78 different countries. The College has from the beginning appointed a representative to serve on its Executive Board. Although hampered by a shortage of funds, many of its working groups have done valuable work. Two deserve special mention. Firstly, a group was set up to study the standards of training and qualification for acceptance as specialists. The recommendations made by this group followed closely the principles enunciated by the College. The second group worked jointly with the International Confederation of Midwives. With substantial financial support from USA International Development and the Rockefeller Foundation, the Study Group has been able to travel widely in order to study the standards of training of .midwives in different countries, and has published two valuable reference works

dealing with maternity services in the world. During its 25 years, FIGO has owed an enormous debt to its Secretary-General Professor de Watteville, whose untiring devotion has resulted in steady progress in its status and effectiveness. Many of those who have served on the Executive Board, whilst appreciating fully the enormous contribution made by the Secretary-General in Geneva, felt that when his term of office came to an end, an alternative administrative structure would be necessary. It was clearly preferable that the headquarters should be in a permanent institution, rather than in the department of an individual gynaecologist whose successor in that department might not necessarily be a suitable person to take over his role in FIGO. After some years of discussion it was finally decided that the headquarters should be in the College in London. Here the Secretariat is now established. The new Secretary-General is a Fellow of the College practising in London, and there are a number of deputy secretaries in different continents. THEPRESIDENT Commenting on the role of Presidents in 1934, Blair Bell wrote “It is no doubt the authority and power vested in the Presidents of the Royal Colleges of Physicians and Surgeons that gives so much prestige to the offices they fill. The President should be given a free hand if he is to exercise initiative and whatever energy he may possess in the interests of the College”. The President holds a key position by combining the roles of figurehead and chief executive. Apart from presiding over Council, he is in theory Chairman of all Subcommittees. In practice, he delegates the majority of these Chairmanships, but in order to keep his finger on the pulse he must attend as many of these important Standing Committees as possible, in an ex oficio capacity. He is the person called upon in the first instance in communications with outside bodies and he has to represent the College on many Statutory Committees. He is, of course, supported by his Honorary Officers, but in spite of this, his job is a somewhat lonely one in that he often has to make decisions on his own and justify them later to Council. Each succeeding President has made his own contributions in his own style as his period of office has coincided with changing

THE ROYAL COLLEGE OF OBSTETRICIANSAND GYNAECOLOGISTS,

national problems. It was a wise decision to lay down in the Charter that the President should not serve for more than three years-a reasonable compromise between continuity and disruption. Communication is one of his important functions. A total Membership of nearly 6000, with more than half practising overseas, creates a real problem in this respect. At first copies of all Council Minutes were circulated to all Fellows and Members, but this soon became impractical and in 1952 the President’s Letter, circulated after each Council Meeting, was initiated, It was an imaginative and effective way of keeping the Membership acquainted with the activities of its elected representatives, and has been copied by many institutions subsequently. The second area of communication is that achieved by face-to-face meetings. In the early days, one or two visits by the President to overseas countries was all that was possible, but over the last 20 years, Presidents have found it necessary to travel overseas more and more frequently, and on the last President’s itinerary were 11 countries never previously visited by a President. These and other visits carried out by Fellows and Members on behalf of the College are of great significance in maintaining interest at the grass roots, and everywhere the welcome has been overwhelming. There has usually been an academic commitment as well in the form of eponymous lectures or participation in scientific and clinical meetings, requiring a good deal of preparation and forethought. The third area of communication is with the media. Times have changed very considerably and the College has responded to a changing atmosphere and a need to communicate with the general public through the media. Periodic gatherings with representatives of the press, either in relation to a scientific or clinical meeting, or preparatory to launching an important special report have become a regular feature of College life. In this task the President is greatly helped by the Honorary Secretary, though much of the onus inevitably falls upon him personally. The President has a very heavy programme of social engagements, and is called upon to make many speeches. In all these tasks he receives the very willing support of his Vice-Presidents. The President’s wife has a xole of her own in too

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many areas to be defined in detail but which are vital in maintaining good relationships both inside and outside the College. During his period of office, no President can possibly carry out all his normal clinical work, although he does as much as possible. This has meant an increased volume of clinical duties thrust upon the shoulders of his hospital colleagues. This fact has always been recognised by hospital authorities, and the willingness of colleagues to accept temporarily the added work load has been of great benefit to, and much appreciated by, both individual Presidents and the College. Whether this will always be so in the future is perhaps less certain. Changing attitudes of both the profession and the public, as well as the ever increasing amount of time demanded by the Presidency, may well create new problems in the future. THEFUTURE The College began with little support and often frank opposition from the older Royal Colleges. Today Colleges are proliferating and there are many faculties within the older Colleges which represent different specialities. These are all united in similar aims and objectives and are working harmoniously together. It is difficult to imagine that the Colleges will disappear from the British medical scene, or that their influence will be seriously undermined by z greater involvement of the State in medical practice, by the entry of Britain into the Common Market, or by the decline in the reality of the Commonwealth. But adaptation to changing conditions will be as inevitable in the future as it has been in the past. There are signs in some of the European countries that there is a necessity for national professional organisations outside the universities, for example the ‘Ordre de Medicin’ in France. A closer collaboration with the obstetricians and gynaecologists in Europe seems certain, concerned as the College is with the establishment and maintenance of standards for specialists in its field of practice. As the barriers of language weaken, communications will be facilitated, and I can visualise a much greater interchange of doctors at all levels. A big question mark must remain over the maintenance of those close ties that have always existed in the past with Commonwealth coun-

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tries, as more and more of them become independent. Similarly, we must ask how the relationships are likely to develop between the College and those Fellows and Members who are practising outside both Europe and the Commonwealth. These numbers are increasing quite rapidly at present. It will be necessary to develop some mechanism for assessing the quality of training programmes undertaken by trainees in those countries who wish to take the Membership examination. Visitation from the College in this country is not only impractical in many cases, but for political reasons is unacceptable. Whether links can be established through the administrative machinery of F I G 0 is a matter for the future, but the presence of its headquarters within the College will make the exploration of this idea much easier. One of the primary objectives in founding the College was to maintain the unity of obstetrics and gynaecology. Today areas of special ifiterest are rapidly developing within the overall discipline of obstetrics and gynaecology, for example, endocrinology, perinatal medicine, fertility control, genetics and others. Is there a danger of fragmentation ? These special areas will inevitably develop their own identity and form Associations or Societies. It is to be hoped that all these sub-divisions will remain under the umbrella of the College, because by so doing they will strengthen their own position and be

able to exert a greater influence than if they operated in total isolation. The College in celebrating its Golden Jubilee can celebrate 50 years of solid achievement. It is still a young College, but it can pride itself without undue arrogance that so many of the basic principles enunciated by the Founders, and carried into practice progressively by their successors, have been taken up by the older institutions. In 1934 Blair Bell wrote “The future holds out to our College the fair prospect of usefulness to our profession, to the State, and to women the world over”. This is as true today as it was 50 years ago. ACKNOWLEDGEMENTS Any attempt to record, in a brief account such as this, the events that have taken place over a period of half a century must inevitably omit many details of historical interest or touch on them only very superficially. I have endeavoured to describe the evolutionary development of the College since its foundation, and indicate its role in both the national and international spheres. I am indebted to my successors in the Presidency for their help in regard to the events of the last decade, and also to the Secretary and many of his staff who have delved into the archives in order to refresh my flagging memory about some of the events which took place during the earlier years of the College’s existence.