Annals of

Royal College




January 1977

FROM THE PRESIDENT I am now well into my final year as your President and I am afraid I am going to be thoroughly conventional and begin by saying that I can hardly believe that it is just on three years since I took office and that this is the last Annual General Meeting at which I shall address you in this way. But so it is -and in preparing my address to you today it seemed to me that I ought to use this occasion to highlight the achievements of the College snce I973 and to look, in so far as we can, into the future and reflect with you upon the tasks that lie ahead. The major affairs of the College fall, with some overlapping of course, into two main groups: domestic College matters, including all those areas of involvement of Fellows throughout the country (for they are every bit a part of the College as are those of us who spend most of our time at Lincoln's Inn Fields), and matters concerned with the College's external relationships, including the place of the College in nationlal affairs. Let us begin with the domestic affairs of the College. I look with great pride at what has been achieved during the last three years, but in saying that to you I must immediately emphasize that no President by himself could havre brought any of them about, nor even a President backed up by a particularly vigorous and well-intentioned Council. Important changes take time not only in their execution but in their development and preparation, and if the harvest we are now bringing in is a satisfactory one let us not forget that the seed was sown, in many instances, during earlier Presidencies. Sir Thomas Holmes Sellors once said to me, 'Nothing is quite so, past as a Past President' but, you know, if by that he meant that this College can easily and swiftly forget his own many great contributions or forget that many of the good things


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we may wish to congratulate ourselves upon today go back to the enlightened thought and wise leadership that characterized his Presidency, then this is one of the few occasions on which his otherwise impeccable judgment has let him down. We have a similar indebtedness to many other Past Presidents. Well now, what changes has the College seen during the last three years? Justice, they say, must not only be done but be seen to be done. I believe that of late it has been seen much more clearly that we are indeed the Royal College of Surgeons of England and not of London. Your Council has accepted every opportunity that presented itself to rub this in by, for instance, taking important College activities, such as Hunterian and Arris and Gale Lectures, out of London. I think we have greatly improved the ways in which the views of Council can be widely dis';eminated and made known to Fellows throughout the country and also, probably of even greater importance, ways in which Council can be informed of the views of its Fellows so that decisions shall be truly representative of the whole corpus of the College. We have, I think, in particular, greatly improved our lines of communication, both ways, with our younger Fellows, and the Council decision, a unanimous one, to remove the I o-year rule in relation to eligibility for election to Council is an example of this. We still await formal approval of this change by the Privy Ceuncil as, of course, is the case in respect of the changes in our Charter which will properly observe the status which our two Faculties ought to have and which will show to all outside the College that within it a Fellow is a Fellow is a Fellow. If the tempo in regard to, formal Privy Council approval is slower than we might wish, be assured that the decisions in Cotuncil have been taken and from them


From the President

there will be no drawing back. In the scientific life of the College I suppose the major change has been the creation of the new Department of Applied Physiology and Surgical Science, of which I first spoke to you at the meeting in Exeter. I remember well that when I first expressed in public Council's ambitions in regard to a director for this splendid venture-that we proposed to appoint a scientist of the highest quality with practical surgical experience and preferably a Fellowship of a Royal College of Surgeons-there were those who reacted with tolerant, mildly amused scepticism. Of course the best answer when told that this, that, or the other cannot be done is always to say nothing more but to go oiut and do it, and Council wisely adopted this course, the result being Professor Taylor, a most welcome addition to the already strong and vigorous scientific life of the College. The other major, indeed radical, change is the grafting into the centre of College activities of the Specialist Associations, physically with their own new, fine premises within the College, philosophically with representation at many levels in the counsels of the College, including a new Board of Surgical Specialties, chaired by a member of Council and reporting direct to Council. Of all the internal changes in the College since the war it may well be that in years ahead this will be regarded as the most important, important not just to the College but to the maintenance of one of the great strengths of British surgery, the insistence that whilst the proper development of specialism is to be applauded, surgery itself is one and indivisible and must not be allowed to become fragmented by detaching specialties from the generality of surgery-indeed from the general practice of medicine. Of the College's external relationships, so much that is new has happened during these few years that I could easily talk to you about them overlong, but I will be as brief as I can. In regard to relations with other Colleges the major change has been the creation of a Conference of Medical Royal Colleges and their Faculties in the UK. This forum for intercollegiate discussion allows, for the first time, the presidents and deans of all the Royal Colleges and their Faculties, north and south of Hadrian's Wall, to meet, to debate matters

of importance to all, and, particularly on national affairs, to present when necessary a united front on behalf of the maintenance of standards and the interests of the community. You may think, as I do, that this Conference represents a major contribution to the cohesion and unity of the profession and as such is much to be welcomed. Interwoven with the development of this Conference of Colleges is the change in the involvement of all Colleges in national affairs, forced upon them by events taking place at the interface between the State and the profession of medicine. Here, although some have expressed the view that the College's only duty is to remain silent and to keep aloof frorm all arguments, I do believe that the majority of Fellows would regard such a course as an abdication of our responsibilities. In deciding what the College should or should not do in this treacherous area, surely we cannot go far wrong if we constantly keep before us two important guiding principles: Firstly, that the College has no negotiating stance whatsoever and should not seek to acquire one, either openly or, still less, through channels of which the profession as a whole is not informed. Secondly, that the College has a duty to the community to use to the full its advisory powers to protect the standards of the practice of medicine in general and of surgery in particular and that if these standards are threatened, from whatever direction the threat may come, we should not wait to be asked to give advice but demand to be heard. Thus I have great sympathy for those who cry fearfully, 'At all costs keep the College out of medical politics', but I would say to them: 'Yes, by all means let us do that, but in so, doing let Us not allow there to be any room for doubt that this College will use any powers it may legitimately wield in defence of the status and the dignity of the profession of medicine in this country'. What, now, of the future? The last few years, have presented us with many difficulties and it seems to me beyond doubt that the next few years will do the same. Those particularly responsible for the financial affairs of the College have already performed prodigies in maintaining a stable

From the President

situation at a time when the national economic scene has been so threatening. How fortunate we have been in having on Council at such a time in the office of Chairman of the Finance Committee Mr Richard Handley and Mr Ronald Raven. No less an effort is going to be needed in the next few years and there can be no justification for complacency or relaxation. The Royal Commission has begun its work and the College's evidence is in an advanced state of preparation. This is due, I think, firstly to the surgical temperament, which does tend to say, 'If there's a job to be done, let's get on with it', and secondly, possibly another way of saying the same thing, to the immediate response from surgeons throughout the country to my request for information and opinions from which the College's evidence would be compiled. For this I and Council are extremely grateful. Armed with this information we shall be able to make sure that the Royal Commission listens to the voice not only of


your President and Council but of those Fellows of the College who carry the heat and burden of the day in practice in surgery, anaesthetics, or dental surgery in Rochdale, in Weymouth, in Bart's and St Thomas's, in York or Folkestone, in Birmingham, in Cardiff, in every corner of the land. You should not take this to mean that there is any great disparity in the views expressed in different parts of the country. The reverse is the case and what we shall say to the Royal Commission must surely have added force wvhen we emphasize this unanimity of opinion. I shall end on this note, for it gives me the opportunity to add, in conclusion, that the reason why I look to the future with optimism is because we are in a fair way to becoming truly one College. We have always been a strong and active body. If we maintain this unity and continuie to speak with one voice, we should surely be daunted by nothing, foir there is no limit to what we can achieve. RODNEY SMITH

(The above is the text of the President's address to the Annual Meeting of Fellows and Members at Leeds on 24th September I976.)

From the president.

Annals of Royal College of the Surgeons January 1977 FROM THE PRESIDENT I am now well into my final year as your President and I am afraid I am...
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