Invited Contribution

The American College of Surgeons and the Royal College ofSurgeons of England: Eighty Years of Friendship

Barry Jackson, MS, PRCS

The American College of Surgeons (ACS), foundedin 1913, has long had close and cordial associationwith the Royal College of Surgeons (RCS) of En-gland, founded in 1800. In this bicentenary year ofthe English College, it is appropriate to recall someof the specific associations between the two datingfrom even before the American College was offi-cially inaugurated.

In November 1913, the inaugural address at thefirst meeting of the American College was given bythe president of the English College, Sir RickmanGodlee, nephew of Lord Joseph Lister, founder ofantiseptic surgery. Godlee presented the newlyformed College with an illuminated parchmentscroll of greeting from the other side of the Atlanticsigned by him and his two vice presidents, express-ing the hope that the new College would have asuccessful career and “fill a position beneficial aliketo the profession and to the community.” Godleewas then inducted as an Honorary Fellow—one offive surgeons so honored at that first convocation.Godlee presented a mallet, used by Lord Lister dur-ing his surgical operations, to be used as a gavel bythe American College. The shaft has a silver inscrip-tion band recording the occasion of the first Collegeconvocation in November 1913.

Perhaps less well known is the fact that FranklinMartin, the founder of Surgery, Gynecology and Ob-stetrics, and the architect behind the original con-

cept of the American College, had traveled to En-gland in August 1913, to ask Godlee if he wouldagree to present the dedicatory address at the firstconvocation and also to gain information about thepossibility of an American College academic gownand hood. This was at the time when George Crile,William Mayo, Harvey Cushing, and John B Mur-phy were being awarded Honorary Fellowships inthe English College. Martin had previouslybroached several colleagues with the possibility of agown being designed and worn at the first convo-cation in the United States, but had been voteddown. Charges of looking ridiculous and creatingan undemocratic atmosphere were made by DrCrile (Fig. 1), and other Regents were equally un-enthusiastic. As Martin sat in the Assembly Hall ofthe Royal College, awaiting the beginning of theFellowship Ceremony, who should arrive but DrCrile himself, bedecked in the full regalia of theRCS. Franklin has recorded how Crile raised hishand in protest as he was asked how he could everbring himself to don such an “undemocratic andutterly ridiculous” costume! The day was won.Franklin returned from London with the design foran academic gown prepared by the ancient firm ofEde & Ravenscroft, founded in 1689, official gownmakers to the King and to the English College. Thedesign was approved and the gown, in blue andscarlet, worn by more than 900 Fellows at the firstconvocation to great acclaim! It has been worn atevery convocation since.

During World War I, close links between thetwo Colleges developed as a result of personalfriendships between surgeons on both sides of theAtlantic. Notable among Anglo-American friend-

No competing interests declared.

Received June 20, 2000; Accepted June 20, 2000.From the Royal College of Surgeons of England, London, England.Correspondence address: Dr. B Jackson, President, Royal College of Surgeonsof England, 35-43 Lincoln’s Inn Fields, London WC2A 3PN, United King-dom.

435© 2000 by the American College of Surgeons ISSN 1072-7515/00/$21.00Published by Elsevier Science Inc. PII S1072-7515(00)00698-0

ships was that of Sir Berkeley Moynihan, later LordMoynihan, who visited the United States towardthe end of the first World War on behalf of theGovernment of Great Britain (Fig. 2). He not onlygave a number of scientific lectures, but also en-listed support of American surgeons for the cause ofthe Allies by superb oratory at the 1917 ClinicalCongress in Chicago on the work of the RoyalArmy Medical Corps in France and Flanders. Hisaddress was titled “What is the War about?” ManyAmerican surgeons enlisted after being stirred byMoynihan’s account of the battle of Ypres and theSomme.

After World War I, Moynihan was a strong sup-porter of the movement to present a ceremonialmace to the ACS “from the consulting surgeons ofthe British Armies in memory of mutual work andgood fellowship in the European war of 1914–1918.” This, the great mace of hand-wrought chis-elled silver gilt, made by Omar Ramsden (Fig. 3), a

distinguished silversmith, is emblazoned with theinsignia of the US Army Medical Corps, the badgeof the Royal Army Medical Corps of Great Britain,the shields of arms of John Hunter and Lord Lister,and a cartouche bearing the words “Philip SyngPhysick 1768–1837, Father of American surgery.”The mace was presented to the College by Moyni-han at the Montreal Congress in October 1920 onbehalf of the 62 British surgeons who subscribed.When accepting this gift George Armstrong, presi-dent of the American College, said “The scientificfire represented in this gift welds another link in thechain that shall forever bind us together in the greatwork of promoting the highest possible standard ofsurgery, as well as peace and good-will among men.”At the same meeting Moynihan gave the first Mur-phy Oration in honor of JB Murphy, who had diedin 1916.

During the interwar years, continued personalfriendships between surgeons of both Colleges de-veloped, and two-way traffic across the Atlantic be-came a regular feature of College meetings. Among

Figure 1. George Washington Crile (1864–1943), founder of theCleveland Clinic, surgical physiologist, surgical scientist, and au-thor, Honorary Fellow RCS 1913, President, ACS 1916.

Figure 2. Lord Moynihan (1865–1936) with Lady Moynihan onone of his many transatlantic crossings, showing that keeping fitby exercise is nothing new!

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distinguished British surgeons who participated inlectures at American College meetings were SirJohn Bland-Sutton (Fig. 4), Sir Gordon Gordon-Taylor, Sir William Arbuthnot Lane, and ProfessorGeorge Grey Turner. Visitors to London includedsuch well-known names as Evarts Graham (Fig. 5),Donald Balfour, John T Finney, and Rudolph Matas.

In May 1941 the London College building inLincoln’s Inn Fields was extremely badly damagedby enemy bombing (Fig. 6). In that same year Gor-don Gordon-Taylor visited several cities in NorthAmerica and was awarded Honorary Fellowship inthe American College. In his acceptance speech hepresented to the American College two pieces fromthe ruins of the English College building, which ledto the Board of Regents voting immediate aid of£2000 toward emergency repairs. Details concern-ing the damage were later included in an articlepublished in the September 1945 edition of theBulletin of the American College of Surgeons. TheBoard of Regents believed that individual AmericanFellows should be offered the opportunity to par-ticipate in the restoration of the English College

Figure 3. Receipt from Omar Ramsden dated July 1920 for thecost of designing and executing the Great Mace presented to theACS from British military surgeons.

Figure 4. The Diploma of Honorary Fellowship of the ACS presented to Sir John Bland-Sutton in 1927. JB-S (1855–1936) was President of the RCS 1923–25, being succeeded by Moynihan. He was a prolific author of surgical texts andphilosophical essays.

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building, resulting in the magnificent sum of morethan $31,000 being collected by 1947. This wassent to Sir Alfred Webb-Johnson, president of theEnglish College, by Irvin Abell, chairman of the

Board of Regents of the ACS. In the letter accom-panying the check, Dr Abell quoted the words of LordMoynihan used at the time Moynihan presentedthe great mace to the American College on behalf ofthe consulting surgeons of the British Armies:

“We pray that you may regard it as a symbol of ourunion in the harsh days of trial; as a pledge of ourdevotion to the same imperishable ideals; as a wit-ness of our unfaltering and unchanging hope thatthe members of our profession in the two landsshould be joined in brotherhood for ever in theservice of mankind.”

Later that same year, in September 1947, theEnglish College bestowed its Honorary Fellowshipon Dr Abell, and on Drs Arthur Allen, Frank Lahey,Dallas Phemister, and Alfred Blalock. Dr Abell thenpresented to the English president a magnificentoak table carved with the coat of arms of the EnglishCollege and the Seal of the American College to-gether with a lectern as “a token of great apprecia-tion of past favours to the American College and ofhigh esteem and undying friendship” (Fig. 7). Apresentation from the ACS to the RCS had firstbeen discussed in the 1920s, but a suitable gift wasnot decided on until the 1930s.

Eventually, in 1937, Regent J Bentley Squier,

Figure 5. Evarts Graham (left) receiving the Lister Medal from SirAlfred Webb-Johnson PRCS in London in 1947. The medal hadbeen awarded several years earlier, but the Second World War andaftermath precluded travel. Graham (1883–1957) was head ofsurgery at Washington University, St Louis for 32 years, andserved as president of the ACS, the ASA, and the InternationalCollege of Surgeons, among many other offices.

Figure 6. The morning of May 11, 1941, College staff sort through the rubble of the entrance hall, with the College Coatof Arms surmounted by eagle unharmed in the background. This now resides in the conservatory of a rebuilt College.

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professor of urology at Columbia, suggested a spe-cially designed table and lectern, a suggestion thendiscussed in detail with the English College. Mat-ters of size and suitable inscription needed to beagreed on. After construction in 1939, delivery ofthe gift was delayed by the war until 1947, whenthere was a meeting in London of the InternationalSociety of Surgery, allowing for an international au-dience to witness the presentation. The table andlectern grace our Great Hall to this day. In acceptingthis present, Sir Alfred Webb-Johnson stated that itwould be a constant reminder of extraordinary gen-erosity at the time of disaster and would help tocement for all time the constant friendship betweenthe two Colleges and countries. The president ofthe American College, Dr Arthur Allen, then deliv-ered a Moynihan Lecture on the subject of duode-nal ulcer, using the lectern for his notes. Fifty-threeyears later, the content of the lecture has becomeobsolete but the desk and lectern are used regularlyevery month of the year!

By May 1954, the rebuilding of the bomb-damaged Great Hall was complete, and it was usedto host a sectional meeting of the ACS held in Lon-don. The advertising material reported that theworld’s greatest and most modern liner, the SSUnited States, was booked, but, for those who werein a hurry and wanted unsurpassed luxury, PanAmerican World Airways offered its new DoubleDeck Flying Clipper overnight from New York toLondon! Some 600 American surgeons and 400British surgeons registered for the meeting, beforethe American delegation moved on to Paris and

Brussels for further meetings. An element of gran-deur and color was added to the eponymous lec-tures by the ceremonial entry of the AmericanBoard of Regents and the English College Council,wearing robes and led by their respective mace-bearers. In addition to the scientific program, therewas a full social program, including a reception atthe House of Lords and a fashion parade for thewives of visiting American surgeons held at the sa-lon of one of England’s leading couturiers, NormanHartnell. Twenty-five years later, in 1979, anotherjoint meeting was held in London (Fig. 8). This wasa 3-day meeting around the theme of the generalityof surgery. Again, an active social program was ar-ranged in addition to the scientific program, thistime with visits to Windsor Castle and theGuildhall.

Other associations between our two Collegesinclude joint development and foundation of theInternational Federation of Surgical Colleges andSocieties, which began in 1958 at the sectionalmeeting of the American College in Stockholm.The origin of the Federation was informal conver-sation at the Clinical Congress in Chicago in 1955,when several delegates suggested international co-operation between surgeons, with the prime objec-tive of elevating standards of surgical treatment,training, and education of surgeons throughout theworld. The following year the English College in-vited the American College to send representativesto London to develop the proposal, and in 1957 atemporary committee structure was establishedwith Sir Harry Platt from the UK and Dr Isadore

Figure 7. The presentation of a gift from ACS of a carved oak table and lectern, September 1947. Left to right: Blalock,Webb-Johnson, President, RCS, Phemister, Lahey, Abell, Graham, Gallie, and Arthur Allen, President, ACS.

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Ravdin from the US as principal voices. From theseearly beginnings the current worldwide organiza-tion developed.

The Joint Conference of Surgical Colleges wasfounded in the UK in 1963 to develop a betterknowledge and fuller understanding of training sys-tems throughout the world and was joined as a fullmember by the American College in 1974. Thesemeetings comprised the presidents of the Collegesand met at bi-yearly intervals at each College inturn. It is particularly appropriate that, after a lapseof some years, this group met again in London inOctober 2000 at the culmination of the EnglishCollege bicentenary celebrations and immediatelybefore the Clinical Congress in Chicago. Repre-sented were the American, English, Edinburgh,Glasgow, Irish, Canadian, South African, and Aus-tralasian Colleges, and the Academies of HongKong, Singapore, and Malaysia. The ACS was rep-resented by its current president, James Thompson,and its immediate past president, George Sheldon,

both of whom were made Honorary Fellows of theEnglish College.

Eighty-seven years have passed since the Amer-ican College was founded, during which time therehas been continued close and warm friendship,both corporately and individually—friendship be-tween the two Colleges and between many individ-ual Fellows. There has been much interchange ofscientific endeavor. It is right to look back fromtime to time and to reflect on these associations, notonly scientific but also social. On August 6, 1913,the day before the award of the English HonoraryFellowships to Crile, Mayo, Cushing, and Murphy,at the time when Franklin Martin, the guiding lightbehind the embryo ACS, was learning first hand ofthe traditions and the atmosphere of the EnglishCollege, an Anglo-American dinner was held in thelibrary of the College in Lincoln’s Inn Fields, Lon-don. The menu was as follows:

Beverages Menu

Punch Thick and Clear Turtle SoupppppGrilled SoleBoiled Troutppppp

Pommeroy 1900 Fillets of Chicken and TongueDevilled LobsterppppppBaron of Beef (cold)Cos Lettuce Saladppppp

Sharzberger 1908 Cumberland HamGreen Peasppppp

Chateau Leoville-Barton Currant and Raspberry Tart1890 Orange Jelly

pppppCheshire Cheese

Croft’s Port 1878 Lemon Water IceStrawberry Ice CreampppppDessertppppp

Old Brandy Coffee

Would that we had the capacity or the inclination todine like that today! But although the gastrointesti-nal tracts of present-day surgeons are less capacious,the warmth of friendship between surgeons of theAmerican and English Colleges is as strong as ever.Long may this continue. Floreant Collegia Angliae etAmericae.

Figure 8. The program cover for the joint meeting of the RCS andthe ACS in London 1979.

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