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Royal College of Surgeons honors Cotton Last week Peter Cotton, M.D., professor of Medicine and director of the Digestive Disease Center, was inducted as an elected fellow of the Royal College of Surgeons of England, at a ceremony in London.  This is an unusual honor for a “non-surgeon.” The Royal College is the professional society supervising surgical training, certification and service quality throughout England, and has had substantial influence on surgical practice throughout the world.  The current Royal Charter dates back only 200 years, but the surgical profession in Britain has long and tenuous roots. Records from the 14th century indicate that minor surgical procedures such as lancing abscesses and extracting teeth were undertaken by the village barbers. From this developed a loose organization of “barber-surgeons.”  Surgeons eventually became independent, but had at the same time to deal with competition from the self-proclaimed “real physicians.” These were the bewigged courtiers who attended the Royals and other great families, drawing blood and prescribing poisons. They would not allow surgeons to be called “Doctor.”  Indeed this tradition persists, so that surgeons in Britain are still called “Mr.” The Royal College is very active in surgical education and innovation. It has elected to fellowship a few “non-surgeons,” who are judged to have made relevant contributions in these fields. In Cotton’s case, these contributions have been in “endoscopy.”  Large areas of surgery have been affected by various forms of “minimally invasive therapy” for the last 20 years. These have been attempts to perform treatments without major incisions (with all that means in terms of pain, hospitalization and etc.). Indeed, it has been stated that there have been three major milestones in the history of “surgery”— anesthesia, disinfection and endoscopy.  “Endoscopy” means using small telescopic instruments to get the job done. Laparoscopic and athroscopic procedures are good examples.  Cotton’s career has been dedicated to the development, evaluation and teaching of techniques using flexible endoscopes as treatment tools. Many digestive conditions, such as polyps, bleeding, strictures and various stones are now managed by medical specialists (gastroenterologists) rather than surgeons, although some surgeons have also embraced the endoscopic revolution.  It is obvious that these could have raised some questions and concerns about “turf,” with different specialists wanting to claim primacy. Cotton has also contributed that debate, arguing that the time-honored distinctions between “medicine” and “surgery” may interfere with best medical practice. Indeed, the Digestive Disease Center that he initiated at MUSC in 1994, was based on the vision that facilitating multidisciplinary collaboration should enhance patient care, and the research and education necessary to improve it. With his new FRCS label,  “Mr.” Cotton can now perhaps better develop that multidisciplinary vision.