In London most of the medical schools had been created within the great old hospitals and were based in them. Qualification was traditionally achieved not by university degree but by examination at the Royal Colleges of Physicians and of the Surgeons, or the Society of Apothecaries. London University was a relatively late addition to medical education in the capital and, even in the 1920s, still not regarded as important in some quarters. London University was an umbrella organization: administering, degree awarding, and examining. In Edinburgh the situation was quite different.The University was the principal seat of medical education and thus an institution primarily devoted to teaching, although research became increasingly important after the Great War. Further complicating the Edinburgh story was the existence of an Extraacademical School of Medicine based at the Royal Colleges. This latter approximated more to the London model.

The Royal Infirmary of Edinburgh was an autonomous institution primarily devoted to patient care.Writing in 1929,A. Logan Turner could see the history of the RIE and the Edinburgh School of Medicine as “one and indivisible.” This was not strictly correct. The relationship was much more one of symbiosis and occasionally mutual parasitism.The sometimes uneasy relations between the RIE and University determined much of the politics surrounding the introduction of academic medicine in this period. An important contribution to this was the status of the physicians and surgeons who served the Infirmary, a number of whom were also employed by the University as teachers and researchers. This situation created dual and occasionally conflicting allegiances and sometimes different priorities. The teachers had an allegiance to the University (and the service of intellectual endeavour) and to the Infirmary Managers, whose prime concern was sound patient care. Further, there were strains within the Infirmary itself. These resulted from the vestiges of an ancient attendance system under which two sorts of practitioner cared for patients and taught students. Although, by the 1920s, for administrative reasons, all senior doctors at the RIE were nominally University teachers, only the Professors of Medicine were University employees (that is, paid University salaries).