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A city in the broadest sense is just a large human settlement; I don’t think that internationally there is any standard definition of how many humans there has to be although I’d have thought 100,000 people is a shoo-in. One just knows a city when one experiences it.In Britain, city status has traditionally been in the gift of the sovereign. At least since Henry VIII created five new bishoprics (with his own placemen in charge) in Chester, Gloucester, Peterborough, St Albans and Bristol and granted charters to those cities (except Bristol which was the revival of a lapsed bishopric). Before that, bishops tended to have their thrones in what had already been important fortified cities by default. Some like Winchester and Lichfield, which are now relatively small places, were extremely important in medieval England; Winchester being the capital of the Kingdom of Wessex and while Lichfield wasn’t the capital of Mercia (that was nearby Tamworth) had much of that status, and both are still important centres. Dorchester-on-Thames ceded its bishop’s throne to Lincoln in the medieval period and has dwindled to a small commuter village between Oxford and Henley. Dunwich in Suffolk literally fell into the sea, its diocese going first to Norwich, then to St Edmundsbury & Ipwich (20th-century bishopric: neither Bury St Edmunds (40,000 people) or Ipswich (135,000 people) are cities. Some English cities like Wells or Ely, despite their big medieval cathedrals which dominate, just don’t have a city feel to them; they are functionally market towns.In the twentieth century city status has been conferred by royal charter only. Periodically there’s an auction of charters to commemorate some royal event: Southampton and Swansea (whose football team Swansea Town became Swansea City) were cities in all but name before 1963, the tenth anniversary of the last coronation. There’s usually one for each of the home countries although Scotland doesn’t have bishops of an established church to show them the way (as Flanders & Swann sang). St Asaph (pop. about 3,500, once a major traffic snarl up but now a quiet small town) got one the last time around I think, which seems silly when Wrexham (pop. 60,000 and the most important commercial centre in the north of the country). There does seem to be a bias in favour of the pre-industrial and well-heeled over the industrial: the sore thumb in Scotland is Paisley (pop 90,000, fifth of the Big Four, more listed buildings per hectare in its centre than Edinburgh, internationally-recognised brand but a declined textile centre), which has taken a back seat to places half the size: Perth, Inverness and Stirling. It’s ultimately a true personal gift of the sovereign and it is said that places like Reading (urban area 310,000) and johnny-come-lately Milton Keynes (230,000, gave itself its own “ecumenical cathedral” without a bishop’s throne) are said to have been overlooked for pre-empting the award and calling themselves cities anyway,Some other English urban settlements that are undoubtedly cities but are still waiting for the acknowledgement are (populations are urban area totals):Middlesbrough, Yorkshire (380,000)Blackburn, Lancashire (120,000, has a C of E Cathedral)Ipswich, Suffolk (135,000, has diocesan offices but not the cathedral which is in Bury St Edmunds)Bournemouth/Poole, Dorset (450,000)Blackpool, Lancashire (240,000)Basildon, Essex (185,000)Birkenhead, Cheshire/Merseyside (325,000)Luton, Bedfordshire (260,000)Southend, Essex (300,000)Swindon, Wiltshire (180,000)Croydon, Surrey/Greater London (330,000)My personal view, for what it’s worth, is that a spade should be called a spade and a city a city. Other monickers are available to indicate royal patronage. There are Royal Boroughs, which rank ceremonially below a city but above a plain borough – when I was on Kensington & Chelsea Council, sorry, The Council of the Royal Borough of Kensington and Chelsea in the 1990s the very Conservative PTB made much of their Mayor being the third-ranked in London after the Lord Mayors of London and Westminster (did I mention that the chief citizen of a city in England and Wales is a Lord Mayor [and a Lord Provost in Scotland] whereas that of a mere town is only a Mayor?). That was a recent creation after the lapse of the Royal Borough of Kensington in 1965, just as the RB of Kingston-upon-Thames inherited the title from Kingston. Kingston had been a much older creation so ranked ahead of Kensington, but the new creations were both on the same day, 1 April 1965, so Kensington & Chelsea edged ahead of Kingston upon Thames on alphabetical order. ‘Royal’ can also be prepended to a town’s name (Tunbridge Well, Leamington Spa, Wootton Bassett) and historically Regis (Lyme, Bognor) could be appended. There’s no shortage of medieval ‘Kings–’ places including Kingston upon Hull, which declared for Parliament in the Civil War and is usually called hull outwith the most formal applications.

Surgery was basically taught in two manners. One was that of an apprenticeship with the local barber surgeons who typically controlled the education and who got to practice in their locality. They were derided as the empiricists by their learned counterparts but generally seem to have been able to perform most minor surgeries at a decent price.In France an ordinance of 1372 authorized barbers to treat “boils, tumors, and open wounds, if the wounds are not fatal,” This, undoubtedly merely recognized an existing practice. The barbers even took over the major therapeutic modality of blood letting. In dress the barber-surgeons were distinguished from the surgeons in that the former wore a short rather than a long robe.It is also noteworthy that among these (barber) surgeons there was specialization to the point that even learned surgeons generally left some surgeries to the barber surgeons. Think of things like removing bladder stones or couching cataract.It was during the Late Middle Ages that surgery also gained acceptance as a separate branch of formal university taught medicine. Students had to be literate in latin and were taught a variety of medical texts from the Ancient Greeks down to Arabs and contemporary Europeans. They were in some way privileged compared to surgeons from the rest of the planet because Christianity held fewer taboo’s against autopsies and dissections. It is not entirely clear but it seems like students had to attend a dissection at least once to get a good grasp of what the inside of a body actually looked liked.The below painting would have been unthinkable in much of the rest of the worldUniversity taught surgeons generally had an extensive training and on top of that some places instituted the practice of only allowing licences surgeons to perform. The licence usually being granted by a small body consisting of other surgeons who could question and possibly observe the skill.In the 13th century the Holy Roman Emperor Frederick tried to impose some form of certification and licencing in his dominions;No doctor shall practice after the completion of the five year period who has not practiced for an entire year under the direction of an experienced doctor. During the period of five years the masters shall teach in the schools the authenticated books of both Hippocrates and Galen, and shall instruct in the theory as well as in the practice of medicine. Moreover, we decree as a measure for the public health that no surgeon shall be admitted to practice who does not present testimonials from masters in the faculty of medicine, stating that he has studied for at least a year in that field of medicine which develops skill in surgery, in particular, that he has learned in the schools the anatomy of human bodies, and that he is proficient in that field of medicine without which incisions cannot be safely made nor fractures healed. The Shift of Medical Education into the Universities…In Paris in 1270 the medical curriculum required six years without a liberal arts degree and five and a half years with one. By 1350 having a Master of Arts degree saved 12 months from the period of medical training. At the end of the 14th century virtually all Paris medical graduates also were masters of Arts (3). At Bologna academic study was a little shorter: five years without a liberal arts degree and four years with this qualification…The other important members of the healing arts were the apothecaries and the herbalists. The latter were held to be inferior, as barbers were inferior to surgeons. Physicians were particularly concerned about the training and practices of the apothecaries because they were dependent on their services for the supply of medications. Inspection of apothecary shops was included among the ordinances of Frederick II early in the 13th century; it became required in Paris in 1353 (8, 20). Because most medicines were botanicals it seems a natural evolution that in England the early apothecaries largely were members of the guild of spicerers-spice merchants. This was still true well after 1312 when an organization of apothecaries already existed in London. As early as 1313 there was a court apothecary, one Odin the Spicer (26). In some ways the apothecaries had to be more learned than the surgeons or barbers, because they had to be able to read Latin, both to fill prescriptions and also, when available, to employ references. In France an apothecary’s apprenticeship lasted four years; its duration in England is uncertain. These practioners, like the physicians whom they served, largely remained in the cities, while the relatively untrained herbalists practiced in the countryside.Now the medical licencing appears in different places centuries apart but it was generally in place by the 15th and 16th century.Not that things always went that smoothly…Medical practice in fifteenth-century England is often seen as suffering from the low status and unregulated practice of which Thomas Linacre later complained. Unlike in many European cities, the provision of physic was uncontrolled, and while urban guilds oversaw surgery as a manual art, no comprehensive system of medical organisation or regulation existed. However, in a remarkable episode of the 1420s, a group of university-trained physicians and elite surgeons associated with Humphrey, Duke of Gloucester, briefly established just such a system. While their efforts initially secured approval for a national scheme, it was only in the City of London that they succeeded in implementing their plans. The detailed ordinances of the collegiate ‘commonalty’ they founded provide a unique insight into their attitudes. Drawing on continental models, they attempted to control all medicine within the city by establishing a hierarchy of practitioners, preventing illicit and incompetent practice, and offering treatment to even the poorest Londoners. Yet they failed to appreciate the vested interests of civic politics: achieving these aims meant curtailing the rights of the powerful Grocers and the Barbers, a fact made clear by their adjudication of a case involving two members of the Barbers’ Company, and the Barbers’ subsequent riposte—a mayoral petition that heralded the commonalty’s end. Its founder surgeons went on to revitalise their Surgeons’ Fellowship, which continued independently of the Barbers until a merger in 1540; in contrast, the physicians withdrew from civic affairs, and physic remained entirely unregulated until episcopal licensing was instituted in 1511.…The right of regulation of surgery [in London] that was claimed in the ordinances of 1423, however, represented a direct attack on the Barbers. In much the same manner as the Drapers continued to assert their right of search and inspection of the Taylors’ cloth under the authority of their ordinances approved by the mayor and aldermen, so the 1423 ordinances gave the surgeons of the new commonalty the right to judge the work of the surgeons of the Barbers’ Company. The application of the 1421 proposals within the City would have been doomed to failure had the Barbers objected to the selection of Surgeons as the arbiters of licensing, for the royal ordinances would have been regarded as an infringement upon civic privilege. But, by moving to institute their ordinances through the authority of the Mayor, the commonalty initially circumvented opposition from the Barbers.…Not only physic, but also surgery, was to be regulated: ‘The lords of the king’s council at the time should have the power, by authority of the same parliament, to assign and designate an ordinance and punishment for such people as shall henceforth meddle in and exercise the practice of the said arts and are not skilled or licensed in them’. Those allowed to practise were defined separately, ‘as befits the same arts’, as ‘physicians in the universities, and surgeons among the masters of that art’. The initiative for the petition may have come from physicians, but the lords in parliament, drawing upon their experience in the French wars, had seen the virtue of applying these regulations also to surgery.Medical Practice, Urban Politics and Patronage: The London ‘Commonalty’ of Physicians and Surgeons of the 1420sNow to a modern medical student things like having to attend or perform a dissection and having to get a license to practice seem like standard things but they were actually rather novel at the time. To a degree though it paid dividends and by the late 16th and early 17th century the stereotype of all Europeans being doctors/surgeons was well established in Asia. In times of need Persian Shah’s, Mughal Emperors and Japanse Daimyo’s seem to have opted for European surgeons if they were around.

My grandfather G. Vasantha Pai was is one of the 3 inspirations in my life (the other two being my Dad and my other grandfather). I disagreed with him on most issues but I admired him for three reasons:HE WAS A PATRIOTHE WAS BRAVEHE WAS ACTION-ORIENTEDWhen I first came to America, I saved money and bought my Ajja a watch. Although it was a cheap $25 Tommy Hilfiger watch, and my Ajja researched that Hilfiger might be a racist, he proudly wore that watch every day including in this below photo:For reference this photo was when my grandfather was well into his 80s. In his 40s and 50s my grandmother says he looked like Gregory Peck, just a lot better looking :-)Ajja got me interested in many cool things in life including reading, traveling the world on a shoestring budget, numerology, palmistry, chess, outdoor sports, etc.Most importantly he helped me learn how to balance being frugal when it doesn’t matter with being super-generous when it counts.Although he was a lawyer he never once imposed his choice of profession on me.the below article is by World Bank Lead Counsel Vikram Raghavan:I wanted to reflect on the passing yesterday of a freedom fighter, lawyer, and patriot, who was largely unknown outside Chennai. G. Vasantha Pai was a senior advocate of the Madras High Court and a former member of the now-abolished Tamil Nadu Legislative Council. He is the younger brother of G. B. Pai, the famous labour lawyer and philatelist, who died last year. He was a towering and inspiring figure, and I want to dwell briefly upon his life and accomplishments.Vasantha Pai joined public life when he was still an adolescent. In his teens, he responded to the Mahatma’s call and participated in demonstrations against the British. He was mercilessly beaten at one demostration by an English police officer on horseback. That incident left him with two proud souvenirs: a deep scar on his shoulder blade and a wooden plaque (with Gandhi in the background of an undivided British India) from his grateful hometown of Cochin recognizing his contribution to our freedom movement.Pai then enrolled as a student of the Madras (now Dr. Ambedkar Government) Law College. His final law exams were scheduled just as Madras was vacated over fears that the Japanese would bomb the city. The lighthouse, which, in those days, was erected over the High Court building, was a choice target. Given its proximity to the Law College, the law students, including Pai (and my late maternal grand-uncle, John D’Souza of Bangalore) were sent to Vorhees College in Vellore. At Vellore, the evacuees endured hostile hostel and hygenic conditions that were hardly conducive to taking a final exam. Pai was the president of the students’ union and under pressure from the agitated rank and file, who were unable to adequately prepare for the exam. So, he successfully persuaded the exam invigilators that the students should be allowed to consult bare acts as they were preparing to become lawyers, and lawyers in courts always appeared with books. This was probably the first officially sanctioned “open book” examination at an Indian law school and the class passed with flying colours.After obtaining his law degree, Pai got his early practical training from his father, Guna Pai, who was a leading commercial lawyer in Ernakulam. Among other things, he learnt the importance of doing your own legal research and legal work. Guna Pai apparently made young Vasanth read every Indian statute from the first section to the last in order to fully understand the structure of the law in its entirety. Years later, Pai passed on that lesson to me. It is one that I use in my own practice when I encounter a new law or legislation that I have to work with.Pai moved to Chennai in the 1950s and began his practice just as Indian high courts began to explore their new constitutional powers under the writ jurisdiction. He became a well-known authority on election law issues and corporate matters. He appeared in, among other things, the landmark Supreme Court case of National Textile Workers v. Ramakrishnan, where the Court ruled that employees have a stake in winding-up proceedings. Yet, Pai was, by no means, only a hired gun. He filed several cases himself — some of them are still very important for their legal principles while the impact of others have faded over the years. Pai appeared himself in almost all of these cases.As the reported decisions reveal, Pai’s advocacy of various causes were not always successful. Yet, he was his indefatigable self as an advocate’s advocate who appeared before six generations of judges at the Madras High Court and in the Supreme Court. He remained a firm believer in the rule of law and in the judiciary’s capacity to administer relief for his clients’ causes and his own personal grievances. He was always arguing, pleading, and insisting that the letter and spirit of the law be followed, that procedures be observed, that rules in force be obeyed, and most importantly, that justice be seen and done, and equity fairly administered. He did so with eloquence, force, conviction, and passion, even when outwitted by an opponent or rebuked by an unsympathetic judge. Oliver Goldsmith’s description of the Village School Master’s skills would aptly apply to Pai: “in arguing too, the person own’d his skill, For e’en though vanquish’d he could argue still.”Pai’s greatest, but largely forgotten, contribution to our legal system was his dogged private investigation in the mid-1960s of Ramachandra Iyer, the Chief Justice of the Madras High Court. Pai discovered that Ramachandra Iyer had concealed his real age in order to gain a longer judicial tenure. He found it most intriguing that the judge’s younger brother had dispatched invitations for his sixtieth birthday, even though the judge, himself, claimed he was not yet sixty. Determined to get to the bottom of the matter, Pai went to Ramachandra Iyer’s birthplace and photographed the original birth registrar (there were no photocopiers in those days). With this evidence, he concluded that the judge had lied about his age. He then relentlessly sought the judge’s removal undeterred by the stone walling that he faced from the home ministry and the higher judiciary. Ultimately, the judge was forced to resign at the urgings of the Chief Justice of India, P.B. Gajendragadkar. K.G. Kannabiran, the great doyen of our human rights bar, explains why Pai’s efforts to have Ramachandra Iyer unseated were important:[Ramachandra Iyer] was known to be a competent judge, but competence and ability are not synonyms for ethical or moral conduct. . . . . Really age has nothing to do with a person functioning as a judge. Nor has it anything to do with the administration of justice. But once an age of entry and exit is fixed, misrepresentation of age becomes unethical and continuation on such representation does affect the administration of justice, not because he is past the age but because he misrepresented to extend his tenure.A key development in ensuring the judge’s exit was Pai’s writ petition against the judge in the Madras High Court. Seeking a writ of quo warranto, Pai asked the High Court to remove Ramachandra Iyer, whom the petition’s cause title described as “Now Holding The Office of the Honourable The Chief Justice of Madras.” This, in itself, was a bold and audacious move, especially at a time where there was great deference in the bar to the judiciary, which was seen as infallible and beyond reproach. Although the High Court later dismissed Pai’s petition after the judge resigned, the case was an important milestone in ensuring judicial accountability. More importantly, it marked among the first examples of what later became public interest litigation.Pai was a senior counsel who refused to delegate his preparation and research to juniors. He spent an enormous amount of time preparing his cases. He was up and at his home-office desk as dawn was just breaking — not in India, but two time zones away in Singapore. He was very fond of reading and he read widely. In the early 1990s, he donated a large collection of his books to the National Law School of India’s fledgling library (giving it its first set of Shiva Rao’s important papers on our Constitution’s framing). He also gave his law reports to the Madras High Court’s Women Lawyers Association. He was particularly keen on properly recalling and constantly refreshing one’s knowledge of legal first-principles and landmark cases. When I was in my first year of law school, he argued a trade mark case with great erudition. He began his arguments with the Gloucester Grammar School Master’s Case, an old rusty decision that one learns and forgets in the first week of the first year of law school. Yet, that antique case vividly and dramatically emphasized Pai’s underlying argument that his client could not be sued for a trademark violation. Pai used the case as a rhetorical device to great effect and the judge was considerably impressed by it.A lot of my early reading on law and legal developments was from books he lent me. Among other things, I read Pai’s copy of Setalvad’s fascinating autobiography from whose title this blog’s name is derived. Pai adored Setalvad with whom he appeared as a junior in several cases. He placed a high premium on professional ethics and was greatly dismayed at what he believed was the rapid erosion of values in the bar. Yet, he had great faith in the legal profession and instituted scholarships for promising young lawyers and created endowments to fund lectures on legal topics.Although he despised the messy arena of party politics, Pai was a firm believer in parliamentary democracy. He contested and won a seat as an independent in the Tamil Nadu Legislative Council from the graduates constituency. He was a stickler for constitutional traditions and legislative propriety. Even after he left the Legislative Council, he wrote frequent letters to prime ministers, chief ministers, and presiding officers admonishing them for their transgressions or providing them with advice on difficult issues of the day. He never earned much goodwill by these actions. He was greatly reviled for his persistence in advocating a cause and attacked for his stubborn and unbending commitment to a case. One particularly mean adversary of his actually shared with me his rotten (and thankfully wrong) belief that Pai would soon succumb to illness so that he and his henchman would be free to pursue their machinations. In this respect, therefore, the ancient Greek praise for Pericles might well apply to Pai:He did not so much follow as lead the people because he framed not his words to please them like one who is gaining power by unworthy means but was able and dared on the strength of high character even to brave their anger by contradicting their will.On a more personal note, “Uncle Vasanth,” as we called him was my family’s neighbour for more than forty years in Chennai’s Gandhi Nagar neighbourhood. As children, we feared his stentorian voice, but we were charmed by his grand-fatherly kindness and limitless generosity. He was hospitable to a fault to all who came to see him. He would leave whatever he was doing — whether reading the latest law reports or preparing for a case in conference with other lawyers — and loudly herald the arrival of his unannounced guests, whether young or old, to his beloved wife. Then, he would proceed, himself, to make for his guests a cool drink from freshly squeezed limes of his garden, which offered a welcome respite from Madras’s unforgiving humidity. No visit to Uncle Vasanth’s home was complete without partaking, at his insistence, nay his most compelling demand, of whatever fruits, sweets, or snacks he had in his larder that day.It was impossible not to be influenced by his local presence. Many a day began for us with an unsolicited 5.30 am wake-up call from Uncle Vasanth to whomsoever picked up the phone. Pai would vent about whatever had been agitating him for the past three hours since his pre-dawn rising. My father, who often took the call, would respectfully answer the phone and then go back to sleep. If Uncle Vasanth was not satisfied with my father’s response, he would pay us a visit at 6.30 am when returning his daily constitutional that consisted of walking three blocks to pick-up that morning’s fresh supply of milk. He was at his best during the evening sun-downer of scotch (for years, he preserved every bottle that he opened), which he shared regularly with my father and grand father. With them, he would share war stories about his cases and pursuits while simultaneously dazzling the starry eyed children, who watched in awe as the adults spoke, with anecdotes from his world travels. Those travels were true adventures and to make them he developed ingenious ways to overcome the harsh foreign-exchange restrictions that the Sarkari Raj imposed on traveling Indians between the 1960s and 1990s.Uncle Vasanth’s constant companion through his journeys and adventures has been his loyal and ever pleasant wife, Shantha. She, in her own right, is an important figure in our country’s constitutional history. Before she married Pai, Shantha Bai (as was her maiden name) sued the University of Madras in 1957 on the grounds of sex discrimination because one of its affiliated colleges did not admit her. This was among the first cases involving the Constitution’s guarantee of equal protection and non-discrimination. However, Chief Justice Rajammannar, one of India’s greatest judges, was unconvinced that a writ could lie against the University as he took a narrow view of the term “state” in Article 12. Ultimately, the Supreme Court reversed Rajamannnar’s decision in a subsequent case paving the way for a broader application of the fundamental rights in our Constitution.Finally, Uncle Vasanth was a true-blooded patriot whose love for country was forged through his wounds as a young freedom fighter. He took it upon himself to nurture in us a strong sense of pride in our democracy and founders. He took me to my first Republic Day parade on the Marina beach in Chennai and never ceased to extol the importance of serving one’s country through participation in public life. Even in his eighties, Uncle Vasanth unfailingly commemorated Republic Day and Independence Day with a dinner reception at home for his friends and neighbours. Even last weekend, as he spent his fourth week in cardiac intensive care, he was busy drawing up a guest list for an event commemorating the Republic’s founding on January 26, which he felt he somehow could pull off by getting better in time for it. Although he never made it out of hospital for Republic Day, we can be comforted that he has now “gone to meet” the Mahatma, Tagore, and India’s other founders, whom he adored and emulated in his life on earth, in that freedom’s heaven where they reside.God bless India!