Show dad dacas letter from london I 1 BY JAMES 11 WALLIS HARILY LY AND ITS significance from last week thus the old diU Ancton betheen btty een the consultant and the specialist la is tending fuse the old general suren sure in and the old dd fashioned corr cori gulting physician are becoming things of the past in conle ways way it la is a pt P ty y for they brought a breadth of clinical knowledge to bear on ir cases m which aich the 1 inan 11 1 trained in a narrower chool cannot hope to emulate but tapir day Is numbered num bored because beatis the general practitioner naturally calls in tho the spec specialist talUt whenever possible there thera are am now new specialists or on every eiery subject from froin infant feeding to senile decay and the alth with hla his teat tae t tubes tv ies tho the liadi with his xray X ray the electro with liis his high frequency ire tre quency currents the psycho an ali alast with Ws his comp completes com lees the deuro loggi the tha trist the dentist are a all U called in fco verity verily amplify or modify tt ra opinion ot of the physician at tl e bedside When whenever cier a new spec lal ty arie arbe the mm WILO tako take lc it up at fit aft t are not as 94 a s a 06 nde ai highly alual fled uly ly as ai ta thouc iose in iii tit arnody I 1 i Laai Lolies ivea fow far a time they are am reu ded iti tk til of it a pro teton 1011 nit cally sceptical of the but as aa soon aa such a begins to justlin it lf moze high lied nien men jakc it tip P and rl thua bring it eventually into line mith thoo already recognized if the la is of A surgical the men meis practising practicing it eventually will be found to possess the ill howship of the royal college of surgeons Surg pons even dentists ow ovi oc catlon catiOn ally RILY oxe fire fellows Fel if it Ls is of a ined medical icat nature mature they thes will hoedl hold the membership of clellow alp of the royal college ot of physicians no one Is a isper specialist who does not hold one or other of these diplomas in addition to his legal practically there are a lerttie number or of men who have made a if afe long study of ceilan aspects of alsea ta slid and are recognized reco aided eliere foie by bi the alit profession as wpc c j waists oi ait oit their even eien though they do not na possess the d meitlon d above but they are few and fu fax and it is only their skill ani and pArson allty velch aich makes then thein able to maintain this posit pasit on oil against the vested tested of tto great collego the royal col leg leges ge have nude it impossible almost for anyone to become a londoner without brej arc or other of their fellowships fello whips ber ause no one practically can get gel elect elected ed to the hon honorary ovary staff of any an london hosp tal wilhoit it such a diploma A man inan who has not got a hospital appointment has little practical opportunity of studee in ili bulk the subject he is interested ir he does not see enough case arid and so lq li enon enormously nov jy hand handicapped capped compared with tile the rival who ho has all the f of the baat outpatient departments of the hospitals from which to choose hla his material that is why doctors give gire so much or 0 their time to the tha hospitals gratuitously they axe u learning leaming all the time they are teaching nta they have adie of leen minds always seln stir me illig them to more perfect methods of diagnosis and treatment and most important of all they have tile the patients on w m hoi i they can try out new methods it Is in an enormous eOr nOs biset to possess posse 33 a 06 hospital appointment appolit ent medicine ja ro lenrer the mastery that Is was mas the spread of fie knowledge the public in the last fifty bears y ears making ma kalns most educated people take tak an all mt elliena inter interest pst in the hoiting voi ranga ting of th r own bodies the whole subject of disette la 13 much more openly dis di cowed tl trail forni exly and v ry oten the t 1 oviers 0 in any lar branch are sus as m well ell knot known ii to the layman as to tle the profession prof zio 1 patients haie lla e therefore cheref om nov not got into the roan av of selections select tins ilig their evl spec aall its independently of their doctors docton s ahn they consider some organ of bodi is not fi ing properly thus ib has conic come about that in the first quarter of this thi j century the old idea that a consultant could not be ap h d except through the family P blont hu his broken down awn and one row rot matte make nn an appointment dl cat with mith any tint tant without reference to ones doctor it Is 13 a pOcI position tion much has pro pio bably borze con to stai it brings con s lit bably morp corp work to the consultant and so he ha makes no 0 cry against it it has certain obvious advantages adan ad nao for the pat tent lent ile he cin can zee see a specialist without hurting his doctors feelus gs when lie is not hob caul quite to happ about th thi pa pi ogress lie he ts bakir je can aia check the op nion of 11 s rector bv reference refe Tence to higher authority auth onty it h w nisim if I 1 f hp has no doctor of ho his own he can go g o dmit to anone lie he chooses the 1 ion 10 1 of i scientific amongst the lilt ita hi hii 1 c 41 ced it a much gr greiter elter tip of the th risks ri ks of dise disease ase than forme li 13 and a g te tend nd i ency to sk expert aalice on in grounds brounds 5 As a I 1 a good deal of the consulting work rolv don la Is tiny iny good reneal antl practitioner beep be ap I 1 competent to hantle handle it it Is lat laa tikon cut an aji elephant eun to shoot a sparrow to demooy caLl tit anta for much of the wk now upon them the consultant dres doea not grumble hla his im fro la 19 uc KUT ana an a the ciso c iso la is simple or the training of tho consultant Is a long and intricate one to keep himself up to date lie ho lias has to be learning leam jig continually lie ile gives on an average two or three hours a day to gratuitous gratum orus hospital hos hosp tol practice so that halt half his working day is thus absorbed d ile he attends discussions on taw subjects that interest him on oll on one or more evenings a week meek and he has to read the medical journals to kep keep himself posted with 11 hs 3 speciality probably therefore lie ha works liand er than any other professional often lie has nob the leisure to play the games or indulge in the le l e creations that he r coram n a 3 to his patients to preserve their health and his reward is seldom anything with trat chith the same saine amount of wil skill and thought expended on any form of business en would bring forth foeth probably it is for this reason that he always discourages hla his sons sona from follow follo v liff 1119 in his footsteps but medicine has a pecolar fascination for certain minds ove on Is always learning one feels that thab one la is doing sume thing good in the world perhaps that is why a doctors doctor s sons soils ii ul in spite of their fathers warnings 0 o af am become dorcuis them themselves seIN ea |