Many years ago I was impressed on reading the Wealth of Nations by Adam Smith. In chapter I, on the causes of improvement in the productive power of labor, he takes as his example the division of labor in the trade of the pin maker. By repetitive action skill is acquired, technic developed and a tremendous increase in production obtained. Specialism increases productivity, enhances accuracy and skill, economizes time and labor and inherently promotes ingenuity and discovery. In the acquisition of medical knowledge in our country we passed through the preceptor period and then the closing of the inferior medical schools through the labors of the Council on Medical Education and Hospitals of the American Medical Association. A little later a standard premedical education was required and the opportunities for postgraduate instruction were greatly increased.
Specialism in medicine has always existed, modified by environment, superstition, religion and the state of