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December 1986

To the Editor-Reply

Author Affiliations

Division of General Medicine and Primary Care

Division of Dermatology Worcester, Mass

Arch Intern Med. 1986;146(12):2416. doi:10.1001/archinte.1986.00360240164033

—What is at issue is not who performed the first skin biopsy but what, in 1986, best serves the interests of patients. The rise of subspecialties has been attributed to the evolution of an anatomic concept of disease, the consequent focus on localized pathology, and the subsequent growth of medical technology.1 By the turn of this century, it had become increasingly unrealistic to expect generalists to be expert in all aspects of medicine. In 1892, Sir William Osler stated that "the rapid increase of knowledge has made concentration in work a necessity; specialism is here, and here to stay."2 We, of course, also recognize, with Osler, that "specialism is not, however, without many disadvantages."2 For that reason, we presented what we thought was a balanced consideration of the skin biopsy procedure in that light. Be that as it may, we fear that Drs Scherger and Patric have

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