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August 4, 1989

'Ravelled Sleeve'? It Seams JAMA Hath Come Apart at Seems

Author Affiliations

New York, NY

New York, NY

JAMA. 1989;262(5):616. doi:10.1001/jama.1989.03430050026016

To the Editor. —  "The Ravelled Sleeve of Care"1 indeed! Residency training may well be in crisis, but how do we manage the stresses brought on by the annihilation of the English language? Or the strain brought on by trying to knit a sleeve. One can hardly imagine how to get it on the needles.What Shakespeare said was, "Sleep that knits up the ravell'd sleave of care." Ravelled is from the verb ravel, of a fabric: to fray out, to suffer disintegration, used by Shakespeare to mean tangled or confused. In current English usage, ravel is synonymous with unravel. Sleave means a slender filament of silk obtained by separating a thicker thread. So, figuratively and beautifully, this phrase means to put something back together that is coming apart.Unfortunately, the legislative approaches imposed in New York State recently on residency training appear to have been conceived in as haphazard