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October 1960

Medical Specialism and the Boards

Arch Dermatol. 1960;82(4):521-525. doi:10.1001/archderm.1960.01580040039007

At the "Conference on Specialism in Medicine"1 in 1959 specialism and particularly the Specialty Boards came in for considerable criticism. Gladston2 reminded us that "medical specialism was first pursued mainly by the laity. The lens coucher, tooth extractor, lithotomist, bone setter, midwife, masseur and barber surgeon were the specialists of the middle ages . . . . They were, as so many are today, technicians, men skilled in crafts rather than knowledgeable in theories." Galdston divided the practice of medicine "into two major categories: episodic and maintenance. Episodic medicine, as the term implies, is the medicine practiced in emergency situations . . . . Maintenance medicine is devoted to fostering the every day well-being of the individual . . . . Episodic medicine is primarily and predominantly the realm of the specialist." In a previous paper Galdston3 stated that "the future of medical service is not to be envisaged as a continued refinement, as well as increase, in the

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