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In March and April of 1981, I enjoyed the privilege of being the British Journal of Surgery Traveling Fellow. The fellowship enabled me to attend the meeting of the Association of Surgeons of Great Britain and Ireland held in Belfast, and to visit nine general surgical centers in Ireland and England. Most of the centers visited were district hospitals, each of which provides general medical care to a local population of 400,000 persons. My gracious and hospitable hosts provided much information of interest.
In a district hospital, the primary responsibility for surgical activities rests on four to six consultant surgeons. Capable, skilled, and experienced, these men had been carefully selected for their posts after a long period of training in clinical and, often, in experimental work. Appointments usually extend throughout their remaining professional lives, so the likelihood of changing to another hospital or another district is slight. This gives