The development of specialty skills in medical and surgical practice in the late 19th and in the 20th century transformed medical practice. For the first time, a patient could visit a doctor with the expectation of an accurate diagnosis and effective treatment. Disease prevention became a realistic proposition. Traditional practice methods became obsolescent, but a yearning for generalist medical wisdom and respect continued until the 2nd World War disrupted progress. In the 19th century, the London Hospital was remarkably open to new ideas, and the Chairman of the Board, Viscount Knutsford, was a master fundraiser. Investment in novel facilities and staff, including the establishment of special departments, and consequent changes in clinical practice led to a growing national and international reputation in clinical practice and education. Specialty skills defined innovations, both in hospital and family practice. More recently, merging St Bartholomew's, the Royal London Hospital and other hospitals has reactivated the advance of specialism.
Michael Swash is Professor of Neurology at the Institute of Neuroscience, University of Lisbon, Portugal, and Emeritus Professor of Neurology at Barts and the London School of Medicine, Queen Mary University of London, UK. He studied at the London Hospital Medical College, UK, the University of Virginia School of Medicine, USA, Case Western Reserve University School of Medicine, USA, and Washington University, USA. He has taught in universities and hospitals across the world and has published more than 750 research papers, and 14 books on clinical medicine, neurology and neuroscience. He has extensive experience in NHS administration and served as Medical Director of the London Hospital NHS Trust. He has been honorary advisor to patient-centred organisations in Britain, Europe, Australia, Japan, and the USA; and was Chairman of the NHS Research Ethics Committee for East London and of the Motor Neurone Disease Association, UK. For 20 years, he was Chief Medical Officer at SwissRe Life and Health in London, UK. As Medical Director of the Royal London NHS Trust, he led the merger with St Bartholomew's Hospital.
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