Abstract
To have been president of this association for the past year has been a great honor, an honor that I feel I should share with my colleagues in the nonuniversity hospitals. Two years ago my several predecessors warned me that I should start immediately to think about the observations which I now wish to present to you. Walter Bauer in a presidential address spoke of its preparation as an awesome duty and a lonely task. I concur with him. My graduate training in surgery was orthodox. Residencies then were limited mainly to hospitals directly associated with medical schools, and many were of the pyramidal type. The late Elliott C. Cutler and one of our recent presidents, Robert M. Zollinger, were responsible for my formative years. When I left their tutelage to be a surgeon in a midwestern community I tried to follow their precepts. Residents in surgery were nonexistant there,
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