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The training of physicians in the past century was based primarily on responsibility and the chain-of-command. Those with the bulk of that responsibility in the fields of pediatrics and internal medicine were residents. Residents trained the medical students and supervised them carefully in caring for patients. Most attending physicians supervised their teams at arm's length, primarily serving as teachers of the finer points of diagnosis and treatment during set periods of the day or week with a perfunctory signature on write-ups or progress notes. Residents endeavored to protect the attending physician from being heavily involved unless they were unsure about a clinical problem. Before contacting the attending physician, a more senior resident would be called. Responsibility was the ultimate teacher. The introduction of diagnosis-related groups by the federal government dramatically changed the health care delivery system, placing greater emphasis on attending physician visibility in the medical record, ultimately resulting in more attending physician involvement in day-to-day care of patients in academic institutions. Without specified content in attending notes, hospital revenues would decline. Although always in charge technically, attending physicians increasingly have assumed the role once dominated by the resident. Using biographical experiences of more than 40 years, the author acknowledges and praises the educational role of responsibility in his own training and laments its declining role in today's students and house staff.

This article provides an analysis of royalist strategy in the viceroyalty
of Peru during the four years between the arrival of José de San Martín's invasion
force in September 1820 and the battle of Ayacucho of December 1824. It pays
particular attention to royalist policy from July 1821, when viceroy José de la
Serna evacuated Lima, the viceregal capital, leaving the city open to San Martín,
who declared independence there on 28 July. Its focus differs, therefore, from
that of most previous commentators on Peru's transition to independence, who
have tended to neglect royalist policy and activity during these crucial final years
in favour of a concentration upon the activities of San Martín, Antonio José de
Sucre, Simón Bolívar and their Peruvian allies. The article begins with a brief
contextual discussion of the historiography of Peruvian independence and
subsequently analyses the main features of historical developments in the
viceroyalty in the period 1810–20. Following substantive discussion of the period
1820–4, it concludes with observations on the historical legacy in Peru of the
royalists' elevation of the city of Cusco to the status of viceregal capital in 1822–4.

This article analyses, first, the principal features of Spain's
commercial
policies towards Spanish America in 1797–1820, and, second, the value,
nature
and distribution of the trade that survived in this period, despite prolonged

international warfare, the admission of neutral shipping, and internal
strife from
1808 in both Spain and America. Like the author's earlier
studies of 'free trade'
in the period 1778–96, its principal sources are shipping registers
and associated
inter-ministerial correspondence in the Archivo General de Indias of Sevilla.
Its
main conclusions are that: (1) despite ambivalence and uncertainty in Spain
about
commercial policy, trade with Spanish America was more buoyant in 1797–1820

than previously realised; (2) nevertheless, by the first decade of the
nineteenth
century most parts of Spanish America were enjoying
de facto, if not de jure, free
trade with foreigners; (3) consequently, commercial discontent was not
a key
factor in the process of emancipation from Spain, particularly in the viceroyalties

of New Spain and Peru which received some 70% of exports from Spain in
this period.

Mark Twain in his travel narrative Roughing It presents a naive, innocent narrator from the East who ventures forth into the largely uncivilized Western frontier during the exciting silver mining boom of the 1860's. In his sojourn the innocent narrator encounters many people, places, customs, values, and experiences that are unfamiliar to him, and because of his status as a tenderfoot unacquainted with the frontier, he is often made a dupe by the mischievous old-timers in the West. The innocent narrator must go through numerous initiations before he is accepted as a member of the vernacular community. In these various confronting experiences with Western values and customs, he cannot help but feel like a misplaced outsider unaccustomed to the freedom inherent in an uncivilized society. Often the tenderfoot is ridiculed and made ludicrous for pretentious behavior, an inflated opinion of himself, as in the sketches involving animal similes, metaphors, and anecdotes. These sketches are of the bootblack, the Sphinx, the coyote, the genuine Mexican plug, and the governmental official. Often the old-timers in the community make sport of the greenhorn for his own education and for their amusement, as in the sketches of the bootblack, Jim Blaine and his grandfather's ram, and the horse auctioneer. Twain manages the narrative from the perspective of a first person narrator who assumes the two-fold stance of a veteran looking back upon his days as a tenderfoot in the West. The naivete of the narrator is deliberately exaggerated for the sake of comedy; he is presented as an individual who seldom confronts any outside force which he thinks he cannot recognize, distinguish, and overcome, and it is the juxtaposition of these innocent, romantic views with reality that is a prime source of comedy for Twain in Roughing It. The education of the innocent narrator is desirable and necessary, for not until he is initiated into the customs and values of the West is he able to enjoy the varied and vast freedoms that the frontier has to offer. Before his education he was ignorant and naive, but after his transformation from greenhorn to old-timer, he learns the sciences necessary in order to survive in the West, and he is now able to fully participate in the glories that the frontier has to offer.