Microalbuminuria: Biochemistry, Epidemiology and Clinical Practice

conditioned to an inferiority complex by teaching hospital consultants. What nonsense this is. GPs are specialists in minor ailments, early diagnosis, separating serious from benign conditions, distinguishing the organic from the psychogenic, which patients need a second or third opinion and from which specialist. GPs have many advantages over hospital doctors because they know the community, relatives and neighbours, as well as local beliefs and language. They have opportunities to see disease in the home, in the supermarket and in the street, hence they do not have to theorize or imagine the impact of illness they see it, in three dimensions. Moreover, with time (the fourth dimension) they can observe the evolution, progression or resolution of various conditions. However, they do have to cope with patients sent back from hospital with unhelpful letters replete with non-illuminating investigation results. Regrettably Henry Head's remark at the beginning of the century remains true 'Choose something common, you'll find nobody knows anything about it'. We can still learn from past great figures. James Mackenzie revolutionized cardiology by direct observation, strapping a smoked drum to the back of his bicycle when he visited his Burnley patients. Pickles gathered valuable information on incubation periods and modes of transmission while a GP to five villages in Wensleydale. And Parkinson, 180 years ago, sitting in London's Hoxton Square, saw 3 of his 6 cases with 'the shaking palsy'; his description has still not been bettered. None required cooperative partners, vast series, statistics, computer or animal models, or attachment to academic departments of teaching hospitals. Disillusioned with consultant practice in London, Sir James Mackenzie returned to general practice. Advice from Hachinski to a newly qualified doctor is invaluable: 'Distinguish information from knowledge and wisdom. Information is overwhelming but largely trivial and retrievable. Knowledge is understanding and wisdom cannot be taught, but can be acquired'4. Dr Tilly Tansey deserves congratulations and thanks for initiating and carrying through these seminars (may we have more). We are privileged to read-no, to hear-scientists talking with contemporary colleagues about memories of discoveries, as well as groping towards understanding and misunderstandings. Doubts and contradictions, occasionally uttered, provide seeds for further progress. Above all history is shown not to be dust-dry or sterile. Few books are so intellectually stimulating or uplifting.