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A Standardized Curriculum
EDITORIALS would be taken by most of the local medical societies. But is not there anything that can be done to eliminate these unwholesome practices that cast opprobrium on all physicians and furnish good grounds for the Government's lack of faith in the ability of the medical profession to act in the best interest of the public? The Government apparently is now fully aware of the existence of rebating and believes it is illegal and harmful to its citizens. We must agree that it contributes to increase the cost of glasses and that in itself is detrimental to the general welfare. Wholesalers and retailers alike must surely want the practice stopped. It does them no good and is financially harmful. The writer suggests that the Executive Committee of the Section on Ophthalmology of the American Medical Association appoint a committee to confer with Government agents, wholesalers of optical goods, and representative retailers for a frank discussion and an effort to adopt a course to bring about a termination of this abuse. The Government may frighten some out of rebating and receiving rebates, but the cooperation of all of those interested in the matter might prove even more effective than the governmental warning and fining of a few individuals selected to be the scapegoats for other possible offenders. National and local ophthalmic societies and The American Board of Ophthalmology have no police powers and should not have, their functions are other than this, but a stronger attitude by them on "kickbacks" and rebates would be helpful in stamping out this pernicious practice and would more definitely indicate to the young men entering our specialty our wholehearted disapproval of it. Lawrence T. Post.
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A STANDARDIZED CURRICULUM The need for more graduate courses in ophthalmology is as acute as it is obvious. The number of applicants for such training is tremendous. The reason for the large number is not difficult to find. Many physicians, while serving in the Armed Forces, were brought into contact with ophthalmology, usually under the guidance of a well-trained, older man. The result is that they would like to choose it for their own specialty. The interest thus stimulated is no idle one, no passing fancy, but rather it is deep and sincere. The ultimate goal of the large majority is certification by the American Board of Ophthalmology. This is gratifying and is as it should be. One has but to interview these men to be convinced of their sincerity and singleness of purpose. _. The available graduate courses in ophthalmology are few. These few are probably satisfactory, but no doubt there is room for improvement. Each course has its strong points, depending upon the interests of its faculty; similarly, each course has its weak points and for the same reason. It behooves us to take stock of our courses, to examine critically their curricula. How well are they preparing candidates for the examination of the American Board of Ophthalmology and, what is more important, for the clinical practice of good, sound ophthalmology? It would be wise to look for weak spots, for they are, surely there. It would be wiser still to have a "stranger" or even a board of strangers examine our curricula than to do it ourselves. It is objective, constructive criticism that is desired. The fresher viewpoint of an outsider would be invaluable. Such a board might be formed under the auspices of the American Board of Ophthalmology or by any one or all of the
1316
EDITORIALS
three national ophthalmic organizations. Its function would be to analyze the curricula of available courses with the view of taking the best from each and developing a standardized program for such courses. Just as the American Medical Association inspects medical schools in this country, so should such a board inspect graduate courses in ophthalmology. O u r courses are probably good, but they could be made better. O n e value of such a standardized curriculum, bearing the Board's stamp of approval, would be that it could be made available to many institutions to serve as a guide for the establishment of more courses. It seems probable that many large institutions have a wealth of clinical material at hand and also a faculty. All that they need is a blueprint in the form of a detailed, standardized, approved curriculum and a little encouragement. At the moment, those conducting the available graduate courses in ophthalmology are on their toes. T h e y should be kept that way. A n d other such courses should be initiated. T h e demand of large numbers of applicants makes it imperative. Richard G. Scobee.
CENTENARY O F A N E S T H E S I A On October 16, 1846, Morton dramatically introduced general anesthesia to the operating theater. The eminent and humanitarian surgeon, John C. Warren, with a courage reminiscent of Joseph Warren, his uncle, who fell at Bunker Hill, risked his great reputation in this hazardous experiment. The patient was Gilbert Abbott, a painter and single. As now the atom holds the spotlight, so, in the early 19th century, gases and vapors dominated scientific attention. Beddoes became mystically inspired by their possible therapeutic value and, in his
Pneumatic Institute, Davy, in 1800, and Faraday, in 1818, discovered the insensibility produced by nitrous oxide and ether, respectively. These observations excited a minimum of attention. Even as later as 1831, Velpeau pontifically dismissed the hope of ever operating without pain. By 1839, however, the Materia Medica mentioned that ether could produce stupefaction. Then Long, at the age of 26, Morton at 27, and Wells at 29— obscure young men ignorant of Velpeau's dictum—demonstrated its fallacy. The concept of "anesthesia" now had a footing, and Oliver Wendell Holmes supplied the word. But not all were convinced. Wrote Thomas E. Bond of Baltimore in the Boston Medical and Surgical Journal of December 15, 1846: "What your correspondents are pleased to call 'producing insensibility' is, in fact, making people 'dead drunk.' . . . Now, doctor, if we are to induce insensibility by this class of means, I very much prefer whiskey-punch to ether, because it is more certain and more permanent in its effects. It is less dangerous, and, lastly, it will be easier to persuade patients to take it." Before the advent of local anesthesia in 1884, eye surgeons faced the choice of operating under general anesthesia or none and not infrequently decided that the advantages were with the latter alternative. William Mackenzie, in 1854, advocated general anesthesia for children, and for discussion on timid adults. But he continued: "In extraction I have not ventured to use it, being afraid lest the vomiting which is apt to follow might cause rupture of the internal structures of the eye. I have read, however, from others who have used it in extraction, a very favorable account of the complete stillness of the eye which it affords." Henry S. Schell of Wills Eye Hospital, in 1881, expressed the same viewpoint: "If the
1315
A STANDARDIZED CURRICULUM The need for more graduate courses in ophthalmology is as acute as it is obvious. The number of applicants for such training is tremendous. The reason for the large number is not difficult to find. Many physicians, while serving in the Armed Forces, were brought into contact with ophthalmology, usually under the guidance of a well-trained, older man. The result is that they would like to choose it for their own specialty. The interest thus stimulated is no idle one, no passing fancy, but rather it is deep and sincere. The ultimate goal of the large majority is certification by the American Board of Ophthalmology. This is gratifying and is as it should be. One has but to interview these men to be convinced of their sincerity and singleness of purpose. _. The available graduate courses in ophthalmology are few. These few are probably satisfactory, but no doubt there is room for improvement. Each course has its strong points, depending upon the interests of its faculty; similarly, each course has its weak points and for the same reason. It behooves us to take stock of our courses, to examine critically their curricula. How well are they preparing candidates for the examination of the American Board of Ophthalmology and, what is more important, for the clinical practice of good, sound ophthalmology? It would be wise to look for weak spots, for they are, surely there. It would be wiser still to have a "stranger" or even a board of strangers examine our curricula than to do it ourselves. It is objective, constructive criticism that is desired. The fresher viewpoint of an outsider would be invaluable. Such a board might be formed under the auspices of the American Board of Ophthalmology or by any one or all of the
1316
EDITORIALS
three national ophthalmic organizations. Its function would be to analyze the curricula of available courses with the view of taking the best from each and developing a standardized program for such courses. Just as the American Medical Association inspects medical schools in this country, so should such a board inspect graduate courses in ophthalmology. O u r courses are probably good, but they could be made better. O n e value of such a standardized curriculum, bearing the Board's stamp of approval, would be that it could be made available to many institutions to serve as a guide for the establishment of more courses. It seems probable that many large institutions have a wealth of clinical material at hand and also a faculty. All that they need is a blueprint in the form of a detailed, standardized, approved curriculum and a little encouragement. At the moment, those conducting the available graduate courses in ophthalmology are on their toes. T h e y should be kept that way. A n d other such courses should be initiated. T h e demand of large numbers of applicants makes it imperative. Richard G. Scobee.
CENTENARY O F A N E S T H E S I A On October 16, 1846, Morton dramatically introduced general anesthesia to the operating theater. The eminent and humanitarian surgeon, John C. Warren, with a courage reminiscent of Joseph Warren, his uncle, who fell at Bunker Hill, risked his great reputation in this hazardous experiment. The patient was Gilbert Abbott, a painter and single. As now the atom holds the spotlight, so, in the early 19th century, gases and vapors dominated scientific attention. Beddoes became mystically inspired by their possible therapeutic value and, in his
Pneumatic Institute, Davy, in 1800, and Faraday, in 1818, discovered the insensibility produced by nitrous oxide and ether, respectively. These observations excited a minimum of attention. Even as later as 1831, Velpeau pontifically dismissed the hope of ever operating without pain. By 1839, however, the Materia Medica mentioned that ether could produce stupefaction. Then Long, at the age of 26, Morton at 27, and Wells at 29— obscure young men ignorant of Velpeau's dictum—demonstrated its fallacy. The concept of "anesthesia" now had a footing, and Oliver Wendell Holmes supplied the word. But not all were convinced. Wrote Thomas E. Bond of Baltimore in the Boston Medical and Surgical Journal of December 15, 1846: "What your correspondents are pleased to call 'producing insensibility' is, in fact, making people 'dead drunk.' . . . Now, doctor, if we are to induce insensibility by this class of means, I very much prefer whiskey-punch to ether, because it is more certain and more permanent in its effects. It is less dangerous, and, lastly, it will be easier to persuade patients to take it." Before the advent of local anesthesia in 1884, eye surgeons faced the choice of operating under general anesthesia or none and not infrequently decided that the advantages were with the latter alternative. William Mackenzie, in 1854, advocated general anesthesia for children, and for discussion on timid adults. But he continued: "In extraction I have not ventured to use it, being afraid lest the vomiting which is apt to follow might cause rupture of the internal structures of the eye. I have read, however, from others who have used it in extraction, a very favorable account of the complete stillness of the eye which it affords." Henry S. Schell of Wills Eye Hospital, in 1881, expressed the same viewpoint: "If the