- Email: [email protected]
An Answer to Dr. Woods
628
CORRESPONDENCE
to any position on the staff of The Johns Hopkins Hospital, and their subsequent cir culations of this resolution. This action Dr. Crisp characterizes as a "rather unpleasant slap at standardization." It is peculiar, how ever, that in his discussion and criticism Dr. Crisp does not similarly indict the Council of Medical Education and Hospitals and the House of Delegates of the American Medi cal Association, who somewhat belatedly have expressed similar views and have now taken official action condemning this prac tice. For some peculiar reason Dr. Crisp ap pears somewhat puzzled that I did not ad versely criticize the American Board of Otolaryngology, whose certificate Dr. Crisp states is "usually rather easier of attain ment." I confess this did not occur to me, nor is it altogether clear even now why I should assail the Board of another specialty, about which I know nothing. The dual mem bership of the Academy and the relative severity of the two Boards were not sub jects of my address. Dr. Crisp next accuses me of an exag gerated fear that the application of the prin ciple, presumably of the requirement of cer tification for appointment, will endanger the research institutions. I assure Dr. Crisp I have no such fear. Fortunately, the research institutions of the country are, far and large, under the control of intelligent men. In my address I merely speculated on what would be the effect did institutions accept such a stifling stricture. Dr. Crisp's concluding charge concerns my opinion of the present policies of the na tional societies in which Board certification is made a prerequisite for membership. Here I stated, "If I am correct in my idea of the lines along which ophthalmology must hence forth develop, the present policies of the national societies lie squarely across this pathway." Here Dr. Crisp accuses me of exaggeration. He presents no arguments controverting my views on the future de velopment of ophthalmology, although here
there is obviously ground for differences of opinion, and it is quite probable Dr. Crisp and I may hold radically different views. Dr. Crisp contends that the national so cieties already fully comply with my "de sideratum," and that no scientist can be regarded as an ophthalmologist unless he possesses the knowledge of clinical ophthal mology demanded by the American Board. On these conclusions, I am in complete disagreement with Dr. Crisp. I am prepared to admit that our concepts of the future development of ophthalmology, and our defi nitions of an ophthalmologist, may be so different there is no probable meeting of minds. I fail, however, to see where funda mentally different concepts of a problem justify the charge of exaggeration. (Signed) Alan C. Woods, Baltimore, Maryland. AN
ANSWER TO DR. WOODS
Editor, American Journal of Ophthalmology: I am glad to have an opportunity to glance through Dr. Wood's comments. Incidentally I notice that, because I once used the word "us" in referring to my colleagues in oph thalmology, Dr. Woods assumes that I am indulging in the editorial "we" and there fore imply general editorial approval. Dr. Woods should know by this time that the policy of the American Journal of Ophthal mology has been to encourage each editorial writer to express his own individual opin ions. As to Dr. Wood's lightly expressed suggestion that I was availing myself of editorial privilege, the editorial writer is surely no more privileged than an Academy president whose presidential address is not open to discussion. In a general way I believe I correctly interpreted the tenor of Dr. Wood's remarks concerning the American Board of Ophthal mology. I may have gone astray a little as to his attitude with regard to the Veterans Administration and its beneficial recognition
CORRESPONDENCE of those having certificates from the Boards. The atmosphere created by the context led me to assume that this was among the dis approved activities of the Boards. I have met others who received the same impres sion. Dr. Woods is certainly mistaken in sup posing that I was accusing his internes of wasting time. Mere inspection of my ques tion (Am. J. Ophth., 31:348 (Mar.) 1948— first paragraph, column 2) will indicate that I referred to systems rather than to persons. Oft-repeated performance of rou tine duties inevitably involves waste of time so far as the education of the individual is concerned. My remarks about the certificate of the American Academy did not criticize the Board of Otolaryngology but suggested a certain result in regard to the Academy's certificate of membership. I am content to have my editorial read in conjunction with the presidential address itself and with Dr. Wood's present letter. My purpose was not to find fault but to analyze the situation. (Signed) William H. Crisp, Denver, Colorado.
629
independent disease of the lymphatic system, but is rather only a symptom of one general lymphatic disease. Both microscopically and clinically, tra choma resembles other diseases of the lym phatic system. The vascular picture in the conjunctiva is frequently strikingly similar to that in lymphatic leukemia. True acute trachoma is very like the "drüsenfieber" of Pfeiffer. TABLE 1 RESULTS OF THE PAUL-BUNNEL TEST IN 32 CASES OF KNOWN TRACHOMA
No. of Patients 8 4 5 1 12 2
Reading 1:112 1:224 1:28 1:448 1:56 1:896
Percent 25 12.5 15 3 37.5 6
* It is generally stated and accepted that a read ing up to 1:56 is normal; over 1:56 is positive. TABLE 2 RESULTS OF THE PAUL-BUNNEL TEST IN 11 CASES KNOWN TO BE FREE FROM TRACHOMA
No. of Patients
Reading
Percent
1 1 4 5
0:00 1:14 1:28 1:56
9 9 36 46
T H E SEROLOGY OF TRACHOMA
Editor, American Journal of Ophthalmology: In 1944, I made sérologie investigations upon trachoma patients. The number of these investigations was small, but in the following years I did not have an opportunity to go on with the work. I am, therefore, re porting the results already obtained in the hope that someone will be interested in con tinuing these studies. I shall explain briefly what has already been done and what I intended to do. The supposition is not an entirely new one. For some time the connection between trachoma and the lymphatic apparatus has been well known (Angelucci, Kuhnt, and so forth). In my opinion, trachoma does not rank as an
With these thoughts in mind, the PaulBunnel test was made in 32 cases of tra choma. As controls, the same sérologie tests were made of 11 cases in which no trachoma was present but in which the following eye diseases had been diagnosed—3, serpent ul cers; 1, acute glaucoma; 1, keratoconjunctivitis sicca; 1, keratitis lymphatica; 1, wound from BB-shot; 2, marginal ulcers; 1, hematoma of the lids; 1, interstitial keratitis. The results are given in Tables 1 and 2. Since many of my patients were young soldiers, some of them may have been arti ficially infected with trachoma. It was in tended, therefore, as the next step to make sérologie examinations of numerous pa tients with trachomatous pannus, as well as
CORRESPONDENCE
to any position on the staff of The Johns Hopkins Hospital, and their subsequent cir culations of this resolution. This action Dr. Crisp characterizes as a "rather unpleasant slap at standardization." It is peculiar, how ever, that in his discussion and criticism Dr. Crisp does not similarly indict the Council of Medical Education and Hospitals and the House of Delegates of the American Medi cal Association, who somewhat belatedly have expressed similar views and have now taken official action condemning this prac tice. For some peculiar reason Dr. Crisp ap pears somewhat puzzled that I did not ad versely criticize the American Board of Otolaryngology, whose certificate Dr. Crisp states is "usually rather easier of attain ment." I confess this did not occur to me, nor is it altogether clear even now why I should assail the Board of another specialty, about which I know nothing. The dual mem bership of the Academy and the relative severity of the two Boards were not sub jects of my address. Dr. Crisp next accuses me of an exag gerated fear that the application of the prin ciple, presumably of the requirement of cer tification for appointment, will endanger the research institutions. I assure Dr. Crisp I have no such fear. Fortunately, the research institutions of the country are, far and large, under the control of intelligent men. In my address I merely speculated on what would be the effect did institutions accept such a stifling stricture. Dr. Crisp's concluding charge concerns my opinion of the present policies of the na tional societies in which Board certification is made a prerequisite for membership. Here I stated, "If I am correct in my idea of the lines along which ophthalmology must hence forth develop, the present policies of the national societies lie squarely across this pathway." Here Dr. Crisp accuses me of exaggeration. He presents no arguments controverting my views on the future de velopment of ophthalmology, although here
there is obviously ground for differences of opinion, and it is quite probable Dr. Crisp and I may hold radically different views. Dr. Crisp contends that the national so cieties already fully comply with my "de sideratum," and that no scientist can be regarded as an ophthalmologist unless he possesses the knowledge of clinical ophthal mology demanded by the American Board. On these conclusions, I am in complete disagreement with Dr. Crisp. I am prepared to admit that our concepts of the future development of ophthalmology, and our defi nitions of an ophthalmologist, may be so different there is no probable meeting of minds. I fail, however, to see where funda mentally different concepts of a problem justify the charge of exaggeration. (Signed) Alan C. Woods, Baltimore, Maryland. AN
ANSWER TO DR. WOODS
Editor, American Journal of Ophthalmology: I am glad to have an opportunity to glance through Dr. Wood's comments. Incidentally I notice that, because I once used the word "us" in referring to my colleagues in oph thalmology, Dr. Woods assumes that I am indulging in the editorial "we" and there fore imply general editorial approval. Dr. Woods should know by this time that the policy of the American Journal of Ophthal mology has been to encourage each editorial writer to express his own individual opin ions. As to Dr. Wood's lightly expressed suggestion that I was availing myself of editorial privilege, the editorial writer is surely no more privileged than an Academy president whose presidential address is not open to discussion. In a general way I believe I correctly interpreted the tenor of Dr. Wood's remarks concerning the American Board of Ophthal mology. I may have gone astray a little as to his attitude with regard to the Veterans Administration and its beneficial recognition
CORRESPONDENCE of those having certificates from the Boards. The atmosphere created by the context led me to assume that this was among the dis approved activities of the Boards. I have met others who received the same impres sion. Dr. Woods is certainly mistaken in sup posing that I was accusing his internes of wasting time. Mere inspection of my ques tion (Am. J. Ophth., 31:348 (Mar.) 1948— first paragraph, column 2) will indicate that I referred to systems rather than to persons. Oft-repeated performance of rou tine duties inevitably involves waste of time so far as the education of the individual is concerned. My remarks about the certificate of the American Academy did not criticize the Board of Otolaryngology but suggested a certain result in regard to the Academy's certificate of membership. I am content to have my editorial read in conjunction with the presidential address itself and with Dr. Wood's present letter. My purpose was not to find fault but to analyze the situation. (Signed) William H. Crisp, Denver, Colorado.
629
independent disease of the lymphatic system, but is rather only a symptom of one general lymphatic disease. Both microscopically and clinically, tra choma resembles other diseases of the lym phatic system. The vascular picture in the conjunctiva is frequently strikingly similar to that in lymphatic leukemia. True acute trachoma is very like the "drüsenfieber" of Pfeiffer. TABLE 1 RESULTS OF THE PAUL-BUNNEL TEST IN 32 CASES OF KNOWN TRACHOMA
No. of Patients 8 4 5 1 12 2
Reading 1:112 1:224 1:28 1:448 1:56 1:896
Percent 25 12.5 15 3 37.5 6
* It is generally stated and accepted that a read ing up to 1:56 is normal; over 1:56 is positive. TABLE 2 RESULTS OF THE PAUL-BUNNEL TEST IN 11 CASES KNOWN TO BE FREE FROM TRACHOMA
No. of Patients
Reading
Percent
1 1 4 5
0:00 1:14 1:28 1:56
9 9 36 46
T H E SEROLOGY OF TRACHOMA
Editor, American Journal of Ophthalmology: In 1944, I made sérologie investigations upon trachoma patients. The number of these investigations was small, but in the following years I did not have an opportunity to go on with the work. I am, therefore, re porting the results already obtained in the hope that someone will be interested in con tinuing these studies. I shall explain briefly what has already been done and what I intended to do. The supposition is not an entirely new one. For some time the connection between trachoma and the lymphatic apparatus has been well known (Angelucci, Kuhnt, and so forth). In my opinion, trachoma does not rank as an
With these thoughts in mind, the PaulBunnel test was made in 32 cases of tra choma. As controls, the same sérologie tests were made of 11 cases in which no trachoma was present but in which the following eye diseases had been diagnosed—3, serpent ul cers; 1, acute glaucoma; 1, keratoconjunctivitis sicca; 1, keratitis lymphatica; 1, wound from BB-shot; 2, marginal ulcers; 1, hematoma of the lids; 1, interstitial keratitis. The results are given in Tables 1 and 2. Since many of my patients were young soldiers, some of them may have been arti ficially infected with trachoma. It was in tended, therefore, as the next step to make sérologie examinations of numerous pa tients with trachomatous pannus, as well as