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Examinations into Qualifications for Special Practice
EDITORIALS
55
their specialty. By inducing schools for graduate instruction to provide more carefully chosen, better arranged and complete courses, than they have done heretofore. By causing chiefs of clinics and teaching specialists to give more instructions and helpful supervi sion to the work of their assistants. By furnishing a guide by which the profession and the public may choose more intelligently the specialists to whom they confide the treatment of their patients or themselves. The extent to which these benefits may be secured by special examina tions, as those in ophthalmology, de pends on the confidence that their col leagues in the specialty, the general medical profession and the public feel in the justness and discrimination of the decisions of those who conduct such examinations. This confidence must in the end rest on the intelli gence, sense of responsibility, fair mindedness and sympathy of the ex aminers ; as shown in the work of the board—the candidates they certify or do not certify, as these come to be known to the medical profession and the public. The passing upon the character and attainments of applicants for a certifi cate of fitness for special practice de mands, with devotion to the purpose of such examination and balance of char acter, the assistance of colleagues. Those who would profit most by get ting such a certificate, will seek it most eagerly, and if they do not deserve it, will try to conceal their deficiencies and make improper considerations count in their favor. Some who should be certificated will hesitate to submit their claims to judges whom they do not know, or in whose fairness they lack confidence. As is pointed out in the communica tion published under Correspondence (p. 61), it is with men already estab EXAMINATIONS INTO QUALIFI lished in special practice that such ex CATIONS FOR SPECIAL aminers find it most difficult to deal PRACTICE. with complete fairness. No matter how These are capable of doing great honestly he may intend to be strictly good : By stimulating those who desire just, the examiner cannot escape from to specialize in practice to a more his personal character and predilec systematic, broad and thoro study of tions. The good natured man, who
moval of. the great bulk of a growth by the knife, it may well be that the use of radium can destroy any remaining cells that have advanced far enough in the direction of malignancy to be come starting points for recurrence. To destroy such isolated groups will probably require the same dosage as has been found effective for removing cancer masses. It seems now fairly well established that normal tissues about the eye are but little affected by radium in general. The highly specialized tissues, suited to the performance of the body func tions, are less influenced by it than those that have deviated from the nor mal type in the direction of malignancy. In this sense radium and the X-rays have a distinctly selective action. Prudence will dictate great care to keep away from the danger line as far as possible. The accidents of the early years of radiology must not be repeat ed. But, except for those very fre quently or continuously exposed to the influence of such radiations, the danger of damage to normal tissue seems slight, from any intelligent applica tion of radium, with the care that it is now understood to require. Cancer has stood for thousands of years as a type of malignant fate. But it seems now that by removal of cells that are developing, or seem liable to develop malignancy, it is being brought under control. About the eye such cell masses are likely to be noticed early and while comparatively small. There prompt treatment should prac tically eliminate the danger of cancer in this region. Even glioma, in which the tendency to malignancy appears at a very early age, and is extremely strong, may yield to early treatment, altho this is not yet fully demonstrated. E. J.
56
EDITORIALS
would like to see everybody pleased, is liable to grant the certificate where there is great doubt of its being de served. The man with a strong con fidence in his own uprightness, and lacking sympathy for others is likely to do injustice in the opposite direc tion. Both are in danger of being swayed by prejudice, prejudgment; impressions already fixed with regard to colleagues or rivals in practice, be fore the task of deciding on profes sional fitness was undertaken, or the facts on which such decision should be based were fairly and fully placed be fore them. It is not likely that the men chosen by the profession for examiners will be consciously influenced by personal feeling. But it is very difficult for most minds to place themselves in the completely judicial attitude, by chang ing the usual currents of their thought of persons and actions; about which they have already taken a certain atti tude, on evidence not so complete or so carefully sifted as it should be for the basis of a judicial decision. There is reason to fear that prejudgment may be the controlling factor in decisions regarding men whose imperfections and mistakes have long been known. Then there is danger that the grant ing of a certificate may be due to con siderations other than those the ex aminers were chosen to pass upon. The Board for Ophthalmic Examina tions is created to pass on knowledge and skill for ophthalmic practice, and ethical fitness for the office of profes sional adviser. Narrowness or breadth of education outside of this, a quarrel some disposition, or an agreeable plausible manner, some public service, or an exhibition of meanness not con nected with the professional relation, should not determine the granting or withholding of a certificate; or the cer tificate will lose its special significance. Fear of giving offense, and a desire to mete out punishment, must be equally excluded from any influence in reach ing a decision. The Board for Ophthalmic Exam inations, or the Examiners of the American College of Surgeons, or the
newly appointed Examiners in OtoLaryngology, or other boards that will be appointed to examine into fitness for special practice, have a difficult sit uation to meet. They need and should have the assistance of the profession they serve. Accurate information re garding candidates; unmixed with per sonal prejudice, and unobscured or magnified by inuendoes and general impressions, should be at their com mand, even regarding those candidates of whom they have no personal knowl edge. Patience must be exercised in regard to the long time sometimes re quired to get at the significant facts. and reach a just estimate of their ac curacy and importance. Most of all, they should have charitable considera tion of their mistakes or prejudices, for they will make mistakes, and be swayed by prejudices; as are all other human beings. In turn it will be the duty of these examiners to help elevate the standard of the profession, by making individ ual members of it better. By recogniz ing defects in education among the older men who grew up under a most defective educational system, or ab sence of system; encouraging them to get added training they need, and promptly recognizing the newly ac quired fitness. By recognizing that old mistakes are honestly regretted and re pented of; and by reducing to a min imum the effect of their personal preju dices and tastes; and exercising that charity for earlier errors of those who promise better things, that their own defects of judgment must ask of the profession they serve. E. J. JOURNAL CHANGES. With the beginning of our fourth volume the list of recently published articles, heretofore printed under the heading "Ophthalmic Literature" is transferred to the journal of that name. This will leave more space each month, which we hope to occupy with a larger number of abstracts, than it has been possible to find room for in the last year or two. The abstract department, it will be noticed, is transferred to near the end of each number.
55
their specialty. By inducing schools for graduate instruction to provide more carefully chosen, better arranged and complete courses, than they have done heretofore. By causing chiefs of clinics and teaching specialists to give more instructions and helpful supervi sion to the work of their assistants. By furnishing a guide by which the profession and the public may choose more intelligently the specialists to whom they confide the treatment of their patients or themselves. The extent to which these benefits may be secured by special examina tions, as those in ophthalmology, de pends on the confidence that their col leagues in the specialty, the general medical profession and the public feel in the justness and discrimination of the decisions of those who conduct such examinations. This confidence must in the end rest on the intelli gence, sense of responsibility, fair mindedness and sympathy of the ex aminers ; as shown in the work of the board—the candidates they certify or do not certify, as these come to be known to the medical profession and the public. The passing upon the character and attainments of applicants for a certifi cate of fitness for special practice de mands, with devotion to the purpose of such examination and balance of char acter, the assistance of colleagues. Those who would profit most by get ting such a certificate, will seek it most eagerly, and if they do not deserve it, will try to conceal their deficiencies and make improper considerations count in their favor. Some who should be certificated will hesitate to submit their claims to judges whom they do not know, or in whose fairness they lack confidence. As is pointed out in the communica tion published under Correspondence (p. 61), it is with men already estab EXAMINATIONS INTO QUALIFI lished in special practice that such ex CATIONS FOR SPECIAL aminers find it most difficult to deal PRACTICE. with complete fairness. No matter how These are capable of doing great honestly he may intend to be strictly good : By stimulating those who desire just, the examiner cannot escape from to specialize in practice to a more his personal character and predilec systematic, broad and thoro study of tions. The good natured man, who
moval of. the great bulk of a growth by the knife, it may well be that the use of radium can destroy any remaining cells that have advanced far enough in the direction of malignancy to be come starting points for recurrence. To destroy such isolated groups will probably require the same dosage as has been found effective for removing cancer masses. It seems now fairly well established that normal tissues about the eye are but little affected by radium in general. The highly specialized tissues, suited to the performance of the body func tions, are less influenced by it than those that have deviated from the nor mal type in the direction of malignancy. In this sense radium and the X-rays have a distinctly selective action. Prudence will dictate great care to keep away from the danger line as far as possible. The accidents of the early years of radiology must not be repeat ed. But, except for those very fre quently or continuously exposed to the influence of such radiations, the danger of damage to normal tissue seems slight, from any intelligent applica tion of radium, with the care that it is now understood to require. Cancer has stood for thousands of years as a type of malignant fate. But it seems now that by removal of cells that are developing, or seem liable to develop malignancy, it is being brought under control. About the eye such cell masses are likely to be noticed early and while comparatively small. There prompt treatment should prac tically eliminate the danger of cancer in this region. Even glioma, in which the tendency to malignancy appears at a very early age, and is extremely strong, may yield to early treatment, altho this is not yet fully demonstrated. E. J.
56
EDITORIALS
would like to see everybody pleased, is liable to grant the certificate where there is great doubt of its being de served. The man with a strong con fidence in his own uprightness, and lacking sympathy for others is likely to do injustice in the opposite direc tion. Both are in danger of being swayed by prejudice, prejudgment; impressions already fixed with regard to colleagues or rivals in practice, be fore the task of deciding on profes sional fitness was undertaken, or the facts on which such decision should be based were fairly and fully placed be fore them. It is not likely that the men chosen by the profession for examiners will be consciously influenced by personal feeling. But it is very difficult for most minds to place themselves in the completely judicial attitude, by chang ing the usual currents of their thought of persons and actions; about which they have already taken a certain atti tude, on evidence not so complete or so carefully sifted as it should be for the basis of a judicial decision. There is reason to fear that prejudgment may be the controlling factor in decisions regarding men whose imperfections and mistakes have long been known. Then there is danger that the grant ing of a certificate may be due to con siderations other than those the ex aminers were chosen to pass upon. The Board for Ophthalmic Examina tions is created to pass on knowledge and skill for ophthalmic practice, and ethical fitness for the office of profes sional adviser. Narrowness or breadth of education outside of this, a quarrel some disposition, or an agreeable plausible manner, some public service, or an exhibition of meanness not con nected with the professional relation, should not determine the granting or withholding of a certificate; or the cer tificate will lose its special significance. Fear of giving offense, and a desire to mete out punishment, must be equally excluded from any influence in reach ing a decision. The Board for Ophthalmic Exam inations, or the Examiners of the American College of Surgeons, or the
newly appointed Examiners in OtoLaryngology, or other boards that will be appointed to examine into fitness for special practice, have a difficult sit uation to meet. They need and should have the assistance of the profession they serve. Accurate information re garding candidates; unmixed with per sonal prejudice, and unobscured or magnified by inuendoes and general impressions, should be at their com mand, even regarding those candidates of whom they have no personal knowl edge. Patience must be exercised in regard to the long time sometimes re quired to get at the significant facts. and reach a just estimate of their ac curacy and importance. Most of all, they should have charitable considera tion of their mistakes or prejudices, for they will make mistakes, and be swayed by prejudices; as are all other human beings. In turn it will be the duty of these examiners to help elevate the standard of the profession, by making individ ual members of it better. By recogniz ing defects in education among the older men who grew up under a most defective educational system, or ab sence of system; encouraging them to get added training they need, and promptly recognizing the newly ac quired fitness. By recognizing that old mistakes are honestly regretted and re pented of; and by reducing to a min imum the effect of their personal preju dices and tastes; and exercising that charity for earlier errors of those who promise better things, that their own defects of judgment must ask of the profession they serve. E. J. JOURNAL CHANGES. With the beginning of our fourth volume the list of recently published articles, heretofore printed under the heading "Ophthalmic Literature" is transferred to the journal of that name. This will leave more space each month, which we hope to occupy with a larger number of abstracts, than it has been possible to find room for in the last year or two. The abstract department, it will be noticed, is transferred to near the end of each number.