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Nurses' Training
EDITORIALS the distribution, and the cicatricial changes of the trachoma follicle do not justify a diagnostic distinction between it and the follicles of other types of con junctivitis. Nor, according to MacCallan, may even corneal pannus and tarsal scars be regarded as characteristic of trachoma. Nicolle, Cuénod, and Blaizot, well known French investigators at the Pas teur Institute in Tunis, express the fol lowing opinion : "It is possible that un der the name of trachoma we today con fuse infections due to different invisible and nonseparable viruses, whose action is expressed by the same conjunctival reactions, under the form of granula tions." Ruata (Rassegna Italiana d'Ottalmologia, volume 1, page 437), working among Italian children at Cairo, Egypt, supports the opinion of Angelucci of Naples that trachoma occurs particu larly in individuals of a lymphatic or adenoid diathesis. Ruata therefore in vestigated the possibility of curing tra choma by means of a mixed bacterial vaccine. He actually used a polyvalent stock vaccine directed against all the bacterial infections of the eye, and pre pared by inoculating various culture media with the conjunctival secretions from trachoma cases with superim posed infections. The vaccine was administered in the form of subconjunctival injections every second day, increasing the dose from 50 million to a maximum of 250 million. Daily swabbings with the vaccine were also used, but no other treatment. Only twenty-two cases are reported upon in Ruata's preliminary communi cation. These included nine cases of florid acute trachoma with pannus and keratitis; five cases of severe corneal ulcer and trachoma ; two cases of per forated ulcer with iridocyclitis ; one case of purulent gonococcic ophthalmia with corneal ulcers ; two cases of diplobacillary infection superimposed upon cica tricial trachoma, with chronic blepharoconjunctivitis and corneal pannus ; and three cases of mucopurulent conjunc tivitis from the Koch-Weeks bacillus. In every case the result was favorable, with regression of symptoms in a period
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of from eight to twenty days and after at most ten injections. Thygeson (in a personal communica tion) suggests a probability that "the problem will be finally solved before too many years have elapsed." If so, we must be in the dark before the dawn. The limited transmissibility of tracho ma is emphasized by Redslob (Revue Internationale du Trachome, ninth year, page 24), who found that among 304,000 Alsatian soldiers living in miserable conditions and exposed to trachoma in the population along the Russian warfront, only three developed this disease. Wilson's study of the Egyptian village of Bahtim (Giza Memorial Ophthalmic Laboratory, sixth annual report, page 88) leads him to the conclusion that tra choma is invariably associated with pan nus, and that this lesion is an essential part of the disease. Step by step, we may approach a more strictly defined concep tion of trachoma, and from this refme'd understanding bacteriological research may lead almost unexpectedly to disclo sure of the offending virus. W. H. Crisp.
NURSES' TRAINING Those of us who are engaged in the instruction of nurses in ophthalmology in the various hospital training schools have a wonderful opportunity for the dissemination of proper ophthalmological knowledge to the lay public. The nurse comes intimately into contact with many patients and friends by whom her advice is sought before the services of an ophthalmologist or other practitioner are employed for the relief of the eye condition from which they suffer. If, in addition to the usual curriculum of how to prepare eye dressings, dress ing trays, and how to handle ophthalmic instruments the class of nurses has been enlightened in a simple manner as to the problems of optometry, the ineffi ciency of muscle exercise for the elimi nation of errors of refraction, and the reason why eye examinations should be made by a graduate in medicine, these nurses may do a great deal toward elimi-
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EDITORIALS
nating the general misunderstanding of the public concerning certain of our present problems. Certainly in this day of fraudulent ad vertising it behooves all ophthalmolo gists to see that the public receives cor rect information concerning ophthalmic practice through as many proper chan nels as possible. Each individual in structor can best work out in his own way the manner of imparting such in formation to his student nurses, but let us by all means be certain that they do not become a party to the spread of false conceptions through lack of proper edu cation by ourselves. M. F. Weymann.
effort that he has given the Journal through the many years of his associa tion with it. We welcome three new members to the Staff ; Dr. Park Lewis, who needs no introduction to any ophthalmologist at home or abroad and who has been a fre quent contributor to our columns in the past ; Dr. H. Rommel Hildreth, who has been conducting the section of Society Proceedings for the past year and a half ; and Dr. Morie F. Weymann, who has recently been appointed Associate Pro fessor and Chairman of the Department of Ophthalmology in the University of Southern California. Lawrence T. Post.
T H E EDITORIAL BOARD The beginning of the new year wit nessed a change in the personnel of the Editorial Staff of this Journal and we cannot let the occasion pass without ex pressing our sincerest appreciation of the aid and support of those retiring from the Board and a welcome to the new members. The retiring members are Dr. E. C. Ellett and Dr. Clarence Loeb. Dr. Ellett has served for the past four years and during his term has lent his wise counsel and continual support to the Journal and we wish to acknowledge his generous help. Dr. Loeb's association with the Journal dates back to the beginning of the combination of the six publications into one, under the name of the Ameri can Journal of Ophthalmology. Too much could not possibly be said in praise of the devoted service that he has rendered the Journal through these years as associate editor and treasurer. For many years much of the manage ment was in his hands and his numerous original contributions and editorials are well known to our readers. It has been a matter of great regret that for the past few years ill health has forced his with drawal from active participation in lit erary production. W e take this oppor tunity upon his retirement from the Board to express sincere sorrow for his continued ill health and a keen apprecia tion of the loyalty, devotion and tireless
MEDICAL CARE FOR T H E AMERICAN P E O P L E This two hundred page text, from the University of Chicago Press, has been so extensively discussed in professional and lay journals that further comment may seem unnecessary but the subject is so vital that reiteration may be par doned. This book is the final report of the committee on the cost of medical care. After five years of work the task is done and recommendations are made. Certain of these are obvious and generally agreed: for example: Medicine of the future must be more preventive; the cost of medical care should be equally distributed; rural communities should have physicians, hospitals, etc. The chief difference of opinion which necessitated a majority and a minority report was the recommendation of the majority that medical care should be given, so far as possible, by organized groups ; cost of this care to be distrib uted over a large number of individuals by a group insurance plan. The hope is expressed that this might be volun tary but the actual fact that voluntary insurance of this kind has had to be re placed by compulsory is also noted. In contradistinction to this, the minority recommends that united attempts be made to restore the general practitioner to the central place in medical practice. Another important recommendation of
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of from eight to twenty days and after at most ten injections. Thygeson (in a personal communica tion) suggests a probability that "the problem will be finally solved before too many years have elapsed." If so, we must be in the dark before the dawn. The limited transmissibility of tracho ma is emphasized by Redslob (Revue Internationale du Trachome, ninth year, page 24), who found that among 304,000 Alsatian soldiers living in miserable conditions and exposed to trachoma in the population along the Russian warfront, only three developed this disease. Wilson's study of the Egyptian village of Bahtim (Giza Memorial Ophthalmic Laboratory, sixth annual report, page 88) leads him to the conclusion that tra choma is invariably associated with pan nus, and that this lesion is an essential part of the disease. Step by step, we may approach a more strictly defined concep tion of trachoma, and from this refme'd understanding bacteriological research may lead almost unexpectedly to disclo sure of the offending virus. W. H. Crisp.
NURSES' TRAINING Those of us who are engaged in the instruction of nurses in ophthalmology in the various hospital training schools have a wonderful opportunity for the dissemination of proper ophthalmological knowledge to the lay public. The nurse comes intimately into contact with many patients and friends by whom her advice is sought before the services of an ophthalmologist or other practitioner are employed for the relief of the eye condition from which they suffer. If, in addition to the usual curriculum of how to prepare eye dressings, dress ing trays, and how to handle ophthalmic instruments the class of nurses has been enlightened in a simple manner as to the problems of optometry, the ineffi ciency of muscle exercise for the elimi nation of errors of refraction, and the reason why eye examinations should be made by a graduate in medicine, these nurses may do a great deal toward elimi-
158
EDITORIALS
nating the general misunderstanding of the public concerning certain of our present problems. Certainly in this day of fraudulent ad vertising it behooves all ophthalmolo gists to see that the public receives cor rect information concerning ophthalmic practice through as many proper chan nels as possible. Each individual in structor can best work out in his own way the manner of imparting such in formation to his student nurses, but let us by all means be certain that they do not become a party to the spread of false conceptions through lack of proper edu cation by ourselves. M. F. Weymann.
effort that he has given the Journal through the many years of his associa tion with it. We welcome three new members to the Staff ; Dr. Park Lewis, who needs no introduction to any ophthalmologist at home or abroad and who has been a fre quent contributor to our columns in the past ; Dr. H. Rommel Hildreth, who has been conducting the section of Society Proceedings for the past year and a half ; and Dr. Morie F. Weymann, who has recently been appointed Associate Pro fessor and Chairman of the Department of Ophthalmology in the University of Southern California. Lawrence T. Post.
T H E EDITORIAL BOARD The beginning of the new year wit nessed a change in the personnel of the Editorial Staff of this Journal and we cannot let the occasion pass without ex pressing our sincerest appreciation of the aid and support of those retiring from the Board and a welcome to the new members. The retiring members are Dr. E. C. Ellett and Dr. Clarence Loeb. Dr. Ellett has served for the past four years and during his term has lent his wise counsel and continual support to the Journal and we wish to acknowledge his generous help. Dr. Loeb's association with the Journal dates back to the beginning of the combination of the six publications into one, under the name of the Ameri can Journal of Ophthalmology. Too much could not possibly be said in praise of the devoted service that he has rendered the Journal through these years as associate editor and treasurer. For many years much of the manage ment was in his hands and his numerous original contributions and editorials are well known to our readers. It has been a matter of great regret that for the past few years ill health has forced his with drawal from active participation in lit erary production. W e take this oppor tunity upon his retirement from the Board to express sincere sorrow for his continued ill health and a keen apprecia tion of the loyalty, devotion and tireless
MEDICAL CARE FOR T H E AMERICAN P E O P L E This two hundred page text, from the University of Chicago Press, has been so extensively discussed in professional and lay journals that further comment may seem unnecessary but the subject is so vital that reiteration may be par doned. This book is the final report of the committee on the cost of medical care. After five years of work the task is done and recommendations are made. Certain of these are obvious and generally agreed: for example: Medicine of the future must be more preventive; the cost of medical care should be equally distributed; rural communities should have physicians, hospitals, etc. The chief difference of opinion which necessitated a majority and a minority report was the recommendation of the majority that medical care should be given, so far as possible, by organized groups ; cost of this care to be distrib uted over a large number of individuals by a group insurance plan. The hope is expressed that this might be volun tary but the actual fact that voluntary insurance of this kind has had to be re placed by compulsory is also noted. In contradistinction to this, the minority recommends that united attempts be made to restore the general practitioner to the central place in medical practice. Another important recommendation of