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Surgical Certification*
CORRESPONDENCE caused by the hormone itself or by some other substance present in the preparation. But they raise the important question whether the indications for the administra tion of corticotrophin should not be recon sidered, since in most cases some of the more potent adrenocortical steroids can be used with advantage. It may be argued that the use of corticotrophin is more "physiological" and that we have to learn "to co-operate with the patients' adrenals"; but for most condi tions hydrocortisone or related compounds will usually be adequate. Perhaps the best antidote for a reaction to corticotrophin, if time permits, is hydrocortisone or cortisone itself. Wilson's patient 3 recovered from a severe illness after being treated with adrenocortical extract, among other things. REFERENCES
1. Feinberg, S. M., Feinberg, A. R., and Brigg, E.: T.A.M.A., 147:40, 1951. 2. Lancet: 2:158, 1951. 3. Wilson, L. A . : Ibid., p. 478. 4. Brown, E. M., and Hollander, J. L.: IT Clin ical Conference on ACTFf, London, 1951. 5. Thorn, G. W., Jenkins, D., Laidlaw, J. C , Goetz, F. C , Dingman, J. R, Arons, \V. L., Streeten, D. H. P., and McCracken, B. H . : New England J. Med., 248:588, 1953. 6. Van Ufford, \Y. T. Q . : Int. Arch. Allergy, 3:229, 1952. 7. Hill, H. R., and Swinburn, P. D . : Lancet, 1:1218,1954. 8. Eisalo, A., Leskinen, O., and Oka, M.: Acta med scand., 155:1, 1956.
CORRESPONDENCE SURGICAL C E R T I F I C A T I O N *
Editor, American Journal of Ophthalmology: I read with interest the announcement of the formation of a Board of Ophthalmic Surgery by one, Merrill J. King. As a diplomate of the American Board of * These are four of the letters which have been received by T H E JOURNAL on surgical certification by the American Board of Ophthalmology. It is not the purpose of T H E JOURNAL to prolong the con troversy which actually should be taken up before medical societies for discussion and clarification. Therefore, no further communications on either side will be published
639
Ophthalmology, I cannot recall being polled on the advisability of such a move. This is distressing, because for several months I have been in process of organizing a new board known as the "American Board of Ophthalmic Surgeons of the Right Eye." Very probably we can resolve our minor dif ferences and merge the two boards, thus avoiding duplication of effort. Everyone is aware that ophthalmology is far too broad a specialty. Since surgery was divorced from barbers (and to some extent, b a r b a r i s m ) , E E N T from surgery, and oph thalmology from E E N T , we have been aware that our specialty is so broad we can not devote the time to develop the niceties of hip and wrist motion that distinguish the true right eye surgeon. Naturally, it is the right eye that should receive our atten tion. W h o among us would care to be con sidered a leftist? The American Board of Ophthalmic Sur geons of the Right Eye will have an august Board of Examiners. F o r this exacting duty we will turn to the Professors of Ophthal mology. It is only fair, however, that they in turn be rigorously examined before they are authorized to examine candidates for A.B.O.S.R.E. I have devoted much thought to this perplexing question and I have ar rived at the following requirements for the Examining Board of A.B.O.S.R.E.: 1. Examiners must be professors of oph thalmology in recognized institutions (a penitentiary is not an institution in this meaning). 2. They must be between five feet and seven feet tall. 3. They must weigh between 100 pounds and 300 pounds. ( I t is believed that persons over 300 pounds cannot get close enough to the table to acquire sufficient manual dexterity.) 4. Every candidate will be asked to hold the point of a Graefe knife against the tip of his nose. This will automatically eliminate, the palsied, the tremors, and the uncorrected presbyopes.
640
CORRESPONDENCE
5. All candidates will be escorted to the local tees and given a five iron. Slicers, dribblers, and users of profanity will automatically be eliminated for obvious reasons. 6. No examiner will be accepted who has operated more than four times on the same eye. Tt will thus be seen that the requirements for Examiner are so rigid and exacting, that few indeed will achieve that status. The du ties of the Examiners will be to meet yearly at the call of the president, to elect officers and transact such business as may properly come before the board. ( N o proxies al lowed. ) All diplomates of the American Board of Ophthalmology will automatically be certifi cated, as it is presumed such diplomates have had the requisite training and experi ence ; otherwise, there would seem no excuse for the American Board of Ophthalmology examining anything except a preference for drinks. The diploma of the A.B.O.S.R.E. will be a thing of grandeur. It will be a red eye couchant on a field of scar tissue rampant. In the lower right hand corner will be a pterydactyl with a ribbon in its mouth. On the ribbon will be inscribed in flowing letters "Semper pronatus." This work of art will be suitably inscribed on high quality rolled paper so that the holder may daily recall his high office. (Signed) Edwin S. Wright. North Hollywood, California.
T h e absurdity of a board within a board will serve only to weaken the parent organi zation. If present surgical requirements are too lenient they should be strengthened. It behooves every physician who aspires to the American Board of Ophthalmology to ob tain the necessary surgical experience and training, either formally or under the spon sorship of a senior surgeon. Those men whose excellence in other than surgical ophthalmology warrants special no tice may be issued a special certificate. They are certainly valued members of our profes sion but do not merit the certificate of a wellqualified all-around ophthalmologist. Are we so specialized that they cannot become capa ble surgeons? Those surgeons of outstanding ability among us are well known and have no need of extraordinary certification, and to the casually interested public such a certificate will mean little. It will mean more to others. It will be putting a means of control of the practice of ocular surgery within the hands of hos pital boards of directors, social welfare groups, sponsors of health plans, insurance companies, and the government. They al ready use the American Board of Ophthal mology for this. Let us not weaken our board by creation of a superboard. Let us not follow this road of bureaucracy but rather further examine the requirements already present and meth ods of determining that they are met. (Signed) Daniel W . Mathias, Akron, Ohio.
Editor, American Journal of Ophthalmology: I do not expect this to be published but must express my views to the editors of T H E JOURNAL regarding the proposed certifica tion in surgery of the American Board of Ophthalmology. I do this with all respect to yourself and the other elders of ophthal mology to whom I owe my education but I do desire to speak my impressions.
Editor, American Journal of Ophthalmology: I wish to express my displeasure in the article written by Dr. Frederick C. Cordes when he chastises those doctors whom he called "six-week wonders" and who set themselves up as "eye, ear, nose and throat specialists." Also it appears to me that he is one of the instigators of the idea that all
1. Feinberg, S. M., Feinberg, A. R., and Brigg, E.: T.A.M.A., 147:40, 1951. 2. Lancet: 2:158, 1951. 3. Wilson, L. A . : Ibid., p. 478. 4. Brown, E. M., and Hollander, J. L.: IT Clin ical Conference on ACTFf, London, 1951. 5. Thorn, G. W., Jenkins, D., Laidlaw, J. C , Goetz, F. C , Dingman, J. R, Arons, \V. L., Streeten, D. H. P., and McCracken, B. H . : New England J. Med., 248:588, 1953. 6. Van Ufford, \Y. T. Q . : Int. Arch. Allergy, 3:229, 1952. 7. Hill, H. R., and Swinburn, P. D . : Lancet, 1:1218,1954. 8. Eisalo, A., Leskinen, O., and Oka, M.: Acta med scand., 155:1, 1956.
CORRESPONDENCE SURGICAL C E R T I F I C A T I O N *
Editor, American Journal of Ophthalmology: I read with interest the announcement of the formation of a Board of Ophthalmic Surgery by one, Merrill J. King. As a diplomate of the American Board of * These are four of the letters which have been received by T H E JOURNAL on surgical certification by the American Board of Ophthalmology. It is not the purpose of T H E JOURNAL to prolong the con troversy which actually should be taken up before medical societies for discussion and clarification. Therefore, no further communications on either side will be published
639
Ophthalmology, I cannot recall being polled on the advisability of such a move. This is distressing, because for several months I have been in process of organizing a new board known as the "American Board of Ophthalmic Surgeons of the Right Eye." Very probably we can resolve our minor dif ferences and merge the two boards, thus avoiding duplication of effort. Everyone is aware that ophthalmology is far too broad a specialty. Since surgery was divorced from barbers (and to some extent, b a r b a r i s m ) , E E N T from surgery, and oph thalmology from E E N T , we have been aware that our specialty is so broad we can not devote the time to develop the niceties of hip and wrist motion that distinguish the true right eye surgeon. Naturally, it is the right eye that should receive our atten tion. W h o among us would care to be con sidered a leftist? The American Board of Ophthalmic Sur geons of the Right Eye will have an august Board of Examiners. F o r this exacting duty we will turn to the Professors of Ophthal mology. It is only fair, however, that they in turn be rigorously examined before they are authorized to examine candidates for A.B.O.S.R.E. I have devoted much thought to this perplexing question and I have ar rived at the following requirements for the Examining Board of A.B.O.S.R.E.: 1. Examiners must be professors of oph thalmology in recognized institutions (a penitentiary is not an institution in this meaning). 2. They must be between five feet and seven feet tall. 3. They must weigh between 100 pounds and 300 pounds. ( I t is believed that persons over 300 pounds cannot get close enough to the table to acquire sufficient manual dexterity.) 4. Every candidate will be asked to hold the point of a Graefe knife against the tip of his nose. This will automatically eliminate, the palsied, the tremors, and the uncorrected presbyopes.
640
CORRESPONDENCE
5. All candidates will be escorted to the local tees and given a five iron. Slicers, dribblers, and users of profanity will automatically be eliminated for obvious reasons. 6. No examiner will be accepted who has operated more than four times on the same eye. Tt will thus be seen that the requirements for Examiner are so rigid and exacting, that few indeed will achieve that status. The du ties of the Examiners will be to meet yearly at the call of the president, to elect officers and transact such business as may properly come before the board. ( N o proxies al lowed. ) All diplomates of the American Board of Ophthalmology will automatically be certifi cated, as it is presumed such diplomates have had the requisite training and experi ence ; otherwise, there would seem no excuse for the American Board of Ophthalmology examining anything except a preference for drinks. The diploma of the A.B.O.S.R.E. will be a thing of grandeur. It will be a red eye couchant on a field of scar tissue rampant. In the lower right hand corner will be a pterydactyl with a ribbon in its mouth. On the ribbon will be inscribed in flowing letters "Semper pronatus." This work of art will be suitably inscribed on high quality rolled paper so that the holder may daily recall his high office. (Signed) Edwin S. Wright. North Hollywood, California.
T h e absurdity of a board within a board will serve only to weaken the parent organi zation. If present surgical requirements are too lenient they should be strengthened. It behooves every physician who aspires to the American Board of Ophthalmology to ob tain the necessary surgical experience and training, either formally or under the spon sorship of a senior surgeon. Those men whose excellence in other than surgical ophthalmology warrants special no tice may be issued a special certificate. They are certainly valued members of our profes sion but do not merit the certificate of a wellqualified all-around ophthalmologist. Are we so specialized that they cannot become capa ble surgeons? Those surgeons of outstanding ability among us are well known and have no need of extraordinary certification, and to the casually interested public such a certificate will mean little. It will mean more to others. It will be putting a means of control of the practice of ocular surgery within the hands of hos pital boards of directors, social welfare groups, sponsors of health plans, insurance companies, and the government. They al ready use the American Board of Ophthal mology for this. Let us not weaken our board by creation of a superboard. Let us not follow this road of bureaucracy but rather further examine the requirements already present and meth ods of determining that they are met. (Signed) Daniel W . Mathias, Akron, Ohio.
Editor, American Journal of Ophthalmology: I do not expect this to be published but must express my views to the editors of T H E JOURNAL regarding the proposed certifica tion in surgery of the American Board of Ophthalmology. I do this with all respect to yourself and the other elders of ophthal mology to whom I owe my education but I do desire to speak my impressions.
Editor, American Journal of Ophthalmology: I wish to express my displeasure in the article written by Dr. Frederick C. Cordes when he chastises those doctors whom he called "six-week wonders" and who set themselves up as "eye, ear, nose and throat specialists." Also it appears to me that he is one of the instigators of the idea that all