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The American Board of Ophthalmology
AMERICAN JOURNAL OF OPHTHALMOLOGY Published Monthly by the Ophthalmic Publishing Company EDITORIAL STAFF LAWRENCE T. POST, Editor P ARK LEWIS 640 S. Kingshighway, Saint Louis 454 Franklin Building. Buffalo WILLIAM H. CRISP, Consulting Editor 530 Metropolitan Building, Denver C. S. O'BRIEN EDWARD JACKSON, Consulting Editor The State University of Iowa. College of Republic Building, Denver Medicine, Iowa City M. URIBE TRONCOSO HANS BARKAN Stanford University Hospital, San Francisco 350 West 85th Street, New York HARRY S. GRADLE 58 East Washington Street, Chicago JOHN M. WHEELER H. ROMMEL HILDRETH 635 West One Hundred Sixty-fifth Street, 824 Metropolitan Building, Saint Louis New York EMMA S. Buss, Manuscript Editor 4907 Maryland Avenue, Saint Louis
Directors: EDWARD JACKSON, President, LAWRENCE T. POST, Vice-President, DR. F. E. WOODRUFF, Secretary and Treasurer, WILLIAM L. BENEDICT. WILLIAM H. CRISP, CHARLES P. SMALL. Address original papers, other scientific communications including correspondence, also books for review and reports of society proceedings to Dr. Lawrence T. Post, 640 S. Kingshighway, Saint Louis.
Exchange copies of medical journals should be sent to Dr. William H. Crisp, 530 Metropolitan Building, Denver. Subscriptions, applications for single copies, notices of change of address, and communications with reference to advertising should be addressed to the Manager of Subscriptions and Advertising, 640 S. Kingshighway, Saint Louis. Copy of advertisements must be sent to the manager by
the fifteenth of the month preceding its appearance. Author's proofs should be corrected and returned within forty-eight hours to the manuscript editor. Twenty-five reprints of each article will be supplied to the author without charge. Additional reprints may be obtained from the printer, the George Banta Publishing Company, 45G-458 Ahnaip Street, Menasha, Wisconsin. if ordered at the time proofs are returned. But reprints to contain colored plates must be ordered when the article is accepted.
THE AMERICAN BOARD OF OPHTHAI~MOLOGY
The history of the American Board of Ophthalmology. now completing its twenty-first year of existence. is something of which the ophthalmologic profession of the United States has much reason to be proud. It is a product of democratic and voluntary organization, an outgrowth of conservative yet flexible types of representation. The Board has made a great contribution to raising of the standards of training in ophthalmology. and it has been the modest pioneer in the creation of similar boards in various lines of special medical practice. Since the movement toward advancement of standards in the medical specialties is entering upon a new phase in which the American Medical Association, the largest medical organization in the
world, is destined to play a prominent part, it may be worth while to review here* some of the salient facts as to the inception and development of the American Board of Ophthalmology. In 1913, on the initiative of a small group of educators, committees were appointed by the American Ophthalmological Society, the Section on Ophthalmology of the American Medical Association, and the American Academy of Ophthalmology and Otolaryngology, for the purpose of conferring and reporting on ophthalmic education. In 1914 these committees recommended that graduate courses in ophthalmology leading to an appropriate degree should be established by first-class medical schools, such courses to represent not less
529
* From a report recently presented to the American Board of Ophthalmology.
530
EDITORIALS
than two years of systematic work after the degree of Doctor of Medicine had been conferred. The committees realized that the number of those who in the near future would take these complete courses leading to a degree would be small, while on the other hand such courses could not solve the problem of differentiating between the competent and incompetent among those who were then practicing ophthalmology. In 1915 the committees made further recommendations aimed at the appointment of a joint board consisting of three representatives from each of the three special societies. A fter much preliminary work, this board was organized in 1916 as the "American Board for Ophthalmic Examinations." The Board was incorporated in May, 1917. A few years ago its name was changed to "American Board of Ophthalmology" for the sake of uniformity with the names of other special examining boards. In 1934 the Board was enlarged by election of four members instead of three from each constituent society. One member is elected each year by each society, to serve for four years, and no member of the Board may serve for two consecutive full terms from the same constituent society. The American Board of Ophthalmology states as its principal functions the establishment of standards of fitness for the practice of ophthalmology, the conducting of examinations and the issuance of certificates as to qualification, and the guidance of prospective students of ophthalmology. Many special eye hospitals as well as a number of general hospitals in all parts of the country make the certificate of the American Board of Ophthalmologv a condition for appointment or promotion on their staffs; and a number of national and local societies require the certificate as a condition for membership.
Up to the beginning of the present year, 1,365 ophthalmologists had received this Board's certificate. In course of time it became evident that some sort of coordination might with advantage be established between the activities and standards of the different examining boards; and in 1933 the American Medical Association authorized the Council on Medical Education and Hospitals to formulate standards upon the basis of which new examining boards might be recognized. The Advisory Board for Medical Specialties was organized in 1934 to give effect to these purposes. It is composed of representatives of the examining boards and of the Association of American Medical Colleges, the American Hospital Association, the Federation of State Medical Boards of the U.S.A., and the National Board of Medical Examiners. The Advisory Board reports to and functions in conjunction with the Council on Medical Education and Hospitals of the American Medical Association. Just as has occurred with the standards for the practice of general medicine, so it is natural that the standards for practice of ophthalmology and other medical specialties should gradually become stricter and more comprehensive. It is already evident that the creation of the Advisory Board for Medical Specialties will contribute materially to this end, although it has to be recognized that no identity of standards can exist as between such widely varying specialties as ophthalmology, laryngology, obstetrics, and dermatology-to mention a few among the various boards which have already been created. It appears probable that after 1938 no physician will be registered in the Registry of Specialists of the American Medical Association unless he holds the certificate of the appropriate examining
EDITORIALS
board. The Advisory Board for Medical Specialties is disposed to set up a minimum of five years training before certificates can be granted. In a recent paper (Archives of Ophthalmology, 1937, volume 17, page 399), Lancaster has pointed out the difficulties associated with excessively hasty and enthusiastic attempts at advanced standardization. He points out that at the present time there are probably not less than 500 physicians who are preparing themselves for the practice of ophthalmology, whereas in the length and breadth of the United States there are not more than three institutions which can offer complete training such as would meet the requirements of the Advisory Board for Medical Specialties. "To set up and insist on a requirement which there is no provision to meet is futile, irrational and stupid." Realizing that those who contemplate the practice of ophthalmology often experience difficulty in obtaining satisfactory guidance with regard to the pursuit of their studies, the American Board of Ophthalmology has recently laid plans for creation of a Preparatory Group of prospective candidates for its certificate.'] Both graduates and undergraduates of approved medical schools are eligible for membership in this group, and those whose applications are accepted will be furnished with various information, including syllabuses of study and advice as to textbooks. Members of the Preparatory Group will be required to keep a summarized record of their activities from year to year, such record to be incorporated in the final application for examination and certification. W. H. Crisp.
t Those who desire to register with this Preparatory Group should communicate with the Secretary of the American Board of Ophthalmology, Dr. John Green, 3720 Washington Boulevard, Saint Louis.
531
A RESOURCE FOR VISION The nautilus, belonging to an ancient type of animal life, has an eye that consists of a cup, lined with retina, to which light is admitted through a small opening. This permits the light from one object to make an impression on only one part of the retina, so that each part of the retina receives the impression of only one object. Euclid and Aristotle understood that in a dark room or dark box, light admitted only through a small hole would give a picture of objects outside in a strong light. This kind of dark room (Latin, camera obscura) was used by magicians and charlatans of the Middle Ages to interest and astonish their followers. For this purpose the effect was increased by placing a convex lens in front of the opening. From this has developed the photographic camera of today. Without any lens but with a strong light, a very small aperture, and by means of a long exposure quite good photographs may be obtained in this way. With the usual photographic lens, the small aperture and long exposures give photographs of deep objects; such as the eye in a deep socket, or an exophthalmos, where one part will have a very different focus from another. Kepler, in about the year 1600, explained that the eye is a camera obscura. The improved vision obtained with a contracted pupil is thus explained, and this accounts in part for the better vision we have with strong light. Heretofore, we have not taken full advantage of this principle, as we learn from the article by Dr. D. H. Rhodes, published in this number of the Journal. Stenopaic spectacles have been described and used before, but not with the brilliant results achieved in this case. To know that such results are possible is a new resource for giving patients better vision. The Esquimaux, Indians, and
Directors: EDWARD JACKSON, President, LAWRENCE T. POST, Vice-President, DR. F. E. WOODRUFF, Secretary and Treasurer, WILLIAM L. BENEDICT. WILLIAM H. CRISP, CHARLES P. SMALL. Address original papers, other scientific communications including correspondence, also books for review and reports of society proceedings to Dr. Lawrence T. Post, 640 S. Kingshighway, Saint Louis.
Exchange copies of medical journals should be sent to Dr. William H. Crisp, 530 Metropolitan Building, Denver. Subscriptions, applications for single copies, notices of change of address, and communications with reference to advertising should be addressed to the Manager of Subscriptions and Advertising, 640 S. Kingshighway, Saint Louis. Copy of advertisements must be sent to the manager by
the fifteenth of the month preceding its appearance. Author's proofs should be corrected and returned within forty-eight hours to the manuscript editor. Twenty-five reprints of each article will be supplied to the author without charge. Additional reprints may be obtained from the printer, the George Banta Publishing Company, 45G-458 Ahnaip Street, Menasha, Wisconsin. if ordered at the time proofs are returned. But reprints to contain colored plates must be ordered when the article is accepted.
THE AMERICAN BOARD OF OPHTHAI~MOLOGY
The history of the American Board of Ophthalmology. now completing its twenty-first year of existence. is something of which the ophthalmologic profession of the United States has much reason to be proud. It is a product of democratic and voluntary organization, an outgrowth of conservative yet flexible types of representation. The Board has made a great contribution to raising of the standards of training in ophthalmology. and it has been the modest pioneer in the creation of similar boards in various lines of special medical practice. Since the movement toward advancement of standards in the medical specialties is entering upon a new phase in which the American Medical Association, the largest medical organization in the
world, is destined to play a prominent part, it may be worth while to review here* some of the salient facts as to the inception and development of the American Board of Ophthalmology. In 1913, on the initiative of a small group of educators, committees were appointed by the American Ophthalmological Society, the Section on Ophthalmology of the American Medical Association, and the American Academy of Ophthalmology and Otolaryngology, for the purpose of conferring and reporting on ophthalmic education. In 1914 these committees recommended that graduate courses in ophthalmology leading to an appropriate degree should be established by first-class medical schools, such courses to represent not less
529
* From a report recently presented to the American Board of Ophthalmology.
530
EDITORIALS
than two years of systematic work after the degree of Doctor of Medicine had been conferred. The committees realized that the number of those who in the near future would take these complete courses leading to a degree would be small, while on the other hand such courses could not solve the problem of differentiating between the competent and incompetent among those who were then practicing ophthalmology. In 1915 the committees made further recommendations aimed at the appointment of a joint board consisting of three representatives from each of the three special societies. A fter much preliminary work, this board was organized in 1916 as the "American Board for Ophthalmic Examinations." The Board was incorporated in May, 1917. A few years ago its name was changed to "American Board of Ophthalmology" for the sake of uniformity with the names of other special examining boards. In 1934 the Board was enlarged by election of four members instead of three from each constituent society. One member is elected each year by each society, to serve for four years, and no member of the Board may serve for two consecutive full terms from the same constituent society. The American Board of Ophthalmology states as its principal functions the establishment of standards of fitness for the practice of ophthalmology, the conducting of examinations and the issuance of certificates as to qualification, and the guidance of prospective students of ophthalmology. Many special eye hospitals as well as a number of general hospitals in all parts of the country make the certificate of the American Board of Ophthalmologv a condition for appointment or promotion on their staffs; and a number of national and local societies require the certificate as a condition for membership.
Up to the beginning of the present year, 1,365 ophthalmologists had received this Board's certificate. In course of time it became evident that some sort of coordination might with advantage be established between the activities and standards of the different examining boards; and in 1933 the American Medical Association authorized the Council on Medical Education and Hospitals to formulate standards upon the basis of which new examining boards might be recognized. The Advisory Board for Medical Specialties was organized in 1934 to give effect to these purposes. It is composed of representatives of the examining boards and of the Association of American Medical Colleges, the American Hospital Association, the Federation of State Medical Boards of the U.S.A., and the National Board of Medical Examiners. The Advisory Board reports to and functions in conjunction with the Council on Medical Education and Hospitals of the American Medical Association. Just as has occurred with the standards for the practice of general medicine, so it is natural that the standards for practice of ophthalmology and other medical specialties should gradually become stricter and more comprehensive. It is already evident that the creation of the Advisory Board for Medical Specialties will contribute materially to this end, although it has to be recognized that no identity of standards can exist as between such widely varying specialties as ophthalmology, laryngology, obstetrics, and dermatology-to mention a few among the various boards which have already been created. It appears probable that after 1938 no physician will be registered in the Registry of Specialists of the American Medical Association unless he holds the certificate of the appropriate examining
EDITORIALS
board. The Advisory Board for Medical Specialties is disposed to set up a minimum of five years training before certificates can be granted. In a recent paper (Archives of Ophthalmology, 1937, volume 17, page 399), Lancaster has pointed out the difficulties associated with excessively hasty and enthusiastic attempts at advanced standardization. He points out that at the present time there are probably not less than 500 physicians who are preparing themselves for the practice of ophthalmology, whereas in the length and breadth of the United States there are not more than three institutions which can offer complete training such as would meet the requirements of the Advisory Board for Medical Specialties. "To set up and insist on a requirement which there is no provision to meet is futile, irrational and stupid." Realizing that those who contemplate the practice of ophthalmology often experience difficulty in obtaining satisfactory guidance with regard to the pursuit of their studies, the American Board of Ophthalmology has recently laid plans for creation of a Preparatory Group of prospective candidates for its certificate.'] Both graduates and undergraduates of approved medical schools are eligible for membership in this group, and those whose applications are accepted will be furnished with various information, including syllabuses of study and advice as to textbooks. Members of the Preparatory Group will be required to keep a summarized record of their activities from year to year, such record to be incorporated in the final application for examination and certification. W. H. Crisp.
t Those who desire to register with this Preparatory Group should communicate with the Secretary of the American Board of Ophthalmology, Dr. John Green, 3720 Washington Boulevard, Saint Louis.
531
A RESOURCE FOR VISION The nautilus, belonging to an ancient type of animal life, has an eye that consists of a cup, lined with retina, to which light is admitted through a small opening. This permits the light from one object to make an impression on only one part of the retina, so that each part of the retina receives the impression of only one object. Euclid and Aristotle understood that in a dark room or dark box, light admitted only through a small hole would give a picture of objects outside in a strong light. This kind of dark room (Latin, camera obscura) was used by magicians and charlatans of the Middle Ages to interest and astonish their followers. For this purpose the effect was increased by placing a convex lens in front of the opening. From this has developed the photographic camera of today. Without any lens but with a strong light, a very small aperture, and by means of a long exposure quite good photographs may be obtained in this way. With the usual photographic lens, the small aperture and long exposures give photographs of deep objects; such as the eye in a deep socket, or an exophthalmos, where one part will have a very different focus from another. Kepler, in about the year 1600, explained that the eye is a camera obscura. The improved vision obtained with a contracted pupil is thus explained, and this accounts in part for the better vision we have with strong light. Heretofore, we have not taken full advantage of this principle, as we learn from the article by Dr. D. H. Rhodes, published in this number of the Journal. Stenopaic spectacles have been described and used before, but not with the brilliant results achieved in this case. To know that such results are possible is a new resource for giving patients better vision. The Esquimaux, Indians, and