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June 15, 1889
JAMA. 1889;12(24):846- 847.
The ophthalmoscope, at one time considered as nothing but an interesting scientific toy, has become an indispensable instrument in physical diagnosis. Its history is a succession of triumphs. The wonderful progress made within the last thirty years in ophthalmology is altogether due to this instrument. By its means the neurologist has been able to penetrate the mystery which enshrouded many cases of brain and spinal disease, and our knowledge of kidney diseases, secured from the ophthalmoscope a valuable contribution when it revealed the existence and nature of the various forms of ocular disturbances concomitant with and due to nephritic disorders. In view of these facts should not the use of so important an instrument be thoroughly taught in our medical colleges? Should not every physician be equipped not with the instrument alone, but with the knowledge and experience necessary for its practical use. Yet how far we are from this state of things. How few of our graduates know how to "throw light into the eye," and of these how small the number who know what they see in the field thus illuminated. If these men only knew enough to know what they don't know, the case would not be so bad, but ignorance is proverbially arrogant, and hence the mistakes of the ignorant are prone to escape correction. It is really humiliating to witness a graduated physician attempting to examine an eye while the light reflected from the mirror is seen illuminating the wall beyond the patient's head, and how often serious blunders in diagnosis occur is best known to those who have had an opportunity to watch graduates at work with this instrument.
A more thorough instruction in the use of the ophthalmoscope is imperative, and our medical colleges should see to it that the student be thoroughly trained in its use. Of course it cannot be expected that the general practitioner shall be an expert, that should be left to the oculist, but every medical man should at least be able to recognize the difference between a transparent and an opaque lens, a normal papilla and a choked disc, and a healthy retina and one affected with retinitis. Then will men be able to recognize also their limitations, and serious blunders will not be so common. Until this condition of things is brought about we cannot lay claim to that high standard of medical education which should characterize the curriculum of the American medical colleges.
The sympathies of the Nation for the past week have been centered upon the sufferers of the Conemaugh Valley. Ten days have now elapsed since the occurrence of that fearful calamity. The actual condition, sad as it is, is less appalling than at first reported. A conservative estimate reduces the number of dead to about five thousand. From the bulletin issued by the State Board of Health, on June 9th, we learn that the general health in the region of the disaster is excellent; that there is no evidence of epidemic disease; that the whole country has been districted and each section placed under control of a competent sanitarian—and it is confidently believed that the work of reclamation will be carried on so rapidly and so well that the general health in the locality will be maintained. This is well, and we heartily commend the State Board of Health for this efficient action.
But the question which we wish to emphasize is this: Who is responsible for this wholesale destruction of human life? Had the Valley been devastated by a volcanic upheaval or had a cyclone swept it to destruction, human agency would not be responsible for that which it could not control. But here it is not so. The primal cause of this calamity was the work of human hands. It was legitimately under the surveillance of sanitary inspection. It could have been averted by legitimate authority and somebody is responsible for the loss of these five thousand lives.
Editorials. JAMA. 2019;321(22):2248. doi:10.1001/jama.2018.15374
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