EDITORIALS 439

silver acetate as a prophylactic, which hasbeen done in the paper upon the subjecton another page of this issue.

Professor Emile de Grosz, of Budapest,is well known to the ophthalmologists ofthis country, since he was the guest of theAmerican Academy of Ophthalmologyand Oto-Laryngology in 1930 and has formany years contributed important andwell-balanced articles to the literature ofophthalmology. The introduction of silveracetate, as a safer and more widely effi­cient prophylactic, should be welcomed.Its general application must often be inthe hands of nurses or registered mid­wives; and in sparsely settled districtswhere new drugs cannot be obtained with­out fatal delay.

In some of the larger cities of thecountry silver acetate can be obtained onlyby sending to the wholesale drug manu­facturers. In the laws of many of ourstates silver nitrate is mentioned as thedrug to be used. This might be consideredan instance of the dangers and difficultiesof "State Medicine." It will be of interestto the profession to have readers whomake trial of the new prophylactic reporttheir experience in early numbers of ourmedical journals. It is a matter that con­cerns not only ophthalmologists but stillmore closely obstetricians, general practi­tioners, nurses, and midwives who areliable to penalties for neglect of safe andnecessary measures.

Edward Jackson

BELGIUM ARGUES SPECIALLICENSURE

A number of European countries have,in one form or other, legal requirementsfor separate licensure of those who aredefinitely qualified for practice of themedical specialties. For a decade or soBelgium has been deliberating concerninga proposal to issue supplemental diplomas

to medical specialists. The subject wascommented upon editorially in this Jour­nal seven years ago, with incidentalreference to the Belgian situation (1930,v: 13, p. 1009). A report on the subjectappears in a recent issue of the Bulletin ofthe Royal Academy of Medicine of Bel­gium (1937, sixth series, v. 2, October 30,p. 470).

A good deal of strenuous opposition tothe Belgian scheme has come, as might beexpected, from the general physicians,who feel that they may be deprived ofprivileges previously assured to them bytheir license to practice "medicine, sur­gery, and obstetrics." The fear is in somedegree reasonable, but is apparently basedupon misunderstanding.

A recent communication to the BelgianAcademy, from the Ministry of PublicHealth, requested a formal reply by theAcademy to the protests which had comefrom medical groups, the medical press,and the daily press. The Academy there­fore adopted a reply which states veryconcisely and effectively some of the argu­ments in favor of special licensure andadequately refutes the objections of Bel­gian opponents.

Some of the critics appear to feel thatthe chief purpose of such legislation is toprotect the fully qualified specialist againstcompetition by those less substantiallyprepared, as well as to protect the publicagainst inadequate specialization. Theyurge the more serious objection that thepractitioner who is not furnished with aspecial diploma might, in relation to aprocedure which exceeded the usualbounds of general medical practice, beaccused of having transgressed the limitsof his competence and might be renderedliable medicolegally for any possible harmsustained by the patient.

The Belgian Academy points out, how­ever, that the proposed legislative enact­ment specifically safeguards general prac-

440 EDITORIALS

titioners in their previously existing rightto practice any medical act whatever, thepatient's recourse for damages being re­stricted to cases of ignorance, negligence,or serious error.

The Academy urges that the purpose ofthe creation of the special diploma is toenlighten the public mind. If the layman,thus provided legally with an opportunityfor discrimination between differentgroups of practitioners, places himself inthe hands of a nonspecialist for care of acondition requiring special qualifications,he will (under the proposed new law) doso on his own responsibility, and will havedeprived himself of legal recourse againstthe physician whom he has selected.

Under the proposed Belgian law thespecial diploma would be granted onlyafter several years of practice. It wouldoffer no other legal prerogative than theright to use the title. No physician wouldbe allowed to call himself "specialist" whodid not possess the required specialdiploma.

The Belgian Academy further ex­presses itself in favor of a requirementthat, as far as possible, only possessorsof the new diploma should be placed incharge of special services in those healthorganizations whose inmates or patientsdo not enjoy free choice of physician.

Under democratic government it seemshardly probable that the private patientwill ever lose the privilege of choosing,however ignorantly, his own physician.But information available to the publicas to special medical qualifications of thosewho are consulted should not be limited to

. the claims made by the physician or hissupporters. The conditions under whichthe title of "specialist" was first assumedin the United States led to the term beingheld in scorn and derision among respect­able physicians and enlightened laymen.The expression is, however, a useful oneand is held in respect in a number of

European countries. It seems likely thatpossession of an authentic special diplomaor license as a legal stamp of approval forspecial qualification will ultimately be re­quired and accepted in every civilizedcommunity.

W. H. Crisp

OCULAR TUBERCULOSIS

In this issue appears a very thoughtfularticle on tuberculosis of the eye by arecognized authority. The paper was readbefore the Inter-State Postgraduate Medi­cal Association of North America whichmet in Saint Louis in October, 1937, un­der the Schneider Eye Research Founda­tion. This foundation, originated about 10years ago in memory of Dr. Schneider ofMilwaukee, was an endowment of theInter-State Postgraduate Medical As­sociation for the purpose of inviting aspeaker to present a paper on some oph­thalmological subject each year before theSociety. This is the only ophthalmologicalpaper on the program, hence must bewritten to interest nonspecialists, whomake up the audience. Tuberculosis inany form does this, and hence proves aparticularly appropriate subject for sucha lecture. Furthermore, this year thespeaker gave a talk of very general in­terest because it has an application totuberculosis wherever located in the body.

Every ophthalmologist is confrontedwith the problem of ocular tuberculosis,its diagnosis, and treatment. In thisarticle is well summarized much of theexisting knowledge on the subject in aclear, concise manner. It requires thought­ful reading but will well repay the timeso spent. In fact a second reading forcareful digestion will prove valuable.

Among the important features is thedivision clinically into two groups, "aclassical nodular iritis, with hard miliarytubercles over the surface of the iris" and