The teaching of clinical ophthalmology / by C.O. Hawthorne.

  • Hawthorne, C. O. (Charles Oliver), 1858-1949
Date:
1914
Catalogue details

Licence: In copyright

Credit: The teaching of clinical ophthalmology / by C.O. Hawthorne. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    <p\ Reprinted from The OPHTHALMOSCOPE, December, 1914.] THE TEACHING OF OPHTHALMOLOGY. BY C. O. Hawthorne, M.D.Glasg. PHYSICIAN TO THE HAMPSTEAD AND NORTH-WEST LONDON HOSPITAL AND TO THE ROYAL WATERLOO HOSPITAL FOR CHILDREN AND WOMEN ; FORMERLY EXAMINER IN THE UNIVERSITIES OF ABERDEEN, EDINBURGH, AND GLASGOW. The question of the teaching of ophthalmology to students of medicine, when discussed in a medical society or journal, may be taken to mean instruction in such knowledge of the visual apparatus, and of the function of vision, as is likely to be of service in the diagnosis, prognosis, and treatment of disease. No doubt this clinical teaching, to be effective, implies a sufficient training in the embryology, anatomy, physiology, and pathology of the several anatomical structures concerned. This training, however, falls to be provided in the appropriate sections of the medical curriculum, and its organisation hardly comes within the present purpose. It is the application of these preliminary studies to medical and surgical practice which constitutes ophthalmology in the ordinary sense of this term, and hence the subject to be considered in the present paper may be more precisely stated as the teaching of ophthalmology in its clinical or practical aspects. That this involves instruction in the actual conditions of disease existing in individual patients is, of course, obvious ; and the immediate question is, by what machinery should this instruction be supplied. In reply, and as a statement of general principle, my proposal would be that clinical ophthalmology, like other branches of the medical art, should be taught in those divisions of the medical curiiculum where its application has the greatest opportunity of practical service. The art of percussion is taught in clinical medicine because there is its occasion and value. The methods of amputation are taught in clinical surgery because there is their field of application. The teaching of ophthalmology ought to be determined by a similar principle ; and were this principle adopted, its translation into an active policy would proceed upon obvious and readily defined lines. Thus, in the first place, there are certain clinical disturbances and defects in the eyeball which are mainly or solely of importance as local conditions producing a greater or lesser degree of visual disturbance—the presence of a foreign body, an opacity of the lens, a corneal ulcer, and an error of refraction may be mentioned as examples. Further, these and such-like local conditions can very largely be removed, or favourably modified, by operative or other mechanical methods ; and their recognition and rectification constitutes the department of ophthalmology known as ophthalmic surgery. Therefore, in accordance with the principle above enunciated, it is in the department of ophthalmic surgery that the student should be taught how to recognise, and how to treat, those clinical states of the eyeball which are susceptible of relief by operative, mechanical, or other topical methods. As contrasted with diseased conditions of local importance, there are other disturbances of the visual apparatus which are not capable of mechanical treatment, and which are significant mainly because they are evidences of the existence of visceral or constitutional disease. Paralysis of the ocular musculature, retinal haemorrhages or exudations or embolism, optic neuritis