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Bucky'S Border Rays
362
EDITORIALS
erable number of books, magazines, monographs and reprints, many of which for various reasons may have a distinct value. Some of these would be of use in filling in deficiencies in series in public libraries. Others, be cause of their rarity or because of the importance of the subject matter which they contain, would have a reference value, which they possess only when they are made readily available to writ ers or research workers. These, while often scientifically important have usu ally little commercial value, and if no adequate provision is made for their ul timate disposition in some library, col lege, hospital or clinic, on the death of the owner, are left to gather dust on old shelves or are scattered through second hand book stalls and practically lost. In the publication of transactions of medi cal societies there is almost always a number of printed copies beyond the actual requirements of the membership. These accumulate in basements or storehouses occupying space which can often be illy afforded and where they are of no practical use whatever. The same is true in regard to medical jour nals. If a reasonable number of copies of these be reserved to meet the occa sional calls that are made for them this should suffice for all necessary require ments. W h y not open a way for the suitable disposal of such excess vol umes of literature so that their useful ness might be continued? Some of our medical periodicals might serve as a medium through which could be communicated the spe cial needs of libraries for journals re quired to complete series or of volumes especially needed to fill omissions. The publication from time to time of lists of such desired volumes would inform the readers where donations would be acceptable or bequests could be advan tageously used. In this way it would be possible to have many of the defi ciencies supplied at small expense and little effort. Volumes which might oth erwise join the over-crowded ranks of the unemployed would be given, there by, a further life of usefulness. Park Lewis.
BUCKY'S BORDER RAYS Internationalism in medical termin ology is highly desirable, but the form of internationalism which consists in blind adoption of words from a foreign language is illogical and objectionable. The responsibility for such mistakes often lies primarily with manufacturers of drugs or medical appliances, who take foreign nomenclature ready made, because it sounds a little more mysteri ous and imposing. The name of Dr. Bucky, a distin guished roentgenologist trained in Leipzig, Germany, but now practicing in New York City, has been descrip tively associated with certain wave lengths of radiant energy intermediate between the shortest ultraviolet and the longest roentgen rays. Bucky's border rays, also known as "supersoft" or "w-rays," resemble x-rays in that they are produced by a unidirectional electrical current pas sing through a vacuum and impinging upon a dense target; but their pene trating power is so low that they are intercepted by the glass of an ordinary Coolidge tube, and they can only be put to practical use by incorporating in the Coolidge tube a window of very thin aluminum or extremely thin glass. Ap parently their action upon the tissues is not yet entirely understood, but they have very little penetrating effect, and hence for superficial use they are prob ably safer than radium and ordinarily roentgen rays. They have been applied particularly to various forms of derma titis, and in the eye to a number of dis turbances of the cornea. When Bucky wrote in German about these rays they were naturally given the title of "Grenzstrahlen," which, quite literally translated into English, means "border rays". In America it has become rather common to speak of these rays by their German name, or, what is even more ridiculous, to retain the first half of the German expression and to translate the second half into English, forming the hybrid "Grenz rays", as though they might have been invented or discovered by a gentleman of the name of "Grenz"! Even so highly
EDITORIALS
intelligent a volume as Sanford Gifford's new "Handbook of ocular ther apeutics" speaks of "the use of the Grenz rays described by Bucky." The expression is comically suggestive of "Pennsylvania Dutch"! Neither in logic nor convenience does there seem to be any good reason why "Grenzstrahlen" should not be trans lated literally as "border rays". W. H. Crisp. SCHILLING COUNT IN T H E DIAGNOSIS OF TUBERCULOSIS One of the most mooted questions in ophthalmology is the causal relation ship of tuberculosis to ocular inflamma tion. Ophthalmologists attribute to tu berculosis from four percent to sixty percent of cases of intraocular inflam matory disease. The reason for such a divergence of opinion is obviously the inability to examine histologically more than a tiny fraction of the total number of these cases. Aside from the patho logical diagnosis from the enucleated eye or rarely a specimen from biopsy, there can be no positive proof. In ad dition there is a small group in which the diagnosis can be made with reason able certainty, composed of those eyes which exhibit characteristic nodules of the iris when other known nodule forming agents are absent. Where these diagnostic evidences are not present the physician has been forced to seek fur ther for data on which to base a differ ential diagnosis. Tuberculin, in one form or another has been used extensively to prove whether tuberculosis is the underlying lesion. No test has been entirely satis factory because there are many factors which influence the findings so greatly as to throw considerable doubt on the interpretation of the reaction. Probably the intradermal use of small doses of old tuberculin is the favorite method just now. It has been shown, however, that many cases of active tuberculosis do not give a positive skin reaction. On the other hand, even if a positive reac tion is obtained there is nothing in the
363
nature of the local reaction to indicate whether it is due to an old healed lesion or to an active process. It is true that at times a so-called focal reaction is ini tiated at the site of the lesion. This, however is not common. It occurred in twenty-two percent of active cases in a large series reported from Saranac in September 1931. This is hardly a suffi ciently high percentage to be of con vincing diagnostic importance. The general or temperature reaction also occurs with no great regularity. Undoubtedly the tuberculin test has real significance but equally surely, it leaves much to be desired. It is probable however, that this is still the best diag nostic procedure at the disposal of most ophthalmologists but it is possible that something better may supersede it and there may even now be a more accurate test at hand. Those who studied hematology fif teen or more years ago were taught dif ferential blood counts after the method of Ehrlich, which was undoubtedly the best method known at that time. They continue to think in terms of the Ehrlich differential although for some years the method of Victor Schilling has been steadily gaining recognition as a more exact procedure. The great difficulty with this method as with most refine ments in technique of every kind, is that it requires far more training to learn and infinitely more experience to in terpret. Merely to become familiar with technique requires many weeks of study. All of the interpretations are by no means universally accepted but some of the findings undoubtedly are correct. In general the difference between the Ehrlich and the Schilling differentials is the further separation of the neutrophilic polymorphonuclear elements. The basophiles, eosinophiles, lympho cytes and monocytes are counted in the same manner in both tests. The neutrophiles are divided into myelocytes, juveniles, "stabs" or rod nuclears and segmented forms. This is fundamen tally an age distinction, the youngest cells being the myelocytes which have large, single, rounded nuclei occupying a very big part of the cell, surrounded
EDITORIALS
erable number of books, magazines, monographs and reprints, many of which for various reasons may have a distinct value. Some of these would be of use in filling in deficiencies in series in public libraries. Others, be cause of their rarity or because of the importance of the subject matter which they contain, would have a reference value, which they possess only when they are made readily available to writ ers or research workers. These, while often scientifically important have usu ally little commercial value, and if no adequate provision is made for their ul timate disposition in some library, col lege, hospital or clinic, on the death of the owner, are left to gather dust on old shelves or are scattered through second hand book stalls and practically lost. In the publication of transactions of medi cal societies there is almost always a number of printed copies beyond the actual requirements of the membership. These accumulate in basements or storehouses occupying space which can often be illy afforded and where they are of no practical use whatever. The same is true in regard to medical jour nals. If a reasonable number of copies of these be reserved to meet the occa sional calls that are made for them this should suffice for all necessary require ments. W h y not open a way for the suitable disposal of such excess vol umes of literature so that their useful ness might be continued? Some of our medical periodicals might serve as a medium through which could be communicated the spe cial needs of libraries for journals re quired to complete series or of volumes especially needed to fill omissions. The publication from time to time of lists of such desired volumes would inform the readers where donations would be acceptable or bequests could be advan tageously used. In this way it would be possible to have many of the defi ciencies supplied at small expense and little effort. Volumes which might oth erwise join the over-crowded ranks of the unemployed would be given, there by, a further life of usefulness. Park Lewis.
BUCKY'S BORDER RAYS Internationalism in medical termin ology is highly desirable, but the form of internationalism which consists in blind adoption of words from a foreign language is illogical and objectionable. The responsibility for such mistakes often lies primarily with manufacturers of drugs or medical appliances, who take foreign nomenclature ready made, because it sounds a little more mysteri ous and imposing. The name of Dr. Bucky, a distin guished roentgenologist trained in Leipzig, Germany, but now practicing in New York City, has been descrip tively associated with certain wave lengths of radiant energy intermediate between the shortest ultraviolet and the longest roentgen rays. Bucky's border rays, also known as "supersoft" or "w-rays," resemble x-rays in that they are produced by a unidirectional electrical current pas sing through a vacuum and impinging upon a dense target; but their pene trating power is so low that they are intercepted by the glass of an ordinary Coolidge tube, and they can only be put to practical use by incorporating in the Coolidge tube a window of very thin aluminum or extremely thin glass. Ap parently their action upon the tissues is not yet entirely understood, but they have very little penetrating effect, and hence for superficial use they are prob ably safer than radium and ordinarily roentgen rays. They have been applied particularly to various forms of derma titis, and in the eye to a number of dis turbances of the cornea. When Bucky wrote in German about these rays they were naturally given the title of "Grenzstrahlen," which, quite literally translated into English, means "border rays". In America it has become rather common to speak of these rays by their German name, or, what is even more ridiculous, to retain the first half of the German expression and to translate the second half into English, forming the hybrid "Grenz rays", as though they might have been invented or discovered by a gentleman of the name of "Grenz"! Even so highly
EDITORIALS
intelligent a volume as Sanford Gifford's new "Handbook of ocular ther apeutics" speaks of "the use of the Grenz rays described by Bucky." The expression is comically suggestive of "Pennsylvania Dutch"! Neither in logic nor convenience does there seem to be any good reason why "Grenzstrahlen" should not be trans lated literally as "border rays". W. H. Crisp. SCHILLING COUNT IN T H E DIAGNOSIS OF TUBERCULOSIS One of the most mooted questions in ophthalmology is the causal relation ship of tuberculosis to ocular inflamma tion. Ophthalmologists attribute to tu berculosis from four percent to sixty percent of cases of intraocular inflam matory disease. The reason for such a divergence of opinion is obviously the inability to examine histologically more than a tiny fraction of the total number of these cases. Aside from the patho logical diagnosis from the enucleated eye or rarely a specimen from biopsy, there can be no positive proof. In ad dition there is a small group in which the diagnosis can be made with reason able certainty, composed of those eyes which exhibit characteristic nodules of the iris when other known nodule forming agents are absent. Where these diagnostic evidences are not present the physician has been forced to seek fur ther for data on which to base a differ ential diagnosis. Tuberculin, in one form or another has been used extensively to prove whether tuberculosis is the underlying lesion. No test has been entirely satis factory because there are many factors which influence the findings so greatly as to throw considerable doubt on the interpretation of the reaction. Probably the intradermal use of small doses of old tuberculin is the favorite method just now. It has been shown, however, that many cases of active tuberculosis do not give a positive skin reaction. On the other hand, even if a positive reac tion is obtained there is nothing in the
363
nature of the local reaction to indicate whether it is due to an old healed lesion or to an active process. It is true that at times a so-called focal reaction is ini tiated at the site of the lesion. This, however is not common. It occurred in twenty-two percent of active cases in a large series reported from Saranac in September 1931. This is hardly a suffi ciently high percentage to be of con vincing diagnostic importance. The general or temperature reaction also occurs with no great regularity. Undoubtedly the tuberculin test has real significance but equally surely, it leaves much to be desired. It is probable however, that this is still the best diag nostic procedure at the disposal of most ophthalmologists but it is possible that something better may supersede it and there may even now be a more accurate test at hand. Those who studied hematology fif teen or more years ago were taught dif ferential blood counts after the method of Ehrlich, which was undoubtedly the best method known at that time. They continue to think in terms of the Ehrlich differential although for some years the method of Victor Schilling has been steadily gaining recognition as a more exact procedure. The great difficulty with this method as with most refine ments in technique of every kind, is that it requires far more training to learn and infinitely more experience to in terpret. Merely to become familiar with technique requires many weeks of study. All of the interpretations are by no means universally accepted but some of the findings undoubtedly are correct. In general the difference between the Ehrlich and the Schilling differentials is the further separation of the neutrophilic polymorphonuclear elements. The basophiles, eosinophiles, lympho cytes and monocytes are counted in the same manner in both tests. The neutrophiles are divided into myelocytes, juveniles, "stabs" or rod nuclears and segmented forms. This is fundamen tally an age distinction, the youngest cells being the myelocytes which have large, single, rounded nuclei occupying a very big part of the cell, surrounded