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Nomenclature of active optic nerve pathology
CORRESPONDENCE
Verlagskatalog, J. F. Bergmann in Miinchen, 1878-1928. Octavo, 166 pages. This is a catalogue, but one of unusual character. It celebrates fifty years of existence of the firm (1878 to the end of 1927), and its alphabetical list covers 136 pages. It carries as frontispiece a beautiful photogravure portrait of Fritz Bergmann, who founded the enterprise in Wiesbaden, and whose unquestionably distinguished service to medical and technical literature was recognized in 1907 by an honorary degree of doctor of medicine from the University of Wiirzburg. The removal of the firm of Bergmann to Munich in 1920 was in part due to difficulties associated with the occupation of Wies baden by the French after the close of the war. There is food for the imagi nation in the part played by a large publishing house in the educational life of its own and other countries. W. H. C.
CORRESPONDENCE Nomenclature of active optic nerve pathology To the editor: The Indiana Academy of Ophthalmology and Otolaryngology has become officially interested in the terms used to describe active involve ment of the optic nerve. At the Janu ary, 1927, meeting, Dr. C. Norman Howard, of Warsaw, Indiana, read a paper on the etiology of papilledema and retrobulbar neuritis. In his con cluding remarks, the author directed attention to the confusion that exists from the indiscriminate use of terms to designate the ophthalmoscopic and other signs of diseases which affect the optic nerve. To illustrate the point, he quoted from May, Diseases of the Eye, eleventh edition, 1924, page 271, as fol lows: "Intraocular optic neuritis . . . . is also known as descending neuritis, papillitis, choked disc and papilledema. These terms are often used interchange ably and much confusion in regard to the exact meaning of each has arisen in consequence". The interest of the
243
Academy was aroused and a committee was appointed. I t was first ascertained that no com mittee on nomenclature had been provided for the Section on Ophthal mology of the American Medical Association, the American Academy of Ophthalmology and Otolaryngology, or the American Ophthalmological Society. A questionnaire was then prepared by listing terms with definitions for each in harmony with established and cur rent literature. These were sent to 123 ophthalmologists and neurologists rep resenting a cross section of opinion in North America and England. Fiftyeight replies were received. The defi nitions submitted and the principal results of the inquiry are here tabulated. Yes No Quali1. Retrobulbar neuritis: A neuritis of the orbital part of the nerve, with no or slight ophthalmoscopic evidence. ... 54 2 1 2. Optic neuritis: An in flammation of the nerve, re sulting in papillitis 49 3 0 3. Papillitis: An inflam mation and moderate swelling of the disc, which may or may not extend into the r e t i n a . . . . 45 2 1 4. Neuroretinitis: A papil litis with retinal hemorrhages and exudates 41 7 4 4B. Is this a proper term to indicate a swelling of t h e papilla due to nephritis? 25 22 6 5. Optic neuritis with edema: An edema of the disc associated with sinus or other infections 26 16 2 6. Papilledema: An edema of the disc due to increased intracranial pressure 46 5 3 7. Choked disc: Synony mous with papilledema 44 6 0
Some of the replies were accompanied by remarks which denoted dissatis faction with existing conditions and exhibited a lively interest in any means which might remedy the situation, so that one who spoke or wrote could express his meaning with exactness. The committee reported at the De cember, 1927, meeting of the Academy, and the definitions were officially ap proved as written, except those num bered 4 B and 5. The Academy then instructed its secretary to communicate
244
CORRESPONDENCE
with other societies, hoping that, by cooperative endeavor, terms used to de scribe active pathology of the optic nerve might be standardized. While at work on the assignment, the committee was impressed with the idea that the logical direction for simplifi cation was toward a reduction rather than an increase in the number of terms. A speaker or writer could select adjectives to express his meaning more exactly when using any of the recog nized terms. This letter is intended to acquaint the profession generally with the pur pose of the Academy. The secretaries of similar organizations are requested to present these proposals to their respective societies for official consideration, and they are also invited to correspond with the Secretary of this Academy. The prosecution of efforts toward reform will depend upon the attitude of the profession as a whole, whether it is or is not content with present usages. Indiana Academy of Ophthalmology and Otolaryngology: C. W. Rutherford, secretary 406 Pennway building, Indianapolis. "Eye physician" or "eye surgeon"? To the editor: I t is interesting to hear that the Guild of Prescription Opticians of America, a worthy organization, at their annual convention at Buffalo, June 17 and 18, 1927, voted to use hereafter in all of their advertising literature the term "eye physician" in place of the word "oculist". This they propose to do to avoid the confusion in the minds of the public which results from the terms optician, oculist, and ophthalmologist. This is certainly a very laudable endeavor, but the question naturally arises whether they have hit upon the most satisfactory term by which to designate the specialist in ophthal mology. The word "ophthalmologist", we must admit, is too cumbersome and requires an explanation to the ordinary layman. Furthermore it is easily con fused with "optometrist", just as "ocu list" is readily confused in the minds of the public with "optician".
The suggestion of the term "eye phy sician" is a very good one, but a consid eration of certain phases of the subject may be wise before our profession endorses the action of the Guild of Prescription Opticians. In the first place, ophthalmology is distinctly a surgical specialty and is recognized as belonging to the department of surgery in many of our best schools where the subject is taught. Again, in the practice of ophthalmology the specialist is engaged to a far greater extent in surgical treatment than he is in medical treatment. He trains himself to be able to perform surgical operations, many of which require the highest degree of surgical technique and skill. Further more the fitting and application of lenses is a surgical rather than a medical procedure. Just as orthopedics is a surgical specialty and the orthopedic surgeon practices surgery in the fitting of braces and trusses for physical defects of the body, so the eye specialist in fitting glasses, which are in the nature of mechanical appliances or braces for defective eyes, engages in a surgical procedure. In England all eye specialists are ranked as surgeons and take their degrees of licensure from the Royal College of Surgeons. Most ophthalmic surgeons in England do not even have the degree of Doctor of Medicine. From the above considerations it seems to me it would be more logical for us to be called "eye surgeons" than "eye physicians", and this term would give us a standing in the minds of the public as being engaged in surgical as well as medical work. I t might be well to encourage some expression of opinion from members of our specialty before allowing a tacit endorsement of the action of the Guild of Prescription Opticians, commendable as such action is. William H. Wilder Chicago Sterilization of sharp instruments To the editor: I t is evident from inquiries that I have had that the com position of the solution referred to in my paper on "the sterilization of sharp
Verlagskatalog, J. F. Bergmann in Miinchen, 1878-1928. Octavo, 166 pages. This is a catalogue, but one of unusual character. It celebrates fifty years of existence of the firm (1878 to the end of 1927), and its alphabetical list covers 136 pages. It carries as frontispiece a beautiful photogravure portrait of Fritz Bergmann, who founded the enterprise in Wiesbaden, and whose unquestionably distinguished service to medical and technical literature was recognized in 1907 by an honorary degree of doctor of medicine from the University of Wiirzburg. The removal of the firm of Bergmann to Munich in 1920 was in part due to difficulties associated with the occupation of Wies baden by the French after the close of the war. There is food for the imagi nation in the part played by a large publishing house in the educational life of its own and other countries. W. H. C.
CORRESPONDENCE Nomenclature of active optic nerve pathology To the editor: The Indiana Academy of Ophthalmology and Otolaryngology has become officially interested in the terms used to describe active involve ment of the optic nerve. At the Janu ary, 1927, meeting, Dr. C. Norman Howard, of Warsaw, Indiana, read a paper on the etiology of papilledema and retrobulbar neuritis. In his con cluding remarks, the author directed attention to the confusion that exists from the indiscriminate use of terms to designate the ophthalmoscopic and other signs of diseases which affect the optic nerve. To illustrate the point, he quoted from May, Diseases of the Eye, eleventh edition, 1924, page 271, as fol lows: "Intraocular optic neuritis . . . . is also known as descending neuritis, papillitis, choked disc and papilledema. These terms are often used interchange ably and much confusion in regard to the exact meaning of each has arisen in consequence". The interest of the
243
Academy was aroused and a committee was appointed. I t was first ascertained that no com mittee on nomenclature had been provided for the Section on Ophthal mology of the American Medical Association, the American Academy of Ophthalmology and Otolaryngology, or the American Ophthalmological Society. A questionnaire was then prepared by listing terms with definitions for each in harmony with established and cur rent literature. These were sent to 123 ophthalmologists and neurologists rep resenting a cross section of opinion in North America and England. Fiftyeight replies were received. The defi nitions submitted and the principal results of the inquiry are here tabulated. Yes No Quali1. Retrobulbar neuritis: A neuritis of the orbital part of the nerve, with no or slight ophthalmoscopic evidence. ... 54 2 1 2. Optic neuritis: An in flammation of the nerve, re sulting in papillitis 49 3 0 3. Papillitis: An inflam mation and moderate swelling of the disc, which may or may not extend into the r e t i n a . . . . 45 2 1 4. Neuroretinitis: A papil litis with retinal hemorrhages and exudates 41 7 4 4B. Is this a proper term to indicate a swelling of t h e papilla due to nephritis? 25 22 6 5. Optic neuritis with edema: An edema of the disc associated with sinus or other infections 26 16 2 6. Papilledema: An edema of the disc due to increased intracranial pressure 46 5 3 7. Choked disc: Synony mous with papilledema 44 6 0
Some of the replies were accompanied by remarks which denoted dissatis faction with existing conditions and exhibited a lively interest in any means which might remedy the situation, so that one who spoke or wrote could express his meaning with exactness. The committee reported at the De cember, 1927, meeting of the Academy, and the definitions were officially ap proved as written, except those num bered 4 B and 5. The Academy then instructed its secretary to communicate
244
CORRESPONDENCE
with other societies, hoping that, by cooperative endeavor, terms used to de scribe active pathology of the optic nerve might be standardized. While at work on the assignment, the committee was impressed with the idea that the logical direction for simplifi cation was toward a reduction rather than an increase in the number of terms. A speaker or writer could select adjectives to express his meaning more exactly when using any of the recog nized terms. This letter is intended to acquaint the profession generally with the pur pose of the Academy. The secretaries of similar organizations are requested to present these proposals to their respective societies for official consideration, and they are also invited to correspond with the Secretary of this Academy. The prosecution of efforts toward reform will depend upon the attitude of the profession as a whole, whether it is or is not content with present usages. Indiana Academy of Ophthalmology and Otolaryngology: C. W. Rutherford, secretary 406 Pennway building, Indianapolis. "Eye physician" or "eye surgeon"? To the editor: I t is interesting to hear that the Guild of Prescription Opticians of America, a worthy organization, at their annual convention at Buffalo, June 17 and 18, 1927, voted to use hereafter in all of their advertising literature the term "eye physician" in place of the word "oculist". This they propose to do to avoid the confusion in the minds of the public which results from the terms optician, oculist, and ophthalmologist. This is certainly a very laudable endeavor, but the question naturally arises whether they have hit upon the most satisfactory term by which to designate the specialist in ophthal mology. The word "ophthalmologist", we must admit, is too cumbersome and requires an explanation to the ordinary layman. Furthermore it is easily con fused with "optometrist", just as "ocu list" is readily confused in the minds of the public with "optician".
The suggestion of the term "eye phy sician" is a very good one, but a consid eration of certain phases of the subject may be wise before our profession endorses the action of the Guild of Prescription Opticians. In the first place, ophthalmology is distinctly a surgical specialty and is recognized as belonging to the department of surgery in many of our best schools where the subject is taught. Again, in the practice of ophthalmology the specialist is engaged to a far greater extent in surgical treatment than he is in medical treatment. He trains himself to be able to perform surgical operations, many of which require the highest degree of surgical technique and skill. Further more the fitting and application of lenses is a surgical rather than a medical procedure. Just as orthopedics is a surgical specialty and the orthopedic surgeon practices surgery in the fitting of braces and trusses for physical defects of the body, so the eye specialist in fitting glasses, which are in the nature of mechanical appliances or braces for defective eyes, engages in a surgical procedure. In England all eye specialists are ranked as surgeons and take their degrees of licensure from the Royal College of Surgeons. Most ophthalmic surgeons in England do not even have the degree of Doctor of Medicine. From the above considerations it seems to me it would be more logical for us to be called "eye surgeons" than "eye physicians", and this term would give us a standing in the minds of the public as being engaged in surgical as well as medical work. I t might be well to encourage some expression of opinion from members of our specialty before allowing a tacit endorsement of the action of the Guild of Prescription Opticians, commendable as such action is. William H. Wilder Chicago Sterilization of sharp instruments To the editor: I t is evident from inquiries that I have had that the com position of the solution referred to in my paper on "the sterilization of sharp