Inside Duke Medicine

Who’s your psammoma?

Tree stump rings? Sliced carrots? Faded Grateful Dead poster? Click below for an answer.

Mystery solved: This is a photo of microsopic psammoma bodies, round collections of calcium that are seen in some tumors.

The term derives from the Greek word psammos meaning “sand.”

Learn more about the history of the device through which this picture was taken in PhotoPath, supervisor Susan Reeves’ summary of the history of the Zeiss Ultraphot II Photomicroscope.

The microscope is being  donated to the Duke University  Medical Center Library’s Collection of Historical Medical Instruments by the Department of Pathology:

The Zeiss Ultraphot II Photomicroscope was purchased in January 1966 for $10,500, by Carl Bishop, the first photographer and originator of the Pathology Photography Lab. (He was one of the high school students assigned to the original departments when the hospital opened in 1930, and after autopsy diener duties for a few years was sent to Eastman to become a photographer so the in-town photographer didn’t need to come in.)

Bishop (and each of the subsequent supervisors, Bill Boyarsky and Susan Reeves) would sit with the staff member at the scope as he or she looked at the tissue, found the best field, and composed it together up on the 4x5 inch ground-glass screen (this latter feature was a key one for quality and pleasure of use). Quality was the imperative, which was assured not only by the extremely well-engineered scope and the use of 4x5 inch film to maximize resolution, but also by the input of the photographer to compose the most aesthetic image and avoid artifacts. (As I was taught early in my training, we create “illustrations of the disease process,” not snapshots.)

The photographer would then adjust the scope to maximum focus and alignment (Köhler illumination), use the skills of experience to apply the best filter for black and white translation, test for exposure, and expose onto 4x5 sheet film. That film was hand-processed and hand-printed in our darkrooms. Prints were usually contact prints, and subsequent prints for publication were made after the proof set was reviewed and narrowed down.

The Ultraphot was in its own class for quality, and for the macro abilities using the Luminar lens system. (Some websites extolling the virtues of this scope are listed at the bottom.) It is known for its fabulous engineering (precise quality which cannot be found on scopes of any brand name today), optical features, as well as the art-object design. It is capable of polarized illumination, phase and darkfield illuminations as well as the routine brightfield. Photomicrographs could be perfectly composed between strict objective magnifications using the “Optovar” and zoom ability. There is great pleasure in using an instrument of such precise design. Even its matching all-metal work desk with the built-in original power supply control contains drawers with sculpted wood inserts for lenses and accessories.

Innumerable publications featured these photos, and the field of pathology was greatly enriched by the seminal works of authors such as Gordon Klintworth, Peter Burger, Edward Bossen, Stephen Vogel, and many other staff at Duke over a 36 year period.

There is an element of this machine and its history that transcends the physical and quality attributes. It represents an era where human interaction and craft were appreciated and required. The satisfaction of crafting the images by hand was enhanced by the human interaction engendered by pairing with the staff to take the photos. This team creation, and ultimate quality, is a luxury that cannot be afforded today, and since most work is created alone or at the computer, it is a very different process. Interaction with faculty is more limited, and we all stay at our computers to work. Cameras are digital, and the entire black and white film/paper reproduction process is largely lost. Across many dimensions, the Zeiss Ultraphot is an artifact of an era of medicine that we should endeavor to preserve.

Websites:

http://micro.magnet.fsu.edu/primer/museum/zeissultrapot2.html
http://www.the-ultraphot-shop.org.uk/