[Reprinted from The Medical News, January 7, 1893.] 
LOW-POWER OBJECTIVES IN MICROSCOPIC 
DIAGNOSIS. 
To the Editor of The Medical News, 
Sir : In this day of microscopic investigations in the 
diagnosis of diseases, we find almost every practitioner 
of medicine in possession of a more or less valuable 
microscope, and doing a certain amount of microscopic 
work in some line or other. It is to be feared that the 
majority of these would-be investigators are led to the 
purchase of a microscope more from the fact that it is a 
popular “fad” than from real motives of investigation, 
or as an instrument facilitating the diagnosis of many 
diseases; but be that as it may, the fact remains that 
very few physicians not specialists in microscopic work 
are able to make correct diagnoses of even simple 
growths and neoplasms. I have observed, even among 
men who paid considerable attention to microscopic 
manipulation, that very few are able to tell with any 
certainty the difference between even well-marked 
benign and malignant growths. 
There are certainly some good reasons for this, one of 
which is undoubtedly the fact that most of these men 
have taken up microscopic study after leaving institu- 
tions in which competent instruction in some of the fun- 
damental principles of microscopy is given ; but from 
personal observation I believe that the real difficulty lies 
in the fact that the majority of persons do not use ob- 
jectives of proper magnifying power. There seems to 
be a fear of using too low magnifying power, and con- 
sequently the opposite result follows, and we find alto- 
gether too high a power being used. 2 
The majority of amateurs seem to feel that any magni- 
fying power of less than 500 diameters is too low, while 
experience shows that a power of about 100 diameters 
is much better for the ordinary diagnosis of tumors. 
With a power of 500 diameters the field of vision is ex- 
tremely limited, and one sees more of the individual 
cells than of the general arrangement of structures. In 
other words, he looks for special landmarks and avoids 
the “ bird’s-eye ” view. This, I believe, is the true 
fault. A field of the microscope may justly be compared 
to a landscape, with the landmarks of clumps of trees, 
rocks, etc., represented by clumps of cells and various 
structures. No person, in attempting to recognize a new 
country, would look at individual trees or stones, but 
would rather take a general view of the whole from 
some hill top, and then confirm the opinion thus formed 
by more minute examination of the woods and plains. 
Just so with the “microscopic landscape” of a new 
tumor. The low power (say, 100 diameters) is the 
bird’s-eye view, and the grouping and arrangement of 
cells will give a better clew to diagnosis than individual 
cells can, no matter how well stained or how clearly 
defined by the lens. 
It seems almost impossible to shake from the minds 
of the general mass of physicians the idea that each 
neoplasm should have its own particular characteristic 
cell, peculiar only to itself. I believe it is the remains 
of this old idea that leads to the use of high-power 
lenses in attempted diagnosis. When the amateur 
microscopist will shake off this idea and confine his 
attention more to general views with lower power objec- 
tives, I believe he will find it much easier to make 
correct diagnoses, at least of benign and malignant 
growths. Very respectfully yours, 
E. H. Williams. 
Iowa City, Iowa. /