William Tell and technology.
our ignorance of the cause. Cryptogenic fibrosing alveolitis, thus, became an accepted term in Europe and the British Isles. However, because the term interstitial pulmonary fibrosis is so entrenched, it is unlikely to be totally superseded by fibrosing alveolitis, even though this may be more accurate. What then are we to do? Purists will not accept the term Hamman-Rich syndrome. Our colleagues across the Atlantic would prefer cryptogenic fibrosing al-veolitis. However, on the North American continent, idiopathic pulmonary fibrosis continues to remain popular. William Osler's textbook of medicine, I came across the following paragraph: In one ofCharcot's cases. .. death occurred about three months and a halfafter the onset ofthe acute disease and the lung was two thirds ofthe normal size, grayish in color, and hard as cartilage. In the only case of the kind which has come under my observation the patient died about a month from the onset of the chill. The lung was uniformly solid and grayish in color. Microscopically these areas showed advanced fibroid changes and great thickening of the alveolar cells This, indeed, is a perfect description of interstitial pulmonary fibrosis by Osler, more than 50 years before the publication of Hamman and Rich, from the John Hopkins Hospital. By calling idiopathic pulmonary fibrosis (cryptogenic fibrosing alveolitis) Osler-Charcot disease, we not only will be clearing up the semantic confusion, but also will be awarding credit to those who observed and described this entity first. I suggest that the entity, which has roamed so long in search ofa title, be now duly crowned as Osler-Charcot disease. 3 Scadding JG. Thiking clearly about diseases of the pulmonary semi. 14th century legend recounts that William Tell was fbrced to shoot an apple from atop his son's head when he refused to pay homage to the governor. A man of great skill with nerves of steel, Tell was very much like our modern bronchoscopists. Armed with 20th century lances and as much concern for their patients as Tell had for his son, they also challenge the status quo. In this issue (see page 573) Schwartz et al describe the piercing ofa bronchogenic cyst using sophisticated radiologic targeting to guide an endoscopically directed needle. Bronchogenic cysts, like apples, are round structures usually found in the periphery of the tracheo-bronchial tree. About one-third are found near the major branches in the mediastinum.' They may even fall off of the tree and …