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The Archives and Instrument Collection of the American Society for Gastrointestinal Endoscopy
Archives and Instrument Collection of the ASGE
REFERENCES 1. Eloubeidi MA, Wade SB, Provenzale D. Factors associated with acceptance and full publication of GI endoscopic research originally published in abstract form. Gastrointest Endosc 2001;53:275-82. 2. Sivak MV Jr. Abstract thoughts. Gastrointest Endosc 2001;53: 389-92. 3. Sivak MV Jr. Endoscopic research in America? Gastrointest Endosc 1997;46:569-70.
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4. Sivak MV Jr. Endoscopic research in America (revisited). Gastrointest Endosc 2003;58:901-7. 5. Brokow, Tom. The greatest generation. Norwalk (with permission of Random House) (Conn): Easton Press; 1998. 6. Florence, Ronald. The perfect machine. Building the Palomar telescope. New York: Harper-Collins; 1994.
volving the ASGE collections since their deposit here in 1989.1 ASGE HISTORICAL ACTIVITIES, 1941-1991
The Archives and Instrument Collection of the American Society for Gastrointestinal Endoscopy The Dittrick Medical History Center of Case Western Reserve University, Cleveland, Ohio, today is the home of the Archives and Instrument Collection of the American Society for Gastrointestinal Endoscopy (ASGE). Many members of the ASGE cherish an abiding interest in the history of endoscopy and especially in the development of the instrumentation that is central to their specialty. Members can rest assured that their heritage is carefully documented and safely preserved at the Dittrick. The stewardship of this collection has proved to be a rewarding experience and has been a key front on which we engage the modern medical world. Moreover, the ASGE collection has brought the Dittrick into contact with many fascinating individuals and institutions. It has brought us cordial ties with the Nitze-Leiter Museum of Endoscopy (Institute of the History of Medicine, University of Vienna, Vienna, Austria) and the William P. Didusch Museum (American Urological Association [AUA], Baltimore, Maryland). The Nitze-Leiter Museum of Endoscopy, based upon the collection of Hans J. and Matthias A. Reuter of Stuttgart, Germany, today is directed by Manfred Skopec, and the Didusch Museum, curated by Rainer M. Engel, houses the largest collection of urologic artifacts in the world. We have collaborated on various historical ventures over the past decade, and the resulting friendships and inspiration have sustained our continued interest in serving the ASGE collections at the Dittrick. Therefore, I welcome the opportunity to review the various activities and endeavors in-
Copyright Ó 2004 by the American Society for Gastrointestinal Endoscopy 0016-5107/$30.00 PII: S0016-5107(04)02283-7 VOLUME 60, NO. 6, 2004
Since its inception as the American Gastroscopic Club, the ASGE has had a great appreciation for the history of endoscopy. This was undoubtedly instilled by Rudolf Schindler, who saw himself as having made historically significant contributions to the development of endoscopic instrumentation. Indeed, Schindler’s own classic, Gastroscopy: the Endoscopic Study of Gastric Pathology, featured a chapter on the history of gastroscopy, highlighting his contributions. Since 1953, the ASGE has marked notable figures in the field by the Schindler Award, recognizing ongoing achievements in GI endoscopy. The first significant effort made toward preserving the heritage of endoscopy came in 1964, when Martin E. Gordon2 (Yale University School of Medicine, New Haven, Connecticut) fashioned an exhibit entitled, ‘‘Evolution of Gastroscopy: From Magenkratzers to Lasers,’’ featuring instruments borrowed from the International College of Surgeons.3 Greater interest in the history of GI endoscopy was stimulated by research on Schindler initiated by Audrey Davis (Smithsonian Institution, Washington, DC), who approached the ASGE requesting early instruments for possible exhibition.4 To formalize its interest in history, the ASGE appointed Gordon to head a new History of Endoscopy Committee in 1972. Gordon initiated a collection of endoscopes, films, and taped interviews with leading figures in GI endoscopy. By 1974, he developed a traveling version of his exhibit, ‘‘Evolution of Gastroscopy: from the Magenkratzer to the Laser,’’ in association with the Armed Forces Institute of Pathology. The exhibit traveled to libraries, museums, and medical meetings all across the country until it was retired in 1981. Gordon’s exhibit was accompanied by a film, ‘‘Eyewitness to Gastroscopy,’’ which was later updated as ‘‘Eyewitness to Gastroscopy—Revisited.’’ After Gordon’s tenure, the ASGE Archives Committee was led by Charles Lightdale (1980), Julian Katz (1984), William Haubrich (1986), Bernard Schuman (1990), and Richard McCray (1992). GASTROINTESTINAL ENDOSCOPY
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lished as a special supplement to Gastrointestinal Endoscopy in April 1991 and have since been a standard reference for historical articles and chapters in major endoscopic publications, many of which used the illustrations that first appeared in the pages of Gastrointestinal Endoscopy (Fig. 1).5 The Dittrick also created a companion temporary exhibit, under the guidance of Archives Committee Chair Bernard M. Schuman, for display at professional meetings. Subsequent to that, I further collaborated with Haubrich by co-authoring a brief ‘‘History of Endoscopy’’ as an introductory chapter for Michael V. Sivak Jr.’s Gastroenterologic Endoscopy.6 ASGE COLLECTION CARE AND USE SINCE 1991 Figure 1. Desormeaux’s endoscope, 1853. Source: Newman, R. The endoscope considered particularly in reference to diseases of the female bladder and urethera. Transactions of the Medical Society of the State of New York for the Year 1870, Fig. 2. Photo courtesy of the Dittrick Medical History Center.
ASGE 50TH ANNIVERSARY CELEBRATION, 1991: A CATALYST FOR CHANGE
In 1989, the ASGE Archives Committee concluded that something special should be done to mark the 50th anniversary of the 1941 founding of the ASGE (then the American Gastroscopic Club) by Schindler and his colleagues. To this end, the ASGE decided to transfer its archive and instrument collection from Yale to Case, where it came under the care of the Dittrick. This came about largely through the intervention of Archives Committee Chair William S. Haubrich and Michael V. Sivak Jr., who approached the Dittrick in hopes of securing a new home for the archives. We at the Dittrick welcomed this proposal, because we have one of the most extensive collections of historical surgical instruments in the country, and the ASGE collection would be a valued addition. Moreover, the Archives Committee proposed transferring older records from the ASGE office in Manchester, Massachusetts. Haubrich arranged for the transfer of the ASGE instrument collection from Yale to Case and personally conveyed the collection in a rented van (Bill was always an enthusiastic driver and thought nothing of crossing the continent from his home in California to alumni events at Case). Then, under the guidance of Archives Committee Chair Bernard M. Schuman, deliberations began for a proper way to mark ASGE’s half century of notable achievements in endoscopy. The ASGE thus commissioned histories of the ASGE and GI instrumentation by Patsy Gerstner and James Edmonson, both of the Dittrick. These were pub970
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After the acquisition of the ASGE collections, the Dittrick set about the task of organizing the archives and developing the instrument holdings. We worked with the Archives Committee to encourage the addition of older instruments from ASGE members, and the result was gratifying. Today we have well over 100 artifacts in the collection and always welcome new additions (See Appendix for a listing). These artifacts include optical and fiber-optic endoscopes (gastroscope, esophagoscope, gastroduodenoscope, colonoscope, sigmoidoscope), accessories, gastrocameras, projectors and power units, and teaching aids. These were catalogued by Case history graduate student Thomas Kinney and subsequently were entered into our online catalogue of library holdings at Case, EuclidPlus, and thus the collection is available on such databases as OCLC and WorldCat. The instrument collection is complemented by the ASGE Archives, which consists of constitution and bylaws, minutes of committees, correspondence, meeting programs, videos, and images. The Archive collection occupies 16 linear feet, filling 30 archival boxes. The presentation of the ASGE’s heritage took a new form in the mid 1990s when Professor Nick Steneck of the University of Michigan developed An Interactive History of the Instruments of Gastrointestinal Endoscopy, in CD-ROM format. Steneck was the founding director of the Historical Center for the Health Sciences at the University of Michigan,7 where Basil Hirschowitz and associates undertook pioneering work on the development of fiber-optic endoscopes in the late 1950s. The center coordinated the production of an interactive CD-ROM presenting the development of GI endoscopy, jointly funded by the ASGE and the American Gastroenterologic Association. Steneck acted as the project director, whereas the content and images came largely from the Dittrick. The technical aspects of the project were VOLUME 60, NO. 6, 2004
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Figure 2. Instruments of Science: An Historical Encyclopedia. Photo courtesy of the Dittrick Medical History Center.
handled by a talented computer science student, Ben Stevenson. The Interactive History presented the history of endoscopy in 4 sections: Chronicle, Profiles, Museum, and Timeline. In the Chronicle section, audio clips presented prominent historical figures (as portrayed by an actor’s voiceover), and videoclips in the Profiles section brought to life more recent developments of endoscopy though interviews with several ASGE members who participated in these events. One can become more familiar with instrumentation, from Schindler’s semiflexible gastroscope (c. 1935) through to the videoendoscope. It was exciting to see such an innovative approach being used to tell the story of endoscopy in a lively fashion. The project also afforded the occasion to work more closely with Archives Committee Chair Richard S. McCray, who exuded an impassioned interest in the history of endoscopy. In 1998, I shared the ‘‘Interactive History of the Instruments of Gastrointestinal Endoscopy,’’ with fellow medical museum curators, presenting it at the meeting of the European Association of Museums of the History of Medical Science at the Thackray Museum (Leeds, U.K.) and again in 1999 at the Nitze-Leiter Museum of Endoscopy (Vienna, Austria) symposium on the history of endoscopy, which marked the dedication of the museum (see more below). Growing acknowledgement of the Dittrick as a center for documentation on the history of endosVOLUME 60, NO. 6, 2004
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Figure 3. Gastrointestinal Endoscopy, 1999. Photo courtesy of the Dittrick Medical History Center.
copy came in 1997, when Robert Bud of the Science Museum (London, U.K.) and Deborah Warner (Smithsonian) requested an article on endoscopy.8 This was included in their Instruments of Science: An Historical Encyclopedia, an authoritative reference work covering 325 scientific instruments, ranging from antiquity to the present, and from the mundane to the highly sophisticated (Fig. 2). Entries explained how the instruments work and traced their invention, development, distribution, and use. Fully illustrated and complete with bibliographies, Instruments of Science examines instruments used for testing and monitoring, as well as those used for research, and it considers a number of widely used laboratory organisms (such as Drosophila and Escherichia coli) as instruments. Important articles on medical technology, in addition to those on endoscopy, included autoanalyzer, CT scanner, dosimeter, electrocardiograph, electroencephalograph, magnetic resonance imaging, positron emission tomography scanner, protein sequencer, US, and x-ray machine. The journal, Gastrointestinal Endoscopy marked the millennial year by featuring illustrations of landmark instruments and innovators on the cover of each issue in 2000 and 2001, accompanied by an essay denoting their historical significance. The GASTROINTESTINAL ENDOSCOPY
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Figures 4 and 5. Gastrointestinal endoscopy display in Allen Library, Case Western Reserve, Cleveland, Ohio. Photos courtesy of the Dittrick Medical History Center.
series, suggested by the editor, Michael V. Sivak Jr., included photographs of instruments and original images from the ASGE archives, as well as portraits of the individuals featured. The very first illustration of the series was of gastroscope images drawn in 1961 for Schindler, the ‘‘father’’ of modern gastroscopy and the principal founder of the ASGE (Fig. 3). Over the ensuing 2 years of this series, we traced the development of endoscopic instruments and procedures, beginning in February 2000 with Philipp Bozzini’s lichtleiter, or ‘‘light conductor’’ of 1804, and ending in December 2001 with Laennec’s cirrhosis, named for Rene Theophile Hyacinthe Laennec. The series was well received and only ended when the author grew to dread the approach of monthly deadlines and happily retired with a newfound respect for the pressures weighing upon the shoulders of a journal editor and the journal staff. Finding space for display of our extensive collection of medical artifacts, including endoscopes, is always a challenge. In 2002, we made significant headway in this direction by installing exhibits (Figs. 4 and 5) devoted to several medical and surgical specialties in the Powell Room9 of the Allen Memorial 972
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Medical Library, the home of the Dittrick Museum. Endoscopy received special consideration, particularly with the support of Northeast Ohio Society for Gastrointestinal Endoscopy, through the cooperation of Bruce Cameron, MD. We have two permanent display cabinets featuring instruments from the days of Schindler through the fiber-optic era of Basil Hirschowitz. THE REUTER CONNECTION AND THE JOSEPHINUM IN VIENNA
Curating the ASGE collection has broadened the horizons of the Dittrick in ways that I could never have anticipated when it came our way in 1989. Of all the new acquaintances fostered by our stewardship over the ASGE collection, perhaps the most remarkable and rewarding are those of Hans and Matthias Reuter, MD, of Stuttgart, Germany, and Manfred Skopec, PhD, of Vienna, Austria. The Reuters, as collectors, and Skopec as a curator, are responsible for the most comprehensive collection of endoscopes in the world, today housed in the Nitze-Leiter Museum of Endoscopy in Vienna. Hans Reuter (Fig. 6) had a very active career, with his own private VOLUME 60, NO. 6, 2004
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Figure 7. Max Nitze Museum of Medical Endoscopy, Stuttgart, Germany. Photo courtesy of the Dittrick Medical History Center. Figure 6. Hans J. Reuter, MD. Photo courtesy of the Dittrick Medical History Center.
urological clinic in Stuttgart, and many urologists came to observe and to learn endoscopic surgical procedures under his tutelage. Over time, he developed an interest in the history of endoscopy and began to collect old instruments. This avocation became a fascination, if not an obsession, and his wife, Waltraut, shared this collecting interest, and his son Matthias, also a urologist, got drawn into the venture, too. I first became aware of the Reuter collection while laboring to build the Dittrick’s body of literature relating to the history of endoscopy. In 1993, we acquired a copy of Philipp Bozzini and Endoscopy in the 19th Century10 by Hans and Matthias Reuter. Inside this book, I found a description of the Max Nitze Museum of Medical Endoscopy in Stuttgart, which housed the growing endoscope collection of the Reuters (Fig. 7). Though originally focused upon urological instruments, the Reuter collection ultimately encompassed all manner of endoscopes, including those familiar to ASGE members. The intent of the museum, according to the Reuters’ brochure, was to stimulate further progress in endoscopy through the study of its history, especially as pursued by the scrutiny of early instruments. The museum also offered scholarships for the study of endoscopy, particularly for doctors from ‘‘Third World countries’’ (South America and Africa). I, therefore, wrote to Hans Reuter and inquired if I might qualify for a scholarship to visit his collection, observing that ‘‘while I do not come from a Third World country, working in a non-profit museum may indeed bear a certain resemblance.’’11 He cordially replied that he would be pleased to welcome me in Stuttgart, cover associated travel expenses, and share his collection with me. VOLUME 60, NO. 6, 2004
After a 1994 medical history museum meeting in Zurich, I traveled to Stuttgart to meet Hans Reuter and his wife, Waltraut, and to see the Maxe Nitze Museum of Medical Endoscopy. I reveled in the range and quality of the Reuter collection. He had acquired not only historically important instruments but associated literature and documentation, most notably the archives of the Leiter Instrument Company of Vienna, and correspondence between Leiter and Nitze and other pioneering endoscopists of the nineteenth century. Truthfully, it was overwhelming, especially because our short visit in Stuttgart scarcely afforded the time to see all of the collection, much less, study it at leisure. We agreed to maintain contact beyond this brief visit and made plans to exchange duplicate instruments. In the mid 1990s, after having assembled the world’s largest collection of endoscopes, Hans Reuter sought a permanent home for his collection. After much deliberation, in 1995, he decided to entrust the greater part of his collection in the form of a permanent loan to the Institute for the History of Medicine of the University of Vienna. This decision made abundant sense. The collection would be in an academic setting where it would not only be preserved and exhibited but also studied and analyzed as historic documentary material. Vienna was, historically, a leading center in the development of endoscopic instrumentation; it is the city where Maximilian Nitze (1848-1906) and the instrument maker Josef Leiter (1830-1892) developed the first viable cystoscope, and where Johann von Mikulicz (1850-1905) and Leiter collaborated in the development of the first esophagoscope incorporating incandescent light. Moreover, the direction of the Institute’s Museum of the History of Medicine, located in the historic Josephinum (the 1785 school for military surgeons created by Emperor Joseph II), is in the capable hands of Manfred Skopec, PhD. GASTROINTESTINAL ENDOSCOPY
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Figure 8. Nitze-Leiter Museum of Endoscopy, Vienna, Austria. Photo courtesy of the Dittrick Medical History Center.
Skopec directs the care of the historical riches in the Josephinum, which include a rare book and print collection, an array of magnificent late eighteenth century anatomical manikins or moulages in wax from Florence, as well an extensive and growing instrument collection that documents the development of medicine and surgery in Vienna. The addition of the Reuter collection would be a notable complement to these already distinguished collections. And so, Skopec oversaw the transfer of the Reuter collection to Vienna in 1996 and planned the installation of the collection in two specially adapted rooms in the Josephinum. This took almost 3 years, and, in 1999, I returned for the dedication of Nitze Leiter Museum of Endoscopy, as will be discussed below. At the time of my visit to Stuttgart in 1994, Hans and Matthias Reuter were preparing a painstakingly comprehensive History of Endoscopy,12 with the collaboration of Rainer M. Engel, MD, curator of the William P. Didusch Museum of the AUA. Hans Reuter and Engel planned to meet at the Didusch Museum in Baltimore, Maryland, in October 1995 to discuss this project and to exchange duplicate instruments, and they invited me to join them. I agreed and had the pleasure of seeing the Didusch, which then occupied the top floor of the AUA headquarters in Baltimore.13 Our brief encounter led to further collaboration, when Hans Reuter asked if I would read and comment upon the draft of his History of Endoscopy.14 I willingly did so and, in the process, became a defacto editor (and not as translator per se, as one might mistakenly infer from his preface to vols. 1-3). My chief contribution lay in ‘‘polishing’’ the translation from German, so that it reads better to an English-speaking audience. Reuter was so pleased with the finished work, which appeared in 1999, that he invited my wife, Christine, and me to visit him again, this time in Vienna. He invited me to present 974
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Figure 9. Skopec lecture at the Dittrick Medical History Center, Case Western Reserve University, Cleveland, Ohio. Photo courtesy of the Dittrick Medical History Center.
a paper at the history of endoscopy symposium at the dedication of the Nitze-Leiter Museum of Endoscopy. In January, 1999, the Institute of the History of Medicine of the University of Vienna officially dedicated the Nitze-Leiter Museum of Endoscopy, and I was privileged to attend that event (Fig. 8). Since the arrival of the Reuter collection at the Josephinum, Skopec had been laboring to create a suitable storage and study area for the collection, as well as to fashion displays of the most interesting and significant artifacts. By the close of 1998, the work was nearing completion, and the time came to formally dedicate the newly configured museum space. To mark the event, the Institute hosted a symposium on the history of endoscopy, as it had since 1996; the theme was ‘‘Lithotomy vs. Lithotripsy: Historical and Recent.’’ I spoke on the introduction of lithotripsy, the first ‘‘minimally invasive surgery,’’ into America. Fortunately, research for my book American Surgical Instruments15 had unearthed intriguing documentation on the transfer of lithotripsy from Europe to America in the early nineteenth century. This became the subject of my presentation, which subsequently appeared in de Historia Urologiae Europaeae, a VOLUME 60, NO. 6, 2004
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series published by the European Association of Urology.16 The dedication of the Nitze-Leiter Museum of Endoscopy was a source of great pride and satisfaction to the Reuters and undoubtedly a source of great accomplishment to Skopec. Still another of the fortunate consequences of getting to know the Reuters and their collection has been the development of cordial ties between the Dittrick and the Josephinum, and personally between myself and Skopec. At the dedication of the Nitze-Leiter Museum of Endoscopy, I was struck by the similarity of our respective museums. They are broadly similar in character and composition of collections, as well as in institutional setting. Both possess an extensive artifact collection that is supported by strong research materials, specifically rare books and manuscripts. Moreover, both institutions function as part of a university, an arrangement that we both clearly favor. Lastly, both institutions are housed in architecturally significant structures. I resolved to invite Skopec to Cleveland, where he might give the Handerson Lecture at the Dittrick. In March, 2001, Skopec presented ‘‘Treasures of the Josephinum, Vienna’s Premier Medical Museum,’’ the first Handerson Lecture.17 The Handerson Lecture is intended to bring to the Dittrick distinguished museum curators from Britain and Europe (Fig. 9). He shared with us more about the fascinating history of Vienna’s medical history museum. As noted above, the Josephinum is home to a magnificent collection of wax anatomical models, or moulages, made by the Florentine artists Giuseppe Ferrini and Clemente Susini under the direction of the anatomist Felice Fontana. Today, the Vienna collection comprises the best surviving assemblage of anatomical wax figures from late eighteenth century Florence and is the crown jewel of Skopec’s museum. Skopec presented the history of these remarkable collections, which were featured in his recent book, Anatomie als Kunst: Anatomische Wachsmodelle des 18. Jahrhunderts im Josephinum in Wien.18 His presentation also highlighted the history of the Vienna Medical School, which became an important center of emerging medical and surgical specialties in the mid nineteenth century, as well as the history of endoscopy. On returning to the Josephinum in January 2002, I presented ‘‘The Dittrick Museum of Medical History, Past and Present.’’ The first part of this presentation provided an overview of the Dittrick, its origins, collections, and present-day activities. The second part focused upon the Dittrick’s photographic collections, with a special emphasis upon our collection of student dissecting room portraits, and was entitled ‘‘Haunting Images: Dissection, Photography, and American Medical Students.’’ VOLUME 60, NO. 6, 2004
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Yet another example of Euro-American cooperation in the history of endoscopy occurred on October 2, 2002, with the return of Bozzini’s lichtleiter, the very first endoscope.19 This event marked the end of a period of American ‘‘captivity’’ for this historic instrument and concluded with its repatriation to the Josephinum. It generally is acknowledged that the modern era of endoscopy dates from 1804, when Philipp Bozzini (1773-1809) introduced the lichtleiter, or ‘‘light conductor.’’20 Bozzini, despite setbacks, rivalries, and an untimely death in 1808, set a landmark precedent with the lichtleiter, and subsequent endoscope design for the next century and a half would be inspired by his example. However, the story of Bozzini’s lichtleiter does not end here. After his death, his instrument became part of the historical collections at the Josephinum. During the World War II, the instrument disappeared mysteriously. It was taken from Vienna, transported to Britain, and brought to the United States, where it was given to the American College of Surgeons. Efforts, including my own urgings to do the right thing, had been underway for the past few years to repatriate the instrument to Vienna and, specifically, to the Nitze-Leiter Museum of Endoscopy. Those efforts culminated in the instrument’s return to Vienna in the summer of 2002, and, to mark the occasion, the Josephinum hosted a special ceremony. At that time, Rainer M. Engel, MD, curator of the William P. Didusch Museum, related the story behind its disappearance and return. From Matthias Reuter, I learned of the sad demise of his father, Hans, on April 18, 2003, after a short illness. His family can be proud of the legacy embodied in his remarkable endoscopy collection, appropriately bequeathed to the Josephinum. The collection will continue to stimulate and support scholarship in the history of endoscopy. James M. Edmonson, PhD, Chief Curator Dittrick Medical History Center Case Western Reserve University Cleveland, Ohio REFERENCES 1. The last report made to the ASGE through the pages of this journal was the following: Edmonson JM. Past tense: history and the ASGE. Gastroint Endosc 1998;47:91-3. 2. Martin E. Gordon, MD, FACP, FAAAS, is a clinical professor of medicine at Yale School of Medicine and the chairman of the Board of Trustees of Associates at Yale’s Cushing/ Whitney Medical Library. He serves on the new Strategic Planning Committee of Connecticut Public TV/Radio. A prior double award winner of this competition, he has also received numerous awards as a producer/director and author of medical films, scientific exhibits, and educational devices used internationally. Gordon was the recent recipient of the Distinguished Alumni Award of Yale University School of Medicine. GASTROINTESTINAL ENDOSCOPY
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3. Palmer ED. Exhibit on the history of gastroscopy. Bull Gastrointest Endosc 1964;11:18. The magenkratzer was a stomach brush consisting of a tuft of horse hair at the end of a whalebone rod. 4. Davis AB. Rudolf Schindler’s role in the development of gastroscopy. Bull Hist Med 1972;46:150-70. 5. See, for example, the following. Modlin IM. A brief history of endoscopy. Milan (Italy): MultiMed; 2000. Hirschowitz BI, Modlin IM. The history of endoscopy: the American perspective. In: Classen M, Tytgat GNJ, Lightdale CJ, editors. Gastroenterological endoscopy. New York: Georg Thieme Verlag; 2002. p. 2-16. Schuman BM. The history of the endoscope. In: DiMarino AJ Jr, Benjamin SB, Al-Kawas FH, et al, editors. Gastrointestinal disease: an endoscopic approach. Thorofare (NJ): Slack; 2002. p. 3-13. 6. Haubrich WS, Edmonson JM. History of endoscopy. In: Michael V. Sivak Jr, editor. Gatroenterologic endoscopy. 2nd ed. Baltimore: WB Saunders; 1993. 7. Center for the History of Medicine, University of Michigan [cited 2004]. Available from: URL: http://www.med.umich. edu/medschool/chm/ 8. Edmonson JM. Endoscope. In: Bud R, Warner DJ, editors. Instruments of science: an historical encyclopedia. London: Science Museum; 1997. 9. Named for Hunter Holmes Powell, MD, dean of Western Reserve University School of Medicine, 1895-1900. 10. Reuter HJ, Reuter MA. Philipp Bozzini and endoscopy in the 19th century. Stuttgart: Max Nitze Museum; 1988. 11. Personal communication with Hans J. Reuter, 10 December 1993. 12. Reuter HJ, Reuter MA, Engel RM. History of endoscopy: an illustrated documentation. Vols. 1-4. Stuttgart: W. Kohlhammer Comunication; 1999. 13. The Didusch was originally located in the former home of Hugh HamptonYoung, the head of Genito-Urinary Surgery at Johns Hopkins in 1897 but has since been relocated to suburban Baltimore. 14. Reuter HJ, Reuter MA, Engel RM. History of endoscopy. Stuttgart: Max Nitze Museum; Vienna: International NitzeLeiter Research Society of Endoscopy; 1999-2003. 15. Edmonson JM. American surgical instruments: an illustrated history of their manufacture and a directory of instrument makers to 1900. San Francisco: Norman Publishing; 1997. 16. Edmonson JM. Lithotripsy in America: transfer of the technique from Europe (1824-1840) de Historia Urologiae Europaeae 2000;7:95-107. I also gave this presentation, at the invitation of Rainer Engel, at the 2nd International Congress on the History of Urology, May 18-20, 2001, Kos Island, Greece. That occasion also afforded the welcome opportunity to discuss the prospects for the Didusch Museum with Rainer Engel. 17. The Handerson Lecture is named in honor of Henry Ebenezer Handerson (1837-1918), a distinguished Cleveland physician and medical historian, whose most important work was Gilbertus Anglicus, Medicine, of the Thirteenth Century. Cleveland: Cleveland Medical Library Association; 1918. 18. Skopec M. Anatomie als Kunst: anatomische Wachsmodelle des 18. Jahrhunderts im Josephinum in Wien. Vienna: Brandsta¨tter; 2002. 19. Edmonson J. The first endoscope: Philipp Bozzini’s lichtleiter. Gastrointest Endosc 2000;51(2):17A-18A; cover. 20. The most comprehensive and balanced account of Bozzini’s achievement is found in Reuter, History of Endoscopy. See especially vol. 1 (1999), p. 16-34.
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Appendix. List of endoscopes in the ASGE collection, Dittrick Medical History Center, Case Western Reserve University, Cleveland, Ohio Collection no.
Endoscopy Wolf-Schindler semi-flexible gastroscope Schindler flexible gastroscope
Benedict operating gastroscope Cameron semi-flexible gastroscope Cameron omni-angle flexible gastroscope
Eder flexi-rigid gastroscope Eder standard gastroscope
Eder-Hufford esophagoscope
Eder-Palmer trans-esophagoscopic gastroscope Eder-Palmer trans-esophagoscopic gastroscope w/Bernstein modification
Olympus gastrocamera GTF Olympus gastrocamera GTF-A
Olympus gastrocamera GT-Va Olympus gastrocamera V
Olympus gastrocamera Va Olympus gastrocamera P Olympus gastrocamera F Eder fiberoptic gastroscope Hirschowitz gastroduodenoscope fiberscope
Hirschowitz gastroduodenoscope FO-5000 Hirschowitz gastroduodenoscope FO-5001 Hirschowitz fiberoptic gastroscope with distal deflection FO-5004 Hirschowitz fiberoptic flexible esophagoscope ACMI ACMI ACMI ACMI ACMI
gastroduodenoscope 5008 flexible gastroscope flexible examining gastroscope fiberoptic gastroscope gastro duodenoscope F5-a
85.52 89.20.4 99.30.4 2000.10.1 90.22.2 90.30.7 93.27.2 93.27.1 66.27.1 89.25.7 89.25.10 90.30.5 66.27.2 82.16.2 97.2.1 90.30.6 82.16.1 89.20.6 89.20.7 89.25.8 90.22.1 90.30.3 90.48.10 99.30.3 89.20.5 89.25.27 89.25.28 90.30.1 89.25.1 89.25.13 92.39.14 92.63.1 89.25.9 92.39.5 92.39.6 92.39.10 92.39.11 92.39.7 92.39.8 92.39.9 89.25.16 89.25.20 89.25.21 90.48.6 89.25.19 90.48.3 89.20.2 90.48.1 89.20.3 90.48.2 93.27.5 93.27.4 89.25.30 92.39.13 92.39.3
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Collection no.
Endoscopy ACMI ACMI ACMI ACMI ACMI ACMI
flexible colonoscope TX-91 flexible coloscope [sic] 9000P operating coloscope [sic] F9-R operating coloscope [sic] F9-A flexible colonoscope FX-92 flexible colonoscope
ACMI fiberoptic sigmoidoscope ACMI flexible sigmoidoscope F91-S ACMI lopresti panendoscope 7089 P Lopresti foroblique esophagoscope Olympus gastrofiberscope GF-B Olympus fiberoptic gastroscope GF-BK
Olympus gastroscope GIF type D
Olympus esophagoscope EF
89.25.2a 89.25.17 91.30.2 92.39.2 91.30.1 91.30.3 92.39.12 93.27.3 89.25.4 89.25.31 93.27.7 93.27.6 89.25.14 89.25.15 92.39.4 92.69.1 89.20.1 89.25.6 92.39.1 90.48.8 90.48.9 92.63.2 92.69.2 89.25.3
Polypectomy: looking back ‘‘The only thing new in the world is the history you don’t know’’ Harry S. Truman
Medical historians and others will look back on the period from 1970 to 1990 as the great era of GI endoscopy. True, endoscopists and instrument manufacturers continue to develop new methods, devices, and technologies, but the frontiers are not as expansive nor the possibilities so seemingly limitless as during the 2 decades before 1990. Those remarkable 20 years of growth saw the inception of colonoscopy, ERCP, and endoscopic sphincterotomy, endoscopic treatments for GI bleeding, and EUS to name but a few. The fountainhead of the great era was the fiberoptic endoscope, a singular achievement that opened possibilities that in 1970 seemed boundless, even though few could then comprehend the full extent of endoscopy as it exists today. In the early 1970s, ERCP was largely theoretical, the ability to endoscopically examine the entire colon was problematic,
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Olympus colonoscope CF-LB Machida gastroscope type B Machida gastroscope type L Machida gastroscope FGS-B Machida gastroscope FGS-CL Fiberoptic duodenoscope Accessories ACMI fiberoptic teaching attachment FO-8910 ACMI Polaroid camera adapter Olympus gastroprojector
Polaroid instant endocamera Olympus GTF stabilized regulator
Fiber optics illuminator Cameron cavicamera Cameron cauteradiodynex Pilling espohageal bougie forceps (with Eder-Hufford scope 89.20.7) esophageal dilator set percutaneous endoscopic gastrostomy button
90.48.7 90.48.4 90.48.5 92.49.1 92.49.2 90.48.11 89.25.2a 89.25.2b 89.25.22 92.39.18 92.39.19 99.30.1 2003.12 89.25.23 92.39.16 92.39.16 92.39.17 89.25.24 89.25.26 89.25.26 89.20.6a 89.20.7a 89.25.5 90.1
and even duodenoscopy was a celebrated achievement. However, the success achieved in reaching the innermost GI tract, including the technologic development of the necessary instruments, albeit remarkable, is of lesser significance from the historical perspective. Instead, it is the adaptation of endoscopy to therapeutic purposes, the development of endoscopic devices and techniques for the treatment of digestive diseases, which assigns GI endoscopy a rightful place in medical history. Therapeutic endoscopy has many triumphs to its credit, devices and techniques that changed the treatment of a digestive disorder. But the number of true milestones, those that fundamentally improved the treatment of digestive disease, is relatively small. Many endoscopic techniques are elegant in their technical sophistication, but categorization as a milestone requires a further dimension. It must achieve the ultimate success: substantial benefit for patients and, preferably, large numbers of patients. In looking back through the catalog of endoscopic therapy composed from 1970 to 1990, it is revealing, and I think important, to consider which of these milestones has proved to be of foremost importance. I often pose this question to gastroenterologists in our advanced endoscopy training program as they struggle to master endoscopic techniques: ‘‘Of the many endoscopic procedures you will perform throughout your career, which do you think is the GASTROINTESTINAL ENDOSCOPY
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REFERENCES 1. Eloubeidi MA, Wade SB, Provenzale D. Factors associated with acceptance and full publication of GI endoscopic research originally published in abstract form. Gastrointest Endosc 2001;53:275-82. 2. Sivak MV Jr. Abstract thoughts. Gastrointest Endosc 2001;53: 389-92. 3. Sivak MV Jr. Endoscopic research in America? Gastrointest Endosc 1997;46:569-70.
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4. Sivak MV Jr. Endoscopic research in America (revisited). Gastrointest Endosc 2003;58:901-7. 5. Brokow, Tom. The greatest generation. Norwalk (with permission of Random House) (Conn): Easton Press; 1998. 6. Florence, Ronald. The perfect machine. Building the Palomar telescope. New York: Harper-Collins; 1994.
volving the ASGE collections since their deposit here in 1989.1 ASGE HISTORICAL ACTIVITIES, 1941-1991
The Archives and Instrument Collection of the American Society for Gastrointestinal Endoscopy The Dittrick Medical History Center of Case Western Reserve University, Cleveland, Ohio, today is the home of the Archives and Instrument Collection of the American Society for Gastrointestinal Endoscopy (ASGE). Many members of the ASGE cherish an abiding interest in the history of endoscopy and especially in the development of the instrumentation that is central to their specialty. Members can rest assured that their heritage is carefully documented and safely preserved at the Dittrick. The stewardship of this collection has proved to be a rewarding experience and has been a key front on which we engage the modern medical world. Moreover, the ASGE collection has brought the Dittrick into contact with many fascinating individuals and institutions. It has brought us cordial ties with the Nitze-Leiter Museum of Endoscopy (Institute of the History of Medicine, University of Vienna, Vienna, Austria) and the William P. Didusch Museum (American Urological Association [AUA], Baltimore, Maryland). The Nitze-Leiter Museum of Endoscopy, based upon the collection of Hans J. and Matthias A. Reuter of Stuttgart, Germany, today is directed by Manfred Skopec, and the Didusch Museum, curated by Rainer M. Engel, houses the largest collection of urologic artifacts in the world. We have collaborated on various historical ventures over the past decade, and the resulting friendships and inspiration have sustained our continued interest in serving the ASGE collections at the Dittrick. Therefore, I welcome the opportunity to review the various activities and endeavors in-
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Since its inception as the American Gastroscopic Club, the ASGE has had a great appreciation for the history of endoscopy. This was undoubtedly instilled by Rudolf Schindler, who saw himself as having made historically significant contributions to the development of endoscopic instrumentation. Indeed, Schindler’s own classic, Gastroscopy: the Endoscopic Study of Gastric Pathology, featured a chapter on the history of gastroscopy, highlighting his contributions. Since 1953, the ASGE has marked notable figures in the field by the Schindler Award, recognizing ongoing achievements in GI endoscopy. The first significant effort made toward preserving the heritage of endoscopy came in 1964, when Martin E. Gordon2 (Yale University School of Medicine, New Haven, Connecticut) fashioned an exhibit entitled, ‘‘Evolution of Gastroscopy: From Magenkratzers to Lasers,’’ featuring instruments borrowed from the International College of Surgeons.3 Greater interest in the history of GI endoscopy was stimulated by research on Schindler initiated by Audrey Davis (Smithsonian Institution, Washington, DC), who approached the ASGE requesting early instruments for possible exhibition.4 To formalize its interest in history, the ASGE appointed Gordon to head a new History of Endoscopy Committee in 1972. Gordon initiated a collection of endoscopes, films, and taped interviews with leading figures in GI endoscopy. By 1974, he developed a traveling version of his exhibit, ‘‘Evolution of Gastroscopy: from the Magenkratzer to the Laser,’’ in association with the Armed Forces Institute of Pathology. The exhibit traveled to libraries, museums, and medical meetings all across the country until it was retired in 1981. Gordon’s exhibit was accompanied by a film, ‘‘Eyewitness to Gastroscopy,’’ which was later updated as ‘‘Eyewitness to Gastroscopy—Revisited.’’ After Gordon’s tenure, the ASGE Archives Committee was led by Charles Lightdale (1980), Julian Katz (1984), William Haubrich (1986), Bernard Schuman (1990), and Richard McCray (1992). GASTROINTESTINAL ENDOSCOPY
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lished as a special supplement to Gastrointestinal Endoscopy in April 1991 and have since been a standard reference for historical articles and chapters in major endoscopic publications, many of which used the illustrations that first appeared in the pages of Gastrointestinal Endoscopy (Fig. 1).5 The Dittrick also created a companion temporary exhibit, under the guidance of Archives Committee Chair Bernard M. Schuman, for display at professional meetings. Subsequent to that, I further collaborated with Haubrich by co-authoring a brief ‘‘History of Endoscopy’’ as an introductory chapter for Michael V. Sivak Jr.’s Gastroenterologic Endoscopy.6 ASGE COLLECTION CARE AND USE SINCE 1991 Figure 1. Desormeaux’s endoscope, 1853. Source: Newman, R. The endoscope considered particularly in reference to diseases of the female bladder and urethera. Transactions of the Medical Society of the State of New York for the Year 1870, Fig. 2. Photo courtesy of the Dittrick Medical History Center.
ASGE 50TH ANNIVERSARY CELEBRATION, 1991: A CATALYST FOR CHANGE
In 1989, the ASGE Archives Committee concluded that something special should be done to mark the 50th anniversary of the 1941 founding of the ASGE (then the American Gastroscopic Club) by Schindler and his colleagues. To this end, the ASGE decided to transfer its archive and instrument collection from Yale to Case, where it came under the care of the Dittrick. This came about largely through the intervention of Archives Committee Chair William S. Haubrich and Michael V. Sivak Jr., who approached the Dittrick in hopes of securing a new home for the archives. We at the Dittrick welcomed this proposal, because we have one of the most extensive collections of historical surgical instruments in the country, and the ASGE collection would be a valued addition. Moreover, the Archives Committee proposed transferring older records from the ASGE office in Manchester, Massachusetts. Haubrich arranged for the transfer of the ASGE instrument collection from Yale to Case and personally conveyed the collection in a rented van (Bill was always an enthusiastic driver and thought nothing of crossing the continent from his home in California to alumni events at Case). Then, under the guidance of Archives Committee Chair Bernard M. Schuman, deliberations began for a proper way to mark ASGE’s half century of notable achievements in endoscopy. The ASGE thus commissioned histories of the ASGE and GI instrumentation by Patsy Gerstner and James Edmonson, both of the Dittrick. These were pub970
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After the acquisition of the ASGE collections, the Dittrick set about the task of organizing the archives and developing the instrument holdings. We worked with the Archives Committee to encourage the addition of older instruments from ASGE members, and the result was gratifying. Today we have well over 100 artifacts in the collection and always welcome new additions (See Appendix for a listing). These artifacts include optical and fiber-optic endoscopes (gastroscope, esophagoscope, gastroduodenoscope, colonoscope, sigmoidoscope), accessories, gastrocameras, projectors and power units, and teaching aids. These were catalogued by Case history graduate student Thomas Kinney and subsequently were entered into our online catalogue of library holdings at Case, EuclidPlus, and thus the collection is available on such databases as OCLC and WorldCat. The instrument collection is complemented by the ASGE Archives, which consists of constitution and bylaws, minutes of committees, correspondence, meeting programs, videos, and images. The Archive collection occupies 16 linear feet, filling 30 archival boxes. The presentation of the ASGE’s heritage took a new form in the mid 1990s when Professor Nick Steneck of the University of Michigan developed An Interactive History of the Instruments of Gastrointestinal Endoscopy, in CD-ROM format. Steneck was the founding director of the Historical Center for the Health Sciences at the University of Michigan,7 where Basil Hirschowitz and associates undertook pioneering work on the development of fiber-optic endoscopes in the late 1950s. The center coordinated the production of an interactive CD-ROM presenting the development of GI endoscopy, jointly funded by the ASGE and the American Gastroenterologic Association. Steneck acted as the project director, whereas the content and images came largely from the Dittrick. The technical aspects of the project were VOLUME 60, NO. 6, 2004
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Figure 2. Instruments of Science: An Historical Encyclopedia. Photo courtesy of the Dittrick Medical History Center.
handled by a talented computer science student, Ben Stevenson. The Interactive History presented the history of endoscopy in 4 sections: Chronicle, Profiles, Museum, and Timeline. In the Chronicle section, audio clips presented prominent historical figures (as portrayed by an actor’s voiceover), and videoclips in the Profiles section brought to life more recent developments of endoscopy though interviews with several ASGE members who participated in these events. One can become more familiar with instrumentation, from Schindler’s semiflexible gastroscope (c. 1935) through to the videoendoscope. It was exciting to see such an innovative approach being used to tell the story of endoscopy in a lively fashion. The project also afforded the occasion to work more closely with Archives Committee Chair Richard S. McCray, who exuded an impassioned interest in the history of endoscopy. In 1998, I shared the ‘‘Interactive History of the Instruments of Gastrointestinal Endoscopy,’’ with fellow medical museum curators, presenting it at the meeting of the European Association of Museums of the History of Medical Science at the Thackray Museum (Leeds, U.K.) and again in 1999 at the Nitze-Leiter Museum of Endoscopy (Vienna, Austria) symposium on the history of endoscopy, which marked the dedication of the museum (see more below). Growing acknowledgement of the Dittrick as a center for documentation on the history of endosVOLUME 60, NO. 6, 2004
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Figure 3. Gastrointestinal Endoscopy, 1999. Photo courtesy of the Dittrick Medical History Center.
copy came in 1997, when Robert Bud of the Science Museum (London, U.K.) and Deborah Warner (Smithsonian) requested an article on endoscopy.8 This was included in their Instruments of Science: An Historical Encyclopedia, an authoritative reference work covering 325 scientific instruments, ranging from antiquity to the present, and from the mundane to the highly sophisticated (Fig. 2). Entries explained how the instruments work and traced their invention, development, distribution, and use. Fully illustrated and complete with bibliographies, Instruments of Science examines instruments used for testing and monitoring, as well as those used for research, and it considers a number of widely used laboratory organisms (such as Drosophila and Escherichia coli) as instruments. Important articles on medical technology, in addition to those on endoscopy, included autoanalyzer, CT scanner, dosimeter, electrocardiograph, electroencephalograph, magnetic resonance imaging, positron emission tomography scanner, protein sequencer, US, and x-ray machine. The journal, Gastrointestinal Endoscopy marked the millennial year by featuring illustrations of landmark instruments and innovators on the cover of each issue in 2000 and 2001, accompanied by an essay denoting their historical significance. The GASTROINTESTINAL ENDOSCOPY
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Figures 4 and 5. Gastrointestinal endoscopy display in Allen Library, Case Western Reserve, Cleveland, Ohio. Photos courtesy of the Dittrick Medical History Center.
series, suggested by the editor, Michael V. Sivak Jr., included photographs of instruments and original images from the ASGE archives, as well as portraits of the individuals featured. The very first illustration of the series was of gastroscope images drawn in 1961 for Schindler, the ‘‘father’’ of modern gastroscopy and the principal founder of the ASGE (Fig. 3). Over the ensuing 2 years of this series, we traced the development of endoscopic instruments and procedures, beginning in February 2000 with Philipp Bozzini’s lichtleiter, or ‘‘light conductor’’ of 1804, and ending in December 2001 with Laennec’s cirrhosis, named for Rene Theophile Hyacinthe Laennec. The series was well received and only ended when the author grew to dread the approach of monthly deadlines and happily retired with a newfound respect for the pressures weighing upon the shoulders of a journal editor and the journal staff. Finding space for display of our extensive collection of medical artifacts, including endoscopes, is always a challenge. In 2002, we made significant headway in this direction by installing exhibits (Figs. 4 and 5) devoted to several medical and surgical specialties in the Powell Room9 of the Allen Memorial 972
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Medical Library, the home of the Dittrick Museum. Endoscopy received special consideration, particularly with the support of Northeast Ohio Society for Gastrointestinal Endoscopy, through the cooperation of Bruce Cameron, MD. We have two permanent display cabinets featuring instruments from the days of Schindler through the fiber-optic era of Basil Hirschowitz. THE REUTER CONNECTION AND THE JOSEPHINUM IN VIENNA
Curating the ASGE collection has broadened the horizons of the Dittrick in ways that I could never have anticipated when it came our way in 1989. Of all the new acquaintances fostered by our stewardship over the ASGE collection, perhaps the most remarkable and rewarding are those of Hans and Matthias Reuter, MD, of Stuttgart, Germany, and Manfred Skopec, PhD, of Vienna, Austria. The Reuters, as collectors, and Skopec as a curator, are responsible for the most comprehensive collection of endoscopes in the world, today housed in the Nitze-Leiter Museum of Endoscopy in Vienna. Hans Reuter (Fig. 6) had a very active career, with his own private VOLUME 60, NO. 6, 2004
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Figure 7. Max Nitze Museum of Medical Endoscopy, Stuttgart, Germany. Photo courtesy of the Dittrick Medical History Center. Figure 6. Hans J. Reuter, MD. Photo courtesy of the Dittrick Medical History Center.
urological clinic in Stuttgart, and many urologists came to observe and to learn endoscopic surgical procedures under his tutelage. Over time, he developed an interest in the history of endoscopy and began to collect old instruments. This avocation became a fascination, if not an obsession, and his wife, Waltraut, shared this collecting interest, and his son Matthias, also a urologist, got drawn into the venture, too. I first became aware of the Reuter collection while laboring to build the Dittrick’s body of literature relating to the history of endoscopy. In 1993, we acquired a copy of Philipp Bozzini and Endoscopy in the 19th Century10 by Hans and Matthias Reuter. Inside this book, I found a description of the Max Nitze Museum of Medical Endoscopy in Stuttgart, which housed the growing endoscope collection of the Reuters (Fig. 7). Though originally focused upon urological instruments, the Reuter collection ultimately encompassed all manner of endoscopes, including those familiar to ASGE members. The intent of the museum, according to the Reuters’ brochure, was to stimulate further progress in endoscopy through the study of its history, especially as pursued by the scrutiny of early instruments. The museum also offered scholarships for the study of endoscopy, particularly for doctors from ‘‘Third World countries’’ (South America and Africa). I, therefore, wrote to Hans Reuter and inquired if I might qualify for a scholarship to visit his collection, observing that ‘‘while I do not come from a Third World country, working in a non-profit museum may indeed bear a certain resemblance.’’11 He cordially replied that he would be pleased to welcome me in Stuttgart, cover associated travel expenses, and share his collection with me. VOLUME 60, NO. 6, 2004
After a 1994 medical history museum meeting in Zurich, I traveled to Stuttgart to meet Hans Reuter and his wife, Waltraut, and to see the Maxe Nitze Museum of Medical Endoscopy. I reveled in the range and quality of the Reuter collection. He had acquired not only historically important instruments but associated literature and documentation, most notably the archives of the Leiter Instrument Company of Vienna, and correspondence between Leiter and Nitze and other pioneering endoscopists of the nineteenth century. Truthfully, it was overwhelming, especially because our short visit in Stuttgart scarcely afforded the time to see all of the collection, much less, study it at leisure. We agreed to maintain contact beyond this brief visit and made plans to exchange duplicate instruments. In the mid 1990s, after having assembled the world’s largest collection of endoscopes, Hans Reuter sought a permanent home for his collection. After much deliberation, in 1995, he decided to entrust the greater part of his collection in the form of a permanent loan to the Institute for the History of Medicine of the University of Vienna. This decision made abundant sense. The collection would be in an academic setting where it would not only be preserved and exhibited but also studied and analyzed as historic documentary material. Vienna was, historically, a leading center in the development of endoscopic instrumentation; it is the city where Maximilian Nitze (1848-1906) and the instrument maker Josef Leiter (1830-1892) developed the first viable cystoscope, and where Johann von Mikulicz (1850-1905) and Leiter collaborated in the development of the first esophagoscope incorporating incandescent light. Moreover, the direction of the Institute’s Museum of the History of Medicine, located in the historic Josephinum (the 1785 school for military surgeons created by Emperor Joseph II), is in the capable hands of Manfred Skopec, PhD. GASTROINTESTINAL ENDOSCOPY
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Figure 8. Nitze-Leiter Museum of Endoscopy, Vienna, Austria. Photo courtesy of the Dittrick Medical History Center.
Skopec directs the care of the historical riches in the Josephinum, which include a rare book and print collection, an array of magnificent late eighteenth century anatomical manikins or moulages in wax from Florence, as well an extensive and growing instrument collection that documents the development of medicine and surgery in Vienna. The addition of the Reuter collection would be a notable complement to these already distinguished collections. And so, Skopec oversaw the transfer of the Reuter collection to Vienna in 1996 and planned the installation of the collection in two specially adapted rooms in the Josephinum. This took almost 3 years, and, in 1999, I returned for the dedication of Nitze Leiter Museum of Endoscopy, as will be discussed below. At the time of my visit to Stuttgart in 1994, Hans and Matthias Reuter were preparing a painstakingly comprehensive History of Endoscopy,12 with the collaboration of Rainer M. Engel, MD, curator of the William P. Didusch Museum of the AUA. Hans Reuter and Engel planned to meet at the Didusch Museum in Baltimore, Maryland, in October 1995 to discuss this project and to exchange duplicate instruments, and they invited me to join them. I agreed and had the pleasure of seeing the Didusch, which then occupied the top floor of the AUA headquarters in Baltimore.13 Our brief encounter led to further collaboration, when Hans Reuter asked if I would read and comment upon the draft of his History of Endoscopy.14 I willingly did so and, in the process, became a defacto editor (and not as translator per se, as one might mistakenly infer from his preface to vols. 1-3). My chief contribution lay in ‘‘polishing’’ the translation from German, so that it reads better to an English-speaking audience. Reuter was so pleased with the finished work, which appeared in 1999, that he invited my wife, Christine, and me to visit him again, this time in Vienna. He invited me to present 974
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Figure 9. Skopec lecture at the Dittrick Medical History Center, Case Western Reserve University, Cleveland, Ohio. Photo courtesy of the Dittrick Medical History Center.
a paper at the history of endoscopy symposium at the dedication of the Nitze-Leiter Museum of Endoscopy. In January, 1999, the Institute of the History of Medicine of the University of Vienna officially dedicated the Nitze-Leiter Museum of Endoscopy, and I was privileged to attend that event (Fig. 8). Since the arrival of the Reuter collection at the Josephinum, Skopec had been laboring to create a suitable storage and study area for the collection, as well as to fashion displays of the most interesting and significant artifacts. By the close of 1998, the work was nearing completion, and the time came to formally dedicate the newly configured museum space. To mark the event, the Institute hosted a symposium on the history of endoscopy, as it had since 1996; the theme was ‘‘Lithotomy vs. Lithotripsy: Historical and Recent.’’ I spoke on the introduction of lithotripsy, the first ‘‘minimally invasive surgery,’’ into America. Fortunately, research for my book American Surgical Instruments15 had unearthed intriguing documentation on the transfer of lithotripsy from Europe to America in the early nineteenth century. This became the subject of my presentation, which subsequently appeared in de Historia Urologiae Europaeae, a VOLUME 60, NO. 6, 2004
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series published by the European Association of Urology.16 The dedication of the Nitze-Leiter Museum of Endoscopy was a source of great pride and satisfaction to the Reuters and undoubtedly a source of great accomplishment to Skopec. Still another of the fortunate consequences of getting to know the Reuters and their collection has been the development of cordial ties between the Dittrick and the Josephinum, and personally between myself and Skopec. At the dedication of the Nitze-Leiter Museum of Endoscopy, I was struck by the similarity of our respective museums. They are broadly similar in character and composition of collections, as well as in institutional setting. Both possess an extensive artifact collection that is supported by strong research materials, specifically rare books and manuscripts. Moreover, both institutions function as part of a university, an arrangement that we both clearly favor. Lastly, both institutions are housed in architecturally significant structures. I resolved to invite Skopec to Cleveland, where he might give the Handerson Lecture at the Dittrick. In March, 2001, Skopec presented ‘‘Treasures of the Josephinum, Vienna’s Premier Medical Museum,’’ the first Handerson Lecture.17 The Handerson Lecture is intended to bring to the Dittrick distinguished museum curators from Britain and Europe (Fig. 9). He shared with us more about the fascinating history of Vienna’s medical history museum. As noted above, the Josephinum is home to a magnificent collection of wax anatomical models, or moulages, made by the Florentine artists Giuseppe Ferrini and Clemente Susini under the direction of the anatomist Felice Fontana. Today, the Vienna collection comprises the best surviving assemblage of anatomical wax figures from late eighteenth century Florence and is the crown jewel of Skopec’s museum. Skopec presented the history of these remarkable collections, which were featured in his recent book, Anatomie als Kunst: Anatomische Wachsmodelle des 18. Jahrhunderts im Josephinum in Wien.18 His presentation also highlighted the history of the Vienna Medical School, which became an important center of emerging medical and surgical specialties in the mid nineteenth century, as well as the history of endoscopy. On returning to the Josephinum in January 2002, I presented ‘‘The Dittrick Museum of Medical History, Past and Present.’’ The first part of this presentation provided an overview of the Dittrick, its origins, collections, and present-day activities. The second part focused upon the Dittrick’s photographic collections, with a special emphasis upon our collection of student dissecting room portraits, and was entitled ‘‘Haunting Images: Dissection, Photography, and American Medical Students.’’ VOLUME 60, NO. 6, 2004
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Yet another example of Euro-American cooperation in the history of endoscopy occurred on October 2, 2002, with the return of Bozzini’s lichtleiter, the very first endoscope.19 This event marked the end of a period of American ‘‘captivity’’ for this historic instrument and concluded with its repatriation to the Josephinum. It generally is acknowledged that the modern era of endoscopy dates from 1804, when Philipp Bozzini (1773-1809) introduced the lichtleiter, or ‘‘light conductor.’’20 Bozzini, despite setbacks, rivalries, and an untimely death in 1808, set a landmark precedent with the lichtleiter, and subsequent endoscope design for the next century and a half would be inspired by his example. However, the story of Bozzini’s lichtleiter does not end here. After his death, his instrument became part of the historical collections at the Josephinum. During the World War II, the instrument disappeared mysteriously. It was taken from Vienna, transported to Britain, and brought to the United States, where it was given to the American College of Surgeons. Efforts, including my own urgings to do the right thing, had been underway for the past few years to repatriate the instrument to Vienna and, specifically, to the Nitze-Leiter Museum of Endoscopy. Those efforts culminated in the instrument’s return to Vienna in the summer of 2002, and, to mark the occasion, the Josephinum hosted a special ceremony. At that time, Rainer M. Engel, MD, curator of the William P. Didusch Museum, related the story behind its disappearance and return. From Matthias Reuter, I learned of the sad demise of his father, Hans, on April 18, 2003, after a short illness. His family can be proud of the legacy embodied in his remarkable endoscopy collection, appropriately bequeathed to the Josephinum. The collection will continue to stimulate and support scholarship in the history of endoscopy. James M. Edmonson, PhD, Chief Curator Dittrick Medical History Center Case Western Reserve University Cleveland, Ohio REFERENCES 1. The last report made to the ASGE through the pages of this journal was the following: Edmonson JM. Past tense: history and the ASGE. Gastroint Endosc 1998;47:91-3. 2. Martin E. Gordon, MD, FACP, FAAAS, is a clinical professor of medicine at Yale School of Medicine and the chairman of the Board of Trustees of Associates at Yale’s Cushing/ Whitney Medical Library. He serves on the new Strategic Planning Committee of Connecticut Public TV/Radio. A prior double award winner of this competition, he has also received numerous awards as a producer/director and author of medical films, scientific exhibits, and educational devices used internationally. Gordon was the recent recipient of the Distinguished Alumni Award of Yale University School of Medicine. GASTROINTESTINAL ENDOSCOPY
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3. Palmer ED. Exhibit on the history of gastroscopy. Bull Gastrointest Endosc 1964;11:18. The magenkratzer was a stomach brush consisting of a tuft of horse hair at the end of a whalebone rod. 4. Davis AB. Rudolf Schindler’s role in the development of gastroscopy. Bull Hist Med 1972;46:150-70. 5. See, for example, the following. Modlin IM. A brief history of endoscopy. Milan (Italy): MultiMed; 2000. Hirschowitz BI, Modlin IM. The history of endoscopy: the American perspective. In: Classen M, Tytgat GNJ, Lightdale CJ, editors. Gastroenterological endoscopy. New York: Georg Thieme Verlag; 2002. p. 2-16. Schuman BM. The history of the endoscope. In: DiMarino AJ Jr, Benjamin SB, Al-Kawas FH, et al, editors. Gastrointestinal disease: an endoscopic approach. Thorofare (NJ): Slack; 2002. p. 3-13. 6. Haubrich WS, Edmonson JM. History of endoscopy. In: Michael V. Sivak Jr, editor. Gatroenterologic endoscopy. 2nd ed. Baltimore: WB Saunders; 1993. 7. Center for the History of Medicine, University of Michigan [cited 2004]. Available from: URL: http://www.med.umich. edu/medschool/chm/ 8. Edmonson JM. Endoscope. In: Bud R, Warner DJ, editors. Instruments of science: an historical encyclopedia. London: Science Museum; 1997. 9. Named for Hunter Holmes Powell, MD, dean of Western Reserve University School of Medicine, 1895-1900. 10. Reuter HJ, Reuter MA. Philipp Bozzini and endoscopy in the 19th century. Stuttgart: Max Nitze Museum; 1988. 11. Personal communication with Hans J. Reuter, 10 December 1993. 12. Reuter HJ, Reuter MA, Engel RM. History of endoscopy: an illustrated documentation. Vols. 1-4. Stuttgart: W. Kohlhammer Comunication; 1999. 13. The Didusch was originally located in the former home of Hugh HamptonYoung, the head of Genito-Urinary Surgery at Johns Hopkins in 1897 but has since been relocated to suburban Baltimore. 14. Reuter HJ, Reuter MA, Engel RM. History of endoscopy. Stuttgart: Max Nitze Museum; Vienna: International NitzeLeiter Research Society of Endoscopy; 1999-2003. 15. Edmonson JM. American surgical instruments: an illustrated history of their manufacture and a directory of instrument makers to 1900. San Francisco: Norman Publishing; 1997. 16. Edmonson JM. Lithotripsy in America: transfer of the technique from Europe (1824-1840) de Historia Urologiae Europaeae 2000;7:95-107. I also gave this presentation, at the invitation of Rainer Engel, at the 2nd International Congress on the History of Urology, May 18-20, 2001, Kos Island, Greece. That occasion also afforded the welcome opportunity to discuss the prospects for the Didusch Museum with Rainer Engel. 17. The Handerson Lecture is named in honor of Henry Ebenezer Handerson (1837-1918), a distinguished Cleveland physician and medical historian, whose most important work was Gilbertus Anglicus, Medicine, of the Thirteenth Century. Cleveland: Cleveland Medical Library Association; 1918. 18. Skopec M. Anatomie als Kunst: anatomische Wachsmodelle des 18. Jahrhunderts im Josephinum in Wien. Vienna: Brandsta¨tter; 2002. 19. Edmonson J. The first endoscope: Philipp Bozzini’s lichtleiter. Gastrointest Endosc 2000;51(2):17A-18A; cover. 20. The most comprehensive and balanced account of Bozzini’s achievement is found in Reuter, History of Endoscopy. See especially vol. 1 (1999), p. 16-34.
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Appendix. List of endoscopes in the ASGE collection, Dittrick Medical History Center, Case Western Reserve University, Cleveland, Ohio Collection no.
Endoscopy Wolf-Schindler semi-flexible gastroscope Schindler flexible gastroscope
Benedict operating gastroscope Cameron semi-flexible gastroscope Cameron omni-angle flexible gastroscope
Eder flexi-rigid gastroscope Eder standard gastroscope
Eder-Hufford esophagoscope
Eder-Palmer trans-esophagoscopic gastroscope Eder-Palmer trans-esophagoscopic gastroscope w/Bernstein modification
Olympus gastrocamera GTF Olympus gastrocamera GTF-A
Olympus gastrocamera GT-Va Olympus gastrocamera V
Olympus gastrocamera Va Olympus gastrocamera P Olympus gastrocamera F Eder fiberoptic gastroscope Hirschowitz gastroduodenoscope fiberscope
Hirschowitz gastroduodenoscope FO-5000 Hirschowitz gastroduodenoscope FO-5001 Hirschowitz fiberoptic gastroscope with distal deflection FO-5004 Hirschowitz fiberoptic flexible esophagoscope ACMI ACMI ACMI ACMI ACMI
gastroduodenoscope 5008 flexible gastroscope flexible examining gastroscope fiberoptic gastroscope gastro duodenoscope F5-a
85.52 89.20.4 99.30.4 2000.10.1 90.22.2 90.30.7 93.27.2 93.27.1 66.27.1 89.25.7 89.25.10 90.30.5 66.27.2 82.16.2 97.2.1 90.30.6 82.16.1 89.20.6 89.20.7 89.25.8 90.22.1 90.30.3 90.48.10 99.30.3 89.20.5 89.25.27 89.25.28 90.30.1 89.25.1 89.25.13 92.39.14 92.63.1 89.25.9 92.39.5 92.39.6 92.39.10 92.39.11 92.39.7 92.39.8 92.39.9 89.25.16 89.25.20 89.25.21 90.48.6 89.25.19 90.48.3 89.20.2 90.48.1 89.20.3 90.48.2 93.27.5 93.27.4 89.25.30 92.39.13 92.39.3
VOLUME 60, NO. 6, 2004
Historical commentary
M Sivak Jr
Collection no.
Endoscopy ACMI ACMI ACMI ACMI ACMI ACMI
flexible colonoscope TX-91 flexible coloscope [sic] 9000P operating coloscope [sic] F9-R operating coloscope [sic] F9-A flexible colonoscope FX-92 flexible colonoscope
ACMI fiberoptic sigmoidoscope ACMI flexible sigmoidoscope F91-S ACMI lopresti panendoscope 7089 P Lopresti foroblique esophagoscope Olympus gastrofiberscope GF-B Olympus fiberoptic gastroscope GF-BK
Olympus gastroscope GIF type D
Olympus esophagoscope EF
89.25.2a 89.25.17 91.30.2 92.39.2 91.30.1 91.30.3 92.39.12 93.27.3 89.25.4 89.25.31 93.27.7 93.27.6 89.25.14 89.25.15 92.39.4 92.69.1 89.20.1 89.25.6 92.39.1 90.48.8 90.48.9 92.63.2 92.69.2 89.25.3
Polypectomy: looking back ‘‘The only thing new in the world is the history you don’t know’’ Harry S. Truman
Medical historians and others will look back on the period from 1970 to 1990 as the great era of GI endoscopy. True, endoscopists and instrument manufacturers continue to develop new methods, devices, and technologies, but the frontiers are not as expansive nor the possibilities so seemingly limitless as during the 2 decades before 1990. Those remarkable 20 years of growth saw the inception of colonoscopy, ERCP, and endoscopic sphincterotomy, endoscopic treatments for GI bleeding, and EUS to name but a few. The fountainhead of the great era was the fiberoptic endoscope, a singular achievement that opened possibilities that in 1970 seemed boundless, even though few could then comprehend the full extent of endoscopy as it exists today. In the early 1970s, ERCP was largely theoretical, the ability to endoscopically examine the entire colon was problematic,
Copyright Ó 2004 by the American Society for Gastrointestinal Endoscopy 0016-5107/$30.00 PII: S0016-5107(04)02380-6 VOLUME 60, NO. 6, 2004
Olympus colonoscope CF-LB Machida gastroscope type B Machida gastroscope type L Machida gastroscope FGS-B Machida gastroscope FGS-CL Fiberoptic duodenoscope Accessories ACMI fiberoptic teaching attachment FO-8910 ACMI Polaroid camera adapter Olympus gastroprojector
Polaroid instant endocamera Olympus GTF stabilized regulator
Fiber optics illuminator Cameron cavicamera Cameron cauteradiodynex Pilling espohageal bougie forceps (with Eder-Hufford scope 89.20.7) esophageal dilator set percutaneous endoscopic gastrostomy button
90.48.7 90.48.4 90.48.5 92.49.1 92.49.2 90.48.11 89.25.2a 89.25.2b 89.25.22 92.39.18 92.39.19 99.30.1 2003.12 89.25.23 92.39.16 92.39.16 92.39.17 89.25.24 89.25.26 89.25.26 89.20.6a 89.20.7a 89.25.5 90.1
and even duodenoscopy was a celebrated achievement. However, the success achieved in reaching the innermost GI tract, including the technologic development of the necessary instruments, albeit remarkable, is of lesser significance from the historical perspective. Instead, it is the adaptation of endoscopy to therapeutic purposes, the development of endoscopic devices and techniques for the treatment of digestive diseases, which assigns GI endoscopy a rightful place in medical history. Therapeutic endoscopy has many triumphs to its credit, devices and techniques that changed the treatment of a digestive disorder. But the number of true milestones, those that fundamentally improved the treatment of digestive disease, is relatively small. Many endoscopic techniques are elegant in their technical sophistication, but categorization as a milestone requires a further dimension. It must achieve the ultimate success: substantial benefit for patients and, preferably, large numbers of patients. In looking back through the catalog of endoscopic therapy composed from 1970 to 1990, it is revealing, and I think important, to consider which of these milestones has proved to be of foremost importance. I often pose this question to gastroenterologists in our advanced endoscopy training program as they struggle to master endoscopic techniques: ‘‘Of the many endoscopic procedures you will perform throughout your career, which do you think is the GASTROINTESTINAL ENDOSCOPY
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