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332 The introduction of the cystoscope into the British isles
332
The introduction of the cystoscope into the British isles Eur Urol Suppl 2014;13;e332
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Noel J.P., Goddard J.C. University Hospitals of Leicester NHS Trust, Dept. of Urology, Leicester, United Kingdom INTRODUCTION & OBJECTIVES: One of the greatest challenges in the history of urology has been the endeavour to visualise the interior of the lower urinary tract through the natural orifice of the urethra. We describe early pioneers of endoscopy in the British Isles and the evolution to modern cystoscopy. In 1844, John Avery, a surgeon at London's Charing Cross Hospital attempted to improve the view of the urethra by using a modified Palmer’s lamp reflector (used by miners) to intensify and redirect candle light onto a mirror in a speculum. In 1865, the Dublin urologist, Sir Francis Cruise introduced an improved version of the Desormeaux endoscope enabling him to perform some of the world’s first endoscopic treatments including endoscopically-assisted urethrotomies. Christopher Heath introduced it to London, using it at the Lock Hospital. However, even with its bright ‘gasogene’ lamp, poor light intensity and excess heat was a problem. In 1867, Mr Archer Warwick of London presented a simple endoscope using natural north light allowing urethral, but limited intravesical visualisation. Not until the invention of the incandescent light bulb by Sir Joseph Swan of Newcastle and Edison of America, could cystoscopy progress. David Newman of Glasgow was the first to use this new technology in early 1883 enabling him to catheterise the female ureters under direct vision. The Swan bulb was used by Robson of Leeds in 1885. In 1887 both Nitze and Leiter used the Edison bulbs in the first truly practical cystoscopes. Sir Henry Thompson, the eminent British Urologist used the Desormeaux, Cruise and Warwick instruments as they appeared and introduced the original Nitze-Leiter scope to Britain in 1880. He reviewed the newer cystoscopes in a lecture at University College London in March 1888 stating that “it will not be necessary very frequently to employ the apparatus”. However, Edwin Hurry Fenwick of The London Hospital disagreed. Fenwick used the cystoscopes at The London and St Peter’s and published widely, encouraging their use. Unlike Thompson, Fenwick predicted the new cystoscope would become “rapidly popular”. Devising his own instrument, taking the best of the Nitze and Leiter models, he showed its use in the diagnosis of urethral, bladder and renal diseases and pointed out its advantage over sounding, bimanual and open digital examination of the bladder especially for ulcers, small bladder tumours and foreign bodies. The addition of the Swan/Edison lamps changed the early cystoscopes from experimental to workable instruments and they were employed by British urologists; but it was not until the invention of the rod lens by the English scientist Harold Hopkins in the 1950’s that the cystoscope truly became the primary instrument in the urologists armamentarium. From the earliest light reflectors to the Hopkins rod lens, the urologists of the British Isles promoted and contributed to the development of today's cystoscopic technology.
The introduction of the cystoscope into the British isles Eur Urol Suppl 2014;13;e332
Print! Print!
Noel J.P., Goddard J.C. University Hospitals of Leicester NHS Trust, Dept. of Urology, Leicester, United Kingdom INTRODUCTION & OBJECTIVES: One of the greatest challenges in the history of urology has been the endeavour to visualise the interior of the lower urinary tract through the natural orifice of the urethra. We describe early pioneers of endoscopy in the British Isles and the evolution to modern cystoscopy. In 1844, John Avery, a surgeon at London's Charing Cross Hospital attempted to improve the view of the urethra by using a modified Palmer’s lamp reflector (used by miners) to intensify and redirect candle light onto a mirror in a speculum. In 1865, the Dublin urologist, Sir Francis Cruise introduced an improved version of the Desormeaux endoscope enabling him to perform some of the world’s first endoscopic treatments including endoscopically-assisted urethrotomies. Christopher Heath introduced it to London, using it at the Lock Hospital. However, even with its bright ‘gasogene’ lamp, poor light intensity and excess heat was a problem. In 1867, Mr Archer Warwick of London presented a simple endoscope using natural north light allowing urethral, but limited intravesical visualisation. Not until the invention of the incandescent light bulb by Sir Joseph Swan of Newcastle and Edison of America, could cystoscopy progress. David Newman of Glasgow was the first to use this new technology in early 1883 enabling him to catheterise the female ureters under direct vision. The Swan bulb was used by Robson of Leeds in 1885. In 1887 both Nitze and Leiter used the Edison bulbs in the first truly practical cystoscopes. Sir Henry Thompson, the eminent British Urologist used the Desormeaux, Cruise and Warwick instruments as they appeared and introduced the original Nitze-Leiter scope to Britain in 1880. He reviewed the newer cystoscopes in a lecture at University College London in March 1888 stating that “it will not be necessary very frequently to employ the apparatus”. However, Edwin Hurry Fenwick of The London Hospital disagreed. Fenwick used the cystoscopes at The London and St Peter’s and published widely, encouraging their use. Unlike Thompson, Fenwick predicted the new cystoscope would become “rapidly popular”. Devising his own instrument, taking the best of the Nitze and Leiter models, he showed its use in the diagnosis of urethral, bladder and renal diseases and pointed out its advantage over sounding, bimanual and open digital examination of the bladder especially for ulcers, small bladder tumours and foreign bodies. The addition of the Swan/Edison lamps changed the early cystoscopes from experimental to workable instruments and they were employed by British urologists; but it was not until the invention of the rod lens by the English scientist Harold Hopkins in the 1950’s that the cystoscope truly became the primary instrument in the urologists armamentarium. From the earliest light reflectors to the Hopkins rod lens, the urologists of the British Isles promoted and contributed to the development of today's cystoscopic technology.