内視鏡の歴史―胃内視鏡を中心に

第2編各種の硬性鏡の発達

抄録

For the endoscopic observation of organs apart from the body surface such as the stomach, introduction of a light source into the body cavity was indispensable for sufficient illumination. Its first attempt was performed by Juluius Bruck Jr., a dentist of Braslau in 1867. He introduced a platinum-loop glow lamp with a water cooling device into the oral cavity or the vagina and tried to observe the root of the teeth or the urinary bladder by trans-illumination (Fig-1). It had no clinical use but the idea was adopted for endoscopy. Max Nitze (1848-1906) was working at a city hospital of Dresden where diaphanoscopy by Bruck's method was actively studied by Schramm . In 1876 Nitze made a cystoscope using a platinum-loop glow lamp. At the same time he applied an optical system to his endoscope for the first time. It was inserted into a tube incorporated with the lamp and cooling device (Fig-2). Later he collaborated with Leiter, an engineer of Wien and completed his instrument. In 1876 he demonstrated his new cystoscope at a meeting of Wien Medical Association under a title of “On a new method for the observation of human cavity ” and made a great success (Fig-3). Nitze is called as the father of cystoscopy today. Nitze and Leiter made various endoscopes. Their gastroscope had an angle of 90 degree at the level of the throat and was flexible when it was introduced into a patient (Fig-4). Because of the angle and its complicated structure, it was never applied for living subjects. Soon disagreement happened between Nitze and Leiter and their collaboration was broken. In 1881 Johanes von Mikulcz (1850-1905), a surgeon of Wien completed his gastroscope with Leiter (Fig-6). It was designed following his careful anatomical and clinical considerations. Its practical application was also studied in detail . Gastroscopy today bases on the technique established by him. The stomach was insuf f lated with air and the examination was carried out in the decubitus position after the injection of morphine . Mikulicz may be the first one who was really able to inspect the stomach with an endoscope. In 1886 Edison's incandenscent lamp became available for endoscopes and sufficient illumination without complicated cooling system was obtained In 1895 Rosenheim showed that a straight rigid gastroscope could be introduced into the stomach by proper manipulation. Until 1930 many types of gastroscope were made (Table-1, Fig-7) They can be divided into three groups :1) open tubes, 2) straight or angulated rigid tubes with optical system and 3) flexible tubes to be straightened after introduction. Among them the straight rigid gastroscopes of Elsner and of Schindler were most extensively uses. When we look at the beautiful color pictures on Elsner's (1911) or Schindler's (1923) textbook, we are astonished by their exact and minute observations (Color photos, Fig-3-9). Needless to say that gastroscopy with a rigid instrument was not easy for a doctor and painful for a patient. Schindler reported that he succeeded in the observation of the stomach in 55% of his examination. Until 1924 at least 15 perforations due to gastroscopy had been reported. Sauerbruch strongly claimed that gastroscopy should be refused by a surgeon. A word of this famous thoracic surgeon retarded the development of gastroscopy considerably. Esophogoscopy was actively carried out by Rosenheim. Light of an electric bulb was reflected from the outside of the body. Since Rosenheim was an internist, he introduced his esophagoscope without observing the pharynx. Bronchoscopy was established by Killian, an otolaryngologist of Freiburg in 1897. He succeeded to remove foreign bodies from the right bronchus. Later on Jackson eagerly endeavored for the practical application of esophagoscopy and bronchoscopy in USA. Their instrument was a straight open tube and it was used until the completion of a fiberscope chiefly for the extraction of foreign bodies. Killian had much interest in