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Gastrointestinal and Genitourinary Conditions

In 1804, Philipp Bozzini published a description of a device he called a lichtleiter ("light-conductor"): a narrow tube into which light was directed by an attached system of angled mirrors, which could be used to illuminate the interior of bodily orifices. Thus began the era of endoscopy, the clinical, nonsurgical exploration of the digestive system.1 The first endoscopes were rigid, bulky, ungainly—in fact, they were far too painful and potentially injurious to use on living patients. Instruments such as the laryngoscope, urethroscope, and lithotrite2 had to be tweaked and refined by many an inventive doctor before their capacity to help patients exceeded their capacity to harm them. A great deal of that refinement happened in Paris, where Pierre Ségalas, Jean Civiale, and others introduced competing models of the same instruments.3 Antonin Jean Desormeaux updated Bozzini's design in 1853 with a stronger light source and focusing lenses, and became the first doctor to use the device in a clinical setting: he located and excised a urethral papilloma. Due to the light source (a kerosene lamp), Desormeaux's endoscope could grow hot enough to burn the urethra.4 In the 1870's and 1880's, light sources small and cool enough to be carried into the body with the endoscope itself obviated the need for mirrors.5 Flexible endoscopes did not come about until 1932, by which point the digestive system could also be imaged radiographically using ingestible radiopaque contrast media.6 New instruments and techniques led to discoveries in digestive system anatomy and pathology. The function and composition of gastric juices came to be better understood, sometimes through the surgical creation of gastro-cutaneous fistulae that allowed observation and testing during the digestive process.7 Charles Richet was able to observe that a patient's gastric secretions increased when he sucked on candy, even though the substance of the candy did not reach his stomach.8

Notes

  1. Shah, "Endoscopy Through the Ages," 645; European Museum of Urology, "Bozzini and the Lichtleiter."
  2. The lithotrite was an instrument meant to be inserted transurethrally to break up bladder stones inside the body.
  3. European Museum of Urology, "The Early History of Lithotripsy."
  4. Shah, "Endoscopy," 645-6; European Museum of Urology, "Desormeaux's Endoscope."
  5. Shah, "Endoscopy," 647.
  6. Edmonson, "History of the instruments," S27; See also the Radiology section of this exhibit.
  7. Wangensteen, "The Stomach since the Hunters," 136-141.
  8. Wolf, "The Psyche and the Stomach," 13-14.

Bibliography & Further Reading

    • Edmonson, James. "History of the instruments for gastrointestinal endoscopy." Gastrointestinal Endoscopy 37.2 (1991): S27-S56.
    • European Museum of Urology. "History of Urology." European Association of Urology, 2018. http://history.uroweb.org/history-of-urology/.
    • Nezhat, Camran. Nezhat's History of Endoscopy. Tuttlingen: Endo Press, 2011.
    • Shah, J. "Endoscopy Through the Ages." BJU International 89 (2002): 645-652.
    • Wangensteen, Owen H. "The Stomach since the Hunters: Gastric Temperature and Peptic Ulcer." in The History of Gastroenterology, edited by T.S. Chen and P.S Chen. Parthenon, 1995: 132-154.
    • Whorton, James. "Civilization and the colon: constipation as the 'disease of diseases'." BMJ 321.7276 (2000): 1586-89.
    • Whorton, James. Inner Hygiene: Constipation and the Pursuit of Health in Modern Society. Oxford University Press, 2000.
    • Wolf, Stewart. "The Psyche and the Stomach: A Historical Vignette" in The History of Gastroenterology, edited by T.S. Chen and P.S Chen. Parthenon, 1995: 13-22.