Quo venis quo vadis: the evolution of arthroscopy.

Those of you who are Latin scholars will know that quo venis quo vadis means ‘‘From whence we came to where we are going.’’ I would like to acknowledge Dr. Clint Bell, my Fellow this year, for his tremendous skill in computers, and also the Archives Committee and the administration of AANA for generously providing information when needed. I am going to talk about how arthroscopy came to be, and illustrate the talk by means of history, artifacts, events, and associations that have evolved, plus some memories, and at the end I will try to project where things might go in the future. Historically, man has always had a desire to look inside body cavities and it goes back to the days of Pompeii, when curious people started looking down throats and up rectums. The first person to develop a device to look into a body cavity was Bozzini who, in 1806, presented his ‘‘Lichtleiter’’ to the Rome Academy of Science. It consisted of a candle and a mirror which reflected light into the bladder. He was laughed at and nothing more was heard of Bozzini. Desormaux came along almost 50 years later, in 1853, with his ‘‘gazogene endoscope.’’ Again this was a device whereby light was produced and reflected into the bladder. The fuel source was turpentine and gasoline, which burned in this combustion chamber with smoke coming out of the smoke stack. Just imagine what it would be like to be in a darkened room with this in your bladder and the smell of smoke. Julius Bruck interestingly enough, in 1860, became involved because he was a dentist. Perhaps in those days they thought that bladder stones were similar to teeth. As he knew how to handle hard tissues, he was involved in removing bladder stones. He did this by visualizing them through transillumination, by sticking a glowing hot wire, encased in a goose quill, into the rectum. This was called a ‘‘diaphanoscope.’’ It wasn’t until Edison came along in 1879 that the incandescent light bulb was developed. This was a major step forward. Then Nitze and Leiter developed a cystoscope in 1886 and 4 years later they were able to take photographs. In the early days of photography, the lens always inverted the image. Another significant advance, therefore, was the development of the AMICI prism by the Zeiss Corporation, which brought the images straight up, so that people could easily see what they were looking at through the cameras. Cystoscopy slowly developed over the next few years. Arthroscopy, to the best of our knowledge, first occurred in 1918, when Takagi took a cystoscope and looked inside a knee. His motivation was to try to detect tuberculous knees early. In Japan, if you had a tuberculous knee, the end result was always a stiff ankylosed knee, which was a serious social disability as well as a physical disability. He thought that if he could diagnose the disease early, he might be able to do something to prevent stiffness. His first arthroscope was made in 1931. He made some bigger and some smaller, and he made some with lenses and some without. By 1938, he had produced 12 different arthroscopes, each numbered consecutively. Almost at the same time, on the other side of the world, Eugen Bircher, in Switzerland, was doing the same sort of thing. He was a famous surgeon, but he later gave up surgery and became a politician, and then a Commander in the Swiss Army. He really did not pursue arthroscopy very far, but, in 1921, he wrote on ‘‘arthroendoscopy’’ in the German literature, and used a Jacobaeus laparoscope, made by Wolf Company, using room air for distension of the joint. A few years later, in 1925, Phillip Kreuscher from the Chicago area, wrote in the Illinois Medical Journal, a plea for Address correspondence and reprint requests to Robert W. Jackson, M.D., Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX 75246, U.S.A. Presented at the 18th Annual Meeting of the Arthroscopy Association of North America, Vancouver, British Columbia, Canada, April 16, 1999. r 1999 by the Arthroscopy Association of North America 0749-8063/99/1506-0002$3.00/0