The Endoscope as an Aid to the Diagnosis and Treatment of Disease
Authors: F. R. Cruise
Journal: BMJ (1865)

LDRead before the medical Society of the King and(I Qiwcws College of Physiciant8 in Ireland, Milatrch 15, 1865.] MR. PRESIDENT AND GENTLEMEN,-I shall not occupy the timiie of the Society very long by the communica tion that I am abouit to make, although I feel con vinced that its importance justifies me in trespassing upon your patience and attention. I believe it will be granted by all, that one of the most important characteristics and improvements of modern medicine, consists in the direct exploration of organs, for the elucidation of their physiology and pathology. This tendency to rest our knowledge upon physical rather than on rational signs, is one of by no means recent date; although, of latter days, it has become more obvious and better appreciated. Undoutbtedly, wvithin the last fifty years, it has made gigantic pro -ress. Percussion, methodised by Avenbrugger and popu larised by Corvisart, seems but to have paved the way for Laennec's discovery of the immeasureable practical value of auscultation. Again, other por tions of the body, lending themselves even more Ireely to examination than the thoracic organs, in duie course have come to be objects of research with special observers, who, froin tilme to time, have de vised means and instrulmients for their more satisfac tory investigation and stuidy. Without delayinig upon this point at the expense of the valuable time of the Society, I may quote, in illustration, the revival by Recamier of the long forgotton specultim uteri; also, the speculumi auris, originated, I believe, by New burgr; the ophthalmoscope of Helmholtz; tlhe laryn Croseope of Czermak; and, though last certainly not least, the endoscope of Desormeaux; which latter in strumnent I have, on the present occasion, the honour of publicly exhibiting for the first time, I believe, in Ireland. Agreeably to the old adage, that  Nought is new Lunder the sun, as each of these valuable additions to our means of diagnosis has been brought under the notice of the profession, claimants have sprung up to dispute the honour and credit of invention. I fear it would be very unprofitable, were I at the present time to discuss at length the precise merits of the competitors in each case; I shall, therefore, pass by that question; merely observing, in order to justify the quotation of the above-mentioned names, that I have endeavoured to associate with each me tlhod and instruLment the name of that individual who has done most to demonstrate and extend its practical utility. With respect to the endoscope in particular, I may observe that Desormeaux, in the introcluctory chapter of his recent valuable memoir, candidly acknowledges that the idea of an instrument capable of throwing light into deep cavities, such as the bladder and urinary passages, was not original with him. He accords to M. Segalas the merit of originating the thought; and alludes to his unsuccessful attempt, as well as to the fruitless labours in the same direc tion of the late Mr. Avery of London and Dr. Hacken of iRiga. He is in error in giving the palm of ori ginality to NI. Segalas; for in 1806 Burrini of Frank fort invented an instrument for the purpose; and others shortly afterwards followed up the matter, in cluding the celebrated Dr. Fisher of Boston, U.S. Withal, it must be acknowledged that to M. Desor meaux alone is due the credit of patiently working at endoscopy, working for more than thirteen years, until he has at last produced a mass of facts so important and interesting that it is impossible for the pro fession any longer to ignore the subject. A propos to the slight shewn towards the endo scope, a long and amusing history might be written of the opposition which has greeted every improve ment in the science and art of medicine fromn its earliest days. Such a history would, I conceive, be out of place here. Frivolous objections avail nothing at the time when they are ad-anced, and only afford material for merriment and ridicule in the future. The practical commentary upon all such opposition lies in the contrast between medicine as we now see it, and medicine as our fathers knew it little better than half a century ago. I shall not trespass on the valuable time of the Society by recounting a detailed history of my own labours at endoscopy. Suffice it to say, that it has been a dream with me since I becanme a student, and a pursuit after which I continually hankered. Years ago I tried to work with Desormeaux's endo scope; but, finding the light insufficient, gave it up in despair; and it is only of late that I resumed the study. Quite recently, a modification of the ilu minatincr portion of the instrument occurred to me. I carried it out; and believe I have thereby succeeded in obtaining as much light as is needful for practical purposes. Since then I have worked assiduously, and have lost no opportunity of extending miy expe rience of the endoscope. For my own part, I amn quite satisfied that it is a most useful instrument; and I now venture to bring it publicly forward to re ceive the criticism and judgflment of others. The endoscope is an instrument devised and con structed for the purpose of throwing light into cer tain regions of the human body entirely out of the rancge of natural visioni. That it is a most unques tionable stuecess, I am satisfied; and I feel justified in stating, that I am convinced its field of practical iutility is almost illimitable. I would venture to hope that, in the course of time, it may work as com plete a revolution in our knowledge of many obscure diseases, as the stethoscope has wrought in the dia gnlosis of affectionls of the lungs and heart. I hope, at no distant period, to bring before the profession a resume of the work which it has already accomplished in certain branches of pathology; and to point out the principal newv facts which it has brought to light, and the facilities it affords in the treatment of many ailments. On the present occasion, I shall but brieily allude to its maniifold capabilities. The endoscope at its birth met with but little favour, anid for many years was absolutely slighted and passed by. Desorineaux tells us how one of his teachers, unable to deny the reality of the instru ment, merely asked him a question- Of what use is it ? The answer to that query conveys its whole worth; namely, it enables us to see parts which, with out its aid, are invisible. Let us for a moment contrast the predicament of the physician called uponi to treat a malady wlhich it is possible for him to see, and one hidden from his view. For example, let us take a case of diseased eye, and a case of diseased urethra. He will not content himself by calling the former an ophthalnia, without ascertaining what structure is engaged and wherefore. He will examine the lids 3t5