The Endoscopic Instruments 
OF 
JOSEPH LEITER, OF VIENNA, 
AND THE 
Present Development of Endoscopy. 
By OTIS K. NEWELL, M.D., 
Assistant Demonstrator of Anatomy at the Harvard Medical School. 
Reprinted from the Boston Medical and Surgical Journal 
of December i, 1887. 
BOSTON': 
CUPPLES AND HURD, Publishers. 
No. 94 Boylston Street, 
1887. THE ENDOSCOPIC INSTRUMENTS OF JOSEPH 
LEITER OF VIENNA AND THE PRESENT 
DEVELOPMENT OF ENDOSCOPY.1 
BY OTIS K. NEWELL, M.D. 
Assistant Demonstrator of Anatomy at the Harvard Medical School. 
Whoever has had much experience with the en- 
doscope, especially in examination of the bladder, 
knows with what difficulty a well-illuminated field is 
maintained, since every deviation of the mirror re- 
flected light, by hand-movement or otherwise, leaves 
the field in darkness, and the examination must be 
discontinued until the light is returned. This want 
of a permanent and easily maintained illumination 
has undoubtedly been what has kept the practice and 
good results of endoscopy so much in the background. 
One year ago, I had the pleasure of showing before 
the Suffolk District Society my own endoscopic tubes. 
Since that time the improvement in methods of illu- 
mination has been so great, that from the practical 
standpoint there is scarcely any comparison. This 
has all been brought about by the successful applica- 
tion of the electric light to endoscopic illumination 
through the efforts of Joseph Leiter, the celebrated 
instrument-maker of Vienna. 
About twenty-five years ago Bruck, of Breslau, 
had produced an electrical illuminating apparatus 
for examination of the mouth and bladder. The 
light was from a platinum wire, and in order to over- 
come the intense heat produced, a coil of pipe for cir- 
culation of cold water about the lamp was necessary. 
This instrument, although it could be used, was 
never of very practical application. 
1 Read before the Massachusetts Medical Society, Suffolk District, 
October 29, 1887. 2 
In 1877-78, Dr. Nitze, of Vienna, devised, and had 
made by Leiter, similar endoscopic instruments, but 
their complexity and high cost stood in the way of 
their extended use either for instruction or practical 
purposes. Urged by Nitze to further continue exper- 
imental work with these instruments, Leiter, by his 
indefatigable energy and admirable devotion to the 
not very remunerative work, has at last succeeded in 
perfecting all that seems necessary to the further and 
rapid development of endoscopy. 
In 1883, I had the pleasure of visiting the Inter- 
national Electrical Exhibition at Vienna, and I after- 
wards learned that it was there that Leiter's attention 
became directed to the carbon filament light, and that 
the problem of endoscopic illumination seemed then to 
be solved. Professor Dittel, who had already obtained 
some good results with the previous instruments in 
examination of the bladder, gave his strong coopera- 
tion to Leiter, and towards the end of 1886 a prac- 
tical endoscope for this purpose, cystoscope, was 
produced. In 1887, an electro-reflector for the illu- 
mination of plain endoscopic tubes was finished, and 
as it was to be applied to all tubes for examination of 
any of the body cavities, Professor Dittel suggested 
for it the name of " Panelectroscope." The gastro- 
scope was made under the the direction of Professor 
Miculicz, who has had the most extended experience 
with this instrument. It corresponds closely to the 
cystoscope in construction differing only in a double 
reflection of the picture in its optical arrangement, 
and in having in addition a double air current through 
its tubes, one for cooling the lamp and the other to 
distend the stomach. 
In March of 1887, Professor Dittel showed the 
instruments before the Imperial Medical Society of 
Vienna, and the thanks of the society were voted to 3 
Mr. Leiter for the self-sacrifice and zeal which he had 
shown in bringing his efforts to a successful termination. 
In detailing the construction of these instruments 
I can do no better than to quote as much as possible 
from a description by my friend, Dr. Alexander 
Brenner, of Vienna, published in the Centratblatt fur 
Chirurgie, 1887, No. 25. 
THE CYSTOSCOPE. 
The body of this catheter-shaped instrument is 
formed by two thin metallic tubes, one within the 
other, separated by an intermediate layer of non-con- 
ducting material. These two tubes are connected 
with the battery. The lumen at the outer end of the 
tubes is closed by an ivory plate into which two cylin- 
drical metal capsules are sunk. The capsules are con- 
nected one with the inner, one with the outer tubes 
for conduction. If now a small incandescent lamp is 
united with the tubes at their lower end, and the 
capsules are connected above to the wires from the 
the battery, the current circulates through the carbon 
filament, and with a strength of about three to four 
volts brings it to a white heat. The intensity of the 
light when run by the battery and fluid as made by 
Leiter (Fluid = 336 gms. pure chromic acid; 250gms. 
sulphuric acid; 2000 gms. water), remains for hours 
equal. The lamps last about thirty hours, and when 
burned out can be replaced. 
In order to be introduced into the bladder, and for 
its best protection, the lamp is covered by a metallic 
capsule, the " lamp-house," which screws down over 
it. A thick crystal glass window is placed in the 
side of the lamp-house, and through it the rays of 
light stream out into the bladder-cavity. The capsule 
forms a water-tight joint about the lamp, and ex- 
cludes possibility of injury to the bladder in case the 4 
lig.L 
Fig.2. 5 
lamp should break. At the same time it admits of 
the lights being held under water whereby the heat 
distributed upon its relatively large surface is rapidly 
conducted away by the fluid in the bladder, the in- 
strument being always used in a bladder filled with 
water to which some antiseptic has been added. The 
water circuit for cooling is thus unnecessary. A cir- 
cuit-breaker is attached to the outer end of the instru- 
ment, the " Pavillion," so that the light may be first 
started after the instrument is within the bladder. It 
consists of a metal switch which is connected with the 
inner tube, and can be moved from an ivory isolating 
plate on to the ring in connection with the outer tube 
and battery, and the current thus conducted to the 
inner tube and lamp. When the switch is pushed 
back upon the isolating plate the current is broken. 
In a bladder distended with from six to eight 
ounces of fluid, the instrument can be kept for an 
hour without any appreciable change in the tempera- 
ture of the surrounding fluid being felt, and without 
causing any pain to the patient from the instrument 
becoming warm. The cystoscope is introduced with 
the circuit open. After introduction the current is 
closed and the bladder illuminated. Before with- 
drawing the instrument the circuit is again opened. 
Figure 6 shows the cystoscope in an artificial bladder. 
The battery for these lights must be so arranged 
as to admit of regulating the current strength in 
order that the lights be not ruined by too high tension. 
Such a battery is the one made by Leiter in which 
the elements are raised and lowered on a supporting 
screw-rod. The plates are lowered into the fluid 
until the lamp glows with sufficient brilliancy. Any 
battery with which the current strength can be regu- 
lated suffices, and the same may be accomplished by 
the use of a rheostat. 6 
Fig. 5. 
Fig 6. 7 
rhe optical part of these instruments is similar to 
the already familiar Nitze instrument, the lenses focus- 
ing for a large field with diminished size of object. 
My endoscopic tubes as 
figured in this Journal of 
November 11, 1886, and 
above, are now made by 
Codman & Shurtleff, attach- 
able to the panelectroscope. 
With them, excepting the in- 
terposition of the fenestrum, 
the object is seen directly, 
but must be gone over in 
detail. Through the open 
tubes instrumentation with- 
in the bladder is admit- 
ted, and small pieces of 
tumor or other objects can 
thus be removed for exami- 
nation. In this connection 
it is perhaps interesting to 
quote from my paper of last 
year Professor Griinfeld's 
statement that " the intro- 
duction of instruments into 
the (male) urinary bladder 
under control of the endos- 
cope, as well as their appli- 
cation there, was, for appar- 
rent reasons, not to be 
thought of." The anterior 
bladder-wall is only to be 
seen by the Leiter-Dittel 
cystoscope with mirror re- 
flection. 
The construction of the panelectroscope is made 
Fig. 4. 8 
Fig. 3. 
apparent by the figure. The electric lamp is moved 
up or down by screw-adjustment so that the rays of 
light may be reflected from the fixed mirror a into 
the tube in the manner indicated by the lines in the 
figure. Over the top of the mirror a view of the 
field is obtained, and instruments may be passed 9 
down into the tubes. A lens may be inserted at b 
for myopic or hypermetropic individuals. 
The importance of these instruments lies in the fact 
that from their simple construction and practicality 
a closer knowledge of the physiological and patholog- 
ical conditions of the bladder may be readily obtained. 
I have already had the pleasure of twice diagnos- 
ing a tumor of the bladder, once for Dr. M. H. Rich- 
ardson, and again for Dr. C. B. Porter, both of the 
Massachusetts General Hospital. It is no exaggera- 
tion to say that the growth could be seen as plainly 
as a section under the microscope, and there seems 
to be now nothing in the way of bringing these hither- 
to obscure cases to rational and intelligent treatment. 
Who is not familiar with that type of intractable 
bladder disease, where with symptoms of stone, tumor, 
foreign body, tuberculosis, or other cause of cystitis, 
all manner of examination still fails to reveal its true 
nature, and it is either necessary to undertake a seri- 
ous operative measure, or, eventually, in case of fatal 
termination, to plead for an autopsy before a correct 
diagnosis is made possible. 
In the use of these instruments, success aside from 
practised manipulation depends upon carefully pre- 
paring the bladder through rest and irrigation so as 
to remove the only hindrance to a clear view of the 
bladder-wall, a fluid made cloudy by haemorrhage, 
mucus or other cause. If, during the examination, 
bleeding is too persistent to admit of clear vision, it 
is necessary to wait a day or two until the viscus is in 
better condition for manipulation. The use of cocaine 
in the urethra is advisable when the examination is 
not made under anaesthesia. The normal bladder 
offers a very instructive and beautiful view, and for 
practice the artificial bladder made of metal by Leiter 
is very useful. 
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