The bronchoscope was first used for extracting foreign bodies and the evaluation of infectious processes, especially abscesses. By the end of the twentieth century, the bronchoscope had been determined the single most useful tool for accurate diagnosis of lung cancer. It allowed for the collection of biopsy specimens or cells for histological and cytological analysis and, in some cases, direct observation of a lesion.
Chevalier Jackson, MD (1865-1958), is considered by many to be the father of modern broncho-esophagoscopy. In 1890, he constructed an oesophagoscope and continually refined his instruments over the next decade-and-a-half using them in a wide variety of clinical cases. Dr. Jackson’s improvements included the major step of removing the lighting system from the distal end, placing it at the proximal end, and making the illuminating tube itself an auxiliary tube. This freed the main lumen for instrumentation. In 1905, he designed a bronchoscope with a suction tube, a light carrier, and a right-angled handle that made the instrument easy to manipulate. He created his own instrument shop for implementing the constant improvements. In 1907, he published the first book on endoscopy, Tracheo-bronchoscopy, Esophagoscopy and Gastroscopy. By the second decade of the twentieth century, his improved instruments and expertise in laryngoscopy and other endoscopic procedures were drawing a worldwide audience of physicians to his postgraduate courses held in Philadelphia as well as Paris. Because of the constant demand, he continued these courses after his retirement until a few years before his death at age 93 in 1958.
Few physicians have exerted as great an influence or remained ‘the world authority’ for as long a period of time. In Surgical Diagnosis and Treatment by American Authors by Albert J. Ochsner, MD, published in 1920, Dr. Jackson describes his use of the bronchoscope and outlines its place in the treatment of disease and foreign bodies:
“Lung Abscesses can be entered directly and drained… Abscesses caused by foreign bodies can be relieved by removal of the foreign body along with the abscess contents… Endobronchial lavage and instillation of local medication (is important)… Removal of secretions are difficult because they are too viscous and a special ‘sponge-pump’ system must be used… Foreign body removal is the bronchoscope’s biggest blessing… if no harm is done, the bronchoscopy can be repeated any number of times. Therefore it is absolutely unjustifiable to take the risk of pulling out a foreign body not free to move… Only too often in the early days of the work death promptly followed the ruthless tearing out of an entangled foreign body.”
(He does not mention its use in identification, biopsy, or the testing of secretions for lung tumors. His only reference to “growths” accompanies this photograph.) The heavy laryngoscope has been removed leaving the light bronchoscope in position. The operator (Dr. Jackson) is inserting forceps. Note how the operator holds the tube lightly between the thumb and first two fingers of the left hand, while the last two fingers are hooked over the upper teeth of the patient, ‘anchoring’ the tube to prevent it from moving in or out or otherwise changing the relation of the distal tube-mouth to a foreign body or growth while the forceps are being used. ■
Excerpted from Oncology: Tumors & Treatment: A Photographic History, The Radium Era 1916-1945 by Stanley B. Burns, MD, FACS. Photograph courtesy of Stanley B. Burns, MD, and The Burns Archive.