A Tool that Transformed GI Care

By Hank Black

Basil Hirschowitz demonstrates his revolutionary fiberoptic endoscope In the early 1950s, the young physician Basil Hirschowitz used to gather with his academic colleagues in the Ann Arbor evenings to share daily medical dramas and dreams of future possibilities. His own dramas usually had to do with his frustrating attempts to see into the human body's gastrointestinal tract with a lighted but primitive metal tube. This frustration gave birth to his dream—to find a way to send light into those recesses of the body.

The group of young physicians sometimes had to laugh out loud at their own audaciousness. When one of them suggested looking inside the body with the camera of the newly popular household appliance called television, another dismissed it with Pogo's remark that "too much of TV is already too hard to swallow."

But the discussion set Hirschowitz to thinking: If an actual TV camera was impossible to swallow, there must at least be some other way to carry visualizing instruments into the body so that physicians could see what was going on there.

Turning Up the Light

Hirschowitz wanted to be able to see the GI tract better because he was eager to learn more about ulcer disease—and to develop more effective treatments. The rigid metal tubes that he was using allowed him to see only the light at the end of the tunnel; along with the tube, his patients had to swallow a source of light, whose dim bulb limited the murky view to the tissue directly in front of the light.

If the idea of swallowing a TV seemed too far-fetched at the time, the idea of transmitting light around the loops and curves of the gastrointestinal tract seemed equally extraordinary. It had been known since 1927 that a strand of glass could carry light, but nothing much followed from that discovery—until 1954, when Hirschowitz saw two articles in Nature magazine describing the use of fiberoptics to transmit images. This so excited Hirschowitz that he traveled to London to see what the authors had done. Unfortunately, "the glass they used did not transmit enough light, and the bundle of fibers did not transmit a clear image," he remembers.

Hirschowitz did, however, take back to Michigan a couple of $12 rolls of glass of the type used to make glass-cloth, and he asked a physics professor (C.W. Peters) and a student (Larry Curtiss) to see what they could do with the material. They later obtained some big rods of optical roll glass from Corning and designed an instrument to melt the glass and draw out fibers. By the end of the summer of 1955, they had constructed a bundle of glass fibers.

The team discovered that the fibers—all 100,000 or so of them—had to be bound together at each end in exact spatial alignment in order for the bundle to transmit an image. Even so, the light that started at one end was so severely reduced by the time it go to the other that the image produced was unusable. Technique after technique was tried, unsuccessfully—until Curtiss tried insulating each fiber of optical glass with a tubular coating of another glass. That worked: The light was passed from one end of the 30-foot bundle of fibers to the other, from one room to another.

A prototype gastroscope was quickly developed, and Hirschowitz tested the prototype in early 1957 by swallowing it himself. He then presented the device to a meeting of the American Gastroscopic Society in Colorado.

Hirschowitz could barely contain his excitement, but the trail to commercial production of this fiberoptic device was surprisingly difficult. One manufacturing company after another turned it down. A maker of cystoscopies finally agreed to commercialize it, and Hirschowitz made weekend trips to the factory to evolve the final design.

By that time, the young medical school in Birmingham was ready to start a division of gastroenterology and Hirschowitz was selected to lead it. In 1960, at the General Clinical Research Center in University Hospital, Hirschowitz used his first commercially made version of his flexible fiberoptic endoscope—the Hirschowitz Fiber Optic Gastroduodenoscope—to peer into the recesses of the stomach of a patient.

Word of the invention and successful use of the endoscope spread quickly in the medical community. Skeptics were won over by the vivid images photographed by Hirschowitz, Soon, flexible fiberoptic scopes became the standard for visualizing and eventually for treating virtually every cavity in the body. The technique of carrying light on strands of glass went on to revolutionize not only medicine, but also industry and communications.

In 1989, Hirschowitz's invention—the first endoscope—was placed in the Smithsonian Institution, where it remains on display today. Already (in 1987) Hirschowitz had been awarded the $100,000 General Motors Cancer Research Foundation's Kettering Award for the device that "revolutionized the diagnosis of many kinds of cancer."

Hirschowitz's invention was later refined. Channels were added to pump in air, to suction, and, in a leap to therapeutic endoscopy, to pass accessories for snipping tissue for biopsy, cauterizing bleeding vessels, tying off polyps, and grasping gallstones.

Only in the past few years has the matchtip-sized charged couplet device (CCD) TV chip replaced much of fiberoptic endoscopy with the widespread use of video of the human insides—bringing television to GI diagnosis and treatment after all.

More Information

UAB Division of Gastroenterology and Hepatology

This article originally appeared in the Fall 1997 issue of UAB Magazine.