[9] The first eight cases are more fully described in the Arch. fur Chirurgie, vol. xxxvi., Part 3 (Dr. Nitze, Beitrage zur Endoscopie der mannlichen Harnblase). The full account of the last seven cases will be published soon.
Finally, on comparing the above cystoscopic appearances with the results obtained by other methods of examination, it must be observed that the examination of the urine, in most cases carefully made, had only in two cases shown the presence of villous tissue, which in one instance was brought out by the catheter. The rectal palpation, when made, had always given negative results. Further, the examination by means of the sound had been made in nine cases before the cystoscopic examination. In none of the cases had the sound revealed the presence of a tumor (which in two had attained the size of a small apple), although the examination was made by most experienced surgeons and eminent specialists. Those cases show how imperfect an instrument the sound is for the diagnosis of bladder tumors.
Only one method can compare with the cystoscope in giving valuable information regarding the size and nature of a bladder tumor—viz., the digital exploration of the internal surface of the bladder after a previous boutonniere, or the high section. The superiority of the cystoscopic method over the latter, on account of the smaller amount of inconvenience it causes the patient, need not be insisted on. The latter involves a cutting operation not free from danger, as well as deep narcosis, while the cystoscopic method is similar to a simple catheterization.
Fig. 5.
The accompanying diagram (Fig. 5) shows the instrument used by me for cystoscopic examination. It has been made by the Berlin instrument maker, Hartwig, according to my instructions. The source of the light (Mignon lamp) is cemented in a silver capsule, which is screwed into the distal end of the cystoscope. This instrument is superior to that made by Leiter, the Vienna instrument maker, because of its greater simplicity in construction, which allows the lamp to be easily replaced when necessary, and also on account of the greater length of the shaft.
I mention this because it differs from the explanation
which Mr. Fenwick gave in his speech concerning my method of examination at the meeting of the Medical Society of London on Jan. 23, 1888. I must also strongly contradict Mr. Fenwick's statements concerning the share which he attributed to the Vienna instrument maker in the construction of the instrument. Leiter's connection with our instrument will be best explained when I say that he had to buy the patent[10] from me first in order to be allowed to make the instrument. Leiter has had no share in those peculiarities which characterize it as new. The introduction of the source of light into the organ had been practically brought about, the optical apparatus enlarging the view designed, the whole construction perfected, the instrument had proved itself useful in examining patients, and had been demonstrated by me in the Saechsisches Landes Medicinal Collegium before Leiter had any idea of the new invention! Also the eventual replacement of the first source of light (platinum wire) had been provided for.[11] Leiter has only made a few technical modifications on the finished instrument. I protest most emphatically against the incorrect explanations given by Mr. Fenwick, and against every connection of Leiter's name with my instruments. I hope to obtain in England the same generous recognition of my labors in this field that has been accorded to me in Germany.—Lancet.
[10] Deutsche Patentschrifte, No. 6, 853.
[11] Ibid.