Gastroscopy

At Manhattan's Columbia and Cornell medical schools last week, physicians had it brought home to them once again that although Adolf Hitler is impoverishing his own land by driving Jewish brains from Germany, he is steadily enriching U. S. medicine. From Chicago, where he has been an associate professor at the University of Chicago medical school since fleeing Germany in 1934, came Dr. Rudolf Schindler to demonstrate his flexible gastroscope,only instrument which makes possible direct observation of a living stomach.

Cancer of the stomach. Dr. Schindler pointed out, comprises 30 to 40% of all cancers in the U. S., kills more people than any other type. But thousands of deaths can be prevented if all patients suffering from "stomach trouble" are given routine gastroscopic examinations. Although the flexible gastroscope is an aid to the X-ray rather than a substitute for it, it enables a properly-trained physician to discover tiny ulcers and tumors which have just begun to grow and cannot be detected by Xray. The gastroscope has also demonstrated the frequency of chronic inflammation of the stomach.

The idea of observing the stomach directly through an inserted pipe originated as far back as the middle of the 19th Century, when Adolf Kussmaul in Germany persuaded a professional sword-swallower to gulp down a long, straight metal tube in the interests of science. But until Dr. Schindler invented the flexible gastroscope in 1932, gastroscopy was seldom practiced, for it was difficult, dangerous, painful.

The Schindler gastroscope is over two feet long. The upper half of the tube is steel and connects with the lower half which is rubber lined with a metal coil. At the lower end there is a flexible guide to ease the tube's passage, a small light and a prism which protrude on one side. Inside the tube, one above the other, are set more than 40 lenses. No matter which way the tube is bent within the patient, the lenses diffract the image at the bottom of the tube so that the physician has a clear view of the stomach wall as he twists the gastroscope. Insertion of the instrument is easy: the physician anesthetizes the patient's throat, grasps the gastroscope in both hands like a billiard cue, pokes the rubber end gently but firmly down the patient's throat and esophagus into his stomach. Examination lasts from three to five minutes, causes the patient slight dis comfort, but no pain.

Only real drawback to Dr. Schindler's gastroscopy is the difficulty in getting his instrument properly made. The one he uses was made in Germany and so far none have been made in this country.

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