02 November, 2005

100 years ago: Session 1905-06; Meeting III - The use of the Cystoscope

Sederunt 34
The Society met in the rooms of the Medical Club, 22 Carlton Place on the evening of Thursday 2nd November 1905 at 9pm.
The President, Professor Stockman, was in the chair and in all 34 gentlemen were present.

I Minutes
The minutes of the last two meetings were read and approved of.

II Correspondence
The secretary read a letter from the Medico-Chirurgical Society, Glasgow, in which members of the Society were invited to be present at an address, to be given, on Nov. 3rd by Mr W. Sampson Handley F.R.C.S. & Hunterian Professor, Royal College of Surgeons England, Subject: "On the mode of spread of Breast Cancer: with special reference to operative treatment."

III New Members
The secretary read a proposal for membership viz.
Dr Edward J. Primrose 551 Dumbarton Rd. Partick
Proposed by John P. Duncan
Seconded by R. Wardrop Forrest

IV Dr Newman's demonstration
Dr David Newman then gave a most interesting and instructive demonstration on "The use of the Cystosope" & illustrated his remarks by means of an opaque projector.
A precis of the demonstration follows this minute. The Chairman at the conclusion of the demonstration made a few remarks on the subject and moved a vote of thanks to Dr Newman. This was most cordially responded to, and then Dr Newman replied in a few words.

V Tariff of Fees
The Secretary moved as follows:
"That, as recommended by the Council of the Society, the Tariff of Fees printed at the end of the book of laws be adopted by the Society".
He explained that the Tariff had not been readopted for several years, and that it was of some importance, in the case of legal proceedings being taken by a member of the Society for recovery of fees, that the tariff should be formally readopted by the Society from time to time.
This was carried [...]

VI Dr J. C. MacEwen's statement
Dr J. C. MacEwen intimated that he had been requested to ascertain the views of the Society on the proposal brought forward by the Eastern Medical Society that a dance be held this winter under the auspices of the Southern, Eastern & Northern Medical Societies. After some discussion, on the suggestion of Dr McGilvray, it was agreed that the matter came within the province of the Amusements Committee of the Medical Club & that Dr MacEwen should approach this committee.
This was all the Business.

Precis of Dr Newman's Demonstration
Dr David Newman demonstrated by means of an opaque projector the cystoscopic appearances of the urinary bladder as presented by the mucous membrane of the trigone and the orifices of the ureters in certain diseases of the kidney. He described his first electric cystoscope (January 1883) still armed with the first electric lamp introduced into a human bladder, and then showed his present cystoscope, which fulfilled the following requirements:–
1. Comparatively small lumen of stem to avoid injury to the urethra or neck of bladder.
2. Large field of vision and a clear view.
3. Easy means of clearing the [...] , should it become obscured, without [...] stem of instrument from bladder
4. Good illumination without danger of scalding the mucous membrane of the bladder.
5. Ease in sterilizing the instrument
6. Facility in emptying the bladder should it be necessary without removing the cystoscope.
7. Ability to demonstrate to a second observer the object seen
8. Means of steadying the instrument during [...] of fixing prism cystoscope at any point, and of defining clearly position of a lesion.

He then demonstrated, by means of a special opaque projector the appearances seen through the cystoscope, so arranged that only a portion of the diagram was illustrated at one time upon the screen: by moving the diagram the appearance of the mucous membrane was seen, bit by bit, as in an inspection with the cystoscope. He first illustrated some easily recognised lesions of the viscal mucous membrane, such as hyperaemia of the bladder in a case of injury to the medulla oblongata, and then an extensive series of morbid conditions, such as ulcers, encysted and other calculi, new growths, ascending and descending urethritis, shoots of blood from the ureters. The last named condition was demonstrated by means of a most impressive working model.

Finally he drew the following conclusions:-
I. When one ureter orifice is altered, the other normal, the renal lesion is on the side of the [...] ureter.
II. When the urinary shoots are more frequent on one side than on the other
a. greater functional activity is indicated by the shoots being uniform in size and regular in rhythm.
b. undue irritation of the kidney is inferred when the shoots, while frequent are irregular in rhythm, unequal, and small in size.
c. Stricture, stone, or chronic ureteritis is suspected when the shoots are distorted in form or irregular in amount.
III. When the urine does not escape in distinct jets
a. dilatation of ureter without paralysis of sphincter is indicated when the urine dribbles into the bladder at intervals.
b. paralysis of sphincter is shown by urine flowing into bladder almost continuously.
IV. The character of morbid fluids escaping from the ureter, or of clots of blood &c, occupying its opening, denotes the changes taking place in the corresponding kidney.
V. The deformity of the orifice also indicates the character of the renal disease
a. Pin-head contraction (chronic inflammation, or impacted calculus)
b. elongated and distorted (distension of renal pelvis or infected nephritis)
c. swollen or pouting (prolonged but not acute inflammation of the renal parenchyma)
d. dilated (advanced tuberculous or calculous pyonephrosis)
e. U shaped (significance doubtful – usually denotes prolonged irritation of renal pelvis).
Ralph Stockman

Archive: Royal College of Physicians and Surgeons of Glasgow
Reference: GB 250 RCPSG 73/1/11 Minute Book No. 6