How cold light was introduced to arthroscopy.

In 1954, in a landmark publication, H. H. Hopkins reported that images could be transmitted through glass fibers. This stimulated many investigations and, in 1957, B. Hirschowitz at the University of Michigan, succeeded in constructing a much-needed flexible gastroscope using optic glass fibers. Coating of the fibers by glass of lower refractive index was the next major step forward. Optical fibers were thus insulated and the accuracy of the transmitted image and the light transmission capacity of the fibers were enhanced. Working with American Cystoscope Makers Inc, L. Curtiss and H. Hett were the first to use glass fibers for illumination in an endoscope, producing a flexible ureteroscope in 1960. The light transmitted by the fibers was named "cold light" because it produced little heat, but the term had been used before for other types of illumination. The first arthroscope equipped with cold light was Watanabe's arthroscope No. 22 built by Tsunekichi Fukuyo in 1967. However, Watanabe was not satisfied with the new instrument and he still preferred the conventionally illuminated No. 21 arthroscope with the offset tungsten bulb at his tip. After R. W. Jackson reintroduced the technique to North America, most American pioneers used this conventionally illuminated arthroscope as well. But the early European arthroscopists had cold light instruments made by the German manufacturers R. Wolf and K. Storz since 1969. These rod-lens cold light instruments expanded in all markets during the following decade.

Eugen Bircher (1882-1956) the first knee surgeon to use diagnostic arthroscopy.

Eugen Bircher was a strong advocate of diagnostic arthroscopy as shown in several papers on the topic of internal derangements of the knee published between 1921 and 1926. During that time, he performed about 60 endoscopic procedures, which usually preceded a meniscectomy. We believe that this was the first time arthroscopy was used in a large scale for clinical purposes. Bircher was the head surgeon of the busy provincial Aarau General Hospital, a right-wing politician, and a highly ranked army officer. His interest in knee surgery was supported by his friend Fritz Steinmann, who was the "man of the pin" and an early promoter of skeletal traction for fracture treatment. Bircher believed in the early surgical treatment of meniscal lesions and, later, in the reconstruction of cruciate ligament lesions. He used the Jacobaeus thoracolaparoscope for arthroscopy, but it had poor endoscopic qualities. The electric lamp at the tip of the optical device was not mechanically protected and was therefore endangered by every manipulation within the joint space. Also, the 90 degrees optical system delivered a dark image. By the late 1920s, Bircher had developed the technique of double-contrast arthrography, and he gave up endoscopy by 1930. In 1935, he left surgery and took a military command in the Swiss army; later he was a representative of the Farmers Party in the National Parliament until his death.