Interview, Part 2, with Joseph B. Kirsner, MD, Phd

Interview, Part 2, with Joseph B. Kirsner, MD, PhD

In the March/April 2006 issue, ASGE News presented the first installment of a series of articles featuring Dr. Joseph Kirsner, founding member of ASGE. Here is the second installment in that series. Joseph Geenen, MD, past president of ASGE, conducted the interview on November 4, 2005.

Joseph Geenen (JG) - How did Rudolf Schindler get to the University of Chicago Hospital? What made him come to Chicago?

Joseph Kirsner (JK) – Dr. Schindler, of course, had been a soldier in the German Army in WWI and had been aware of the GI complaints of the soldiers. He felt that he needed to define the diagnosis better, because in Germany, they had health insurance. If you had a diagnosis, you could get compensation.

He used the gastroscope, which had been in use in Germany, in one form or another, since the middle of the 19th century. He used an instrument called the Elsner gastroscope. He didn’t like it very much, but he used it extensively. He became known throughout Europe for his skill with holding the head. However, that was the job his wife, Gabrielle, did. She moved the head synchronously with the way he introduced the instrument. One day, when he went to Paris without her, he experienced an accident because she wasn’t holding the head. So, Gabrielle was my teacher in holding the head, and Schindler was the one who taught me gastroscopy.

While he was still in Germany, Schindler had fired an employee, because he felt she had been stealing silverware from him. She went to the Gestapo and told them that Schindler had spoken badly of the Gestapo. She also told the Gestapo that he had an ancestor that was partly Jewish; actually Schindler was Lutheran. As a result, he was incarcerated in Dachau. Some people argue that he may have been placed in prison in Munich, but he had become well-known enough that an international group of physicians gathered together to help him. Walter Palmer, associate professor of gastroenterology at the University of Chicago at the time, had become aware of Schindler. Dr. Palmer was part

1 of the group that raised enough money to get Schindler out of prison so that he could come to Chicago as a visiting professor at the University of Chicago.

So, that’s how he came to Chicago in July 1934, and I started working with him in 1937. In time, I became his assistant. On days that he was giving presentations, I would get a call from his wife, saying I should do the gastroscopies.

JG - Was this still a rigid scope?

JK - It was semi-rigid. That principal was developed on the basis of something that had been published in the German literature years earlier by a scientist named Hoffman. If you put lenses at short focal distances from each other on a wire, you could look around the corner. That was part of the basis of the flexibility of the distal end of that instrument. It was basically a rigid instrument; just the lower end was flexible.

JG - Did Dr. Schindler train a lot of people while he was at the University of Chicago?

JK - Oh yes, it became a sensation worldwide, and there never was a day when there wasn’t somebody here from somewhere on earth. There were hundreds and hundreds of people that came to see this phenomenon of observing the living stomach through this instrument. I still remember someone coming to see me from Baghdad--an English physician who was entranced by looking through this gastroscope. In the course of time, Schindler was very concerned about not making it a major specialty; he did not want it to compete with surgery or medicine. He wanted it to be a well-organized diagnostic discipline. He was very careful not to overemphasize the instrument; that really was one of his main concerns during the time I experienced my work with him.

Gastritis was a major issue with him and that’s what led to a major difference of opinion between Schindler and Walter Palmer. In 1943, Schindler left Chicago to go to California and he had other experiences in California and South America.

2 JG - When did Dr. Schindler decide to develop the American Gastroscopic Club?

JK - In the course of those early years, he felt there had to be an organization to regulate a set of training standards and to make sure that well-trained physicians were performing the procedures and evaluating them properly. He had a map that showed where all the visitors had come from, and he chose a dozen individuals who had been prominent in endoscopy, including Ed Benedict of Boston and me. Schindler held a discussion at his house on November 21, 1941, where he argued for the formation of an organization; Dr. Benedict was against the idea. At the end of the day, the vote was positive.

Schindler chose the term club to emphasize that this was another advance, but not the world-shaking event that people might wish.

JG - And he had about 12 physicians at this meeting?

JK - About 12 and they came from different parts of the country. All of them were established gastroenterologists–some were better known than others, but they were certainly involved with the endoscope. Most of the physicians were in private practice, but there were some that were involved in academic affairs. I think that you might say that Herman Moersch from the Mayo Clinic was involved in academic affairs.

JG - Tell me about the bylaws.

JK - Schindler worked with lawyers to set up a constitution and bylaws. The interesting thing about the bylaws was Article 7. In that article, it was written that after 20 years, the organization should be dissolved, because it would no longer be necessary. The practice would be incorporated into the fabric of gastroenterology and medicine generally. As you would expect, that article was the source of much discussion. When I was president, we discussed Article 7 at great length, and we decided to dismiss the principle and not get involved in dissolution.

3 JG - What year was that? When were you president?

JK - I was the sixth president, 1949-50. There was a lot that happened before that.

JG - Tell us about the dues structure.

JK - I was the first secretary-treasurer; the dues were $10 a year. The only requirement was to follow the standards of the endoscopist and to attend meetings. It was one of those situations where the membership steadily grew. The first annual meeting was held in Atlantic City in 1942 on gastritis, which was an important subject with Schindler. In 1943, they had a second meeting on the differential diagnosis of gastric ulcer and gastric carcinoma and at the third meeting, they had was a discussion on limitations of both radiology and endoscopy.

I left the organization in 1943 to join the Army for WWII and turned the secretary- treasurer duties over to Marie Ortmeyer. I picked them up again when I returned from overseas at the end 1946. Incidentally, Peggy Gershoner wrote a detailed account of the organizing meetings as published in Endoscopy in 1955 if anybody is interested in reading about it. It was, for me, as a young physician, very exciting to be part of this.

JG - Why did the name change?

JK – Well, as the organization grew, technology was improving, and, the club did not reflect its expanding dimensions. Eventually, I think it was in 1961, that the name was changed to the American Society for Gastrointestinal Endoscopy.

JG - How did the group get along with the American Gastroenterological Association?

4 JK - Actually, Schindler, even before the organizing meeting, had written to the American Medical Association and several other major organizations, pointing out the importance of the method but not creating another major discipline. We had no problems with any of these organizations. I can’t recall any particular situation. It was a steady, expanding growth, as each year there would be new developments. And of course a major, major development was Basil Hirschowitz’s work with fiber optics.

JG – So, in the early 20th century, did most of the endoscopy was done in Europe and many of our people went over there to study?

JK – Oh, yes, no question. That’s how Marie Ortmeyer came upon Schindler in the first place. She was looking in a bookstore in Vienna and came across a book by Rudolf Schindler on gastroscopy. It had color photographs. She was the one who told Dr. Palmer about this, and on one of his trips to Europe, he visited Schindler. Palmer was aware of what Schindler was doing before he came to the United States. In the meantime, gastroscopy flourished all over the world.

JG - What about the gastric camera? Did you have much to do with the gastric camera?

JK – Schindler played around with it for a little but I don’t think he was impressed by it, and we never did use it at the University of Chicago. One summer, we worked together to try to develop a better instrument that would take pictures, and we failed to achieve our goal. I think that was the time that two people from Rochester, New York, working with the Eastman Kodak Company were able to develop an improvement in that area.

There were all sorts of improvements that used to come without end. You would think that we reached the end of the line, but each year, something new comes along that makes a difference. And of course, it’s hardly necessary to explain what the status of the camera today. It’s an indispensable part of our work.

5 JG - Where do you think the future of endoscopy is going to go?

To find out where Dr. Kirsner sees the future of endoscopy heading, watch for the next issue of ASGE News.