The Beginnings of Bronchoscopy at the sanatorium of the Canton of Zurich at Arosa-Altein

The first flexible fiberoptic bronchoscope Type „Machida“ of the Sanatorium

Prof. Dr. Johannes Gartmann

Former physician-in-chief

In the early fifties bronchoscopies were, if at all, mainly performed by ENT-specialists, both at university hospitals and in sanatoriums. The intervention was considered unpleasant and painful, the reason why it was preferentially done under general anesthesia.

The then head of the sanatorium in Altein-Arosa, Prof. Dr. Ernst Tanner, sent his collaborator Dr. Roger Hug to Paris, where Dr. J.M. Lemoine had developped the technique of rigid bronchoscopy for diagnostic and therapeutic purposes using local anesthesia and who had trained generations of pulmonary physicians in that technique. By this means bronchoscopy became an essential instrument in the hands of the pulmonary physician. My guess is, that between 1950 and 1978, pulmonary physicians of the sanatorium in Altein-Arosa performed between 2000 to 3000 rigid bronchoscopies, mostly under local anesthesia.

I kept in touch with Lemoine for professional reasons, but at a friendship level as well. I was deeply impressed how Lemoine, who had published his vaste experience drawing from over 50 000 mostly rigid bronchoscopies („Bronchoscopie Clinique“, Editions Piccin, Padova, 1983), switched to the new fiberoptic technique.

In the second half of the sixties we complied with the developpment of new techniques and introduced the flexible fiberbronchosope. In the early phase we introduced the thin „Machida“ instrument through the tube of the rigid bronchoscope. This enabled us to  remove the insrument and to clean the lenses. Later on the instrument was used without any additional splint. I was always amazed how well both, flexible and rigid, bronchoscopy were tolerated under local anesthesia.

PS: also, we only rarely experienced difficulties  when we introduced a double lumen endotracheal tube under local anesthesia for separate measuement of right and left side lung volumes and oxygen consumption.

February 2010