Reflecting on and with Harold Hopkins

Reflecting on and with Harold Hopkins

Who was Harold Hopkins? And why reflections? I will explain.

Like most gastroenterologists, and countless patients, I am greatly in his debt. Hopkins was largely responsible for laying the groundwork for the development of “fibrescopes” (Englishspeak for fiberscopes), the flexible medical instruments like colonoscopes with which many of my readers (if there are any) will be intimately (sic) familiar. I will tell you about him, but first a glimpse at the situation before that to show how revolutionary it all was.

Harold Horace Hopkins

The practice of digestive medicine (Gastroenterology) was very different when I was in training. I think I chose it because it seemed the simplest of the specialties. Nothing too complicated to learn. The role was mainly consultative. We listened, poked and advised with few tools or effective treatments (and no reason to be called out at night or at weekends). There were no scans or endoscopes. We ordered barium meal and enema xray studies to examine the stomach and intestines. Important diseases like ulcers and cancers were usually diagnosed too late for effective treatment. Some brave surgeons (like my surgical teacher in med school, Norman “Pasty” Barrett) used rigid instruments to examine the esophagus. They were rumored to practice on sword swallowers.

A few intrepid gastroenterologists used the “semi-flexible gastroscopes” promoted by Rudolph Schindler and others in the 1940s and 50s. Only the rubber covered tip was somewhat flexible and deflectable. They did not become popular with many doctors (and probably even fewer patients).

The one in the box in the photo is a variant that I found in 1968 in the “gut hut” at St Thomas’s Hospital where I was in training. That actual instrument was presented to me by friends when I revisited St Thomas’s Hospital about 40 years later and adorns my office at MUSC.

My mentor, Brian Creamer, was not impressed with that equipment. He said that it was difficult to use (for both doctor and patient) the views were poor, nobody believed what you said you saw, and there was no way to take photos. More important, he said that gastroscopy would become useful only when it would be possible to take specimens for pathological examination. By happy coincidence, an article appeared in the British Medical Journal that same year describing experience with an early fibreoptic gastroscope made by the Olympus company, which provided great views and a biopsy capability. Brian bought one and my career took off.

Enough about me, back to Hopkins and fiberscopes. He was born into a poor family in northern England just over 100 years ago, excelled at school and eventually studied and worked at Imperial College in London. He moved to the University of Reading (an hour west of London) as Professor of Physics in 1967. In 1954 he published a seminal article in the prestigious journal Nature describing how a bundle of glass fibres (fibers) could transmit light around corners, and actual images if the bundles were “coherent”, ie arranged the same at both ends. An important addendum was published by Abraham van Heel in the same issue of Nature showing that light was propagated better if each fibre was coated with glass of a lower refractive index

Hopkins kindly signed this copy of his seminal paper for me when opening my endoscopy unit at the Middlesex Hospital in 1982

As you will now realize this story is indeed all about “reflections”

Hopkins was certainly not the first to show that light can go around corners, indeed it is obvious to anyone seeing a lighted fountain. Hecht has written a comprehensive chronology reaching back to Roman times (https://www.jeffhecht.com/chron.html). One favorite landmark was the device developed by the Reverend Colladon. Another interesting snippet is a patent application by Logie Baird of Scotland in 1926 concerning fibreoptics, and foreseeing Television.

It was Basil Hirschowitz, a South African born gastroenterologist studying in the United States, who took these ideas to practice. He visited Hopkins and his Indian assistant Narinder Kapany in London in 1956, returned to the University of Michigan in USA and teamed up with engineers C.Wilbur Peters and Larry Curtis. They wound their own fiber bundle over an oats can, made a prototype instrument and used it to take an iconic photograph.

Basil passed the instrument on himself and a patient in 1957, and collaborated with ACMI (American Cystoscope Makers Inc) to produce the first commercial fibreoptic gastroscope in 1960. His presentations to several medical meetings provoked skeptisism as well as enthusiasm, but his Lancet article in 1961 awakened the world to the new era.

Basil had a long and distinguished career at the University of Alabama, Birmingham, focusing more on digestive science (especially acid-related disorders) than endoscopy. Most of the subsequent extraordinary advances in fibreoptic instrumentation have happened in Japan.

Similar fibreoptic instruments found applications in other specialties (thus bronchoscopy, ureteroscopy, sinusoscopy) and some non-human targets. Many of us have examined other animals, from snakes to dolphins (who swallow plastic balls), horses (usually well compensated) and even a panda at London zoo.  Years ago I was asked to look inside a treasured violin to see if there were any strands of glue that can affect the tone. There were not. And one scary moment (there have been several) was helping the police at a kidnap situation in the local spaghetti house restaurant. “Please peek over the windowsill with your instrument to check who is inside”. Industrial “boroscopes” are used by engineers (including my brother and son) to look inside engines and various pipes.

Both Hopkins and Hirschowitz were nominated for Nobel prizes.

It is fair to add that fibrescopes were made obsolete in the mid 1980s when the image system was replaced by increasingly small CCD chips. Fibreoptics now live on in our communications systems.

But, Hopkins was not finished. He also invented the rod-lens optical system which greatly improved the images in rigid instruments and which is now integral to many surgical tools such as laparoscopes and arthroscopes.

Above is the “old” system with thin lenses (in blue) with air between them. The rod-lens system had long lenses with small air gaps.

I am privileged to have met and worked with some of these giants. Hopkins was present at a meeting I attended in 1970 at the headquarters of the National Health Service at the “Elephant and Castle” in London. The NHS brass were concerned about spending so much money buying instruments from Japan (at least 10 by then) and decided to design and build a British endoscope. I remember a confused representative from a glass company that was used to making windows, and the Infection control officer for Britain who insisted that the instrument could be boiled. It hasn’t appeared yet.

There was an even earlier almost concordance, unknown at the time. The building in which Hopkins worked at Reading University (to be named for him later) was but a few miles from where I spent 5 happy years at Leighton Park School. And, as mentioned, he much later opened an endocopy unit for me

I invited Larry Curtiss to give a short speech before dinner at the first big endoscopy conference I organized, at the Holiday Inn in Swiss Cottage, in 1972. I had asked for a brief entertaining expose of the early experiments but got most of his rather boring life history until he was closed down by the British traditional way of showing displeasure, a volley of bread rolls from the younger members of the audience. Sorry Larry.

Finally, Basil Hirschowitz. We met often at medical meetings and I was honored to give the first lecture in his honor at UAB.

How very lucky I have been to have been caught up in this story! Thank you, Professor Hopkins

If anyone wants to go deep into this topic, try to find a copy of “A Brief History of Endoscopy” a book by Irv Modlin, a South African Surgeon, at Yale. It is not brief, but is brilliant. Published in 1999 by Moderna

All part of life’s rich tapestry