Rediscovering Leo Buerger: The Unwritten Legacy Behind the Brown-Buerger Cystoscope

Abstract

Introduction

Few instruments are as strongly associated with the urologist than the cystoscope. Its development over 400 years to the modern instrument reflects many innovators but the contribution of Leo Buerger, the early 20th century American urologist, cannot be understated. The Brown-Buerger cystoscope was the first American-made cystoscope, was widely adopted throughout the US by 1910, and established itself as the standard instrument in urologic practice, to the extent that Hugh Hampton Young remarked that there was little need for further refinement. Little is known, however, of Leo Buerger himself, from his rise to prominence, to his untimely death in a Manhattan hotel room. Our objective was to fully describe Leo Buerger and how his contributions revolutionized urology.

Sources and Methods

We used historical materials derived from PubMed and Google Scholar; the archives of the William P. Didusch Center for Urologic History, and the archives of the City College of New York, municipal archives, and historical newspapers

Results

Designed by Leo Buerger and manufactured by Wappler Electric Company, the Buerger cystoscope integrated many prior innovations into what would be recognized by today’s urologist as a modern equivalent and included a catheterizing
channel, mirrored lenses, and an irrigating system. Buerger himself, growing up as a European émigré in late 20th century New York, rose to educational prominence in city schools where he was a classmate and friend of Upton Sinclair Jr, trained at Mt Sinai in New York and in Breslau, Germany, and then practiced in the medical wards of Manhattan which served the indigent poor and wealthy alike. His observations of obliterating vascular disease in smokers became known as Buerger’s Disease. His personality was abrasive and a urologic career in California and a real estate enterprise in Manhattan proved unsuccessful. He died in his apartments at the Sherry-Netherland Hotel at the age of 64 in 1943.

Conclusions

Leo Buerger’s revolutionary innovations in instrumentation produced the Brown-Buerger cystoscope which has been the field’s 'work horse' for a century. His personal life was less successful, was sued for divorce, struggled with antisemitism, and grappled with financial failure, and loss. The Brown-Buerger cystoscope, however, remains a coveted prize for the winner of the annual history essay competition of the American Urological Association.

Key Words

Leo Buerger, Frederick Tilden Brown, cystoscopy,