August Karl Gustav Bier (24 November 1861 – 12 March 1949) was a German

surgeon In medicine, a surgeon is a medical doctor who performs surgery. Even though there are different traditions in different times and places, a modern surgeon is a licensed physician and received the same medical training as physicians before spec ...

. He was the first to perform

spinal anesthesia Spinal anaesthesia (or spinal anesthesia), also called spinal block, subarachnoid block, intradural block and intrathecal block, is a form of neuraxial regional anaesthesia involving the injection of a local anaesthetic with or without an opioi ...

and intravenous regional anesthesia.

Early medical career

Bier began his medical education at the Charité – Universitätsmedizin Berlin in 1881, transferred to the

Leipzig University Leipzig University (), in Leipzig in Saxony, Germany, is one of the world's oldest universities and the second-oldest university (by consecutive years of existence) in Germany. The university was founded on 2 December 1409 by Frederick I, Electo ...

in 1882, and transferred again to the

University of Kiel Kiel University, officially the Christian Albrecht University of Kiel, (, abbreviated CAU, known informally as Christiana Albertina) is a public research university in the city of Kiel, Germany. It was founded in 1665 as the ''Academia Holsator ...

in 1883. After receiving his medical degree from the University of Kiel in 1886, Bier worked as a general practitioner and ship's surgeon just outside the city of Kiel – which is a major port on the Baltic Sea. Bier began his residency in 1888 at the surgical clinic at the University of Kiel, under the mentorship of Friedrich von Esmarch. After professorships in

Greifswald Greifswald (), officially the University and Hanseatic City of Greifswald (, Low German: ''Griepswoold'') is the fourth-largest city in the German state of Mecklenburg-Western Pomerania after Rostock, Schwerin and Neubrandenburg. In 2021 it surpa ...

and

Bonn Bonn () is a federal city in the German state of North Rhine-Westphalia, located on the banks of the Rhine. With a population exceeding 300,000, it lies about south-southeast of Cologne, in the southernmost part of the Rhine-Ruhr region. This ...

, Bier was appointed Chief Surgeon and

Geheimrat was the title of the highest advising officials at the imperial, royal, or princely courts of the Holy Roman Empire, who jointly formed the ''Geheimer Rat'' reporting to the ruler. The term remained in use during subsequent monarchic reigns in Ge ...

Professor of Surgery at the Charité - Universitätsmedizin.

Spinal anesthesia

On 16 August 1898, Bier performed the first operation under spinal anesthesia at the Royal Surgical Hospital of the

. The patient was scheduled to undergo

segmental resection Segmental resection, or segmentectomy, is a surgical procedure to remove part of an organ or gland as a sub-type of resection, which might involve removing the whole body part. It may also be used to remove a tumor and the normal tissue around it ...

of his left ankle, which was severely infected with

tuberculosis Tuberculosis (TB), also known colloquially as the "white death", or historically as consumption, is a contagious disease usually caused by ''Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can al ...

, but he dreaded the prospect of

general anesthesia General anaesthesia (UK) or general anesthesia (US) is medically induced loss of consciousness that renders a patient unarousable even by painful stimuli. It is achieved through medications, which can be injected or inhaled, often with an analgesi ...

because he had suffered severe adverse

side effect In medicine, a side effect is an effect of the use of a medicinal drug or other treatment, usually adverse but sometimes beneficial, that is unintended. Herbal and traditional medicines also have side effects. A drug or procedure usually use ...

s during multiple previous operations. Therefore, Bier suggested " cocainization" of the

spinal cord The spinal cord is a long, thin, tubular structure made up of nervous tissue that extends from the medulla oblongata in the lower brainstem to the lumbar region of the vertebral column (backbone) of vertebrate animals. The center of the spinal c ...

as an alternative to general anesthesia. Bier injected 15 mg of cocaine

intrathecally Intrathecal administration is a route of administration for drugs via an injection into the spinal canal, or into the subarachnoid space (sin. ''intrathecal space'') so that it reaches the cerebrospinal fluid (CSF). It is useful in several appl ...

, which was sufficient to allow him to perform the operation. The subject was fully conscious during the operation, but felt no pain. Two hours after the operation, the subject complained of

nausea Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. It can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the throat. Over 30 d ...

vomiting Vomiting (also known as emesis, puking and throwing up) is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenteritis, pre ...

, severe

headache A headache, also known as cephalalgia, is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of Depression (mood), depression in those with severe ...

, and pain in his back and ankle. The vomiting, back and leg pain improved by the following day, but the headache was still present. Bier performed spinal anesthetics on five more subjects for lower extremity surgery, using a similar technique and achieving similar results. After this series of six subjects, Bier was to receive a spinal anesthetic administered by his assistant, August Hildebrandt. Unfortunately, although Hildebrandt placed the spinal needle correctly, with

cerebrospinal fluid Cerebrospinal fluid (CSF) is a clear, colorless Extracellular fluid#Transcellular fluid, transcellular body fluid found within the meninges, meningeal tissue that surrounds the vertebrate brain and spinal cord, and in the ventricular system, ven ...

flowing freely from it, the

syringe A syringe is a simple reciprocating pump consisting of a plunger (though in modern syringes, it is actually a piston) that fits tightly within a cylindrical tube called a barrel. The plunger can be linearly pulled and pushed along the inside ...

was only then discovered to not fit into the hub of the needle. During the efforts to fit the syringe into the hub of the needle, a great deal of cerebrospinal fluid escaped, most of the cocaine to be injected was lost, and the spinal anesthetic was consequently a complete failure. Later that same evening, Bier performed a cocaine spinal anesthetic on Hildebrandt. After the injection, Hildebrandt was temporarily unable to move or feel any sensation in his legs. The profound anesthesia of his legs was demonstrated using increasingly painful stimuli, including a needle inserted down to the femur, a blow with an iron hammer to the shins, forceful avulsion of pubic hair, and "strong pressure and traction" to the testicles. Later that evening, they celebrated their success with wine and cigars. Like all of Bier's previous experimental subjects, Bier and Hildebrandt both experienced severe post-spinal headaches. Hildebrandt's symptoms lasted about four days, while Bier remained confined to bed for nine days.

Intravenous regional anesthesia

In 1908, Bier pioneered the use of intravenous regional anesthesia, a technique which is commonly referred to as a "Bier block". This technique is frequently used for operations of brief duration upon the hand, wrist, and forearm. It can also be used for operations of brief duration upon the foot, ankle, and leg.

Charité – Universitätsmedizin Berlin

In 1903 he joined the faculty of the

University of Bonn The University of Bonn, officially the Rhenish Friedrich Wilhelm University of Bonn (), is a public research university in Bonn, North Rhine-Westphalia, Germany. It was founded in its present form as the () on 18 October 1818 by Frederick Willi ...

as a full professor, where he taught until 1907. Then he went to Berlin, where he was appointed

Professor Professor (commonly abbreviated as Prof.) is an Academy, academic rank at university, universities and other tertiary education, post-secondary education and research institutions in most countries. Literally, ''professor'' derives from Latin ...

of Surgery and Chief Surgeon at the Charité – Universitätsmedizin. Bier was elected President of the German Surgical Society in 1911. Bier treated many important people, such as

Kaiser Wilhelm II Wilhelm II (Friedrich Wilhelm Viktor Albert; 27 January 18594 June 1941) was the last German Emperor and King of Prussia from 1888 until his abdication in 1918, which marked the end of the German Empire as well as the Hohenzollern dynasty ...

, family members of

Nicholas II of Russia Nicholas II (Nikolai Alexandrovich Romanov; 186817 July 1918) or Nikolai II was the last reigning Emperor of Russia, Congress Poland, King of Congress Poland, and Grand Duke of Finland from 1 November 1894 until Abdication of Nicholas II, hi ...

, and

Vladimir Lenin Vladimir Ilyich Ulyanov ( 187021 January 1924), better known as Vladimir Lenin, was a Russian revolutionary, politician and political theorist. He was the first head of government of Soviet Russia from 1917 until Death and state funeral of ...

. Although he was arguably the most accomplished surgeon of his time, not all of his operations were successful.

Hugo Stinnes Hugo Adolf Eugen Victor Stinnes commonly known as Hugo Stinnes (12 February 1870 – 10 April 1924) was a German industrialist and politician who served as a member of Reichstag from 1920 to 1924 (his death). During the late era of the German Em ...

business magnate A business magnate, also known as an industrialist or tycoon, is a person who is a powerful entrepreneur and investor who controls, through personal enterprise ownership or a dominant shareholding position, a firm or industry whose goods or ser ...

and politician who was among the wealthiest men in the world at that time) died on 10 April 1924, about a month after Bier performed a

cholecystectomy Cholecystectomy is the surgical removal of the gallbladder. Cholecystectomy is a common treatment of symptomatic gallstones and other gallbladder conditions. In 2011, cholecystectomy was the eighth most common operating room procedure performed i ...

on him. On 24 February 1925, Bier performed an

appendectomy An appendectomy (American English) or appendicectomy (British English) is a Surgery, surgical operation in which the vermiform appendix (a portion of the intestine) is removed. Appendectomy is normally performed as an urgent or emergency procedur ...

Friedrich Ebert Friedrich Ebert (; 4 February 187128 February 1925) was a German politician of the Social Democratic Party of Germany, Social Democratic Party (SPD) who served as the first President of Germany (1919–1945), president of Germany from 1919 until ...

, the first

President of Germany The president of Germany, officially titled the Federal President of the Federal Republic of Germany (),The official title within Germany is ', with ' being added in international correspondence; the official English title is President of the F ...

, who had signed the

Weimar Constitution The Constitution of the German Reich (), usually known as the Weimar Constitution (), was the constitution that governed Germany during the Weimar Republic era. The constitution created a federal semi-presidential republic with a parliament whose ...

into law in 1919. Ebert, who had suffered from

appendicitis Appendicitis is inflammation of the Appendix (anatomy), appendix. Symptoms commonly include right lower abdominal pain, nausea, vomiting, fever and anorexia (symptom), decreased appetite. However, approximately 40% of people do not have these t ...

for two weeks before it was diagnosed, died of

septic shock Septic shock is a potentially fatal medical condition that occurs when sepsis, which is organ injury or damage in response to infection, leads to dangerously low blood pressure and abnormalities in cellular metabolism. The Third International C ...

four days after the operation. Bier was Chief Surgeon at the Charité in Berlin until 1928, when

Ferdinand Sauerbruch Ernst Ferdinand Sauerbruch (; 3 July 1875 – 2 July 1951) was a German surgeon. His major work was on the use of negative-pressure chambers for surgery. Biography Sauerbruch was born in Barmen (now a district of Wuppertal), Germany. He st ...

(18751951) assumed the position. Bier remained at the Charité as Professor Emeritus until his retirement in 1932.

Sports medicine

Bier is also considered to be a pioneer in the field of

sports medicine Sports medicine is a branch of medicine that deals with physical fitness and the treatment and prevention of injuries related to sports and exercise. Although most sports teams have employed team physicians for many years, it is only since the ...

, having played a pivotal role in establishing it as a discipline. Along with Arthur Mallwitz (18801968), Bier organized the first lectures in sports medicine at the

University of Berlin The Humboldt University of Berlin (, abbreviated HU Berlin) is a public research university in the central borough of Mitte in Berlin, Germany. The university was established by Frederick William III on the initiative of Wilhelm von Humbol ...

in 1919. Bier served as director of the '' Deutsche Hochschule für Leibesübungen'' ("German University of Physical Education") in Berlin from its founding in 1920 until 1932. Sauerbruch temporarily headed the academy until 1933, when

Karl Gebhardt Karl Franz Gebhardt (23 November 1897 – 2 June 1948) was a Nazi physician and a war criminal. Gebhardt was the main coordinator of a series of medical atrocities performed on inmates of the concentration camps at Ravensbrück and Auschwitz. ...

(18971948) assumed the directorship. Gebhardt became the first professor of sports medicine in Berlin. Gebhardt expanded on Bier's methods, adopting an academic approach to sports medicine and awarding degrees.

Awards

In 1910, Bier was awarded the

Cameron Prize for Therapeutics of the University of Edinburgh The Cameron Prize for Therapeutics of the University of Edinburgh is awarded by the University of Edinburgh College of Medicine and Veterinary Medicine, College of Medicine and Veterinary Medicine to a person who has made any highly important and v ...

. The title of

was bestowed upon Bier by German Emperor Wilhelm II. On 24 November 1936, Bier received the Eagle Shield of the German Reich. On 30 January 1938, Bier became one of only nine people to ever receive the

German National Prize for Art and Science German(s) may refer to: * Germany, the country of the Germans and German things **Germania (Roman era) * Germans, citizens of Germany, people of German ancestry, or native speakers of the German language ** For citizenship in Germany, see also Ge ...

, an award created by

Adolf Hitler Adolf Hitler (20 April 1889 – 30 April 1945) was an Austrian-born German politician who was the dictator of Nazi Germany from 1933 until Death of Adolf Hitler, his suicide in 1945. Adolf Hitler's rise to power, He rose to power as the lea ...

that year as a replacement for the

Nobel Prize The Nobel Prizes ( ; ; ) are awards administered by the Nobel Foundation and granted in accordance with the principle of "for the greatest benefit to humankind". The prizes were first awarded in 1901, marking the fifth anniversary of Alfred N ...

, which he had forbidden Germans to accept.

Death

Bier's wife Anna died in 1947. In January 1949, he suffered from

apoplexy Apoplexy () refers to the rupture of an internal organ and the associated symptoms. Informally or metaphorically, the term ''apoplexy'' is associated with being furious, especially as "apoplectic". Historically, it described what is now known as a ...

and later died in Soviet-occupied Sauen in March 1949 after contracting

influenza Influenza, commonly known as the flu, is an infectious disease caused by influenza viruses. Symptoms range from mild to severe and often include fever, runny nose, sore throat, muscle pain, headache, coughing, and fatigue. These sympto ...

and

pneumonia Pneumonia is an Inflammation, inflammatory condition of the lung primarily affecting the small air sacs known as Pulmonary alveolus, alveoli. Symptoms typically include some combination of Cough#Classification, productive or dry cough, ches ...

. He was 87. They were buried in a forest on their estate.

References

External links

* * {{DEFAULTSORT:Bier, August 1861 births 1949 deaths People from Bad Arolsen People from the Principality of Waldeck and Pyrmont German surgeons Academic staff of the University of Bonn Academic staff of the University of Greifswald Imperial German Navy personnel Physicians of the Charité Leipzig University alumni