August Bier

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August Bier
August Bier.jpg
August Bier
Born(1861-11-24)24 November 1861
Died12 March 1949(1949-03-12) (aged 87)
Nationality German
Citizenship German
Known for spinal anesthesia, intravenous regional anesthesia
Awards Geheimrat, Eagle Shield of the German Reich, German National Prize for Art and Science
Scientific career
Fields surgery, anesthesiology
Institutions University of Greifswald,
University of Bonn,
Charité - Universitätsmedizin
Influences Friedrich von Esmarch, William Stewart Halsted, Karl Koller, Heinrich Quincke, Carl Ludwig Schleich, Rudolf Virchow

August Karl Gustav Bier (24 November 1861 – 12 March 1949) was a German surgeon. He was the first to perform spinal anesthesia [1] and intravenous regional anesthesia. [2] [3] [4]

Germans are a Germanic ethnic group native to Central Europe, who share a common German ancestry, culture and history. German is the shared mother tongue of a substantial majority of ethnic Germans.

Surgeon physician with surgical specialty

In modern medicine, a surgeon is a physician who performs surgical operations. There are also surgeons in podiatry, dentistry maxillofacial surgeon and the veterinary fields.

Spinal anaesthesia

Spinal anaesthesia, 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 or opioid into the subarachnoid space, generally through a fine needle, usually 9 cm (3.5 in) long. It is a safe and effective form of anesthesia performed by nurse anesthetists and anesthesiologists which can be used as an alternative to general anesthesia commonly in surgeries involving the lower extremities and surgeries below the umbilicus. The local anesthetic or opioid injected into the cerebrospinal fluid provides anesthesia, analgesia, and motor and sensory blockade. The tip of the spinal needle has a point or small bevel. Recently, pencil point needles have been made available.


Early medical career

Bier began his medical education at the Charité – Universitätsmedizin Berlin in 1881, transferred to the Leipzig University in 1882, and transferred again to the University of Kiel 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. [5] After professorships in Greifswald and Bonn, Bier was appointed Chief Surgeon and Geheimrat Professor of Surgery at the Charité - Universitätsmedizin. [6]

Charité university hospital in Berlin, Germany

The Charité – Universitätsmedizin Berlin is one of Europe's largest university hospitals, affiliated with Humboldt University and Free University Berlin. With numerous Collaborative Research Centers (CRC) of the Deutsche Forschungsgemeinschaft it is one of Germany's most research-intensive medical institutions. From 2012 to 2019, it was ranked by Focus as the best of over 1000 hospitals in Germany. US Newsweek ranked the Charité as fifth best hospital in the world and best in Europe (2019). More than half of all German Nobel Prize winners in Physiology or Medicine, including Emil von Behring, Robert Koch and Paul Ehrlich, have worked at the Charité. Several politicians and diplomats have been treated at the Charité, including German Chancellor Angela Merkel and Julia Timoschenko from Ukraine.

Leipzig University university in Germany

Leipzig University, in Leipzig in the Free State of Saxony, Germany, is one of the world's oldest universities and the second-oldest university in Germany. The university was founded on December 2, 1409 by Frederick I, Elector of Saxony and his brother William II, Margrave of Meissen, and originally comprised the four scholastic faculties. Since its inception, the university has engaged in teaching and research for over 600 years without interruption.

University of Kiel university

Kiel University is a university in the city of Kiel, Germany. It was founded in 1665 as the Academia Holsatorum Chiloniensis by Christian Albert, Duke of Holstein-Gottorp and has approximately 27,000 students today. Kiel University is the largest, oldest, and most prestigious in the state of Schleswig-Holstein. Until 1864/66 it was not only the northernmost university in Germany but at the same time the 2nd largest university of Denmark. Faculty, alumni, and researchers of the Kiel University have won 12 Nobel Prizes. Kiel University is a member of the German Universities Excellence Initiative since 2006. The Cluster of Excellence The Future Ocean, which was established in cooperation with the GEOMAR Helmholtz Centre for Ocean Research Kiel in 2006, is internationally recognized. The second Cluster of Excellence "Inflammation at Interfaces" deals with chronic inflammatory diseases. The Kiel Institute for the World Economy is also affiliated with Kiel University.

Spinal anesthesia

Cerebrospinal fluid flowing through a 25 gauge spinal needle during spinal anesthesia Liquor bei Spinalanaesthesie.JPG
Cerebrospinal fluid flowing through a 25 gauge spinal needle during spinal anesthesia

On 16 August 1898, Bier performed the first operation under spinal anesthesia at the Royal Surgical Hospital of the University of Kiel. The patient was scheduled to undergo segmental resection of his left ankle, which was severely infected with tuberculosis, but he dreaded the prospect of general anesthesia because he had suffered severe adverse side effects during multiple previous operations. Therefore, Bier suggested "cocainization" of the spinal cord as an alternative to general anesthesia. Bier injected 15 mg of cocaine intrathecally, 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, vomiting, severe headache, 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. [1] [4]

Segmental resection is a surgical procedure to remove part of an organ or gland, as a sub-type of a resection, which might involve removing the whole body part. It may also be used to remove a tumor and normal tissue around it. In lung cancer surgery, segmental resection refers to removing a section of a lobe of the lung. The resection margin is the edge of the removed tissue; it is important that this shows free of cancerous cells on examination by a pathologist.

Tuberculosis Infectious disease caused by the bacterium Mycobacterium tuberculosis

Tuberculosis (TB) is an infectious disease usually caused by Mycobacterium tuberculosis (MTB) bacteria. Tuberculosis generally affects the lungs, but can also affect other parts of the body. Most infections do not have symptoms, in which case it is known as latent tuberculosis. About 10% of latent infections progress to active disease which, if left untreated, kills about half of those affected. The classic symptoms of active TB are a chronic cough with blood-containing sputum, fever, night sweats, and weight loss. It was historically called "consumption" due to the weight loss. Infection of other organs can cause a wide range of symptoms.

General anaesthesia

General anaesthesia or general anesthesia is a medically induced coma with loss of protective reflexes, resulting from the administration of one or more general anaesthetic agents. It is carried out to allow medical procedures that would otherwise be intolerably painful for the patient; or where the nature of the procedure itself precludes the patient being awake.

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 flowing freely from it, the syringe 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 [7] . 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. [1] [4]

Hypodermic needle Device to inject substances into the circulatory system

A hypodermic needle, one of a category of medical tools which enter the skin, called sharps, is a very thin, hollow tube with a sharp tip that contains a small opening at the pointed end. It is commonly used with a syringe, a hand-operated device with a plunger, to inject substances into the body or extract fluids from the body. They are used to take liquid samples from the body, for example taking blood from a vein in venipuncture. Large-bore hypodermic intervention is especially useful in catastrophic blood loss or treating shock.

Cerebrospinal fluid clear colorless bodily fluid found in the brain and spine

Cerebrospinal fluid (CSF) is a clear, colorless body fluid found in the brain and spinal cord. It is produced by the specialised ependymal cells in the choroid plexuses of the ventricles of the brain, and absorbed in the arachnoid granulations. There is about 125mL of CSF at any one time, and about 500 mL is generated every day. CSF acts as a cushion or buffer for the brain, providing basic mechanical and immunological protection to the brain inside the skull. CSF also serves a vital function in cerebral autoregulation of cerebral blood flow.

Syringe a simple pump consisting of a plunger that fits tightly in a tube

A syringe is a simple reciprocating pump consisting of a plunger that fits tightly within a cylindrical tube called a barrel. The plunger can be linearly pulled and pushed along the inside of the tube, allowing the syringe to take in and expel liquid or gas through a discharge orifice at the front (open) end of the tube. The open end of the syringe may be fitted with a hypodermic needle, a nozzle or a tubing to help direct the flow into and out of the barrel. Syringes are frequently used in clinical medicine to administer injections, infuse intravenous therapy into the bloodstream, apply compounds such as glue or lubricant, and draw/measure liquids.

Intravenous regional anesthesia

Intravenous regional anesthesia Venadaxili regional anesteziya.jpg
Intravenous regional anesthesia

In 1908, Bier pioneered the use of intravenous regional anesthesia, [2] [3] a technique which is commonly referred to as a "Bier block". [4] 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. [2] [3]

Intravenous regional anesthesia

Intravenous regional anesthesia (IVRA) or Bier's block anesthesia is an anesthetic technique on the body's extremities where a local anesthetic is injected intravenously and isolated from circulation in a target area. The technique usually involves exsanguination of the target region, which forces blood out of the extremity, followed by the application of pneumatic tourniquets to safely stop blood flow. The anesthetic agent is intravenously introduced into the limb and allowed to diffuse into the surrounding tissue while tourniquets retain the agent within the desired area.

Charité - Universitätsmedizin Berlin

In 1903 he joined the faculty of the University of Bonn as a full professor, where he taught until 1907. Then he went to Berlin, where he was appointed Geheimrat Professor of Surgery and Chief Surgeon at the Charité - Universitätsmedizin. Bier was elected President of the German Surgical Society in 1911. [8] Bier treated many important people, such as Kaiser Wilhelm II, family members of Nicholas II of Russia, and Vladimir Lenin. [5]

University of Bonn public research university located in Bonn, Germany

The University of Bonn is a public research university located in Bonn, Germany. It was founded in its present form as the Rhein-Universität on 18 October 1818 by Frederick William III, as the linear successor of the Kurkölnische Akademie Bonn which was founded in 1777. The University of Bonn offers a large number of undergraduate and graduate programs in a range of subjects and has 544 professors and 32,500 students. Its library holds more than five million volumes.

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 German-speaking areas of Europe until the end of the First World War. At its origin the literal meaning of the word in German was 'trusted advisor'. The English-language equivalent is Privy Councillor.

Professor academic title at universities and other post-secondary education and research institutions in most countries

Professor is an academic rank at universities and other post-secondary education and research institutions in most countries. Literally, professor derives from Latin as a "person who professes" being usually an expert in arts or sciences, a teacher of the highest rank.

Although he was arguably the most accomplished surgeon of his time, not all of his operations were successful. Hugo Stinnes (a Business magnate 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 on him. [9] On 24 February 1925, Bier performed an appendectomy on Friedrich Ebert, the first President of Germany, [10] who had signed the Weimar Constitution into law in 1919. Ebert, who had suffered from appendicitis for two weeks before it was diagnosed, died of septic shock four days after the operation. [11] Upon Ebert's death, Paul von Hindenburg was elected as successor.

Bier was Chief Surgeon at the Charité in Berlin until 1928, when Ferdinand Sauerbruch (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, having played a pivotal role in establishing it as a discipline. [12] Along with Arthur Mallwitz (18801968), Bier organized the first lectures in sports medicine at the University of Berlin in 1919. [13] [14] 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 (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. [12]


The title of Geheimrat was bestowed upon Bier by German Emperor Wilhelm II. [6] 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, [15] an award created by Adolf Hitler that year as a replacement for the Nobel Prize, which he had forbidden Germans to accept.

See also

Related Research Articles

Anesthesia State of medically controlled temporary loss of sensation or awareness

Anesthesia or anaesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical purposes. It may include analgesia, paralysis, amnesia, or unconsciousness. A patient under the effects of anesthetic drugs is referred to as being anesthetized.

Local anesthesia is any technique to induce the absence of sensation in a specific part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It allows patients to undergo surgical and dental procedures with reduced pain and distress. In many situations, such as cesarean section, it is safer and therefore superior to general anesthesia. It is also used for relief of non-surgical pain and to enable diagnosis of the cause of some chronic pain conditions. Anesthetists sometimes combine both general and local anesthesia techniques.

Local anesthetic medication that causes reversible absence of pain sensation

A local anesthetic (LA) is a medication that causes absence of pain sensation. When it is used on specific nerve pathways, paralysis also can be achieved.

Lumbar puncture Procedure to collect cerebrospinal fluid

Lumbar puncture (LP), also known as a spinal tap, is a medical procedure in which a needle is inserted into the spinal canal, most commonly to collect cerebrospinal fluid (CSF) for diagnostic testing. The main reason for a lumbar puncture is to help diagnose diseases of the central nervous system, including the brain and spine. Examples of these conditions include meningitis and subarachnoid hemorrhage. It may also be used therapeutically in some conditions. Increased intracranial pressure is a contraindication, due to risk of brain matter being compressed and pushed toward the spine. Sometimes, lumbar puncture cannot be performed safely. It is regarded as a safe procedure, but post-dural-puncture headache is a common side effect.

Werner Forssmann German physician, Nobel prize winner

Werner Theodor Otto Forßmann was a physician from Germany who shared the 1956 Nobel Prize in Medicine for developing a procedure that allowed cardiac catheterization. In 1929, he put himself under local anesthesia and inserted a catheter into a vein of his arm. Not knowing if the catheter might pierce a vein, he put his life at risk. Forssmann was nevertheless successful; he safely passed the catheter into his heart.

Ferdinand Sauerbruch German surgeon

Ernst Ferdinand Sauerbruch was a German surgeon.

Friedrich Trendelenburg German surgeon

Friedrich Trendelenburg was a German surgeon. He was son of the philosopher Friedrich Adolf Trendelenburg, father of the pharmacologist Paul Trendelenburg and grandfather of the pharmacologist Ullrich Georg Trendelenburg.

Karl Gebhardt Nazi doctor and war criminal

Karl Franz Gebhardt was a German medical doctor and a war criminal during World War II. He served as Medical Superintendent of the Hohenlychen Sanatorium, Consulting Surgeon of the Waffen-SS, Chief Surgeon in the Staff of the Reich Physician SS and Police, and personal physician to Heinrich Himmler.

Jean Emily Henley from was an anesthesiologist. She was the only child of Eugene Henry and Helen Esther Heller, who emigrated from Hungary and Germany respectively into the United States. She was fluent in German, due to that being her parents native language. The father changed the family surname to Henley while she was still a child. Both parents practiced lay psychotherapy and later obtained PhDs. As both a sculptor and linguist, she had many accomplishments.

Rudolf Ulrich Krönlein Swiss surgeon

Rudolf Ulrich Krönlein was a Swiss surgeon who was a native of Stein am Rhein.

Fidel Pagés Miravé was a Spanish military surgeon, known for developing the technique of epidural anesthesia.

History of general anesthesia aspect of history

Attempts at producing a state of general anesthesia can be traced throughout recorded history in the writings of the ancient Sumerians, Babylonians, Assyrians, Egyptians, Greeks, Romans, Indians, and Chinese. During the Middle Ages, which correspond roughly to what is sometimes referred to as the Islamic Golden Age, scientists and other scholars made significant advances in science and medicine in the Muslim world and Eastern world.

Brachial plexus block

Brachial plexus block is a regional anesthesia technique that is sometimes employed as an alternative or as an adjunct to general anesthesia for surgery of the upper extremity. This technique involves the injection of local anesthetic agents in close proximity to the brachial plexus, temporarily blocking the sensation and ability to move the upper extremity. The subject can remain awake during the ensuing surgical procedure, or s/he can be sedated or even fully anesthetized if necessary.

The following outline is provided as an overview of and topical guide to anesthesia:

History of neuraxial anesthesia

The history of neuraxial anesthesia goes back to 1885.

James Leonard Corning American neurologist

James Leonard Corning was an American neurologist, mainly known for his early experiments on neuraxial blockade in New York City.

William Keiller

William Keiller was a Scottish born anatomist who trained in anatomy at the Edinburgh Extramural School of Medicine and was appointed as the first Professor of Anatomy at the University of Texas Medical Branch (UTMB) at Galveston, a post he held for 40 years. He served as Dean of the UTMB Medical School and as President of the Texas Medical Association. Many of his anatomical drawings and paintings are preserved and displayed at the Blocker History of Medicine collection at UTMB Moody Medical Library.


  1. 1 2 3 Bier, A (1899). "Versuche uber cocainisirung des ruckenmarkes (Experiments on the cocainization of the spinal cord)". Deutsche Zeitschrift Fur Chirurgie (in German). 51 (3–4): 361–9. doi:10.1007/bf02792160.
  2. 1 2 3 Bier, A (1908). "Ueber einen neuen weg localanasthesie in den gliedmaassen zu erzeugen (On a new technique to induce local anesthesia in extremities)". Langenbeck's Archiv für Klinische Chirurgie (in German). 86: 1007–16.
  3. 1 2 3 Bier, A (1909). "Ueber venenanasthesie (On venous anesthesia)". Berliner Klinische Wochenschrift (in German). 46: 477–89.
  4. 1 2 3 4 Wulf, HFW (1998). "The centennial of spinal anesthesia". Anesthesiology. 89 (2): 500–6. doi:10.1097/00000542-199808000-00028. PMID   9710410.
  5. 1 2 Van Zundert, A; Goerig, M (2000). "August Bier 1861-1949. A tribute to a great surgeon who contributed much to the development of modern anesthesia on the 50th anniversary of his death". Regional Anesthesia and Pain Medicine. 25 (1): 26–33. doi:10.1016/S1098-7339(00)80007-3. PMID   10660237.
  6. 1 2 Little Jr., DM (1962). "Classical file". Survey of Anesthesiology. 6 (3): 351. doi:10.1097/00132586-196206000-00068.
  8. Shrady, George Frederick; Stedman, Thomas Lathrop (21 January 1911). "Fiftieth anniversary of Berlin Medical Society". Medical Record: A Weekly Journal of Medicine and Surgery. 79 (3): 119–20.
  9. "Hugo Stinnes dead; was one of the world's richest men and German leader". The Lewiston Daily Sun. Lewiston, Maine. Associated Press. 11 April 1924. p. 1,7. Retrieved 9 June 2012.
  10. "German president has appendicitis". The Evening Record. Ellensburg, Washington: Ellensburg Daily Record. Associated Press. 24 February 1925. p. 2. Retrieved 9 June 2012.
  11. Kershaw, I (1998). Hitler, 1889-1936: Hubris. New York: W. W. Norton & Company. p. 267. ISBN   978-0393320350.
  12. 1 2 Silver, JR (2011). "Karl Gebhardt (1897–1948): a lost man". Journal of the Royal College of Physicians of Edinburgh. 41 (4): 366–71. doi:10.4997/JRCPE.2011.417. PMID   22184577.
  13. Beamish, R; Ritchie, I (2006). ""Sport", German traditions, and the development of "training"". Fastest, Highest, Strongest: A Critique of High-Performance Sport. New York: Routledge. p. 53. ISBN   978-0415770422.
  14. Berg, A; König, D (2002). "History of sports medicine in germany with special reference to the university of Freiburg". European Journal of Sport Science. 2 (4): 1–7. doi:10.1080/17461390200072402.
  15. Nimmergut, J (2001). Deutsche Orden und Ehrenzeichen bis 1945 (German medals and decorations to 1945) (in German). Band 4: Württemberg II – Deutsches Reich (Volume 4: Württemberg II - German Empire). Munich: Zentralstelle für Wissenschaftliche Ordenskunde. p. 1915. ISBN   978-3-00-001396-6.

Further reading

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