August Karl Gustav Bier

August Karl Gustav Bier (1861 – 1949)

August Karl Gustav Bier (1861 – 1949) was a German Surgeon.

Student of Johannes Friedrich August von Esmarch – the Esmarch tourniquet formed the basis of his eponymous Bier block regional anaesthesia

Credited with the first spinal anesthetic, Bier experimented with self cocainisation of the spinal cord.


Biography

  • 1861- Born 24th November in Helsen, Germany
  • 1886 – Graduated from the University of Kiel. While in residency, he became an assistant to Johannes Freidrich von Esmarch and supervised the changeover from the antiseptic to aseptic system in operating theatres
  • 1889 – Performed the first spinal anaesthetic
  • 1903 – Became Professor of Surgery at Bonn
  • 1905 – Married his first patient, Anna Esau with whom he had 5 children
  • 1907 – Appointed Chair of Surgery in Berlin
  • 1908 – Described intravenous procaine analgesia (Bier’s Block)
  • 1915 – Military physician Friedrick Schwerd and Professor August Bier of the Technical Institute of Hanover developed the prototype M16 steel helmet for German troops in WW1.
  • 1937 – Awarded the German National Prize for the Arts and Science
  • 1949 – Died 12th March, aged 87

Medical Eponyms

  • Bier Block
  • Bier Bandage

Key Medical Attributions

In 1889, he performed the first spinal anaesthetic using 3mL of 0.5% solution of cocaine on a 34 year old man with disseminated tuberculosis who required partial amputation of the leg. According to Bier, the man reported having no feeling in the lower half of his body, remained conscious throughout the operation and informed Bier that he had not felt any pain. Bier also noted that the patient could not move his limbs throughout the procedure

After successfully administering six spinal blocks, Bier allowed his junior colleague, Otto Hildebrandt (1868- 1954) to inject 2 mL of 1% cocaine solution into his own (Bier’s) spinal fluid. Unfortunately the syringe did not fit the needle, causing the cocaine and his CSF to leak out. He then performed a successful spinal anaesthetic on Hildebrandt whereby analgesia of the lower limbs occurred within eight minutes. The following day both men had severe headaches that lasted almost a week

In 1908, he performed his first case of intravenous procaine analgesia (later known as Bier’s Block) during an elbow resection of a girl. He used an Esmarch bandage to exsanguinate the arm from the extremity of the fingers to above the elbow. He then dissected the median cubital vein under infiltration anaesthesia, inserted a cannula pointing distally, sutured it in place, ligated the vein proximally and injected 100 mL of 0.25% procaine though the cannula


Controversies

Bier’s block technique largely forgotten until 1946, when Flavio Kroeff-Pires, Brazil modernized and popularized the technique using 0.5% procaine


Major Publications


References


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Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and informatics. Asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | vocortex |

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