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.
- 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
- 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
Bier’s block technique largely forgotten until 1946, when Flavio Kroeff-Pires, Brazil modernized and popularized the technique using 0.5% procaine
- Bier A. Ver über cocainisierung des Ruckenmark. Deutsche Zeitschrift für Chirurgie 1899; 51: 361. Translated in ‘Classical File’: Bier, August. “Experiments Regarding the Cocainization of the Spinal Cord.” Survey of Anesthesiology 1962; 6: 352–358.
- Bier A. Hyperemia as a therapeutic agent [Translated Belch GM 1905]
- Bier A. Ueber emen neuen Weg Lokalanästhesie an den Gliedmaassen zu erzeugen. Arch Klin Chir, 1908; 86: 1007-1016. [Bier block]
- Bier A. A new method for local anaesthesia in the extremities. Ann Surg, 1908; 47: 780.
- Bier A. On local anaesthesia, with special reference to vein anaesthesia. Edin Med J, 1910; 5: 103-123.
- Erjavic N. August Karl Gustav Bier (1861–1949). Embryo Project Encyclopedia. 2017
- Hilgenhurst G. The Bier block after 80 years: a historical review. Reg Anesth. 1990 Jan-Feb;15(1):2-5.
- Goerig M et al. The versatile August Bier (1861-1949), father of spinal anesthesia. J Clin Anesth. 2000 Nov;12(7):561-9.
- Bacon DR. August Bier’s legacy: more than just a pioneer in regional anesthesia? J Clin Anesth. 2000 Nov;12(7):501-2.
- dos Reis A Jr. Eulogy to August Karl Gustav Bier on the 100th anniversary of intravenous regional block and the 110th anniversary of the spinal block. Rev Bras Anestesiol. 2008 Jul-Aug;58(4):409-24.
- Bateman BT, Alston TA. Commonly used eponyms in anesthesia. J Clin Anesth. 2009 Feb;21(1):67-71
- Maltby R. Notable Names in Anaesthesia. The Choir Press; pp 19-21 (2013)
- Jacob. A Short History of the German Steel Helmet of the Great War. 2014
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