There is an urban myth in anaesthesia about August Bier, his assistant Hildebrandt, and the invention of spinal anaesthesia. We were having a giggle about it on Covid ICU this weekend – but it turns out the truth is so much better:
(a thread, edited from the paper) (1/n)
(a thread, edited from the paper) (1/n)
At 7:38 p.m. I injected 0.5 cc. of a 1 per cent solution of cocaine. This resulted in Hildebrandt experiencing a feeling of warmth in both legs.
After 7 minutes: Needle pricks in the thigh were perceived as pressure; tickling of the the sole of the foot was barely felt. (2/n)
After 7 minutes: Needle pricks in the thigh were perceived as pressure; tickling of the the sole of the foot was barely felt. (2/n)
After 8 minutes: A small incision in the skin of the thigh was felt as pressure; introduction of a large, blunt, curved needle into the soft tissues of the thigh produced no pain at all.
(7 minutes is how we often check. 8 is a reasonable test of anaesthesia) (3/n)
(7 minutes is how we often check. 8 is a reasonable test of anaesthesia) (3/n)
After 10 minutes: A long needle was pushed down to the femur without evoking the least pain. Pinching the skin severely and seizing and crushing it in toothed forceps was experienced as pressure.
(possibly pushing it a little, but still in the realm of reasonable science) (4/n)
(possibly pushing it a little, but still in the realm of reasonable science) (4/n)
After 11 minutes: Pain sensibility was markedly diminished in the arm.
(slightly concerning for anyone who knows about spinal anaesthesia, but Bier and Hildebrandt carry on undeterred…) (5/n)
(slightly concerning for anyone who knows about spinal anaesthesia, but Bier and Hildebrandt carry on undeterred…) (5/n)
After 13 minutes: A burning cigar applied to the legs was felt as heat, but not as pain. Ether' produced a feeling of cold.
(definitely crossing ethical boundaries here. Hildebrandt probably needs a safeguarding referral...) (6/n)
(definitely crossing ethical boundaries here. Hildebrandt probably needs a safeguarding referral...) (6/n)
After 15 minutes: Tickling the sole of the foot was no longer felt as such but only as movement. Pinching the leg was felt as light pressure but pinching the upper chest was very painful.
(phew! The craziness has ended… back to establishing a spinal “level”) (7/n)
(phew! The craziness has ended… back to establishing a spinal “level”) (7/n)
After 18 minutes: Strong pinching was hardly felt at all below the nipples.
(OK... making sure...) (8/n)
(OK... making sure...) (8/n)
After 20 minutes: Avulsion of pubic hairs was felt simply as elevation of a fold of skin, but avulsion of chest hair above the nipples on the contrary was very painful. Strong hyperextension of the toes was not unpleasant.
(what??!) (9/n)
(what??!) (9/n)
After 23 minutes: A strong blow to the shin with an iron hammer did not provoke pain.
(what kind of surgery are they planning for??) (10/n)
(what kind of surgery are they planning for??) (10/n)
After 25 minutes: Strong pressure and traction on the testicles was not painful.
(Hildebrandt has clearly forgotten his safeword…) (11/n)
(Hildebrandt has clearly forgotten his safeword…) (11/n)
After 32 minutes: Tickling the sole of the foot was perceived as faint touch. Needling down to the femur and strong pressure on the testicle were not painful.
(Interestingly long gap there. I imagine much of it trying to smooth things over with Hildebrandt.) (12/n)
(Interestingly long gap there. I imagine much of it trying to smooth things over with Hildebrandt.) (12/n)
After 40 minutes: Strong blows on the shin did not hurt. The entire body began to perspire gently.
(Another long gap… and the hammer again… The perspiration is understandable! Clearly at this point enough is enough, and Bier decides to sweeten things with Hildebrandt.) (13/n)
(Another long gap… and the hammer again… The perspiration is understandable! Clearly at this point enough is enough, and Bier decides to sweeten things with Hildebrandt.) (13/n)
After performing these experiments we proceeded without any symptoms to dine, drink wine and smoke cigars. I went to bed at 11 pm, slept the whole night, awoke the next morning hale and hearty and went for an hour's walk.
(A satisfactory conclusion for Gentleman Science) (14/n)
(A satisfactory conclusion for Gentleman Science) (14/n)
Towards the end of the walk I developed a slight headache which gradually got worse. By 3pm I was looking pale and my pulse was fairly weak.
(Before you feel too bad for Bier, Hildebrandt spent the night vomiting and then got up to perform surgery.) (15/n)
(Before you feel too bad for Bier, Hildebrandt spent the night vomiting and then got up to perform surgery.) (15/n)
Also, I had a feeling of very strong pressure on my skull and became rather dizzy when I stood up rapidly from my chair. In the evening I was forced to take to bed and remained there for nine days.
(Hildebrandt had the afternoon off and was in theatre the next morning). (16/n)
(Hildebrandt had the afternoon off and was in theatre the next morning). (16/n)
(Epilogue – Bier goes back to Gentleman Sciencing)
Three days later I was able to make a fairly long journey by rail without difficulty and was able to thoroughly enjoy an 8-day hunting holiday in the mountains. (17/n)
Three days later I was able to make a fairly long journey by rail without difficulty and was able to thoroughly enjoy an 8-day hunting holiday in the mountains. (17/n)
(Epilogue II – Hildebrandt)
Dr. Hildebrandt's legs became painful and bruises developed in several places, especially over the tibia where sensibility had been tested by crushing and heavy blows.
(no mention of his testicles) (18/n)
Dr. Hildebrandt's legs became painful and bruises developed in several places, especially over the tibia where sensibility had been tested by crushing and heavy blows.
(no mention of his testicles) (18/n)
Not much information available on what happened to Hildebrandt after all this – but by 1905 he had become a fierce opponent of Bier… I wonder why? (n/n)
