If you want to make it into the history books as a hero of medical science, you can’t beat a bit of experimentation – on yourself, that is. Is a new drug safe? Take some and find out. Does that vaccine work? Try it and see. The only catch is that you have to survive the experiment long enough to write up your results in a suitably eminent medical journal. One man who did, and earned worldwide fame, was the German surgeon August Bier. In 1898, Bier invented spinal anaesthesia. After a few promising tests on patients, Bier wanted to find out how much they felt during an operation and why they developed horrible headaches afterwards. So, one summer’s evening, he asked his assistant to anaesthetise him. It was an experiment they might have preferred forgotten.
THE TWO surgeons had finished work for the day. But instead of going home, they began to prepare for one more operation – a little out-of-hours experiment intended to advance the art of anaesthesia. August Bier was a rising star at the Royal Surgical Clinic in Kiel. His young assistant, August Hildebrandt, had agreed to help him.
What happened next was not so much heroic as comic. Just one little mistake and courageous selflessness turned to black comedy. It made Bier’s name. But the events of that evening would be forever etched on Hildebrandt’s memory, not to mention several other parts of his body.
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In the 1890s, general anaesthesia was decidedly dodgy. Chloroform sent patients gently to sleep – but there was no room for mistakes. A few drops too many and the patient would be dead before the surgeon picked up his scalpel. Ether wasn’t quite so dangerous, but it was slow to act – surgeons sometimes started to operate before their patients had gone under. The survivors suffered unpleasant side effects – from violent headaches and vomiting to ether pneumonia.
Bier reasoned it should be possible to banish sensation from most of the body without knocking the patient out completely by injecting a small dose of cocaine into the cerebrospinal fluid that bathes the spinal cord. He tried his technique on half a dozen patients. They lost sensation from the lower part of their bodies long enough for him to carve out chunks of diseased bone from their ankles, knees and shins – and even the thigh and pelvis. “On the other hand, so many complaints had arisen in association with this method that they equalled the complaints usually occurring after general anaesthesia,” he wrote. “To arrive at a valid opinion, I decided to conduct an experiment on my own body.”
The procedure was simple enough. Hildebrandt had to make a lumbar puncture by plunging a large needle through the membranes that protect the spinal cord into the fluid-filled space beneath. Then he had to fit a syringe on the needle and inject a solution of cocaine. But preparations for the experiment had been less than meticulous.
Hildebrandt made the lumbar puncture. Then, with his finger over the hub of the needle to prevent fluid from leaking out, he took up the syringe of cocaine – only to find it was the wrong fit. As he fumbled with the needles, Bier’s cerebrospinal fluid began to squirt out. Horrified, Hildebrandt stopped and plugged the wound. This was when the pair should have called it a day. Instead, Hildebrandt offered to take Bier’s place.
At 7.38 pm, after checking the needles more carefully, Bier began. The cocaine worked fast. “After 7 minutes: Needle pricks in the thigh were felt as pressure; tickling of the soles of the feet was hardly felt.” Bier jabbed Hildebrandt in the thigh with a needle. Nothing. He tried harder, stabbing the thigh with the surgical equivalent of a stiletto. Still no response. Then, 13 minutes into the experiment, Bier stubbed out a cigar on Hildebrandt’s leg.
Bier now wanted to know how far the insensitivity extended, and invented a simple test. “Pulling out pubic hairs was felt in the form of elevation of a skinfold; pulling of chest hair above the nipples caused vivid pain.” So now he knew. It was more than 20 minutes since Hildebrandt had stopped feeling pain. How much more could he take? Bier increased his efforts. He smashed a heavy iron hammer into Hildebrandt’s shin bone and then, when that failed to have any effect, gave his testicles a sharp tug. In a final burst of enthusiasm, Bier stabbed the thigh right to the bone, squashed hard on a testicle and, for good measure, rained blows on Hildebrandt’s shin with his knuckles.
After 45 minutes, the effect of the cocaine began to wear off. The two surgeons, one missing a significant amount of cerebrospinal fluid, the other battered, burnt and suffering from serious stab wounds, went out for dinner. “We drank wine and smoked several cigars,” wrote Bier.
The next morning, Bier woke feeling bright and breezy. By the afternoon he had turned pale, his pulse was weak and he felt dizzy whenever he stood up. “All these symptoms disappeared as soon as I lay down horizontally, but they returned when I arose. In the late afternoon, therefore, I had to go to bed.” He stayed there for the next nine days. When he finally got up again he felt quite well. “I was perfectly able to tolerate the strain of a week’s hunting in the mountains,” he wrote.
Hildebrandt didn’t escape so lightly. The first night he was violently ill. He had a splitting headache and was sick. But someone had to tend to the clinic’s patients and, with Bier in bed, the job fell to him. Each morning for the next week, Hildebrandt dragged himself to work. Each afternoon, he staggered home and collapsed into bed. “Dr Hildebrandt’s legs were painful, and bruises appeared in several places,” wrote Bier, rather understating the case.
When Bier wrote his ground-breaking paper describing the experiment, he gave a blow-by-blow account of what Hildebrandt had endured. As far as Bier was concerned, the experiment was a huge success. He had shown that a tiny dose of cocaine could deaden sensation for long enough to perform a major operation. Spinal anaesthesia was far safer than general anaesthesia, and within two years surgeons around the world were using it. Bier put the headaches down to the loss of cerebrospinal fluid, and he was right – this was finally proved in the 1950s.
Hildebrandt, though, had gone right off Bier and became one of his most vehement critics. When a row blew up over who had really been first to invent spinal anaesthesia, Hildebrandt championed Bier’s rival, an American neurologist called James Corning. Hildebrandt never said why. Perhaps he was shocked by the zeal with which Bier had battered him. Maybe he was miffed because in the end Bier was recognised as a pioneering surgeon, while he was forever known as the man whose boss had tugged his testicles.
