[Rudolf Frey - a biographical sketch on the occasion of his 100th birthday]. / Rudolf Frey ­ eine biografische Skizze aus Anlass seines 100. Geburtstags.

The life of an outstanding human being, a creative personality, will find the interest of posterity if he is acknowledged not only as a representative of his time but also decades later can be described as a formative character. This applies to Rudolf Frey who, like no other, has deeply influenced the development of German language anesthesiology after the Second World War. In the 1950s and 1960s as a visionary he already portrayed the four pillars of our discipline as the future field of work of anesthetists: anesthesiology, intensive care, emergency medicine and pain therapy. The authors take the anniversary of his 100th birthday as an occasion to recall Rudolf Frey's extraordinary biography.

[Hans Franz Edmund Killian - nestor of German anesthesia : Critical appraisal on the 125th anniversary of his birth]. / Hans Franz Edmund Killian ­ Nestor der deutschen Anästhesie : Kritische Würdigung zum 125. Geburtstag.

The surgeon Hans Killian was born on 5 August 1892 in Freiburg im Breisgau, Germany. Together with the pharmacologist Hellmut Weese and the surgeon Helmut Schmidt he was one of the nestors of modern German anesthesia. Early on during his scientific and clinical career, he addressed problems of surgical anesthesia and in 1928 he became one of the editors of the first German journal of anesthesia Narcosis and Anesthesia ("Narkose und Anästhesie"). In 1934 he published the textbook Anesthesia for Surgical Purposes ("Narkose zu operativen Zwecken"). Between World Wars I and II, he campaigned for anesthesia to become an independent medical discipline comparable to the situation in the Anglo-Saxon countries at that time. Because of his merits in the foundation of the German Society of Anesthesia on 10 April 1953 he became its first honorary member. Killian died on 7 March 1982 in Freiburg, Germany. Excerpts of his autobiography which he wrote a few years before his death and which were part of his inheritance are published here for the first time.

[Beginning of continuous wound infusion with local anesthetics : With special emphasis on the contributions from Walter Capelle and Ewald Fulde]. / Anfänge der kontinuierlichen Wundinfusion mit Lokalanästhetika : Unter besonderer Berücksichtigung der Beiträge von Walter Capelle und Ewald Fulde.

Wound infusion with local anesthetics is a proven and safe analgesic procedure for modern perioperative patient care. Even the pioneers of local anesthesia practiced wound analgesia and emphasized the shortcomings of "single-shot" wound infusions. At the same time, they drew attention to the importance of long-lasting pain relief to prevent sequelae, especially after upper abdominal surgery with pneumonia, embolic events or postoperative ileus. In the early 1930s there were first sustained efforts to improve the efficiency and quality of pain therapy, especially after upper abdominal surgery by continuous wound infiltration with local anesthetics via intraoperatively introduced special cannulas. This measure was carried out to enable reduction in pain and allow early postoperative mobilization. The conceptual development of this pioneering analgesia method is closely connected with the names of the Berlin surgeons Walter Capelle and Ewald Fulde; however, their inaugurated and propagated therapy concept did not find the attention and dissemination that it deserved. This is a reason for us to remember their pioneering ideas on pain management in the context of current developments.

[History of anesthesia : "From narcosis to perioperative homeostasis"]. / Geschichte der Anästhesie : "Vom Narkotiseur zum perioperativen Homöostatiker".

In the western World 16 October 1846 is often called "Ether Day", marking the beginning of anesthesia. Before that date, for physicians there was only a struggle against pain. In the following 170 years all fields of general anesthesia as well as regional and local anesthesia were continuously developed. Pharmacological developments and technical innovations made this evolution possible. The complexity of this field of medicine requires a specialist: the anesthesiologist, whose selection of the most suitable form of anesthesia for the patient makes the surgical intervention painless. In addition, the history of anesthesia was characterized by personalities who were responsible for the progress of this medical field. Anesthesia is one part of the discipline of anesthesiology, which also includes resuscitation, intensive care medicine, emergency medicine and pain therapy.

[From the legacy of Carl Koller. Notations on his experiments with cocaine]. / Aus dem Nachlass von Carl Koller: Aufzeichnungen zu seinen Experimenten mit Kokain.

The history of local anesthesia began with the discovery of the anesthetic properties of cocaine by the physician Carl Koller from Vienna 130 years ago. After he had realized the options for painless surgery using this substance, he analyzed cocaine in detail from this point of view and evaluated the drug's significance in animal experiments, in self-experiments and in colleagues. The findings of his experiments were accurately recorded by Koller and after his death remained in the possession of the family for a long time until his daughter Hortense Becker-Koller handed these documents over to the Library of Congress in Washington. These recordings were recently studied and will now be presented to the public for the first time ever.

[Ernst von der Porten : looking for facts before and after forced emigration]. / Ernst von der Porten : Spurensuchen vor und nach der erzwungenen Emigration.

The Ernst von der Porten medal has been awarded for many years to exceptional personalities by the Alliance of German Anesthesiologists to honor the outstanding achievements of the physician Ernst von der Porten from Hamburg in the development of anesthesiology as an autonomous discipline Only recent access to hitherto inaccessible documents enabled the reconstruction of his final years. He was persecuted and excluded by the National Socialist (NS) regime due to his Jewish roots and finally forced to emigrate. Records revealed that even in the so-called safe exile, degrading treatment and humiliation continued for Ernst von der Porten and his family. He eventually evaded this situation by committing suicide.

[From Morbus Sudeck to complex regional pain syndrome]. / Vom Morbus Sudeck zum komplexen regionalen Schmerzsyndrom.

Burning pain and autonomic disorders, such as change of skin color, hyperhidrosis, edema and stiffness in joints of extremities were first described in 1864 by Silas W. Mitchell. The German expression "Morbus Sudeck" takes its name from the surgeon Paul Sudeck from Hamburg who described spotty decalcification in x-rays in 1900. In the Anglo-Saxon world, the theory that the sympathetic nervous system was involved in the generation and sustention of these alterations was based on the observations of the French surgeon René Leriche and in 1846 James A. Evans introduced the expression sympathetic reflex dystrophy. As doubts arose that the sympathetic nervous system could not be the sole culprit, the descriptive phrase of complex regional pain syndrome was introduced to substitute for more than 60 synonyms focusing on the fact that the disease develops after minor trauma or nerve lesions and does not correlate with the severity of the trauma. Diagnosing this syndrome is still hampered by the fact that no specific laboratory or radiological marker has yet been identified. Multidisciplinary and interdisciplinary approaches to therapy seem to be inevitable. Since Sudeck first described the disease, 110 years have passed. The underlying hypothesis and theories as well as the development during this time period are summarized.

[Co-editors and editors with Jewish origins of the first German journals for anaesthesia. Their fate under National Socialism and an attempt at a biographical appreciation]. / Mitarbeiter und Herausgeber mit jüdischer Herkunft der ersten deutschen Anästhesiezeitschriften. Ihr Schicksal im Nationalsozialismus und der Versuch einer biografischen Würdigung.

The decision to publish the journals Der Schmerz and Narkose und Anaesthesie in 1928 was an important step towards the professionalization of anaesthesiology in Germany. The appearance of both journals, which for economic reasons merged into Schmerz - Narkose - Anaesthesie 1 year later, was initiated and vehemently supported by Jewish physicians. As editors and co-editors they were deeply involved with the editorial tasks of the journals for years from the early beginnings. When the National Socialistic Party took over the government in Germany many of the Jewish colleagues were forced to quit their editorial tasks, were eliminated and replaced by "Arians", they were persecuted and often arrested, forced to emigrate or decided to commit suicide due to inhumane personal circumstances. It is our intention to recall the biography and the terrible fate of the nearly unknown Jewish members of the editorial board of the first German anaesthesia journals. Moreover the biographic sketches promote a continuous discussion about the victims of an inhumane and barbarous ideology.

[Adam hammer (1818 - 1878) - remarks on a forgotten pioneer of ether anaesthesia in obstetrics]. / Adam Hammer (1818 - 1878) - Anmerkungen zu einem vergessenen Pionier der Atheranwendung in der Geburtshilfe.

Adam Hammer, born in 1818, and working as a doctor for the poor since 1847 in Mannheim, was the first person in the German speaking world to use ether for pain relief during labor on February 18th 1847. He took part in the abortive April 1848 Revolution in Mannheim - a pinnacle of German liberalism and later of political radicalism, which attented to abolish the Monarchy and introduce a democratic Republic. After the revolution was put down, Hammer emigrated to the United States and settled down in St. Louis, Missouri. Remaining politically active, he joined the Republican Party, founded in 1854 and served as a military surgeon in the Union Army during the American Civil War. Even before the war, he was engaged in efforts to improve the level of medical training in America and was involved with the foundation of High Schools which offered training courses along the lines of German universities. His ideas and innovations were not introduced immediately, but had a significant impact on medical training methology later on in the US. During a visit in Europe in 1876, he was the first to diagnose a coronary thombosis as the cause of a heart attack on a live patient. The diagnosis was later confirmed by post-morten autopsy on the patient. In 1877 he returned to Germany and died one year later. The biography of Adam Hammer mirrows that of many other German-Americans whose emigration proved to be a gain for America but a loss for Germany. This story was destinated to be repeated in terrible circumstances some decades later.

[Early contributions for the development of nitrous oxide-oxygen anesthesia in central Europe]. / Frühe Beiträge zur Entwicklung der Lachgas-Sauerstoff-Anästhesie in Mitteleuropa.

The American dentist Horace Wells was the first to administer nitrous oxide for pain relief during painful tooth extractions. Since, however, an official demonstration of the pain-relieving properties of the gas at Massachusetts General Hospital in Boston ended in failure, use of the drug was abandoned. A few years later, Gardner Quincey Colton, a former coworker of Wells, took up Wells' idea to use nitrous oxide for pain relief and this was instrumental in its reintroduction into daily practice. Colton's publications on the advantageous use of nitrous oxide caused Stanislav Klikovitch from St. Petersburg, Russia, to administer the drug for pain relief during labour. In order to minimize the risk of asphyxia during the inhalation of the gas, he used an anaesthetic mixture consisting of 80% nitrous oxide and 20% oxygen. Moreover, it is to Klikovitch that we owe the first description of effective self-administration of nitrous oxide mixtures for pain relief. He recommended that inhalation should start 30-60 seconds before the expected pain and said between 2 and 6 inhalations would give the expected effect. Additionally, he suggested taking deep breaths and doing so at the beginning of subsequent pains. This is the first description of patient-controlled analgesia. Klikovitch reported his experiences with the new anaesthetic method in several German-language publications. Among those who were fascinated by his pain-relieving concept was Paul Zweifel from Leipzig, one of the leading obstetricians of his time in Germany. Together with numerous of his pupils, he popularized the method, using new apparatus for a safer kind of administration. Further technical developments in the early twenties, such as the introduction of the circle system or the clinical use of oxygen-monitoring devices, were additional milestones in nitrous oxide/oxygen anaesthesia.

The versatile August Bier (1861-1949), father of spinal anesthesia.

"A professor is a gentleman with a different point of view." This characteristic and sarcastic statement was often recited by August Bier (1861-1949) and can also be aptly applied to him. As the father of spinal and intravenous regional neural blockade, Bier had a tremendous impact on surgery and anesthesia. It took him only two years to become a senior lecturer in surgery (so-called "Habilitation") under the guidance of Friedrich von Esmarch. In 1899, he was appointed chairman of the Department of Surgery at the University of Greifswald. From there, he moved to the University of Bonn in 1903 and then succeeded Ernst von Bergmann in Berlin in 1907. Bier's interest in the philosophical theories of Hippocrates and Heraclitus had a significant influence on his outlook on medical practice. His surgical colleagues disapproved of this and his interest in homeopathy. On the other hand, he earned much respect as the co-author of a surgical textbook, i.e., Chirurgische Operationslehre (Operative Surgery). He had a remarkable breadth of nonmedical interests, including philosophy and forestry, and the ideas he expressed are viable even today. His publications on philosophical subjects are as up to date as his concepts in forestry. In 1932, Bier finally decided to retire, although by then he was no longer operating. From that time on, he lived out his days at his estate in Sauen, and he died in 1949 at the age of 88. In this paper we describe some previously unknown aspects of Bier's work in both surgery and research; anesthesiologists and their patients are the beneficiaries of two other of his inventions, namely, spinal and IV local anesthesia. Unfortunately, it is not possible to acknowledge all the innovations of this ingenious surgeon, who truly deserved the description "A professor is a gentleman with a different point of view."

[The Eppendorf University Hospital, Hamburg--a cradle of German- speaking anesthesia?]. / Das Universitäts-Krankenhaus Eppendorf, Hamburg--Eine Wiege der deutschsprachigen Anästhesie?

"The time will come when German medicine, too, will have to concern itself with the issue of a professional narcotiseur. Until then it will be our duty to keep the interest in narcosis, which has increased satisfactorily in the past years, alive." With this statement the editors of the journal "Der Schmerz" substantiated the publication og a German-speaking anestesiological journal in 1928. Ernst von der Porten, a professional anesthesist working in Hamburg was the chief initiator for the appearance of the new journal. Possible he was incited by his former teacher, the Eppendorf surgeon Paul Sudeck, to delve deeper into our special field. Very early Sudeck himself began to concern himself with anesthesiological questions and he found an ardent supporter of the idea of specialisation in anesthesiology (quite unheard of in Germany at that time) in Helmut Schmidt, a staff member. Schmidt habilitated on an anesthesiological theme and that again was reason enough for the editors to write an editorial about. Schmidt who one of the chief organizers of the "90. Tagung Deutscher Naturforscher und Arzte" in the late summer of 1928 was hindered by the surgeons on founding the Deutsche Narkosege-sellschaft (German Narcosis Society) with colleagues. After World War II German surgeons rethought their position, mainly influenced by Anglo-American narcosis specialists. After the foundation of the Deutsche Gesellschaft für Anaesthesiein the year 1953, the first professorate for the special field of anesthesiology was given to Karl Horatz--one of the founding members--10 years later. Not surprisingly the professorate was instituted at the university hospital in Eppendorf which could be called the cradle of German-speaking anesthesia. The following concerns itself with some of the impulses that were given by the "Neues Allgemeines Krankenhaus Eppendorf" and became important stepping stones in our special field through the decades.