On August 16, 1898, August Bier went into the history books when he became the first person to perform spinal anesthesia on a patient.
The man had previously undergone general anesthesia, but had suffered from severe side effects during recovery. The 34-year-old was now "hopelessly riddled" with tuberculosis and needed to have ulcers removed from his foot, but dreaded going under general anesthetic again.
Bier had the (cocainey) solution, and suggested to the patient that he try "cocainization of the spinal cord", something that had not been attempted before.
"The lumbar puncture is performed painlessly with the aid of Schleich infiltration anesthesia, infiltrating first the skin and then, with a long needle, the soft tissues down to the vertebral column," Bier wrote of his methods. "The cocaine spreads in the cerebrospinal fluid and reaches not only the surface of the cord but, most importantly, the unsheathed nerves that traverse the space, and also the ganglia."
In layman's terms, he was going to inject a bunch of cocaine into his spinal column. The patient agreed, and the operation was successful. He reported no pain, though he groaned, "aware that something was being done to his sick foot" as "the lower ends of the leg bones were sawn off, and the tuberculous capsule excised".
Apart from headaches during recovery and a raised pulse (unsurprising, considering he'd just been shot up with cocaine), the side effects were minimal. Bier went on to test spinal cord cocainization on five further patients – all without any major problems – before he decided to give it a go himself in order to investigate the headaches and nausea experienced by several of the patients.
This is where the real fun began.
Bier first asked his surgical assistant, Dr August Hildebrandt, to inject him with the solution. During the process, a lot of his cerebrospinal fluid leaked out, making it unsafe to proceed. Instead, he performed the procedure on Dr Hildebrandt, as he "immediately offered to have the same study performed on himself without delay."
Seven minutes after injection, Bier started off his tests with some light tickling of Hildebrandt's feet, and a few needle pricks in his thighs. Nothing was felt except for a little pressure, meaning it was time to escalate matters. Next, he made a small incision on his thigh, before jamming a large, curved, blunt needle in there. Still nothing.
At this point, in what today would surely warrant a "quick chat" with HR, Bier began to really beat the crap out of his colleague. At 10 minutes post-injection, he took a long needle and pushed it down the femur, before "seizing and crushing" the skin with toothed forceps. At 13 minutes, he pushed a burning cigar onto his legs, which was "felt as heat, but not as pain."
At 15 minutes he went back to foot tickling – probably making it all the more surprising when at 20 minutes he started yanking out Hildebrant's pubic hairs (which was only felt as pressure), and his chest hair above the nipples ("very painful") for contrast.
Minute 23 was not a highlight for Hildebrandt, with Bier inflicting "a strong blow to the shin with an iron hammer", but at least he couldn't say it was a total surprise when two minutes later "strong pressure and traction" was applied to his testicles. When someone starts smacking you in the shins with a hammer, surely one of your first thoughts is "you know what, I reckon this guy is the kind of person who's into mashing someone's balls".
The next 20 minutes saw some more hammer blows to the shins and strong pressure to the testicles before the cocaine began to wear off, after which the two doctors proceeded to dine, drink wine, and smoke cigars together. Hildebrandt and Bier both experienced headaches and nausea later, but only 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 update was given about the state of his testicles, nor the impact on their professional relationship going forward.