Arthur Läwen

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Arthur Läwen

Arthur Georg Läwen (born February 6, 1876 in Waldheim , Saxony ; † January 30, 1958 in Lüneburg ) was a German surgeon and pioneer of anesthesiology.

Life

Läwen's parents were the royal Saxon administrative officer Gustav Adolf Läwen and his wife Ernestine Clara nee. Guth . From 1895 Arthur studied human medicine at the University of Rostock , the Albert Ludwig University of Freiburg , the Ludwig Maximilians University in Munich and the University of Leipzig . In 1900 he was licensed as a doctor and with a bacteriological dissertation in Leipzig as a Dr. med. PhD .

He then began his surgical training with Heinrich Braun in the Deaconess Hospital in Leipzig . In 1904 he went to Friedrich Trendelenburg at the Surgical University Clinic in Leipzig, where he completed his habilitation in 1908 . In 1911 he became chief physician at the St. Georg Hospital in Leipzig . In the same year he married Kathrine Hubert, who gave him five children. A medical officer in the First World War , he returned to the Sankt Georg Hospital in 1918. In 1919 he followed the call of the Philipps University of Marburg to its chair for surgery.

In 1928 he switched to the chair at the Albertus University in Königsberg . During the Second World War he was an advisory surgeon with Siegfried Hoffheinz in the (East Prussian) 2nd Army ; he was in many theaters of war and operated in many hospitals . In 1939 he was shot through in the right hand.

From 1941 to 1943 he was President of the German Society for Surgery ; In 1943 he chaired their last war congress in Dresden . From 1927 to 1945 he was an advisory surgeon in the Reichswehr and the Wehrmacht .

In November 1944 his wife moved to Gut Severloh in the district of Celle . Still a professor, he fled to West Germany in a hospital ship on January 31, 1945 in the battle of Königsberg . He worked in hospitals until he also came to Severloh in early 1946. In 1948 the family moved to Hermannsburg in the Celle district. The onset of dementia became apparent in the early 1950s . In 1954 the family placed him in the Lüneburg sanatorium and nursing home, where he died shortly before his 82nd birthday.

plant

Läwen (at the foot end with folded arms) and Friedrich Trendelenburg (left in front of Läwen) during an operation around 1909

Läwen has published around 200 scientific papers - articles or books. In accordance with his experiences in the two world wars, these include titles such as Experiences with gunshot injuries and their early operation in the field hospital (1915), Handbook of Medical Experience in World War I (1922), Early Operation for Severe Burns (1936), Basics in War Surgery (1940), Über Keeping war gunshot wounds open by means of makeshift wound spreaders (1943) and partial resection of the hip joint in cases of suppuration after gunshot injuries (1943). These also include general surgical titles such as On lung complications after abdominal operations (1906), On the practical application of instrumental artificial respiration (1910), On periarterial sympathectomy in extremity tuberculosis (1924) and Surgery in disorders of the autonomic nervous system (1927). But his contributions to local anesthesia are outstanding ; and his suggestion for the use of curare , the prototype of muscle relaxants , in operations was ingenious .

Local anesthesia

After cocaine was introduced as a local anesthetic in 1884, there were many attempts to find a less toxic agent. Ultimately, the synthesis of procaine by Alfred Einhorn , his medical examination by Heinrich Braun and Läwen in Leipzig and Braun's fundamental knowledge that adding the adrenaline (= suprarenine ), which was just discovered at the time, to the solution of procaine, firstly strengthened and prolonged its effect at the injection site, led to success and second, weakened its “systemic” effect, i.e. the effect outside the injection site. In 1905, the Farbwerke Hoechst AG brought procaine to the market as novocaine . It has remained the standard local anesthetic for many decades.

In 1899 Heinrich Braun took over the management of surgery at the Leipzig Deaconess House, and in 1900 Läwen joined him. Local anesthesia became a lifelong issue for both of them. A first detailed study by Heineke and Läwen dates from the same year 1905 as Braun's first communication about novocaine.

Läwen was not only involved in the introduction of the standard local anesthetic, but also in the development of many local anesthetic techniques, such as spinal anesthesia and epidural anesthesia .

Braun's book Local anesthesia - its scientific principles and practical application, 1st edition 1905, renamed from the 5th edition to Local anesthesia - its scientific bases and practical application, Läwen has the 8th edition in 1933 and the 9th edition in 1951 with published.

Pharmacological Supplements

Both Braun and Heineke and Läwen reported in 1905 essentially on observations on people, including many self-experiments.

However, during his time in Leipzig with Heinrich Braun and Friedrich Trendelenburg, Läwen often visited the Pharmacological Institute in Leipzig, headed by Rudolf Boehm . Basic research on animal experiments was carried out here parallel to the clinical work. In 1907, Laewen compared procaine, cocaine and other local anesthetics for the first time in an isolated nerve, the sciatic nerve of the frog.

Adrenaline strengthens the local and reduces the "systemic" effect of procaine by contraction of the blood vessels at the injection site, i.e. vasoconstriction and thus delaying the removal of procaine through the bloodstream. Läwen extended his basic research to the vasoconstriction by adrenaline. He used blood vessels from frogs and introduced a method that was later developed by the pharmacologist Paul Trendelenburg and became known as the Laewen-Trendelenburg frog preparation .

Läwen observed that the blood vessels cleared adrenaline from the surrounding fluid and spoke of a "strong selective absorption capacity" of the blood vessel cells for adrenaline - an observation that was confirmed half a century later by the identification of the transport proteins.

Curare

Rudolf Boehm and his Pharmacological Institute in Leipzig were leaders in researching curare and its ingredients. Even repeated attempts had been made, tetanus treat -Patients with curare, without much success. Nevertheless, Läwen, encouraged by Friedrich Trendelenburg, initially took up the subject in 1906 using animal experiments . Later in Marburg he treated the patients combined with a sedative , a curar preparation and artificial ventilation - which is still the basis of treatment today.

Muscle relaxation during operations - idea, realization, forgetting and memory

In 1912 Läwen published an essay on the connection between local anesthesia and general anesthesia, on high extradural anesthesia and epidural injections of anesthetic solutions in the case of tabular gastric crises . The formulation shows the breadth of Läwen's surgical thinking, but actually hides the ingenious idea and its realization, which are only described casually towards the end on just over one of the 22 pages:

“A great disadvantage with superficial anesthesia is that the patient excessively tenses the abdominal muscles, especially when suturing the abdominal wall, so that a proper layer suture is very difficult. It is precisely this abdominal wall tension that is to blame for the fact that deep anesthesia is often required in the last stage of the operation. This again brings the risk of overdosing into the vicinity. I have now tried to prevent this tension in the abdominal muscles in other ways. I used curarin, the active substance made by Boehm from the curare preparations. Curarin has the great advantage over curar drugs of being a precisely dosed preparation, in which the same dose always corresponds to the same effect with absolute reliability. With the usual curare preparations I would never have dared to experiment on humans. My intention was that the anesthesia and the curarin effect should, as it were, meet each other. The former causes a weakening of the motor innervation impulse. The latter, by inserting a block between the motor nerve endings and the striated muscles, causes the weaker innervation stimulus to come to a barrier, so to speak, and not at all, or only to a small extent, bring about a muscle contraction. The effect on the abdominal wall suture was very clear and pleasant. Unfortunately, the curar drug is currently not available in sufficient quantities. "

- Arthur Läwen

In terms of the problem, the solution idea, the scientific correctness and the intelligibility of the language, this is an exemplary text that was nevertheless granted to be forgotten, probably for the reason given by Läwen. It was only 30 years later that the report The use of curare in general anesthesia by the Canadian doctors Harold Randall Griffith and G. Enid Johnson was picked up worldwide . Curar preparations were now freely available, other muscle relaxants followed, billions of people have since benefited from these auxiliary substances in operations, but Griffith and Johnson apparently no longer knew anything about Läwen's pioneering work.

The crime was rediscovered by the British anesthetist Cyril F. Scurr, who wrote in 1951:

"Such enlightened observations unfortunately attracted little notice at the time, and owing to shortage of supplies of the drug Laewen's work was curtailed."

In 1969, Scurr found its way into the popular scientific curare book by Philipp Smith Arrows of Mercy, in which Läwen serves as an example:

"Medical history if full of examples of discoveries being made before their time - that is, before the world was ready for them."

Nevertheless, in 1989 Läwen is missing from a short historical treatise by the Canadian anesthetist RL Knill on curare. Pointed out by Hamburg anesthetist Michael Goerig, Knill and his German-speaking student Brueggemann replied:

“His [Läwens] 1912 article is fascinating, not only with respect to the suggested usefulness of curare during anesthesia. [...] Laewen seems to have been a highly inquisitive and innovative surgical registrar who saw solutions to important anesthetic problems many years before they were thought of again and introduced into practice. He was decades ahead of his time. "

- RL Knill

The sentences can be followed by an assessment by the Heidelberg surgeon Karl Heinrich Bauer , which Läwen's Hamburg biographers Goerig and Schulte am Esch cite with approval in 1993:

"There is no doubt that the young Läwen had all the keys to today's anesthesia in his hands as early as 1910 with curarization, intubation and artificial ventilation."

- Karl Heinrich Bauer

Honors

  • Member of the Society for the Promotion of All Natural Sciences in Marburg (1920)
  • Member of the German Academy of Sciences Leopoldina (1940)
  • Honorary member of the Association of Lower Rhine-Westphalian Surgeons (1948)
  • Honorary member of the German Society for Surgery (1950)
  • Honorary member of the Society of Surgeons in Vienna

literature

  • Katrin Wesemeier: Arthur Läwen - pioneer of anesthesiology . Diss. Univ. Magdeburg 1994.

Web links

Individual evidence

  1. ↑ a b c d M. Goerig and J. Schulte am Esch: Arthur Läwen - a pioneer of modern anesthesia procedures. In: Anesthesiology, Intensive Care Medicine, Emergency Medicine, Pain Therapy 1993; 28: pp. 315-325.
  2. ↑ a b c d Grit Groth: Arthur Läwen - a pioneer of German anesthesia. Medical dissertation, Rostock 1996.
  3. ^ Website of the University of Leipzig
  4. ↑ Internet site of the St. Georg Clinic Leipzig ( Memento of the original from December 5, 2009 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.sanktgeorg.de
  5. ↑ Dissertation: On the influence of the reaction of the culture medium on the multiplication of cholera vibrio .
  6. ↑ Habilitation thesis: Experimental studies on the behavior of x-rayed animals against bacterial infections .
  7. ↑ H. Braun: About the influence of the vitality of the tissue on the local and general toxic effects of local anesthetics and about the importance of adrenaline for local anesthesia. In: Archive for Clinical Surgery 1903: 69: pp. 541-591.
  8. ↑ H. Braun: About some new local anesthetics (Stovain, Alypin, Novocain). In: German Medical Weekly 1905; 31: pp. 1667-1671.
  9. ↑ H. Heineke and A. Läwen: Experimental investigations and clinical experience on the usability of novocaine for local anesthesia. In: German journal for surgery 1905; 80: pp. 180-198.
  10. ↑ A. Läwen: Comparative studies on the local effects of cocaine, novocaine, alypin and stovain on motor nerve trunks. In: Archives for Experimental Pathology and Pharmacology 1907; 56: pp. 138-160.
  11. ^ Leopold Ther: Pharmacological methods. Stuttgart, Wissenschaftliche Verlagsgesellschaft 1949, page 191.
  12. ↑ A. Läwen: Quantitative studies on the vascular effects of Suprarenin. Archives for Experimental Pathology and Pharmacology 51 (1904), pp. 415-441.
  13. ^ Klaus Starke : A history of Naunyn-Schmiedeberg's Archives of Pharmacology 358 (1998), pp. 1–109, here page 36.
  14. ↑ A. Läwen: About the connection of local anesthesia with anesthesia, about high extradural anesthesia and epidural injections of anesthetic solutions in tabular gastric crises. In: Contributions to clinical surgery 80 (1912), pp. 168-189; quoted with small cuts.
  15. ↑ Harold R. Griffith and G. Enid Johnson: The use of curare in general anesthesia. In: Anesthesiology 1942; 3: pp. 418-420.
  16. ↑ Cyril F. Scurr: A comparative review of the relaxants. British Journal of Anesthesia 23 (1951), pp. 103-116.
  17. ^ RL Knill: D-tubocurarine and upper airway obstruction: a historical perspective. Anesthesiology 71: 480 (1989).
  18. ^ Michael Goerig: Pioneering curare in anesthesia. Anesthesiology 73 (1990), pp. 189 f.
  19. ^ RL Knill and H. Brueggemann: In reply. Anesthesiology, 73: 190 (1990).
  20. ^ KH Bauer: The changes in anesthesia from the point of view of the surgeon. In: Archive for clinical surgery 282 (1955), pp. 163-177.
personal data
SURNAME Läwen, Arthur
ALTERNATIVE NAMES Läwen, Georg Arthur (full name)
BRIEF DESCRIPTION German surgeon and university professor
DATE OF BIRTH February 6, 1876
PLACE OF BIRTH Waldheim , Saxony
DATE OF DEATH January 30, 1958
Place of death Luneburg