Gustav Killian

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Gustav Killian around 1911 when he was called to Berlin

Gustav Johann Killian (born June 2, 1860 in Mainz , † February 24, 1921 in Berlin ) was a German doctor ( ear, nose and throat doctor ), laryngologist (larynx specialist) and founder of the bronchoscopy, which he presented to the professional world in 1898 .

Adolescence and medical training

His father, Johann Baptist Caesar Killian (1820–1889), son of a municipal road supervisor, was born in Mainz and was a doctor of philosophy and high school professor in Mainz and later in Bensheim . His mother Apollonia (1833–1865), née Höpfel, died at the age of 31 of cholera , as did three of his siblings. Only he and his older brother Johann August Killian survived. His father is said to have become "melancholy and irritable" as well as alcoholic . His brother later became a resident ENT doctor in Worms .

Killian first attended elementary school and then, after the prescribed time, transferred to the Grand Ducal Realgymnasium in Mainz. Since his father was transferred to Bensheim an der Bergstrasse in 1873 , he then attended the local high school. After graduating from high school in 1878, Gustav Killian began studying medicine in Strasbourg, where he passed the preliminary medical examination on July 14, 1880 after four semesters as the best in his class. He studied the other clinical semesters in Berlin, Freiburg and Heidelberg . Gustav Killian graduated there on December 9, 1884. The engagement to Helene Hein took place on December 17, 1884. He had met the daughter of a wholesale merchant during his student days. Subsequently, from May 1, 1884, he began his clinical training at the Mannheim City Hospital , in the external department of the General Hospital in Mannheim. He stayed here until October 1, 1884, after which he was drafted into the army as a one-year volunteer with the 5th Baden Infantry Regiment 113 in Freiburg. The military service lasted from October 15, 1884 to October 15, 1886.

In 1885 he received his doctorate at the University of Strasbourg with a thesis on the anatomy of parovarial cysts . He then moved to Frankfurt am Main , where he accepted a position as an assistant doctor with the medical officer Johann Georg Alexander Knoblauch (1820–1899) in the local community hospital .

The time in Mannheim, Freiburg and Berlin

Mannheim (1887)

On January 17, 1887, he settled in Mannheim as a specialist in ear, nose and throat diseases , and on June 2 of the same year he married Helene Hein.

Freiburg

When Wilhelm Hack died in 1887, Killian moved to Freiburg im Breisgau, where he was given the provisional management of the Hack Polyclinic for Rhinolaryngology and Killian was a member of the university's teaching staff. In 1888, Killian completed his habilitation in rhinology and laryngology and was able to succeed Wilhelm Hack. Here, too, Killian was responsible for the field of ear, nose and larynx diseases, which at that time still belonged to the field of internal medicine , while ear medicine was carried out by another lecturer. His work there for almost a quarter of a century was extremely productive. In 1897 he published his studies on direct bronchoscopy , i.e. the reflection of the trachea and main bronchi using a Kirstein laryngoscope, named after the Berlin internist Alfred Kirstein (1863-1922).

In 1890 he completed his habilitation in Freiburg with a thesis on the bursa and tonsilla pharyngea . In 1892 he was appointed professor and associate professor. The family lived in 1892 on Fahrenbergplatz , where his first son Hans was born (later they moved to Josephstrasse). Frequent guests in the house of the Killian family were the poets Emil Strauss and above all Emil Gött .

In 1897, Killian removed a foreign bronchial body for the first time. He extracted a piece of pig bone from the bronchus of a 63-year-old man without first having a tracheostomy . In May 1898 he gave a lecture at a medical congress in Heidelberg about the removal of three other foreign bodies with this bronchoscopy procedure, which he had developed. As a result, patients from all over Europe and sometimes overseas sought help from Gustav Killian.

His special interest lay in the improvement of diagnostics and therapy in the field of ENT, such as his improvement in laryngoscopy , the laryngoscopy according to Killian, and then in 1902 the radical surgery of the frontal sinus . A student from this time, June 1903, was the Japanese doctor and pioneer of Japanese ear, nose and throat medicine, Kubo Inokichi , who honored his teacher as a "knight in the fight against death" with a real samurai sword.

Berlin

Killian decided to contact Arthur Hartmann , the head physician of the rhino-laryngological department, who is responsible for ear, nose and larynx diseases, department of the Rudolf Virchow Hospital in Berlin, and Bernhard Fränkel , the first chief physician of the throat and nose clinic at the Berlin Charité to train as a rhinolaryngologist. He worked as an assistant under the conducting doctor Arthur Hartmann in the ENT department of the Rudolf Virchow Hospital in Berlin, which was newly founded in 1907 . On the initiative of Rudolf Virchow, a fourth municipal hospital was built in the north of Berlin ( Wedding district ) between 1898 and 1906.

After the eventful history of the departments for ear, nose and throat patients at the Charité, in 1897 the Prussian ministerial director Friedrich Althoff , who worked in the Prussian Ministry of Spiritual, Educational and Medical Affairs, converted and renewed the now common clinic for Ear, nose and throat patients created. The new building was opened on May 4, 1901. The clinic building was structured in such a way that the patient rooms faced the south side, while the operating theaters were on the west side due to the lighting conditions. The outpatient clinic was set up on the ground floor with separate entrances from Luisenstrasse , and there was also a small lecture hall. It was also thanks to Killian that the Gutzmann Outpatient Clinic for Speech Disorders , which was founded between 1907 and 1908 at Ziegelstrasse 18-19 , was incorporated into his outpatient clinic at the Charité. It was very important to Killian that all of his assistants went through the Gutzmann department as scheduled.

Maximilian Weingärtner and Walther Albrecht from Freiburg came to Berlin with Killian.

Gustav Killian performs an esophagoscopy in the left lateral position according to von Mikulicz .

After pioneering scientific work in his field, he was appointed to Berlin ( Charité ), conferring the title of Privy Medical Council , where he was made full professor the following year. His predecessor Bernhard Fränkel informed him on May 25, 1911 that he had proposed him as his successor. Despite various opposing intrigues and machinations, he was appointed to the chair of rhino-laryngology on October 1, 1911. Killian's move to Berlin is also said to have resulted in the company for the production of medical instruments FL Fischer from Freiburg opening a branch at Luisenstrasse 64 directly opposite the Charité. The instrument maker Fischer was also a guest at Killian to discuss new instruments. In this collaboration, many instruments were designed, such as the Killian speculum or the Killian-Claus septum chisel .

Gustav Killian among his colleagues at the Charité in 1912. In a black suit, Hermann Gutzmann sen. , next to Gustav Killian

The Fränkelsche Neck-Nasenklinik and the Trautmannsche Ohrenklinik , whose successor was Carl Adolf Passow , remained organizationally separated from each other, although they were located close to each other. There was already considerable rivalry between the two clinic directors, the medical advisor Bernhard Fränkel and the secret medical advisor Carl Adolf Passow. Even when Gustav Killian took over the chair from Bernhard Fränkel in 1911, there was no further rapprochement between the clinics and their directors. Numerous anecdotes prove the disagreements at that time.

Nevertheless, the rejection of Carl Adolf Passow's suggestion, as in his lecture “Otology and Laryngology - Union or Separation” from 1908, with regard to a union of the two specialist disciplines, must probably be understood from the historical context, since laryngology was only just beginning has grown into a recognized subject and should not possibly rise or fall in a larger whole.

He has received an invitation from the US Oto-Rhino- Laryngological Society, The American Laryngological, Rhinological and Otological Society , to participate in the major national North American congresses and separate lectures. In 1907 he set out on this almost three-month trip with the Kaiser Wilhelm der Große of North German Lloyd . It took him from New York to Washington , Pittsburg, Cincinnati , Chicago , Buffalo , Montreal, Boston , Albany and back to New York.

The time after the First World War

In May 1918 he received an invitation from leading Swedish laryngologists to give a lecture tour to Uppsala and Stockholm , where he reported on his progress in the field of bronchoscopy. Here he also met Arthur Edvard af Forselles (1864–1953) and his successes with radium implantation ( radio-oncology ), which was a forerunner of brachytherapy .

In 1920 his full professorship was converted into a full professorship at the medical faculty in Berlin. In the same year he was dean of the faculty. In 1921 Gustav Killian died unexpectedly of metastatic colon carcinoma or after a laparotomy or abdominal operation.

His son Hans Franz Edmund Killian (1892–1982) was also a doctor. He founded the journal Anesthesia and Anesthesia in 1923 and also distinguished himself as a writer, so it appeared in 1957. Behind us there is only God. A surgeon remembers . His second son, Peter Killian, died as an air officer in 1918 in the First World War . He crashed his plane and contracted a purulent meningitis as a result. Despite his father's surgical intervention, he died.

Merits

The results of his many years of scientific work are diverse, for example he published an improved form of representation of the posterior larynx wall for the first time in 1890, which is now known as "Killian's position". During the same period, Killian introduced elongated specula to examine the middle and posterior nasal passages and the olfactory fissure.

Under his name, a "weak point" between the horizontal and inclined part of the cricopharyngeal muscle was mentioned for the first time, which he identified as the cause of the pulsation diverticulum of the posterior hypopharyngeal wall, see also Zenker's diverticulum . The cricopharyngeus muscle is also known as the Killian's whiplash muscle , as it forms a loop around the upper entrance of the esophagus , together with some muscle fibers from neighboring muscles, which are functionally organized into the upper esophageal sphincter and thus determine the tone in this area of ​​the hypopharynx .

The M. constrictor pharyngeus inferior. Below and in the direction of the arrow is the cricopharyngeus muscle

Anatomical and comparative anatomical studies

During his time in Freiburg he worked at the anatomical institute there for about three years. So he dealt with the comparative anatomy and the embryology of the masticatory muscles of vertebrates at the anatomical institute of the University of Freiburg under the direction of Robert Wiedersheim . In general, the tensor tympani muscle, together with the tensor veli palatini muscle, is considered a descendant of the mammalian pterygoideus internus muscle . In his monograph from 1890 on the comparative anatomy and comparative history of the development of the ear muscles, Killian derives the tensor veli palatini muscle together with the tensor tympani muscle due to their common nerve path from the pterygoideus (internus) muscle of reptiles and amphibians , and the M. pterygoideus (internus) in turn from the adductor mandibulae muscle of the Selachians . For this purpose Carl Hagenbeck had sent him the carcass of a dead crocodile.

Bronchoscopy

Rigid bronchoscopy according to G. Killian with a lamp according to A. Kirstein

Gustav Killian's greatest achievement was the development and establishment of bronchoscopy, which enabled diagnoses and life-saving measures that were previously not possible in the case of inadequately developed x-ray technology and not yet generally available positive pressure ventilation with negative pressure chambers or intubation . Decisive for this were the observations and performance of Adolf Kussmaul , who had succeeded in inserting a straight tube into the esophagus of a sword swallower picked up at the fair. Killian experimented with similar tubular devices.

Killian preparing for bronchoscopy
Killian demonstrates rigid bronchoscopy on an anatomical specimen

On Tuesday, March 30, 1897, bronchoscopy was used for the first time in a patient, a sawmill from the Black Forest , in whose right main bronchius a piece of bone was identified that could be removed with an esophagoscope . His assistant from the Freiburg Polyclinic, Otto Kollofrath, took over the publication of the case report in 1897 in the MMW Münchener Medizinische Wochenschrift . In the following year he presented the method at a laryngological conference and at the same time proved that it did no harm to the patient, since the bronchial tubes, which do not form a system of rigid branches as previously assumed, turned out to be so elastic that they could be removed from the introduced bronchoscope do not oppose too much resistance. Before the First World War, Wilhelm Brünings worked for Killian in Freiburg and was involved with the construction of the broncho- and laryngoscopes. Further developed instruments for rigid bronchoscopy are still used for diagnosis and therapy in the case of corresponding indications in the bronchial system. A great advantage of rigid bronchoscopy is the wide working channel in the bronchoscope. This allows special instruments, such as biopsy forceps, to be inserted without any problems.

Contemporary rigid bronchoscopy performed on an anesthetized patient

Swinging laryngoscopy

Using the indirect hypopharyngoscopy developed by Carl Otto von Eicken (senior physician under Killian), Killian inserted a right-angled spatula with a long handle over the tongue and epiglottis on an overstretched corpse's head with his mouth wide open . Since holding and levering the larynx always required the physician's physical capacity, Killian locked the spatula on the table. This was the hour of birth of swing laryngoscopy. In 1911 Gustav Killian presented this process with some technical improvements at an international congress.

Surgical techniques

Gustav Killian's second great merit is to be found at the operational level. In 1902, for example, he developed a radical operation of the frontal sinus, a surgical procedure for chronic frontal sinus inflammation that replaced the previous Riedel operation that disfigured the patient . In addition, Killian first introduced the submucosal window resection of the nasal septum to correct deep septal deviations . The rehabilitation times for the patient were reduced from four to eight weeks to three to four days compared to previous methods.

For the operation on the frontal sinus , Killian developed the method of Jansen-Ritter further. For example, an arched incision is made under anesthesia along the nasal or medial corner of the eye to the eyebrow . A window or opening is made in the bone on the floor of the frontal sinus so that the mucous membrane can be removed. Afterwards, an access is made to the main nasal cavity and a permanent connection is created between the two cavities. After the modification by Killian, a windowing of the front wall of the frontal sinus is constructed while protecting the floor of the orbit .

Gustav Killian did not live to see the publication of his book Hearing Organ, Upper Air and Food Paths . It was published in 1921 by its co-author Otto Voss (* 1869). Voss had been the chief physician of the Municipal Ear Clinic in the Carolinum in Frankfurt am Main since 1907 , where he was appointed full professor in 1914.

Killian was also the first to begin developing his submucosal septal resection technique around 1900 . The introduction of cocaine as a local anesthetic by the ophthalmologist Carl Koller and Sigmund Freud in 1884 was a prerequisite .

Honors and memories of Killian's work

The World Congress for Bronchology and Interventional Pulmonology (WCBIP) awards the Gustav Killian Centenary Medal in memory of Killian . It was originally awarded in 1997 on the centenary of the latter and in memory of his first bronchoscopy.

Publications (selection)

  • About the pharyngeal bursa and tonsilla. 1888.
  • Examination of the posterior wall of the larynx. 1890.
  • The position of the sinuses of the nose in relation to the neighboring organs. 1903.
  • Swinging laryngoscopy and its practical use. 1920.
  • Submucous window resection of the nasal septum. In: Archives for Laryngology and Rhinology. 16, 1904, pp. 362-387.
  • The origin of choanal polipi. In: The Lancet . 2, 1906, pp. 81-82.
  • About the treatment of foreign bodies under bronchial stenosis. Freiburg.
  • Swinging laryngoscopy. In: Arch Laryngol Rhinol. 26, 1912, pp. 277-317.
  • For comparative anatomy and comparative development history of the auricular muscles. 1890.
  • The ear muscles of the crocodile along with preliminary remarks on the homology of the stapedius muscle and the stapes. In: Jenaische Zeitschrift für Naturwissenschaft. 24th vol. (New version 17 vol.) 1890.
  • On the anatomy of the parovarial cysts. In: Archives for Gynecology. Volume 26, Issue 3, 1885, pp. 460-477.

literature

  • Werner Kindler: The History of Oto-Rhino-Laryngology in Berlin . Georg Thieme Verlag, Stuttgart 1956.
  • Hans Killian: Gustav Killian, his life, his work, at the same time a contribution to the history of bronchology and laryngology . Dustri-Verlag, Remscheid-Lennep 1958.
  • Hans Killian: There is only God behind us. Sub umbra dei. A surgeon remembers. Kindler, Munich 1957; Paperback edition: Herder, Freiburg / Basel / Vienna 1967; 10th edition 1975, ISBN 3-451-01779-2 , pp. 11-19 (Further licensed editions also under different main titles, e.g. A surgeon remembers. )
  • Peter K. Plinkert: Gustav Killian - A pioneer in endoscopy. In: ENT. 46, 1998, pp. 629-630.
  • Hans Behrbohm: Fundamentals of instrument science for the ear, nose and throat doctor and plastic facial surgeon. Cutting instruments, scalpels and scissors. online (PDF; 5.5 MB)

Web links

Individual evidence

  1. ↑ Discover regional studies online. For Baden-Württemberg
  2. ↑ Frida Heckmann, Helmut Klingelhöfer:  Civilian widow commission . (= Repertories Hessisches Staatsarchiv Darmstadt ) Holdings G18, p. 151 (PDF; 513 kB). In: Archive Information System Hessen (Arcinsys Hessen), as of June 2007, accessed on September 19, 2016.
  3. ↑ Thorsten Dette, Lutz Schneider: Student Discipline and Academic Jurisdiction in the First Half of the 19th Century Name register of the students listed in the disciplinary court records of the University of Giessen. GIESSEN UNIVERSITY LIBRARY (1997) p. 90, online (PDF; 6.1 MB)
  4. ↑ Franz Kössler (Ed.): Register for the matriculation and inscription books of the University of Gießen WS 1807/08 - WS 1850. GIESSEN UNIVERSITÄTSBIBLIOTHEK (1976), p. 92, online (PDF; 12.4 MB)
  5. ↑ Hans Killian: There is only God behind us. A surgeon remembers. Herder, Freiburg / Basel 1984, ISBN 3-451-01779-2 , p. 12.
  6. ↑ Hans Killian: Gustav Killian his life - his work. Dustri-Verlag, Remscheid-Lennep 1958, pp. 13-15.
  7. ↑ Until 1907, the Bürgerhospital was located on the Hinter der Schlimmen Mauer and the corner of Radgasse (today 30 Stiftstrasse ) near the Eschenheimer Tower .
  8. ↑ John A. Nakhosteen, Barbara Khanavkar, Kaid Darwiche, Andreas Scherff, Erich Hecker, Santiago Ewig: Atlas and textbook of Thoracic Endoscopy: Bronchoskopie, Thorakoskopie. Springer Verlag, 2008, ISBN 978-3-540-79939-9 , pp. 2-6.
  9. ↑ a b c d e f g h i Hans Killian: There is only God behind us. Sub umbra dei. A surgeon remembers. Kindler, Munich 1957; here: Licensed edition as Herder paperback (= Herder library. Volume 279). Herder, Freiburg / Basel / Vienna 1975, ISBN 3-451-01779-2 , pp. 12-19.
  10. ↑ M. Reinhard, E. Eberhardt: Alfred Kirstein (1863-1922) - pioneer of direct laryngoscopy. In: Anästhesiol Intensivmed Emergency Med Schmerzther. 30 (4), 1995, pp. 240-246.
  11. ^ Alfred Kirstein: Autoscopy of the larynx and the trachea (Laryngoscopia directa, euthyscopy. Viewing without a mirror). In: Arch Laryngol Rhinol. 3, 1895, pp. 156-164.
  12. ↑ Hans Killian: Gustav Killian his life - his work. Dustri-Verlag, Remscheid-Lennep 1958, p. 58.
  13. ↑ Norbert Stasche: Flexible and rigid endoscopy of the airways and upper food passages. (PDF; 134 kB). MEDICINE (52) In: Deutsches Ärzteblatt. 96, issue 4, January 29, 1999.
  14. ^ Wolf Lübbers: Historical nasal specula. On the history of rhinoscopy. In: ENT news. 2, 2009. (PDF; 235 kB)
  15. ↑ History of the Charité and ear, nose and throat medicine in Berlin. ( Memento of the original from July 21, 2012 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 / hno-ccm.charite.de
  16. ↑ Independent company until 1984 - u. a. for stereotactic instruments - from then part of the US company Stryker Corporation
  17. ↑ Hans Behrbohm: Fundamentals of instrument science for the ear, nose and throat doctor and plastic facial surgeon Cutting instruments, scalpels and scissors.  ( Page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. P. 23. (PDF; 5.5 MB)@1@ 2Template: Toter Link / www.imwe-berlin.de  
  18. ↑ The Gutzmanns. From Heinz Zehmisch after a lecture on the occasion of a ceremony of the Berlin Charité in memory of Hermann Gutzmann sen. on January 29, 2005, p. 4. ( Memento of the original from September 24, 2015 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF; 2.7 MB)  @1@ 2Template: Webachiv / IABot / www.phoniatrics-uep.org
  19. ↑ Karl Max Einhäupl, Detlev Ganten, Jakob Hein: 300 years of Charité: in the mirror of their institutes. Walter de Gruyter, 2010, ISBN 978-3-11-020256-4 , p. 121.
  20. ↑ Hans Killian: Gustav Killian his life - his work. Dustri-Verlag, Remscheid-Lennep 1958, p. 143.
  21. ↑ Csaba Nikolaus Nemes: Southwest - a cradle of German anesthesia. Überlingen am Bodensee 2008, p. 7, online (PDF; 202 kB)
  22. ↑ Hans Killian: CV. (PDF file; 27.78 kB)
  23. ↑ John A. Nakhosteen, Barbara Khanavkar u. a .: Atlas and textbook of thoracic endoscopy: bronchoscopy, thoracoscopy: quality assurance, diagnostics and therapy. Springer, Berlin / Heidelberg 2009, ISBN 978-3-540-79939-9 , p. 5.
  24. ^ The history of the anatomical institute of the University of Freiburg, online
  25. ↑ On the comparative anatomy and comparative history of the development of the auricular muscles. In: Anatomischer Anzeiger . Volume V, 1890.
  26. ↑ Hans Killian: Gustav Killian his life - his work. Dustri-Verlag, Remscheid-Lennep 1958, pp. 63-64.
  27. ^ Heinrich Matthys, Werner Seeger: Clinical Pneumology. Springer, Berlin / Heidelberg 2008, ISBN 978-3-540-37682-8 , p. 86.
  28. ↑ Gustav Killian, Otto Kollofrath: Removal of a piece of bone from the right bronchus in a natural way using direct laryngoscopy. In: MMW. 38, 1897, pp. 1038-1039.
  29. ↑ Norbert Stasche: Gustav Killian Symposium - 100th anniversary of the bronchoscopy: Flexible and rigid endoscopy of the upper air and digestive tract. In: Dtsch Arzteblatt. 96 (4), 1999, pp. A-204 / B-163 / C-159. (PDF file; 130 kB)
  30. ↑ Robert Kropp: Pneumology. Thieme, Stuttgart 2011, ISBN 978-3-13-165111-2 , p. 180.
  31. ↑ Archives for Laryngology and Rhinology. 16, 1904, pp. 362-387.
  32. ↑ W. Becker, HH Naumann, CR Pfaltz: Ear, Nose and Throat Medicine. Georg Thieme Verlag, Stuttgart 1986, ISBN 3-13-583003-9 , pp. 241-242.
  33. ↑ The Baroness Hannah Luise von Rothschild founded the Carolinum in Frankfurt am Main Niederrad in 1890 in memory of the late father Mayer Carl von Rothschild
  34. ↑ Illustration of the young Gustav Killians and his medal founded in his honor. ( Memento of the original from May 5, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.  @1@ 2Template: Webachiv / IABot / www.wabip.com
personal data
SURNAME Killian, Gustav
ALTERNATIVE NAMES Killian, Gustav Johann
BRIEF DESCRIPTION German physician, pioneer of otorhinolaryngology
DATE OF BIRTH June 2, 1860
PLACE OF BIRTH Mainz
DATE OF DEATH February 24, 1921
Place of death Berlin