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UNIVERSITÄTSKLINIKUM HAMBURG-EPPENDORF Die Darstellung Der UNIVERSITÄTSKLINIKUM HAMBURG-EPPENDORF Zentrum für Anästhesiologie und Intensivmedizin Prof. Dr. med. Alwin E. Goetz Klinik und Poliklinik für Anästhesiologie Prof. Dr. med. Christian Zöllner Die Darstellung der Anästhesie in gängigen Lehrbüchern der Chirurgie in Deutschland von 1846 bis in die 1950er Jahre Dissertation zur Erlangung des Grades eines Doktors der Medizin an der Medizinischen Fakultät der Universität Hamburg. vorgelegt von: Anna Hofmann aus Coburg Hamburg 2017 Angenommen von der Medizinischen Fakultät der Universität Hamburg am: 28.03.2018 Veröffentlicht mit Genehmigung der Medizinischen Fakultät der Universität Hamburg. Prüfungsausschuss, der/die Vorsitzende: Prof. Dr. Michael Goerig Prüfungsausschuss, zweite/r Gutachter/in: PD Dr. Rebecca Schwoch 2 Inhaltsverzeichnis 1 Einleitung .............................................................................................................. 7 1.1 Stand der Forschung und Fragestellung ....................................................... 8 1.2 Methoden ...................................................................................................... 9 2 Die ersten 100 Jahre der modernen Anästhesie - ein historischer Abriss ......... 12 2.1 Von Äther und Lachgas - Der Beginn der modernen Anästhesie ............... 12 2.2 Das Aufkommen des vermeintlich gefahrlosen Chloroforms und wieder zurück zum sicheren Äther .................................................................................... 14 2.3 Alternativen zur inhalativen Narkose werden entwickelt ............................. 16 2.3.1 Die Lokalanästhesie .............................................................................. 16 2.3.2 Die intravenöse Anästhesie ................................................................... 19 2.4 Von der Zungenzange zur Intubation – Über die Sicherung des Atemweges 21 2.5 Narkoseapparate und erste Beatmungsgeräte ........................................... 26 2.5.1 Die Apparatnarkose ............................................................................... 26 2.5.2 Erste Beatmungsgeräte ......................................................................... 29 2.6 Die Wiederbelebung im Rahmen der Narkose ............................................ 33 2.7 Die Anästhesie etabliert sich ....................................................................... 38 3 Ergebnisse ......................................................................................................... 43 3.1 Die Berücksichtigung der Anästhesie in Lehrbüchern der Chirurgie – biographische Anmerkungen zu den Autoren ........................................................ 43 3.1.1 Eduard Albert (1841-1900): Lehrbuch der Chirurgie und Operationslehre 1877-1897 .......................................................................................................... 43 3.1.2 August Bier (1861-1949), Heinrich Braun (1862-1934) und Hermann Kümmell (1852-1937): Chirurgische Operationslehre 1912-1952 ...................... 45 3.1.2.1 Heinrich Braun (1862-1934) ............................................................ 47 3.1.2.2 Ferdinand Sauerbruch (1875-1951) ................................................ 51 3.1.2.3 Erwin Gohrbandt (1890-1965) ......................................................... 54 3.1.3 August Borchard (1864-1940) und Victor Schmieden (1874-1945): Lehrbuch der Kriegschirurgie 1917-1937 ........................................................... 56 3 3.1.4 Friedrich von Esmarch (1823-1908): Handbuch der kriegschirurgischen Technik 1877-1901 ............................................................................................. 58 3.1.5 Walter Hermann von Heineke (1834-1901): Compendium der Operations- und Verbandlehre 1871-1885 ......................................................... 62 3.1.6 Carl Hueter und Hermann Lossen: Grundriss der Chirurgie 1880-1897 64 3.1.6.1 Carl Hueter (1838-1883) ................................................................. 64 3.1.6.2 Hermann Lossen (1842-1909) ........................................................ 67 3.1.7 Martin Kirschner (1879-1942): Die Chirurgie 1926-1949 und Allgemeine und spezielle Operationslehre 1927-1991 .......................................................... 68 3.1.7.1 Martin Kirschner (1879-1942) und Otto Nordmann (1876-1946) Die Chirurgie 1926-1949 ....................................................................................... 69 3.1.7.1.1 Friedrich Pels Leusden (1866-1944) .......................................... 69 3.1.7.1.2 Rudolf Friedrich (1901-1973) ..................................................... 72 3.1.7.2 Martin Kirschner (1879-1942) und Alfred Schubert (1886-?): Allgemeine und spezielle Operationslehre 1927-1991 ................................... 73 3.1.7.2.1 Martin Kirschner (1879-1942) .................................................... 74 3.1.7.2.2 Gerd Hegemann (1912-1999) .................................................... 77 3.1.8 Theodor Kocher (1841-1917): Chirurgische Operationslehre 1892-1907 79 3.1.9 Arno Krüche (1854-1926): Allgemeine Chirurgie und Operationslehre 1882-1907 .......................................................................................................... 81 3.1.10 Félix Lejars (1863-1932): Technik dringlicher Operationen 1902-1914 83 3.1.11 Erich Lexer (1867-1937): Lehrbuch der allgemeinen Chirurgie 1904-1957 .......................................................................................................... 86 3.1.12 Ignaz Josef Neudörfer (1825-1898): Handbuch der Kriegschirurgie 1864-1872 .......................................................................................................... 88 3.1.13 Otto Nordmann (1876-1946): Praktikum der Chirurgie 1915-1952 .... 89 3.1.14 Hermann Tillmanns (1844-1927): Lehrbuch der allgemeinen und speciellen Chirurgie 1888-1911 .......................................................................... 93 3.2 Die Darstellung der Anästhesie in den Lehrbüchern der Chirurgie ............. 94 4 3.2.1 Bewertung der Anästhesie aus chirurgischer Sicht und Praxisanleitung zur Narkose ........................................................................................................ 94 3.2.1.1 Wohltat oder Unheil? - Bewertung der Narkose aus chirurgischer Sicht 96 3.2.1.2 Praxisanleitung zur Narkose ......................................................... 104 3.2.2 Zwischen den Zeilen gelesen - Unbeabsichtigte Inhalte ..................... 110 3.2.3 Grundlage und Aktualität der Lehrinhalte ............................................ 116 3.2.3.1 Unzureichende anästhesiologische Forschung und Praxis? - Grundlage der Empfehlungen zur Narkose ................................... 116 3.2.3.2 Waren die Empfehlungen auf aktuellem Stand? - Aktualität verwendeter Methoden und Apparate .......................................................... 122 3.2.3.2.1 Aktualität empfohlener Methoden - Prüfung anhand der Prämedikation ........................................................................................... 122 3.2.3.2.2 Aktualität der verwendeten Apparate ....................................... 129 3.2.4 Zur Person des Narkotiseurs ............................................................... 135 3.2.4.1 Wer narkotisierte? ......................................................................... 135 3.2.4.2 Der Tod in der Narkose ist die Schuld des Arztes - Anforderungen an den Narkotiseur ....................................................................................... 140 3.2.4.3 Der Operateur hüte sich den Narkotiseur zu hetzen - Zur Zusammenarbeit zwischen Narkotiseur und Operateur ............................... 144 3.2.5 Entwicklungen im Laufe der Auflagen ................................................. 147 3.2.5.1 Wir haben keine Ahnung - Unsicherheit mit der neuen Aufgabe des Narkotisierens ............................................................................................... 147 3.2.5.2 Die Unruhe weicht - Zunehmende Erfahrung mit der Narkose ..... 152 3.2.5.3 Beginnendes Sicherheitsdenken und Individualisierung der Anästhesie - Narkose im Sinne des Patienten? ........................................... 156 3.3 Der Patient soll im Mittelpunkt stehen - Ein kurzer Einblick in erste deutschsprachige Lehrbücher der Anästhesie ..................................................... 165 4 Diskussion und Ausblick ................................................................................... 173 5 Zusammenfassung ........................................................................................... 185 6 Summary .......................................................................................................... 187 7 Literaturverzeichnis .......................................................................................... 189 5 8 Anhang ............................................................................................................. 203 8.1 Zeittafel des ersten Jahrhunderts der modernen Anästhesie ................... 203 8.2 Weitere deutschsprachige Lehrbücher im ersten Jahrhundert der modernen Narkose ................................................................................................................ 205 8.2.1 Lehrbücher der Chirurgie ..................................................................... 205 8.2.2 Lehrbücher der Anästhesie .................................................................. 206 8.3 Abbildungsverzeichnis .............................................................................
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