Anesthesia

Perfusion, drip chamber

Drip chambers from MARTIN, about 1920

In 1911, August MARTIN (1847-1933), gynecologist in Greifswald, invented the notorious "WIGAND-MARTIN-WINCKEL" handle on the breech. Son of gynecologist Edmund Arn. MARTIN (1809-1875), invented this drip chamber, with which one was able to regulate and monitor the dripping speed of perfusions.

Anesthesia

Hose clamp

Hose clamp, about 1940

The flow rate of the infusion could be regulated by turning the clamp [frz. "collier de serrage"] on the hose.

Anesthesia

Perfusion, isotonic

Kleininfusion Kleininfusion Kleininfusion

Aus der geburtshilflichen Tasche des ab 1923 in Diekirch niedergelassenen Arztes Paul HETTO stammt diese 23 cm lange Infusions-Ampulle der "Laboratoires Clin" mit 125 ml Kochsalzlösung. Man beachte das klassische "Schweineschwänzchen" zum Aufhängen der Ampulle. So wie man früher mit Blutransfusionen sehr sparsam umging, so auch mit der Zufuhr von physiologischen Salzwasserlösungen. Ob solch homöopathische Mengen einen positiven Effekt hatten wage ich zu bezweifeln.

Laboratoires CLIN
"Vers 1880, Louis Ferdinand COMAR, né en 1832 à Gisors, pharmacien rue de Cléry, puis rue Saint Bernard à Paris, décide de prendre à son compte la fabrication de formules pharmaceutiques spécialisées qu’il mettait au point ou qu’il exploitait pour le compte d’autres pharmaciens, souvent provinciaux. Afin d’enraciner dans une structure juridique et financière solide son développement, il constitue, le 21 août 1887, la Société « COMAR et Cie », société en commandite dont le siège est à Paris, rue Saint Claude. Louis Ferdinand COMAR, « Pharmacien de 1ère classe », en est le gérant. A cette date Louis Ferdinand et ses deux fils, Charles et Léon, tous deux pharmaciens, ont déjà pris en main la destinée des Laboratoires CLIN. Ces derniers, fondés en 1864 par le docteur Ernest Marie CLIN, ancien interne des Hôpitaux de Paris et pharmacien, lauréat de la Faculté et membre de l’Académie de Médecine, sont désormais intégrés à la nouvelle société. Le succès est tel que des déménagements successifs sont nécessaires dans des locaux convenablement aménagés et construits, en dernier lieu 20 rue des Fossés Saint Jacques dans le Vème arrondissement. C’est d’ailleurs là que s’installeront en 1972 les laboratoires MIDY après leur fusion avec CLIN-BYLA* et, plus tard, en 1985, les directions opérationnelles de SANOFI.
La grande originalité de Louis Ferdinand COMAR est d’affermir, par des liens juridiques étroits, les travaux des pharmaciens exploitants et les «apporteurs» de formules comme AUBERGIER, LAVILLE, LAROCHE, NOURRY et CLIN. En plus des laboratoires de Paris, voués à la préparation des produits stérilisés pour injections, des colloïdes et des médicaments galéniques, trois usines assurent la production: celle d’Issy-Les-Moulineaux, où sont effectuées les préparations à base d’alcool, les sirops et les vins médicamenteux comme le Quina Laroche, un des rares remèdes disponibles à l’époque contre le paludisme, les élixirs NOURRY ou DERET, celle de Clermont-Ferrand, destinée aux produits à base de lactucarium AUBERGIER, et celle de Sceaux, occupée exclusivement à la préparation des arsénobenzènes.
Le Catalogue des Laboratoires CLIN - société d’exploitation de «COMAR et Cie» - se compose alors de sirops contre la toux, d’élixirs reconstituants, de préparations antirhumatismales, de préparation à base de colchique «anti-goutte», de métaux «colloïdaux» (Electrargol), d’ampoules hypodermiques de divers principes actifs chimiques. Dans le même temps, l’action thérapeutique des glandes endocrines et exocrines est précisée. Les préparations à base de muqueuses gastriques et intestinales, les sucs de viande, les poudres d’organe entrent dans la thérapeutique. Leurs fabrications mettent en œuvre des procédés délicats d’extraction et de stabilisation, cyrodessication en particulier, et la disposition des ateliers, rue des Fossés Saint Jacques, ainsi que la dispersion et la petitesse des usines, s’avèrent rapidement un frein à l’évolution. En 1916, il est donc décidé d’acquérir à Massy un terrain d’une superficie de 30.000 m2, sur lequel est installée une usine fabriquant pour l’armée, et d’y construire les premiers bâtiments destinés à la fabrication de substances chimiques à vocation thérapeutique. Nombre de produits provenant des ateliers de la rue des Fossés Saint Jacques et des usines sont alors progressivement transférés à Massy, qui devient ainsi, dès 1917, le centre de production de la société. Parallèlement le développement de sérums anti-infectieux, à partir du sang de chevaux élevés et traités dans les écuries installées dans l’usine, est privilégié".

Source : Archives historiques SANOFI-AVENTIS, 2005.

Anesthesia

Perfusion, open cylinder

Perfusion devices from ESMARCH

Routinely i.v. Saline infusions at the end of the 19th century were used in the wake of the work of the Leipzig surgeon Albert Sigmund LANDERER (1854-1904), who proved in 1886 that 0.6-0.7% saline solution was well tolerated even in large quantities.

It is a sad fact that since the mid-20s industrially manufactured infusion solutions (such as Stereofundin, Tutofusin, Normosal) were NOT used in the clinics. Until the 1950s, the hospital pharmacies manufactured the infusion solutions themselves for cost reasons, and these were then infused with open irrigator containers. In the process, decades of open systems remained in use, in which it was possible to "refill" again and again. LANDERER became better known when he suggested treating tuberculosis with tartaric acid.

We present 2 ESMARCH  devices from the fundus of the Elisabeth-Klinik, where they were used until the 1950s to infuse saline solutions of own production.

Friedrich Wilhelm von ESMARCH (1823-1908) studied in Kiel and Göttingen and in 1857 became professor of surgery in Kiel. Several times he served as a surgeon in the army:
- Denmark War (1848)
- Austrian War (1866)
- France War (1870/71)
This explains his special commitment to emergency care.

Anästhesie

Perfusion, open set

Glaskanüle,  Mini-infusion

Lit.: Alexander Sudahl, Das Rote Kreuz im Königreich Württemberg. Inauguraldissertation zur Erlangung des medizinischen Doktorgrades der Medizinischen Fakultät Heidelberg der Ruprecht-Karls-Universität, 2001.

Anesthesia

Perfusion, salty (1)

Kochsalz 1 Kochsalz 2 Kochsalz 3 Kochsalz 4

First saline infusion using closed bottles only from 1886 by Karl Hugo KRONECKER (1839-1914) in Bern.

In a fragile glass ampoule (20 cm long, 4.5 cm thick), this salt water solution, wrapped in a double layer of cardboard, was put on the market in the 1840s ... in truly bad times, as much glass in Shards went!

Note the elegant button closure around which the doctor presumably wrapped a string to hang the ampule at the bedside or on a stand next to his patient's bed! So that the liquid flowed out on the lower side, however, the tip of the head had to be sawn off ...
"Soluté médicamenteux Soluté injectable isotonique apyrogène de Chlorure de Sodium à 9 grams for mille ml

Authorization Ministérielle D 218 "

Manufacturer: Fa. SEROCOD / Choisy.

For the first time, we come across the term pyrogens - substances that cause fever ("pyros" for fire) when injected or infused. Classical pyrogens are the decay products of bacterial cell walls consisting of polysaccharides ... These substances do not represent an infectious agent, but testify to the presence of killed microorganisms (bacteria, fungi), particles of different materials and chemical substances (eg pharmaceuticals) cause fever, circulatory and organ failure, even fatal shock. All these "pyrogens" have one thing in common: they trigger in the organism the synthesis of the formation of interleukin 1-beta, which leads to the described complications. Every doctor feared this complication when injecting fluids intravenously or subcutaneously. In 1924, SEIBERT coined the term "pyrogenic" to refer to the dangerous substance. The Belgian Albert HUSTIN studied the pyrogens when he investigated the possibilities of blood transfusion
In order to declare a solution "pyrogen-free", the solution must have been tested on rabbits (rabbit test, USA 1942) or other, complex procedures have been tested
- in vitro IPT test by Hartung and Wendel, 1995;
- in vitro limulus amebocyte lysate test (LAL).

The first "apyrogenic" solutions were manufactured in 1928 by the American physician Donald E. BAXTER (1882-1935) and patented from 1931 by the company Baxter as Vacoliter Containment, the secret of the fabrication: the solutions became sterile, above all but bottled under exclusion of air ...

Anesthesia

Perfusion, salty (2)

Kochsalz (2) Kochsalz (2)

- On May 27, 1881, the surgeon Albert Sigmund LANDERER (1854-1904) first injected saline into a human being. The introduction of intravenous injection into the clinic was successful in postoperative therapy using a PRAVAZ syringe. LANDERER recommended a technique in which the vein had not previously been exposed by venae-sectio, but was dotted after stasis directly through the intact skin - as the doctor still does today ...

- On October 10, 1881, the same LANDERER had the opportunity to make an infusion of alkaline saline solution on a patient with acute anemia - the first saline infusion in humans!

LANDERER came from Tübingen. From 1879 to 1883 he was an assistant to Carl THIERSCH (1822-1895) at the Leipzig University Hospital.

In 1912, the owner of the Hirsch Pharmacy in Frankfurt, dr. Eduard FRESENIUS (1874-1946), his pharmacy laboratory to a pharmaceutical company, which in 1933 separated from the pharmacy (the Nazis did not tolerate the mixture company / pharmacy) and was moved to Bad Homburg. He founded the first "homeopathic society" in Frankfurt ... When the company founder died in 1946, both the pharmacy and the plant, the "Chem. Pharm. Industrie Dr. Fresenius KG", were bought by his general-owner, the pharmacist Else FERNAU (1925- 1988). This young woman had lived as a "foster daughter" in the Fresenius house since her father's death in 1928, had entered the Fresenius pharmacy in 1944 as an intern and had studied pharmacy at the expense of Eduard FRESENIUS, whose marriage had been childless.
After the end of the war, the company was in the red and was full of debt. Of the original 400 employees, 30 were left. Initially, "everyday items" such as the nose ointment "Bormelin" and the cough syrup "Terpinol" were produced.

When FERNAU took over the management of the business in 1951, specialized in injection solutions - her husband, the lawyer Hans Gottfried Noël Kröner (1909-2006), which she married in the 60s, was the main initiator of the 1955 reorientation of the operation.
The increasing number of serious traffic accidents and the increasing numbers of operations in the hospitals, the new anesthesia procedures, in which a venous access was desired, all these innovations in medicine promised a good return ... The bill worked, the company could expand: from 1974 production in St. Wendel in Saarland, from 1979 in Schweinfurt in Lower Franconia, from 1997 in Friedberg in Hesse!

The presented 250ml infusion vial comes from the fundus of the H (aus) -K (nipp) pharmacy in Duisburg and was probably intended as a subcutaneous infusion in the 60s ...

Anesthesia

Perfusion, seawater

um 1910

Glass infusion bottles were introduced at the beginning of the 1950s. Long before, however, there were glass ampoules that were used as an infusion. Such an ampoule is discussed here.

Presented is an original bottle of the company "Laboratoires A. FANDRE" from Nancy:
"Eau de Mer isotonique stérilisée (Plasma de Quinton)".

Outer mass of the packaging 25 cm, length of the ampoule 18.5 cm. Note the "gooseneck" of the vessel on which it was hung.
René QUINTON (1867-1925) had already demonstrated in 1896 the similarity of the most debased plasma with the seawater of the sea, and had managed to keep alive a living human cell (a "white blood cell") in seawater. In 1904 he published "L'Eau de mer, milieu organique, constance du milieu marin originel, comme milieu vital des cellules, a travers la série animale" in which he pointed out that our "inner" milieu is nothing but a subsequent state of seawater, where all life once took its source. Hence his suggestion to use sea water for rehydration ... Thousands of people were saved by using this solution. However, the "Plasma de Quinton" disappeared after the Second World War from pharmacies and was replaced by synthetic products.

One reason for the high mortality in previous operation was the shock, which was defined by LeDRAN in 1773, but was not accessible to any treatment, especially as first attempts at blood transmission failed (POTTER 1650, LOEWER 1666). Only in 1881 did Albert-Sigmund LANDERER (1854-1904) succeed in Leipzig in the stabilization of circulation by saline infusions. To bind this solution longer in the vascular system was added during the First World War gum arabic, a process that was quickly abandoned because of occurring chills and fever ...

In 1907, the "Plasma de QUINTON" was first commercialized. The fact that it is nowadays prescribed against all possible causes is rooted in the anthroposophical roots of Quinton's views - plasma against cancer, plasma against childhood diarrhea, plasma to cleanse the colon ...
QUINTON's plasma was much more than a modern "isotonic saline solution" - it was a "living" water. Quinton's original water was pumped out of the sea in very specific places, from the so-called "vortex", i. Vertebrae, where special biological and electrical conditions prevail.
www.graal-france.net/index.php?printpreview=true&page=2331

"René Quinton détermina certaines zones spéciales pour prélever une eau pure et" vivante ", destinée à préparer son" Plasma de Quinton. "Ces zones sont appelées techniquement" Vortex "et présentent des courants tourbillonnaires, une température constant, une composition minérale peu variable , ce qui permet la reproduction du phyto et du zooplancton, Recueillie par 30 mètres de profondeur et à 10 mètres du fond de l'océan, analysis et filtrée sur place, l'eau est transportée aux laboratoires Quinton sous température contrôlée et conservée à 4º / 6º C in chambre spéciale, au maximum pendant 45 jours.A laboratire, l'eau est à nouveau microfiltrée à froid and conditionnée dans des ampoules stériles de 10 ml; on obtient ainsi une eau de mer naturelle hypertonique (30 g / l) , 30 grams of sels totaux par litre, commercialized sous le nom de Quinton® Hypertonic Buvable, Pour ramener la concentration marine à l'isotonie sanguine de 9 g / l, l eau de mer est diluée au laboratoire avec de l'eau naturelle minérale non chauffée (Aqua Fontana) car Quinton avait mis en évidence que l'eau distillée (stérilisée par chauffage) faisait perdre beaucoup de ses propriétés à l'eau de mer. On obtient ainsi une eau dont la salinité est de 9 g / l de sels totaux; elle est commercialisée sous le nom de Quinton® Isotonic Buvable (appelé à l'origine "Plasma de Quinton") ".

The infusions were initially given intra-arterially. LANDERER could prove in the late 19th century that the same effect was achieved by intravenous administration. Nevertheless, for decades, they continued to apply the solutions subcutaneously or rectally ...
www.quinton.ch/prelevement.htm

Anesthesia

Perfusion, sugar

Glukoselösung Glukoselösung

The external packaging on which a label affixed indicates that the solution is "hypertonic", it explains how to handle the bottle:

"Plonger l'ampoule dans l'eau tiède vers 40 ° à 45 ° pendant le temps nécessaire pour tiédir le sérum Couper la partie inférieure avec la lime que contient chaque boîte, y adapter le tube Lavoisier femme par une pince, puis couper l 'extrémité supérieure et y fixer le bout de caoutchouc garni d'ouate stérilisée pour empêcher l'air de souiller le liquid, suspendre l'ampoule par son anneau et faire l'injection'.

The "Tube Lavoisier" is named after the famous chemist Antoine Laurent de LAVOISIER (1743-1794), who ended up as a tax collector "fermier général" of the king on (respectively below) the guillotine.

Anesthesia

Plasma diluting agent

This rusted tin container comes from the stocks of the US Army, a Luxembourgish farmer kept his rusty nails for years in it, and its medical significance emerges only from the printed text:

"600 cc
DISTILLED WATER
Pyrogenfree, Distilled, and Sterilized to 0.1 percent citric acid. Contains therefore sterile equipment to be used with the needles contained in the plasma can, for admi- nistering restored plasma.
See instructions for use and
diagrams on plasma can.
ELI LILLY AND COMPANY
Indianapolis U.S.A. "

The presented tin box once contained a glass bottle of sterile water and sterile material to be used in conjunction with a second, unshaped, mold-like jug containing the dried plasma and the transfusion needle, the whole for making and infusing so-called. "restored plasma", ie restored plasma.
"The package contained a waterproof fiberboard box, a rubber stoppered bottle of dried plasma, evacuated to 28 inches of vacuum, with the sterile, pyrogen-free equipment to be administered, contained in a sealed can After a few changes in the initial specifications, this package, which was first produced by commercial laboratories in 1941, was used with satisfaction throughout the war. "The first package was made up of dried plasma, with the appropriate amount of dilute fluid." "Late in 1943, the amount of plasma in each package was increased to 500 cc."

Source: history.amedd.army.mil/booksdocs/wwii/actvsurgconvoli/CH06.htm.

See also the picture: history.amedd.army.mil/booksdocs/wwii/blood/ch07fig42.jpg

The pharmaceutical company Eli Lilly has existed since 1876 and today produces the so-called "Humulin", a human insulin that is synthesized by bacteria.

Anesthesia

Resuscitation

At the beginning of the 20th century, the French chocolate factory CARPENTIER participated in the vulgarization of basic medical knowledge. In the picture, the patient lies in an overstretched supine position, the doctor or helper makes with his arms a kind of wing movement. This overstretching of the body is in contradiction to an ancient method (18th century), to awaken the drowned to life: they tied them belly down (!) On a barrel that you rolled back and forth ...

Although an imperial patent by Maria Theresa dated July 1, 1769, already gave the "instruction" on how to "sustain the seemingly drowned, stupid, or suffocated human beings," and recommended "to close the nostrils and keep the air strong and sustained to blow one's mouth ", this modern-looking instruction fell into oblivion. Until the mid-1950s, the method of chest compression described by Henry Robert Sylvester (1828-1908) in 1859 was the method of choice. A direct ventilation of the lungs was not carried out. It was the Austrian Peter SAFAR (1924 to 2003) who scientifically examined the breath in the USA in 1954 through mouth-to-mouth resuscitation. A method that midwives have been successfully using on newborns since the 16th century. His results were excellent and the new method quickly gained worldwide acceptance. Since approximately 1958, this form of oral or oral mouth-to-mouth contraception, in combination with external chest compressions, has been successfully used in resuscitation and taught in each first aid course. Peter Safar is now considered the father of Cardio Pulmonary Resuscitation (CPR).

The history of the revival
* 1744 First resuscitation of a miner by mouth-to-mouth resuscitation by the surgeon TOSSACH,

* 1847 manual ventilation by v. HASSELT,

* 1858 improved manual ventilation by SYLVESTER. The tongue was pulled out of the mouth and tied to the chin by a neck knot.

* Following the so-called Sylvester breathing exercise, the methods followed SCHÄFER and

* In 1871 the HOWARD method: the rescuer knelt astride the victim lying on his stomach with his face turned to the side, placing his hands on his lower ribs so that his thumbs were parallel and touching each other. Then a strong pressure was applied, which was slowly withdrawn so that the hands remained on the back.

* In 1938, the stretching of the thorax was added in a lateral position after KOHLRAUSCH.

Presented is a 8x5 cm card, bought on 22.4.2006 at a flea market in Steinfort - recto (above), verso (below). It comes from the series "La médecine" by the chocolate manufacturer Carpentier, with a revival scene "Respiration artificielle". The basic evil is described on the map as "asphyxia", as "suffocation". No distinction is made between suffocation caused by drowning, carbon monoxide poisoning, poisoning, etc. Carpentier had his large advertisements designed by Henri GERBAULT (1863-1930). Whoever drew the small collection pictures (fashion, etc.), we do not know.

Anesthesia

Tongue grasper

Tongue grasper by  MATHIEU

1. 1. "Instruments de Chirurgie Maison L. Mathieu. R. & H. Mathieu Fils Ses. 113 Bvard. St. Germain Paris"

Bibliography

"Maison Mathieu , fabrique d'instruments de chirurgie. Catalogue de vente. Arsenal chirurgical : orthopédie, prothèse. Mathieu éd. , 15e édition , sd ( 1906 ) , in-8 pl. toile verte, de XVIII ( index) - 484 pp. , plus de 10.000 descriptions , accompagnées pour chaque page de 1 à 20 gravures"...