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[Otto Kappeler--a pioneer in anesthesia in German-speaking regions].

The publication of textbooks on anaesthesiology reflects the enormous progress made over the last decades. This new branch of medicine was first completely described in Germany by Otto Kappeler from Switzerland, who was asked to do so by his famous colleague Theodor Billroth from Vienna. Starting with remarks concerning the history of anaesthesiology, he described on more than 220 pages everything that was known about the anaesthetics used at that time. Additionally, he outlined the prospects of the then also brand new methods of local anaesthesia. Undoubtedly it was of Kappeler's special concern to avoid the risk of iatrogenic complications while the patient was under any anaesthetic. This can easily be proved by the fact that he put special emphasis on precautions concerning life-threatening situations and their therapy. To avoid the dangers of an acute airway obstruction by the patient's tongue, he modified the so-called "Esmarch-Heidberg" manoeuvre, which later on became known as the "Kappeler" flick. For the first time ever, Kappeler managed to describe sphygmographically the circulatory effects of narcotics in an anaesthesia-related textbook. Basically, he could not find any differences between them, since " ... all higher dosages of anaesthetics used during operations caused ... a strong widening of the blood vessels ... by paralysing the vasoconstrictors". He believed it would be possible to exclude the dangers of overdosing drugs by introducing devices to perform anaesthesia. In using his self-designed device, which was a modification of the device used at that time, invented by Junker, he was able to come closer to the goal of "in somno securitas" he so vehemently fought for. This confidence he derived from the fact that he was already a strong believer in the advantage of the "self-conducted chloroformation or anaesthesia".