Johann Friedrich August von Esmarch — a pioneer in the field of emergency and disaster medicine

Abstract

Esmarch was born on 9 January 1823 in northern Germany, into a family of physicians, judges and lawyers with a long academic tradition. His father was a highly respected surgeon, who encouraged his gifted son to follow in his footsteps. von Esmarch began his medical studies at the University of Kiel in 1843, to graduate only 3 years later from the University of Gottingen. His career advanced at a rapid pace and he received an appointment as professor and chairman of the department of surgery at the University of Kiel. In 1867 von Esmarch married, an aunt of Emperor Wilhelm II, who raised him to the rank of a peer in 1887 in recognition of his outstanding achievements in the field of medicine. von Esmarch founded the German Society of Surgeons and was named president in 1894. On 23 October 1908 he died from the effects of an influenza infection. In the early 19th century the focus of surgical interventions was primarily on the body surface and the extremities. From the beginning of his medical career von Esmarch showed a passionate interest in trauma care, placing the emphasis on reconstructive surgery instead of the conventional practice of limb amputation in battle victims. The political climate of the time favoured decisions made on the battlefield over diplomatic solutions and his work as a surgeon in the campaigns against Denmark, led by Bismarck in 1848 and 1864, provided him with ample experience in the treatment of war injuries. In contrast to the rapid progress in war technologies with all their horrible consequences, improvements in the military medical service sadly lagged behind and the soldiers received inadequate treatment under unacceptable conditions which had remained unchanged over the preceding centuries. Common consequences of surgical interventions were wound infections, frequently leading to the death of a patient due to massive septic shock. In the 1850s the causes of wound infections were still largely unknown by the practising physicians. von Esmarch’s observation that the cooling of wounds resulted in a reduction in local inflammation and pus-formation and thus to an improvement in the patient’s outcome led him to introduce cryotherapy into clinical practice. In 1862 he published his findings, introducing his new therapeutic