Today I wanted to give y'all a little fun medical history lesson all about CPR. Have you ever heard the term “blowing smoke up your butt?” Have you ever wondered where that term came from?
In the 18th century there was something called the “tobacco smoke enema” that lead us to modern resuscitation. Tobacco was mainly imported from New America from the Native Americans. At that time, Native Americans used tobacco medicinally and would physically blow tobacco smoke up the anus to ease symptoms of constipation, diarrhea, abdominal cramps, and even hernias
Prior to the Columbian Exchange, tobacco was unknown in the Old World. After explorers came to the Americans, Europeans became aware of the tobacco for its theorized medicine purposes. At that time, medical science was based heavily on humorism– Hippocrates theory that the there must be an equilibrium in the body of the vital bodily fluids (blood, phlegm, yellow bile, and black bile) and an imbalance of the humors would cause illness (later to be overturned by the understanding of germ theory). During this time, tobacco was thought to be able to soak up moisture in warm parts of the body, providing equilibrium to the body. At this time tobacco was even used to fumigate buildings to “discourage disease.”
Slowly this information became known to Europe from travelers, mostly sailors, that came back to Europe. Richard Mead, an English physician, first published a single case report of a smoke enema that saved someone from drowning. In 1745, a woman that fell overboard in London was resuscitated after a passing sailor had told the husband of the woman to insert the stem of a pipe into her rectum and blow tobacco smoke which apparently revived the woman.
This was revolutionary because at this time resuscitation was based solely on taking someone, warming them up, and stimulating them. At the time, artificial respiration and the blowing of smoke into the lungs or the rectum were thought to be interchangeably useful, but smoke enema was considered more potent because they believed it internally warmed and stimulated more effectively.
In the 1770s, London formed a rudimentary form of its first lifeguard crew. Drs William Haws and Thomas Cogan formed the Royal Humane Society, which was a society promoted to rescue drowning people and would pay their “guard” money for anyone successfully brought back to life. The Royal Humane Society had placed resuscitation kits that included smoke enemas along the River Thames in which young men would stand along the docks and save people from the water. First they would warm the drowned person and then would “stimulate respiration” with a smoke enema. Artificial respiration with the bellow was then used if the tobacco smoke enema failed. The lifeguards would use the below bellows:
This continued for some time and “bellowing” air into the lungs and smoke into the rectum continued to be a favored form of resuscitation. Prior to bellows in the mouth, there were documented forms of mouth-to-mouth resuscitation in the 1730s that was favored prior to the bellow.
This became a very popular “treatment” for many ailments of the time till it fell out of favor when in 1811 English scientist Benjamin Brodie discovered that nicotine was toxic to the heart.
Eventually artificial resuscitation evolved into many different methods prior to the ones we have today. In the 1850s, Marshall Hall, thought that the best way to artificially respirate someone was to rotate the body from the prone position to the side to increase the size of the chest cavity, followed by applying pressure to the chest to release the air. Around the same time, Henry Silvester questioned this technique and had patient’s lay on their back rather than their side, raising their arms above their head to expand the chest and allow air to flow into the lungs. He then would have the patient's arms crossed on their chest and then press on their chest to expel the air.
These became widely accepted and used techniques until the late 1800s when open cardiac massage was discovered to restore circulation by a German scientist Moritz Schiff who was able to restore blood circulation in a dog after massaging its exposed heart in an open-chest surgery. Not but a few years later, a German surgeon Freidrich Maass was able to successfully resuscitate two patients with only external chest compressions while using respiratory ventilations for resuscitation, similar to our CPR today, however this was ignored for almost 70 years where open heart resuscitation continued to be the standard. So for 70 years people continued to have their chests cut open to have their hearts internally massaged for resuscitation.
It wasn’t until the 1950s-1960s that CPR as we know it today actually took shape. In 1956, Peter Safar, James Elam, and Archer Gordon were able to prove that mouth-to-mouth resuscitation, which was largely abandoned for two centuries, was sufficient in resuscitating a victim. Safar, along with William Kouwenhoven and James Jude, would then in 1960 prove that combining mouth to mouth with external chest compressions was successful and would call it “cardiopulmonary resuscitation.” In the 1960s, the AHA started a program to acquaint physicians with closed-chest cardiac resuscitation and a life sized training manikin called “Resusci Anne” was born, which was used to train physicians how to perform CPR.
So every time you are coding a patient, think about how what we do currently all evolved from blowing smoke up someone’s anus!
Hannah Blakely