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History of CPR

Fascinating insight into early attempts to resuscitate people.


How at all began

The first apparent attempt at resuscitation interestingly enough was recorded around 800 BC. The first resuscitation was Elisha's mouth to mouth (Bible, 2 Kings, iv, 34.).

 "...And he went up, and lay upon the child, and put his mouth upon his mouth, and his eyes upon his eyes, and his hands upon his hands; and he stretched himself upon the child; and the flesh of the child waxed warm."

Early Ages - Heat Method

Very early in our history, people realized that the body became cold when lifeless and connected heat with life. In order to prevent death from taking the person, the body was warmed. The use of warm ashes, burning excrement, or hot water placed directly on the body were all employed in an attempt to restore life.

Early Ages - Flagellation Method

In the early ages, the would-be rescuers would actually whip the victim in an attempt to stimulate some type of response.

1530 - Bellows Method

In the 1500's it was not uncommon to use a bellows from a fireplace to blow hot air and smoke into the victim's mouth, a method that was used for almost 300 years. Unfortunately, not many people carried fireplace bellows with them, but the success of this procedure motivated various manufacturers to design and manufacture Bag-Valve-Mask Resuscitators.

However, in those days, the medical authorities were not aware of the anatomy of the respiratory system and did not appreciate the need to extend the victim's neck in order to obtain a clear airway.

In 1829, Leroy d'Etiolles demonstrated that over distension of the lungs by bellows could kill an animal, so this practice was discontinued.

1711 - Fumigation Method

In the 1700's a new method of resuscitation was used. This "new" procedure involved blowing tobacco smoke into the victim's rectum.  According to the literature, smoke was first blown into an animal bladder, then into the victim's rectum. It was used successfully by North American Indians and American colonists an introduced in England in 1767.

This practice was abandoned in 1811 after research by Benjamin Brodie when he demonstrated that four ounces of tobacco would kill a dog and one ounce would kill a cat.

1770 - Inversion Method

Other methods were developed in the 1700's in response to the leading cause of sudden death of that time, drowning. Inversion was originally practiced in Egypt almost 3,500 years before and it again became popular in Europe. This method involved hanging the victim by his feet, with chest pressure to aid in expiration and pressure release to aid inspiration.

In response to the increasing numbers of drowning during this time period, societies were formed to organize efforts in resuscitation. England's Royal Humane Society was founded in 1774. Although it was the most famous, it was not the first. It was preceded by the Dutch Society for Recovery of Drowned Persons, established in 1767. The Dutch recommendations included:

  1. Warming the victim (which sometimes required transporting the body to a different location) by lighting afire near the victim, burying him in warm sand, placing the body in a warm bath, or placing in a bed with one or two volunteers;
  2. Removing swallowed or aspirated water by positioning the victim head lower than his feet and applying manual pressure to the abdomen, vomiting was induced by tickling the back of the throat with a feather;
  3. Stimulation of the victim, especially the lungs, stomach and intestines by such means as rectal fumigation with tobacco smoke, or the use of strong odours;
  4. Restoring breathing with a bellows;
  5. Bloodletting.

These and other methods had been applied for years as documented in the report of Anne Green's hanging, resuscitation and recovery in 1650.

Other methods included physical and tactile stimulation in an attempt to "wake up" the victim. Yelling, slapping, even whipping were used to attempt to resuscitate.

1773 - Barrel Method

In an effort to force air in and out of the victim's chest cavity, the rescuer would hoist the Victim onto a large wine barrel and alternately roll him back and forth. This action would result in a compression of the victim's chest cavity, forcing air out, and then a release of pressure which would allow the chest to expand resulting in air being drawn in.

1803 - Russian Method

This concept involved reducing the body's metabolism by freezing the body under a layer of snow and ice. Unfortunately, what the medical authorities did not realize at the time, was that the most critical organ which needed to be frozen in order to accomplish a reduction of the body's metabolism was the brain.

1812 - Trotting Horse Method

In 1812 Lifeguards were equipped with a horse which was tied to the Lifeguard station. When a victim was rescued and removed from the water, the Lifeguard would hoist the victim onto his horse and run the horse up and down the beach. This resulted in an alternate compression and relaxation of the chest cavity as a result of the bouncing of the body on the horse. This procedure as banned across the United States in 1815 as a result of complaints by "Citizens for Clean Beaches".

1856 - Roll Method

As late as 1856, manual ventilation was given low priority, concentration was on maintaining body heat. These were the same recommendations as provided by the Dutch nearly 100 years earlier. A significant change in priorities occurred when Marshall Hall challenged the conventional wisdom of the Society. His contention that time was lost transporting the victim; that the restoration of warmth without some type of ventilation was detrimental; that fresh air was beneficial; and that if left in the supine position, the victim's tongue would fallback and occlude the airway.

Because the bellows were no longer an option, Marshall Hall developed a manual method in which the victim was rolled from stomach to side 16 times a minute. In addition, pressure was applied to the victim's back while the victim was prone (expiratory phase). Tidal volumes of 300 ml to 500 ml were achieved and soon became adopted by the Royal Humane Society.

Late 1892 - Tongue stretching

Other methods still used included stretching the rectum, rubbing the body, tickling the throat with a feather, waving strong salts, such as ammonia, under the victim's nose.

In 1892, French authors recommended tongue stretching. This procedure was described as holding the victim's mouth open while pulling the tongue forcefully and rhythmically.

1950 - Mouth-to-Mouth Resuscitation

During World War II, this procedure was advocated within the United States military services. In 1950, organizations like the American Red Cross began an aggressive education campaign in order to educate the American public. In the 1960's this training was expanded by which Lifeguard Personnel were instructed in this procedure by performing mouth-to-mouth resuscitation in the water using Rescue buoys, paddleboards, and boats and canoes as flotation supports while performing this procedure in the water.

1960 - Cardiac Massage

The next major step in resuscitation was closed chest massage which was introduced in the 1960's by Dr. Kowenhoven, The crucial aspect of this technique is that the patient receives oxygen which is transported to the brain by the development of a minimal blood circulation. On this basis many national and international guidelines to perform CPR came out.

1973 - CPR practice for the population

During the Vietnam War the US army introduced CPR to the people for the first time. Then, in 1973 the American Red Cross and the American Heart Association (AHA) began a big campaign to teach the American population this method.





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