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Articles of Interest
Modern day CPR was “invented” as recently as the 1950's and 60's…….. Jackie Southworth of Sovrin Training looks back at resuscitation techniques.
CPR and resuscitation are terms requiring no further explanation to readers, and due to TV, a large proportion of the general public will have a general idea what they mean even if they're not aware of the finer details and have never actually undertaken training.Most experienced first aiders will go on to a type of autopilot when practising or even administering CPR, the ratio and timing will have been practiced over and over again, and many could literally do it blindfold and probably without too much thought. It remains the basis of first aid training and probably the easiest way to save a life without specialist equipment. We are taught why we administer CPR, the technical reasons, what's happening to the casualty etc, but how many have every given a thought to where the idea of CPR originated?
Modern day CPR was “invented” as recently as the 1950's and 60's, and although older readers may remember the numerous changes in the ratio of breaths to chest compressions, the basic principles remain the same. Various methods of resuscitation have been used throughout the ages with the oldest example from around 3000 BC, being the introduction of smoke into the rectum as depicted in hieroglyphics and cave drawings of the Mayan and Inca peoples of South and Central America.
What is believed to be the earliest recorded actual resuscitation is to be found in the Bible (c. 896 BC), “And he (Elisha) 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 stretched himself upon the child; and the flesh of the child waxed warm. Then he returned, and walked in the house to and fro; and went up, and stretched himself upon him: and the child sneezed seven times, and the child opened his eyes”.1
It didn't take long to establish the connection between life and warmth, having realised apparently lifeless bodies were normally very cold to touch, warming was found to aid recover. Some of the more successful methods included immersion in warm water, placing near a fire and even burying the casualty in warm sand. Unfortunately, not all attempts to warm casualties were successful, such crude methods as placing hot or burning objects directly on the skin, including hot ash and burning excrement, obviously led to other problems!
Fire bellows were a popular tool used in resuscitation at a time when they were an everyday item. Their most basic use being to aid in the introduction of air through the mouth however, this method later fell from favour when it became known that over inflation of the lungs could be fatal. Other common uses included blowing hot air or tobacco smoke into the mouth and a rather more interesting use of fire bellows was rectal fumigation which involved blowing hot air, fire smoke or even tobacco smoke in to the casualties rectum. It is not known exactly what this later method hoped to achieve, although the initial shock to the casualty may in some small way contributed to their revival!
Repeated application and release of pressure to the chest cavity was found to prompt recovery, but it was not until modern times that chest compressions as we now know them were introduced. Rather more elaborate but effective methods in the 1700's and 1800's involved a barrel and a horse, both everyday items at the time. In the case of the barrel, a large wine barrel or similar was placed on its side, the casualty lay across it face down, and repeatedly rolled backwards and forwards over the barrel, this movement would continually apply and release pressure on the chest cavity. If no suitable barrel were available, you would lay the casualty face down across your horse and encourage your horse to trot, the movement of the horse causing the repeated application and release of pressure to the chest cavity. As with today's methods, the application of pressure compresses the chest cavity expelling air from the lungs, when the pressure is released the chest cavity expands causing air to be drawn into the lungs.
Casualties of drowning were often hung up by their feet and pressure applied to the chest, this had the added benefit of draining water from the lungs and the weight of the head would in most cases maintain the air way. Many lifeguard stations maintained portable frames designed for “hanging” casualties.
Up to the 1850's, emphasis was placed on maintaining the casualties body heat and little priority given to manual ventilation.2 It was then established by Marshall Hall, that warming the casualty without artificial ventilation was detrimental, he realised leaving the casualty supine allowed the tongue to fall backwards blocking the airway. He advocated the prone position and developed a method of rolling the casualty from side to side at a rate a 16 times per minute and applying pressure on the back whilst in the prone position.3 Other methods later developed included those known as Schafer, Silvester and Holger-Neilson, some of which were taught to first aiders as recently as the 1980's, for use in resuscitating casualty's also suffering major chest or facial injuries. Even though the late 1800's saw major advances, it should be borne in mind that rather more bizarre practices such as rectum stretching, tongue stretching and tickling the casualty's chin with a feather, were still in common practice and accepted by the medical community as effective methods of attempting to revive lifeless bodies.
Although mouth to mouth resuscitation had been used at various times through the ages, as medical knowledge advanced in the 18th century mouth to mouth fell from favour due to fears of germ transfer between the casualty and rescuer. This put the emphasis on bellows type resuscitators, which through development resulted in the modern bag, valve, and mask devices available today.
During the 1950's, research first proved the oxygen content of expired air was sufficient to maintain oxygenation and that resuscitation was improved by tilting the casualty's head back to open the airway. Mouth to mouth was accepted as the most efficient method of artificially ventilating a casualty and separate research led to the discovery that cardiac massage created artificial circulation maintaining a limited oxygen supply to the brain. In 1960, mouth to mouth resuscitation was eventually combined with cardiac massage to become cardio pulmonary resuscitation, as we now know it.
References:
1. Bible 2 Kings, chapter 4 verses 34 & 35
2. Lancet 1856. Marshall Hall. Asphyxia, its rationale and remedy.
3. Medical Times Gazette 1857. FD Fletcher. Dr M Hall’s method of treatment of asphyxia.