Resuscitation Greats

Abstract

This is a collection of essays from the journal Resuscitation, about individuals who have made contributions to resuscitation. The 87 essays span seventeen centuries and are mostly about Western European and North American subjects, although there are contributions about Russians who invented a defibrillator 20 yr before anyone else. There is also one Turk who in 1903 in Istanbul used open cardiac massage when ventricular fibrillation complicated chloroform anaesthesia. All but two of the subjects are men. Throughout the book, there is a theme of discoveries being made and then being forgotten. Versalius performed autopsies in Louvain in 1536, which challenged the authorized teaching of Galen. Versalius pioneered experiential learning, ‘you touch with your own hands and trust in them’. It seems strange to us that his findings were thought so challenging but he had to tread carefully to avoid upsetting authorities. He performed a tracheostomy on a dog, and was then able to demonstrate the independent functions of the heart and lungs. The Oxford school of scientists continued these grizzly vivisections on dogs in the seventeenth century, where Hooke and Mayow discovered that some vital component was being removed from air by the lungs, which was necessary for heart function. In Paris, Antoine Lavoisier was able to assimilate these physiological observations with Priestley's discovery in 1774 of ‘dephlogisticated air’. Lavoisier named the gas oxygen and worked out that oxygen was being absorbed by the lungs and carbon dioxide was exhaled. In the late eighteenth century, a number of European cities (Amsterdam, Copenhagen, Hamburg, and London) formed societies for the resuscitation of people who had drowned. In 1796, in Denmark, Herholdt and Rafn published a book on ‘Lifesaving measures for drowning persons’. They advocated insufflation of the lungs using bellows, and if necessary, intubation of the trachea. They also advocated the use of electric shock to stimulate the heart. It would be another 170 yr before these advances could be implemented. In the nineteenth and twentieth centuries, Hall, Silvester, Howard, Sharpey-Schafer, and Holger Nielsen advocated their own methods of artificial respiration. Sharpey-Schafer used his own assistant and a spirometer to compare these different methods of ventilation. Not surprisingly, he found that his own technique, introduced in 1904, gave the best results. Mouth to mouth or mouth to mask ventilation finally superseded all these techniques in 1958. Elam and Safar in Baltimore showed, in a set of remarkable investigations performed on 31 volunteers who allowed themselves to be paralysed and ventilated, that expired air respiration techniques were more efficient than these eponymous techniques. Herholdt and Rafn in 1796 had been correct about ‘insufflation’ or ventilation. In 1899, Prevost and Batelli in Geneva showed that they could stop and start a dog's heart beat using high-voltage current. In the Soviet Union, Gurvich and Yuniev were able to defibrillate a dog's heart in 1939 and develop low-voltage biphasic defibrillators before these developments were made independently in the USA 20 yr later. Language and politics hindered the free flow of scientific information. We learn about the quirks of these men. The irascible William Harvey always carried his knife with him. Stig Holmberg always carried a knife too, to be ready to perform open massage at his coronary unit in Sweden in the 1960s. For administrative ingenuity, it is hard to beat Nancy Caroline, one of the two women featured in the book. She set up an advanced ambulance service in Pittsburgh in 1967, using 44 novice emergency medical technicians who she trained on a 400 h 9 month course to make a successful advanced ambulance service. Caroline and her mentors Safar and Nagel showed that the skills of resuscitation can be acquired and practiced by the trained lay man. Similarly, in the UK in the 1970s, Chamberlain trained staff at Brighton football club to perform advanced cardiopulmonary resuscitation. His final chapter ‘a tale of resuscitation medicine’, is a masterly overview of the subject. So who is this book for? You could read it in your retirement, but it would be better to read it when young, to see who has discovered what already. It is not always an easy read. The book is quirky itself, with inconsistent fonts between chapters. Both the Baskett brothers write very well and some of the chapters are extraordinarily good.