When Technology Goes In ReverseMarch 2014
By Steven B. Harris, MD
Excerpted and reprinted with permission from The Society for the Recovery of Persons Apparently Dead by Steven B. Harris, MD1,2
In 1767 a few wealthy and civic-minded citizens in Amsterdam gathered to form the Society for Recovery of Drowned Persons.3 Amsterdam is a city of canals and hence people fell in and drowned. It thus became the birthplace for the teaching and promotion of the resuscitation of dead persons.
Within 4 years of its founding, the society in Amsterdam claimed that 150 persons were saved by their recommendations.4 The Society’s techniques involved a range of methods to stimulate the body applying manual pressure to the abdomen and breathing respirations into the mouth of the victim.4
The Society for Recovery of Drowned Persons introduced scientific principles and techniques, along with ethical changes that started a collective belief that resuscitation of the dead was possible.
Following successes of the Amsterdam society, rescue societies sprang up in most European capitals in the 18th century, all with the goal of finding a way of successfully resuscitating victims of sudden death. Many of these techniques (or variations of them) are used in modern emergency medical practice.
Today we call this cardiopulmonary resuscitation (CPR). It continues to improve using hypothermia to extend the period of time a person can be “dead” yet restorable back to healthy life.
What you’ll learn in this article is how the revival of dead persons came to a virtual halt for surprising reasons, and then once again gained acceptance.
I’ll describe a number of medical innovations we take for granted today and the erratic pace they were accepted by the mainstream.
Overlooking Important Ideas
The history of technological innovation is an account of the tortuous paths that advances often take before gaining acceptance.
It might seem at first that it is the nature of important ideas to spring up nearly everywhere, independently, as soon as the world is ripe for them. But this is only the view at first glance. In actuality, the “synchronicity” of discovery usually turns out to be a late phenomenon. The “new” idea in question often follows a period in which it’s long been around in some form or another, but steadfastly ignored.
How long can an important idea be overlooked? The model steam engine was demonstrated by Hero of Alexandria in the first century AD,5 sixteen centuries before people started thinking along these lines again. Gregor Mendel published the basic principles of genetics in 1866, and was ignored until 1900.6 Oswald Avery published strong evidence that DNA was the principle of heredity in 1944, but no one really believed it until the time of Watson and Crick almost a decade later.7 The time between conception, discovery and acceptance varies, depending on circumstance.
“The human mind treats a new idea the way the body treats a strange protein; it rejects it.”
—Biologist P.B. Medawar
Delayed acceptance of discovery happens in all areas of science, but it always happens in the field of medicine with great poignancy, since there the human costs of dropping the technological ball are usually great. We may consider, for instance, the numbers of lives which might have been saved if not for the following delays:
Leeuwenhoek invented the microscope in 1668 and saw animal cells and protozoa with it—but unfortunately for humanity, doctors weren’t interested in that kind of thing in 1668, and wouldn’t be for another couple of centuries. In the meantime they missed out on the germ theory of infectious disease; thus, as late as 1850, when good Doctor Semmelweiss tried to get his Hungarian colleagues to curb the incidence of fatal “childbed fever” by washing their hands between dissecting diseased cadavers and examining patients, his colleagues responded by hounding him out of his job. Meanwhile diseases continued to spread on the hands of well-meaning doctors.
Several explorers like Sir Richard Hawkins independently discovered the anti-scurvy properties of oranges and limes in the 18th century, and James Lind in 1754 even published the results of a controlled experiment in which he showed that citrus was superior to other folk methods for the curing of scurvy. The world, however, was not ready for the discovery, and sailors continued to suffer and die from this quite treatable nutritional disease for more than half a century after Lind’s demonstration. Scurvy was also rampant among the troops of both the North and South during the American Civil War, though the means was available to prevent it, and as late as 1912 the famous explorer Robert Falcon Scott died on his way back from the South Pole, probably as the result of scurvy.
An investigator before the First World War discovered the curative powers of penicillium mold extracts on infected animals, but could not interest his colleagues, although he published the work. It remained for Alexander Fleming, ignorant of the earlier work, to rediscover the antibacterial effect of penicillium in a laboratory accident in 1928.
Alexis Carrel, the French-American scientist who won the Nobel Prize in 1902 for techniques of suturing blood vessels, demonstrated in 1910 that a saphenous vein graft between aorta and main coronary artery in animals could bypass a blockage there, and speculated that the technique might be useful in the treatment of angina. Although Carrel (with aviator Charles Lindbergh) later went on to develop the heart-lung machines that would make such surgery possible, the medical community contented itself for the next half-century with ineffective treatments for severe coronary heart disease, and it was not until 1967 that the saphenous-graft coronary bypass operation was employed on humans.
To the historian, some medical fields seem more plagued with delays in the acceptance of new ideas than others. The medical study of infectious disease has been prominent in this dubious regard, as noted, and the above examples are sad enough.
Still, there is possibly one field of medicine which is at least the equal of infectious disease in its record of ignoring proven lifesaving strategies for the longest time.
The medical field in question is that of resuscitation, the art of restoring clinically dead people to life. It took a long time before resuscitation was universally accepted, meaning many people who were revivable instead needlessly remained dead. The problem persists today as the best resuscitation technologies are not always employed. We’ve seen these controversies already, and we’ll see them again. Perhaps we can profit by exploring them further.
History Of Resuscitation
Historically, the art of resuscitation turns out to be old. The idea of resuscitating a seemingly dead person by more or less physical means occurs in the Hebrew Scriptures. Both I Kings 17 and II Kings 4 contain descriptive elements of resuscitation by chest compression. In II Kings, Elisha also places his mouth on the child’s mouth. Clearly there is something more than mystical prayers and incantations going on. Perhaps the oral traditions which were later codified into these tales once contained descriptions of one or more medical resuscitative events.
By a few millennia later, things were better defined. Italian writings of the 15th century indicated that midwives had, even then, long been using mouth-to-mouth breathing techniques to resuscitate newborns who did not spontaneously breathe. These techniques were soon to be imitated in the mechanical experiments of the Enlightenment. Paracelsus (1493-1541), an alchemist and perhaps the greatest physician of his age, was said to have attempted the resuscitation of a corpse using bellows, a trick he perhaps picked up from Arabic medical writings. And Andreas Vesalius (1514-1564), the father of modern anatomy, reported successfully using bellows to resuscitate asphyxiated dogs.
Bellows may not always have been available, but physicians eventually learned (possibly again from laymen) that simple mouth-to-mouth resuscitation sometimes worked on recently asphyxiated adults just as it did on newborns. By the 1740s, several cases of successful mouth-to-mouth resuscitation had been reported, the most famous of which was Tossach’s 1744 report of the resuscitation of a clinically dead coal miner who had been suddenly overcome after descending into a burned-out mine. By the 1760s, in the wake of such reports, a number of groups advocating the resuscitation of drowned persons had sprung up in Europe. The thinking at this time in many places was strikingly modern. Here, by way of example, is a quote from a 1766 governmental edict from Zurich:
“. . . Experience has shown that the drowned who are considered dead and that lay for some time under water have often been restored again and kept alive by proper maneuvers. From which one rightly concludes that life has not been completely suspended in the drowned, but that there is hope to save them from death if, as soon as they are withdrawn from the water, prompt and careful help is administered.”
The Swiss may have been their usual regulation-happy selves about the subject, but in the rest of the Western world resuscitation was being pushed typically by entirely private societies (voluntary clubs). In 1774, a society was founded in London to promulgate the idea of attempting to resuscitate the dead in some circumstances. Called, after a bit of experimentation, the Society for the Recovery of Persons Apparently Drowned, it quickly evolved into the Humane Society (and still later, with official patronage and funding, the Royal Humane Society).
The First Case Of Defibrillation
The Humane Society (London) advocated techniques which were highly advanced. Three months after the society’s founding, as an example, a society member had the opportunity to minister to a 3-year-old child named Catherine Sophie Greenhill, who had fallen from an upper story window onto flagstones, and been pronounced dead. The society member, a pharmacist named Squires, was on the scene within twenty minutes, and history records that he proceeded to give the clinically dead child several shocks through the chest with a portable electrostatic generator. This treatment caused her to regain pulse and respiration, and she eventually (after a time in coma) recovered fully.5
The resuscitation of little Catherine Greenhill was probably the first successful cardiac defibrillation of a human being, and it followed earlier suggestions by American scientist Benjamin Franklin and others that electricity might possibly be used to “revivify” the human body.
And so it proved able to do in certain circumstances. In 1788, a silver medal was awarded to Humane Society member Charles Kite, who was by this time not only advocating the resuscitation of victims in cardiac arrest with bellows and both oropharyngeal and nasolaryngeal intubation, but had also developed his own electrostatic revivifying machine which used Leyden jar capacitors in a way exactly analogous to the DC capacitative countershock of the modern cardiac defibrillator. (I must confess that to my mind all of these contraptions were fantastic devices in their time, yet they actually existed. A time-traveling physician from the present could not have put together a better resuscitation kit, given the primitive technology of the era.)
Resuscitation Technology Goes Dark
Despite its amazing progress, the enlightened state of the late 18th century regarding resuscitation was not to last. From the very first, dark images from the human psyche began to gather in resistance to the new ideas. Technology never intervenes in a major way into the borderland between life and death without creating major anxieties and social backlash. Resuscitation had its problems.
To begin with, as the modern reader may guess, the 18th-century discovery that “death” was not a sure and objective state did not exactly sit well in the public mind.
By the end of the first quarter of the 19th century, the public’s view of scientific resuscitation had intruded into the macabre. The fictional potential of the new electromechanical resuscitative technology had its influence on Mary Shelley, who in 1818 had first set out to write a ghost story, but instead ended up producing a cautionary tale of the technological resuscitation of a soulless corpse by a medical experimenter. The book became an instant sensation. Given the spirit of the times, the story touched a public nerve as if one of the new electrical resuscitation machines might create a Frankenstein’s monster.
Shortly after the publication of Shelley’s famous story, the new medicine began to go out of favor, and the science of resuscitation began to suffer on both the technical and mythological fronts. It happened for several reasons.
It is the propensity of all social movements to go too far. The Humane Society’s problem was that, when it came to complicated biology, the late 18th century did not possess the experimental expertise necessary to separate the wheat from the chaff. Thus, within a few years after its founding, the Humane Society had gone from mouth-to-mouth resuscitation to the more impressive use of bellows. Following a number of instances of lung rupture with the bellows, however, these complicated and difficult-to-use devices were discarded early in the 19th century.
Mouth-to-mouth resuscitation, unfortunately, was not re instituted at that time, partly because of misconceptions about the life-giving oxygen. For the next century and a quarter, therefore, resuscitative techniques centered around chest massage and arm lift techniques. Mouth-to-mouth breathing did not return until the middle of the twentieth century.
Emergency electrical defibrillation fared no better. The new phenomenon of electricity had been transformed early-on into a practice of passing mild shocks through the body in an attempt to cure disease, and its reputation tarnished due to lack of efficacy.
Later, and perhaps even more devastatingly, the charming new electricity was transmuted into a powerful and dangerous force by the giant transformers of Westinghouse (maligned from the first for their deadliness, in a PR campaign by rival industrialist-inventor Thomas Edison) and by the newfangled American electric chair. Technologies as well as people suffer from social stigmas. Mary Shelley had originally not specified the method of the revivification of her monster, but by 1930, in the new electrified America, Frankenstein’s monster came into the movies electrically charged.
The upshot of all these social transformations was that therapeutic electric shock, so full of promise in the 1790s, did not again come into its own for lifesaving purposes until about the same time resuscitative breathing was being reassessed, in the late 1950s.
Other resuscitative techniques like chest/cardiac compression had been used sporadically since the late 19th century as well, but they too did not see acceptance until the late 1950s, when almost inexplicably all of the "modern" techniques came together approximately simultaneously in what we know as "cardiopulmonary resuscitation" (CPR). The world, apparently, was not ready until the Space Age for any of these techniques, and simply rejected them when brilliant and well-meaning scientists invented them too early.
Some General Observations On Medical History
What are we to make of all this? Is there anything to be learned? In looking at the history of resuscitation and medicine we might ask if there are any observations to be made about it which might apply as well to the medicine of today and tomorrow.
The first thing we notice is that there seem to be some themes in medical history that occur again and again. Important medical discoveries, like important philosophical discoveries, seem quite likely to be made by outsiders. In some cases, the "outsiders" in medicine have been doctors working outside the traditional groves of academe, and in others, the important medical discoveries have not been made by doctors at all.
Leeuwenhoek, for instance, was a haberdasher, Pasteur a chemist, Fleming a bacteriologist. Recall that mouth-to-mouth resuscitation was the secret of midwives, and passed to medicine quite late. The original Humane Society, though founded by a doctor, was less a professional medical group than a group of ordinary and somewhat evangelistic citizens who had banded together for humanitarian reasons and out of fear of being buried alive.
A second observation which can be made about the history of medicine and technology in general is that discoveries depend for acceptance upon a very complex social milieu which may have little to do with technological discovery. A major advance will not be accepted in a world that is not ready for it socially. The idea of using a steam engine to replace human muscle, for example, will not catch on in a world where human muscle power, because of slavery, is cheap.
For an analogous example of this phenomenon from medicine, we might consider the history of anesthesia. As we know from their writings, Muslim physicians practiced various forms of anesthesia during surgery back as far as the 8th century A.D. In Christendom, conversely, where the idea of "redemptive suffering" held sway, anesthesia took much longer to catch on. Thus, the anesthetic properties of nitrous oxide had been widely and publicly noted by Sir Humphrey Davy as early as 1798, yet it was not until the 1840s that an obscure general practitioner from Georgia and a couple of part-time dentists (remember our observation about outsiders) began to try out inhaled anesthetics for surgical purposes. Even at that, there was an ecclesiastical outcry when Queen Victoria requested chloroform for childbirth, soon after the first anesthetic demonstration in America. One prominent cleric complained that “travail and pain” in childbirth had been ordained by God in the Bible, and that therefore anesthesia was against the will of God. (Others pointed out Genesis 2:21 where Adam is put to sleep as the rib is taken for Eve. Scriptural wars can be quite inventive.)
What then held up full cardiopulmonary resuscitation until the late 1950s, even though the world had discovered all of its essential features before 1900? We can only speculate, but the answer may lie in the fundamental change in the way that people began to relate to and trust technology between 1900 and 1950—a social change that is as profound as any generation of humans has ever had to cope with.
Mythmaking, as ever, played a role. If technology first crept into our nightmares with Frankenstein, it later (redemptively) crept into our heroic myths and won some measure of acceptance. Thus, if the new 20th-century technology of aviation was capable of creating a new kind of hero like Charles Lindbergh, the public was also willing to let Lindbergh have a technological shot at death with his new artificial heart machine. In any case, the mantle of Dr. Frankenstein had by the middle of the 20th century passed to the physicists and their atom bombs, and medicine for the time being was at last back in the heroic mode.
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