History of the cardiopulmonary resuscitation (Part One)

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History of CPR (cardiopulmonary resuscitation) Part one. Ancient history.


Herrero S, Varon J, Sternbach GL, Fromm RE: History of the Cardiopulmonary resuscitation. 2011 ” Pearls in Intensive Care Medicine 2012. Vol. 25

Dr. Herrero-Varon’s Blog WordPress © 2011-2012 ·Todos los derechos reservados. All rights reserved!

Dr. Joseph Varon
Joseph Varon MD, FACP, FCCP, FCCM

Dr. Joseph Varon (University General Hospital, Houston, TX, USA)


  1. Adam and mouth of mouth!
  2. The Bible.
  3. ISIS and the kiss of life. The Egyptian period (Inhotep)
  4. Inverse PCR (method of resuscitation)
  5. External stimuli
  6. The Middle Ages. Witchcraft
  7. The first ventilation in the ninth century
  8. The use of bellows in CPR
  9. Paracelsus
  10. In 1700
  11. The Humane Societies
  12. Dr. Charles Kite
  13. The Dutch Humane Society
  14. The assassination of Abraham Lincoln (Charles August Leal, MD)
  15. The Russian method (1803)
  16. Other methods

“Give life” or “give life to the patient or who has the misfortune”, is the highest and most noble cause that has accompanied us from the history of medicine at the current time.

The causes for the lost life are many and various. In principle, any person who enters the process of dying due to natural causes or diseases, the trigger is the same as “cardiac arrest” (PCR) or after “cardiac respiratory arrest comes.”

Heart and lung intimately linked to life, can not pass one without the other.

Cardiopulmonay arrest can appear in different conditions:

  1. It could be the beginning of a sudden illness
  2. After an accident (usually after a traffic accident caused serious injuries).
  3. After a long or short illness (cancer, chronic diseases).
  4. After environmental poisoning or long term volunteer (alcohol, drugs).
  5. After an attempt autolytic (self-suicide).
  6. After a mass disaster (earthquakes, terrorism, etc).
  7. After a violent act (after a shot or using a knife).

History always teaches us things!. Interpreted as mainly with events back to life but there are initially naive indeed!

Although it is most certain that life when we must return to be applied because the cause that led to death is reversible.

1 .- Adam mouth to mouth!
Adam mouth to mouth

We move between fiction and the crushing reality!

Faith tells us that it was God who created man in his image [God created man in His own image, the image of God he created him, male and female he created them. (Gn.1.27)] of shape your body in mud and once done, to spice it did through a puff of breath (“breath of life”).

This breath of life means that it can generate an amount of air that makes between the lungs and lead to the resuscitation. But this is one of the basic mechanisms of CPR.

The air enters the lungs, the air of life, without them we could not live and that’s what really makes our brain is kept alive.

Anyway, life is not only that, the heart must take a step forward and that blood flow to all destinations in our body. Therefore prior to the birth of a living being (a fetus) has assisted circulation by the mother, but the act of living is the first fan! Yes, if I said no ventilation and breathing!

I remember the first part of the Blog on Anatomy of a fan, which gave clear details such as ventilation and breathing …

The figure shown here is a comic version of the first “air puff” or first breath of life!

1740-Mouth of Mouth

The Paris Academy of Sciences officially recommended mouth-to mouth resuscitation from drowning.


2.- The Bible

The image shows the prophet Elisha …

Elisha (Hebrew: אֱלִישַׁע, God is my salvation) was a noted prophet who lived circa 850-800 BC in Israel and what happened to Elijah the prophet during the reign of the Kings. In Islam it is known as Al-Yasa or Alyassa.

The Bible sometimes mentioned as a source of written descriptions of the first cases of resuscitation. A number of events on the recovery of death was found in the Bible. Two episodes from the Old Testament that seem to describe the resuscitation are listed in the books of Kings, and involve the Hebrew prophets Elijah and Elisha. The story of Elisha, Elijah successor as prophet of Israel, is the most frequently cited in medical articles, which represents the first documented case of mouth to mouth resuscitation. The opinions of biblical scholars and doctors differ on this point. Another episode that can represent the revival is told in the New Testament, and refers to an action by the apostle Paul. Within a century of this episode, Galen’s research marked the beginning of a new era in medical research that will ultimately lay the scientific basis of reanimation. However, the episodes of the Bible and had served to show the possibility that resuscitation could be achieved.

The Facts

The first miracle of Elisha is acceding to the request of locals and sanitation prophets of the spring waters of Jericho (II Kings 2, 22) and to this day that place is named after “The Fountain of Elisha” (Ayn es-Sultan ).

Multiply the oil in the house of a widow (2 Kings 4: 1-7) and raises a child died of a disease Shunammite to the head. The first description of a successful resuscitation is related in the Bible, the Book of Kings. A child of a couple Shunammite complained of a headache and died. The prophet Elisha prayed, and then: “… was placed on the child put his mouth on his mouth, his eyes on his eyes and his hands upon his hands, he leaned over him and the boy’s body grew warm .. . he stepped down, walked once up and down the room, then sits up and bent over him, then the child sneezed seven times, and the boy opened his eyes. “(2 Kings, iv, 34) . . (See figure).

3.-ISIS and the kiss of life. The Egyptian period (Imhotep)

You can see this article about Imhotep

The Egyptian goddess Isis revives her husband Osiris!

Wife of Osiris, Horus’ mother, sister Santa and Nephthys. Daughter of Nuit, the sky goddess Global, and Geb, god of the earth. His name translated to “the throne”. The real name is Auset Isis. Pronounced “Isis” by the Greeks, and this is the best known name today. She was the first born Egyptian goddess on earth and on the first day between the creation of the early years. Isis was known as the goddess of women and children and the mother of all living beings in the Ptolemaic period. He traveled around teaching women in Egypt on the skills of knitting, cooking and raising children. It also helped during the birth process. Isis was away when she learned that her beloved husband Osiris was killed. She was horrified when he learned that his brother Seth had killed him. Isis is known here in his role as the wife of mourning. Imitation of Isis was an important ritual for many women whose husband had died. She wandered the country in search of Osiris’ body while pulling hair, throwing dirt on himself and beating his chest. These gestures became the classic signs of mourning women in ancient Egypt. Once he found the body of her husband began to work his magic to revive him. Isis, after kiss (kiss of life) life was restored enough to conceive Horus Osiris. Shortly after September known as Osiris died and was not made him very angry. He was returned to locate and cut the body into 14 pieces and threw them into the Nile Upon hearing the news, Isis was again thrown into a state of mourning. She, along with Nephthys and Anubis, traveled across the Nile to get the pieces of Osiris. Isis asked Thoth for their help in the resurrection of Osiris. He taught Isis the mummification process. This process ensured the death of a life after death and in the case of Osiris, who assured him the position of king of the underworld. Isis was saddened by the death of gratitude for his true love, but she was comforted by two things: 1) Osiris lived again in hell, 2) She was pregnant with Horus. Isis told Thoth that Horus was to avenge the death of his father and become the rightful heir to his kingdom.

In these terms, one speaks of the resurrection and the return of life through kissing (or act of venting), were the beginnings of an attempt cardiopulmonary resuscitation (CPR).


4.-The inverse PCR (method of resuscitation) from 3,500 BC to 1770

Other methods have been developed in the 1700s in response to the leading cause of sudden death from that point, drowning. The investment was originally practiced in Egypt almost 3,500 years ago and became popular again in Europe. This method involves hanging the victim by the feet, with chest pressure to help the inspiration.
In response to increasing numbers of drowning during this period of time, societies were formed to organize the efforts of resuscitation. Royal Humane Society in England, was founded in 1774.
These and other methods have been applied for years as documented in the report of hanging “Anne of Green”, resuscitation and recovery in 1650.


5.-External stimuli

Other methods include physical and tactile stimulation in an attempt to “wake up” to the victim. Yelling, slapping, spanking, even used to try to resurrect.

Century 500 to 1500

Several methods including flogging, external heating, rolling over a barrel, or straps on the back of a horse that ran across the field. The first report of an experimental tracheal intubation was probably by the great Muslim philosopher and physician Avicenna (Abu Ali Al-Hussein Ibn Abdallah Ibn Sinna) around the year 1000.

“When necessary, a tube of gold, silver or other suitable material is advanced down the throat to support the inspiration.”

Andreas Versalius published “De humani corporis fabrica” describes blowing into a tube to resuscitate an animal.


6.-The Middle Ages. Early methods of Heat and Witchcraft!

Early methods of heat

Early in our history, people realized that the dead body is cooled, so the heating method and connect those dead heat, was a way to revive with life. In order to avoid killing the person, the body is heated and used hot ashes, burning excrement, or hot water directly on the body. These methods were all employed in an attempt to restore life. Undoubtedly, this technique had been quite limited its success over the years.


Witchcraft is a practice and partial knowledge of magic, where practitioners often have acquired their knowledge through ‘inheritance’ (oral tradition) and rituals are usually limited to the spirits that inhabit nature itself. Witchcraft usually makes use of magic to intercede on behalf of people claiming the practitioner favors, including return life to their peers. The concept that “The magic is as natural as land, water, fire and air, the four main elements of life.”

An American surgeon: Englebert Dunphy said, it seems true that “Medicine was born of religion and witchcraft and surgery, however, emerged as a necessity of war.”

In medieval Europe was related to the magic of alchemy and astrology, demonic occult activities considered by the Catholic Church and were persecuted especially during the late Middle Ages and the Modern Era. Some 500,000 people were tried and executed largely by civil and religious courts, accused of witchcraft, over nearly five centuries. There was witchcraft trials until the nineteenth century, both in Europe and North America. In Europe, the Tribunal of the Inquisition developed a role in these events. It should be noted that none of the major religions accept the practices of magic (yes believe that magic exists as such), no other Christian faiths. In regard to Judeo-Christian religions in particular. They are quite a few negative references to the wizards in the Old and New Testaments.

Margaret Jones
In 1648, Margaret Jones, wife of William Jones, became the first person executed as a witch by the Colony of Massachusetts Bay. Boston Medical Era and was accused of witchcraft, after several of his patients died. It is believed that the reason that patients get worse or even died because they refused to take it was prescribed medication for it, because it was a very advanced in medicine and their patients did not trust their revolutionary methods. On June 15, 1648 in Charleston, New England, was executed in the City of Boston, accused of being “stuck a stick” as medicinal.No use but not confirmed that procedures had been made to restore life to one of their patients.


7.-The first ventilation (1796)

FIRST intubation

8.-The use of bellows in CPR

In 1500 it was not uncommon to use a fireplace bellows to expel hot air and smoke. The method of the bellows (Bellows) resuscitation placed in the mouth of the victim, is a method that is used for nearly 300 years. Unfortunately, many people had no fireplace bellows with them, but the success of this procedure, for various reasons led manufacturers to design and manufacture a bellows valve bag and mask resuscitation.
However, in those times, medical authorities had no knowledge of the anatomy of the respiratory system and do not appreciate the need to extend the neck of the victim in order to obtain a patent airway.

Phillipus von Hohenheim, wrote about the use of a bellows to resuscitate people 1493-1541
In 1829, Leroy d’Etiolles demonstrated that over distension of the lungs through tires could kill an animal, so this practice was discontinued then


Paracelsus studied the chemical basis of disease
Medicine can only learn from those eyes can see and touch your fingers!
Paracelsus reported using the bellows in the resuscitation attempts

10.-In the 1700’s. Method of fumigation

In 1700, a new method of resuscitation was used. This “new” procedure involved blowing smoke into the rectum snuff (fumigation) of the victim was in cardiac arrest. According to the literature, the smoke was blown for the first time in an animal bladder and then into the rectum of the victim. It was used successfully by American Indians and American settlers and introduced in England in 1767. This practice were included in the publications of the Royal Humane Socities (see below)

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

11.-The Humane Societies

Several articles were published by the Royal Humane Society. Dr. William Hawes M.D. (1736-1808) began as an apothecary in London who took up the cause of raising a man from drowning in the river (near drowning) of which there are paintings of that time (see below), and founded the Royal Humane Society .

He became a doctor at the age of 45 years and participated in charity work and literary societies.

In 1773, according to the magazine “Gentleman’s Magazine” (December 1808) Dr. Hawes, “became very well known because of its relentless effort to draw public attention to perform the resuscitation of apparently dead, mainly drowning. ” His first efforts were ridiculed, as few believed in the possibility of resuscitation. Hawes persevered, and announced it would reward those who rescued a drowning person apparently bridges between Westminster and London, so I would give immediate notice. He co-founded (1774) of the Royal Humane Society. Asked the Parliament to provide “welcome home” for people who were drowning in all the parishes of England, and to establish schools where medical students learn the principles of resuscitation. In 1778, he was appointed Secretary of the Society, and edited the Society’s annual reports from 1780 until his death in 1808. This image informs the moment trying to get the water to a person “near drowning”, where Dr. Hawes is coordinating the rescue and the next paint the same patient after being revived. Here Dr. Hawes is located behind the patient.

Dr. Edmund Goodwyn, MD (1756-1829) was an English medical writer. He was the son of Edmund Goodwyn, surgeon, Framlingham, Suffolk. Goodwyn was born and baptized on December 2, 1756. After graduating in medicine, practiced as a physician in London, but retired to Framlingham few years before his death, which took place on August 8, 1829. Published:
Dissertatio Medica Submersorum morte, Edinburgh, 1786.
Connecting with the breath of life or experimental research on the effects of strangulation submersion and various types of harmful air live animals … and the most effective means of healing, London, 1788, (translation of No 1) (See photo of the book).


12.-The Doctor Charles Kite

Dr Charles Kite was a member of the Corporation of Surgeons of London and Kent Gravefend Surgeon.

Dr Charles Kite made ​​the first scientific study of sudden death. in clinical trials: “Recovery of apparent death” in 1778. That article describes a 3 year old child was taken for dead after falling from a window. An “apothecary” was sent and could do nothing, then resuscitation was performed by an electrostatic generator power with a Leyden jar condenser. (Fig. 1)

Kites apparatus

Apparatus as in Kite ‘Essay upon the Recovery of the Apparently Dead’ “(1788)
Charles Kite said on this subject,
“No (these incidents) clearly states that electricity is the most powerful stimulus we can apply, and not justified on the assumption that if such force is able to excite the action of external muscles, you will be able reproduce the motion of the heart is infinitely more irritable, and thereby achieve our great desideratum, the renewal of the movement. “However, note that So we almost matched the description of the resuscitation of electricity, this time by two Danish scientists Herboldt and Rasner (1796) in his little book “Ways to save people drowning and all information of the best ways by which they can return to life. ” Originial: “Life saving measures for drowning persons and information of the best means by which they can be brought back to life.”


13.-The Dutch Humane Society

Royal Humane Society in England, was founded in 1774. The inversion method of the 1700’s CPR. Although it was the most famous, was not the first. It was preceded by the Dutch Society (Dutch Society) for the recovery of drowned persons, established in 1767. The recommendations included were:
* The heating of the victim (which sometimes required transporting the body to a different location) by lighting on fire near the victim, burying him in warm sand, placing the body in a hot bath, or place on a bed one or two volunteers;
* Removing swallowed or aspirated water by positioning the victim’s head lower than his feet and applying manual pressure to the abdomen, vomiting induced by tickling the back of the throat with a feather;
* Stimulation of the victim, especially the lungs, stomach and intestines by such means as rectal fumigation with smoke, snuff, or use of strong odors;
* Restoring breathing with a bellows;
* Bloodshed.


15.-El asesinato de Abraham Lincoln (Charles August Leale, MD)

Abraham Lincoln’s assassination took place on Friday, April 14 in Washington, DC 18651 C., when the American Civil War came to an end. The murder occurred five days after the commander of the Army of Northern Virginia Robert E. Lee surrendered his troops to General Ulysses S. Grant and the Army of the Potomac. Lincoln was the first U.S. president to be assassinated.

The sixteenth U.S. President Abraham Lincoln was shot in the head while attending to the representation of the play “Our American Cousin” by Tom Taylor, Ford’s Theatre in Washington D. C., with his wife and two guests. Lincoln died the next morning following the shooting received.

Charles Leal, a young military surgeon license attended the theater, went through the crowd towards the presidential box. The door opened and Rathbone not realized that was blocked by a piece of wood. He removed the bolt and opened to Leal.

Leal entered the box and found in abundance Rathbone bled a deep wound throughout her forearm. It did not stop and went directly to Lincoln, slumped in his seat and secured by Mary. The President had no pulse and Leal him for dead and laid him on the floor.

A second doctor who was also among the public, Charles Sabin Taft, arrived at the scene by climbing over the railing of the box. Leal Taft and cut the collar of Lincoln and opened it, then, Leal made the following acts: “A”, “B” and “C”

Method “A” “... As the President made no move to revive then, I thought of another way of death, apnea, and I assumed my preferred position for him with artificial respiration to revive …” “… I knelt on the floor on the President, with one knee on each side of the pelvis and in front of him. I leaned forward, opened my mouth and inserted two fingers of his right hand as far as possible .. . and then I opened the larynx and I did a free passage for air to enter the lungs … “

Method “B”: “… I put an assistant in each of his arms to manipulate in order to expand the chest and then slowly pushed his arms down the side of the body as I pressed the diaphragm above: These methods caused the vacuum and air is forced out of their lungs … “

Method “C”: “… Also with the thumb and fingers of my right hand pressure intermittent sliding pressure below the ribs stimulated the apex of the heart …”

In this way, Dr. Leal made 3 moves correctly described later as “A, BC” of CPR. The “A” or “Airway” is to leave the open air for ventilation, the “B” or “Breathing” the act of venting and “C” or “Circulation” promote circulation.

“… Convinced that something must be done to preserve life, I leaned forward to apply force directly on your body, chest, chest, face to face, and several times made a long sigh, which is force expanded his lungs and his breathing improved … “Charles Augusto Leal”

Felt it and found the wound left on the back of the skull near the left ear. Remove a blood clot, which the injured person to breathe again. However, Leal knew that this recovery was only temporary and said, “His wound is mortal. It will be impossible to cure. “

Lincoln’s deathbed.

Dr. Leal, Taft and another doctor named Albert King quickly agreed and decided that the President could not be brought to the White House because of the tumbling of the carriages. After considering driving to a nearby saloon of Peter Taltavull, decided to take him to a house opposite the theater, known as the Pension Petersen. The three doctors and soldiers who attended the show took the President to the entrance. Across the street, a man holding a lantern and said, “Bring him here!, Bring it here!” It was Henry Safford, a resident of the house of William Petersen (Petersen pension) which was outside the theater . Men charged to Lincoln to the pension and put it on the bed in a room on the second floor.

The wounded vigil held in the pension Petersen. The three doctors were joined by Army Surgeon General Joseph K. U.S. Barnes, Dr. Charles Henry Crane, Dr. Anderson Ruffin Abbott and Dr. Robert K. Stone. Crane was the assistant Barnes and Stone, Lincoln’s personal physician. The president’s sons, Robert and Thomas Lincoln joined them, as Secretary of the Navy Gideon Welles and Secretary of War Edwin M. Stanton.

While Mary Lincoln wept one of the lounges, Stanton was installed in another and took command of the U.S. government, sending and receiving telegrams, reading the statements of witnesses and the prosecution of organized Booth. Nothing more could be done for the wounded, at 7:22 am on April 15th, Lincoln died at the age of 56 years, 2 months and 3 days


15.-The russian method (1803)

CongelaciónThe Russian method of resuscitation, described in 1803, was to cover a patient with snow awaiting the return of spontaneous circulation.

Cooling the body to raise the dead, was used by Russian doctors (not only in winter) in early 1800.

This concept involved reducing the body’s metabolism by freezing of the body under a blanket of snow and ice. Unfortunately, what the medical authorities did not realize then was that the most important organ that needs to be cooled in order to decrease the body’s metabolism, was the brain.


16.-Other methods

Método Roll, Horses, Howard (1871) and Holger-Nielson (1922)

1812 – Horse jogging Method

In 1812, life-saving appliances were equipped with horses. When the victim was rescued and removed from the water, lifesaving equipment, making the victim was hoisted on his horse mouth and run down the horse up and down the beach. This resulted in an alternating compression and relaxation of the chest cavity as a result of the rebound of the body on the horse. This procedure was banned in the United States in 1815 as a result of complaints by citizens “requiring clean beaches”.

1773 .- Barrel Method

CPR Method barrel around 1730

In an effort to force air in and out of the chest of the victim, the rescuer has to lift the victim in a large wine barrel and, alternatively, pull back and forth. This action would result in a compression of the chest of the victim, forcing the air, then release pressure to allow the chest to expand resulting in air being expelled. This technique was in many ways a precursor of modern CPR who tried to force air in and out of the lungs.

1871. John Howard Method

The first record of external compression of the chest was written around 1871 by John Howard. Almost simultaneously, Dr. Friedrich Maass reported the first use of chest compressions in humans. In 1904, Dr. George Washington Crile reported the first successful resuscitation of a patient with external chest compressions.

Century 19. Silvester Method

In the 19th century, Dr. HR Silvester described a method (Silvester Method) of artificial respiration which puts the patient on his back and his arms raised above his head to aid inhalation and then pressed your chest to help exhalation. The procedure is repeated sixteen times per minute. This type of artificial respiration is occasionally seen in films made in the first part of the 20th century.

1911 .- Technique of Holger Neilson

A second technique, called the Holger Neilson technique, described in the first edition of the Boy Scout in the United States in 1911, describes a form of artificial respiration where the person was placed in front with his head to side, resting on the palms of both hands. Upward pressure applied to the patient’s elbows raised the upper body while the air pressure in his forced return to the lungs, essentially the Silvester Method with the patient but dump (prone)


History of cardiopulmonary resuscitation (PART TWO). Next link soon!



  1. Herrero S, Varon J, Sternbach GL, Fromm RE: History of the Cardiopulmonary resuscitation. Pearls in Intensive Care Medicine 2011. Vol. 25
  2. Varon J, Sternbach GL: Cardiopulmonary resuscitation: Lessons from the past. J Emerg Med 1991;9:503-7.
  3. Sternbach GL, Varon J, Fromm RE: Resuscitation in the Bible. Crit Care & Shock. 2002;2:88-90.
  4. Varon J, Fromm RE: History of cardiopulmonary resuscitation. (Historia de la resuscitación cardiopulmonar). Neumología y Cirugía del Tórax 1995;54(4):117-20.
  5. Chen K, Sternbach GL, Fromm RE, Varon J: Mechanical ventilation: Past and present. J Emerg Med. 1998: 6(3):453-60.
  6. Davis JE, Sternbach GL, Varon J, Fromm RE: Paracelsus and mechanical ventilation. Resuscitation 2000;47(1):3-5.
  7. Sternbach GL, Varon J, Fromm RE, Baskett PJF: The Resuscitation Greats: The Humane Societies. Resuscitation.2000;45:71-75
  8. Sternbach GL, Varon J, Fromm RE: Charles Augustus Leale and the Resuscitation of Abraham Lincoln. Resuscitation.2000;45:3-5.
  9. (History of CPR) http://www.texasonsitecpr.com/History.html
  10. “Silvester’s method”. University College London. Retrieved 2007-06-12.


Herrero S, Varon J, Sternbach GL, Fromm RE: History of the Cardiopulmonary resuscitation. 2011 ” Pearls in Intensive Care Medicine 2012. Vol. 25

Dr. Santiago Herrero’s Blog WordPress © 2011-2012 ·Todos los derechos reservados

Calle de los Prados, 33394 Gijón, España

Author: Santiago Herrero, MD

Former Head of Department Cardiac Intensive Care The Jilin Heart Hospital 5558 Jingyue Street Changchun, Jilin Province 130117 China

2 thoughts on “History of the cardiopulmonary resuscitation (Part One)”

  1. I’m preparing a talk for the American College of Emergency Physicians on hands on defibrillation. I ran across your well written article on the history of CPR which i enjoyed. May I reference your article and use some of your images and quotes in my presentation and attributing you as the source?

    J. Scott Wieters MD

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