A SAMPLE ENTRY FROM THE BOOK
Drowning, Choking and Asphyxiation
Background Information
Drowning, choking and asphyxiation may lead to unconsciousness and death from the lack of oxygen (hypoxia). In drowning the person's mouth and nose are immersed in a liquid, usually water, which is inhaled thus cutting off oxygen. Worldwide, drowning is the third leading cause of unintentional death and causes grief for family members and friends. Drowning is highest in low-and middle-income nations. Risk factors include a very young age, access to water, being male, or being under the influence of alcohol or drugs while recreating on or in the water. In flood disasters, drowning accounts for about 75 percent of all deaths. The term drowning was first used in the 14th century from the Middle English drounen meaning being "drowned." Drownings deaths have been recorded since the 17th century. English civil servant John Graunt (1620–1674) reported that in London in 1632, out of 9,535 deaths, 34 people died from "drowned." In the United States (US), the 1850 census, reported that .84 per cent of the reported deaths were from drowning.
Choking is severe difficulty in breathing and lack of air and is a frightening experience for the person who is choking. It occurs when breathing is blocked by an obstruction in the trachea such as a piece of food, or constriction such as an allergic reaction which swells the throat. If insufficient oxygen is delivered to the body, hypoxia, asphyxia, and death may occur. Risk factors for choking deaths include being under two years, and over 75 years of age; the primary cause is food. In the US, less than one death per 1000 people is from choking. The first use of the term "choking" is from the 14th century from the Middle English achoken, from Old English ācēocian, from cēoce, meaning "jaw" or "cheek."
Choking leads to asphyxiation, sometimes referred to as suffocation. It can result from mechanical, or non-mechanical, constriction of the airway or from a decrease in breathable air leading to hypoxia. In addition to choking, asphyxiation can result from drowning, strangulation, poisonous gas, or conditions such as lung cancer and infections such as Covid-19 leading to oxygen starvation. This in turn damages the organs such as the heart which stops beating, resulting in unconsciousness and death. Of people seen in emergency rooms for suffocation, the overall mortality is around 10 percent. Data for suffocation has also been recorded in the past. For example, the 1850 U.S. Census reports that out of all deaths, 3.3 of 1,000 people had died of asphyxiation. The word "asphyxia" is from New Latin, from the Greek a, meaning "without" plus sphyxis, meaning to "throb" or stoppage of the pulse and was first used in the late 18th century.
Drowning, choking and asphyxiation have been part of the human condition since its beginning. First aid and medical procedures we take for granted today for these issues were found in antiquity. The Egyptian Ebers Papyrus (c. 1550 bce), for instance, recommends the surgical procedure of tracheotomy (cutting into the trachea below the vocal cords) for choking. But Hippocrates (ca. 460–ca. 370 bce) cautioned against tracheotomy, fearing that it could damage arteries in the neck. Instead, he recommended tracheal intubation which would have been difficult without anesthesia. In ancient Greece, it was reported that Alexander the Great (356–323 bce) performed a tracheotomy with the point of his dagger to save one of his soldiers from asphyxiation. Ancient Greco-Roman physician, Galen of Pergamon (129–199) noted the procedure was used in life-threatening situations although the patient often died of infections caused by the procedure. Tracheotomy has continued to be used into the present in the cases of life-threatening airway obstructions, coma, and certain surgeries.
For choking, instruments for extracting fish bones from the throat were common in ancient Egypt, Greece, and Roman societies. Some eating establishments in the 20th century carried bent forceps to extract food from a choking person. In 1972, American physician Henry Heimlich (1920–2016), a thoracic surgeon, developed the abdomen thrust sometimes called the Heimlich Maneuver for choking. From the mid-1980s until around 2005, abdominal thrusts were the only recommended treatment for choking. Now the person is encouraged to cough. If they are unable to talk, a bystander can administer five slaps on the back alternated with five abdominal thrusts. However, the maneuver is only recommended as a last resort as it was found to sometimes cause broken ribs. The abdominal thrust is not done with a drowning victim due to the risk of vomiting leading to aspiration and asphyxiation.
In antiquity, "mouth-to mouth-resuscitation" with expired air was used. It is mentioned in the Christian Old Testament and Hebrew Torah (c. 1200 and 165 bce) scriptures where the prophet Elisha gave the "breath of life" to a child who was revived. Hebrew midwives may have performed the procedure on newborn infants and also on newborn animals. Throughout the Middle Ages the technique was thought to be used secretly by midwives to resuscitate newborns. Known as the "biblical method," mouth-to-mouth was fostered in the early 18th century for adult resuscitation after Scottish physician William Tossach (c. 1700 –1771) in 1732 revived a suffocated coal miner. But the technique fell out of favor in the 19th century as being vulgar and unhygienic and was not reinstituted until the mid-1950s. Although in some circumstances, "rescue breathing" is not used today and has been replaced by cardiopulmonary chest compression when there is no pulse.
Moreover, into the 17th century, it was thought to be unlucky to rescue and revive a drowned person as it was believed drowning was God's will. Once this belief was abandoned, rescue societies were formed. In the mid-1770s, the Amsterdam Rescue Society and in England the Society for the Recovery of Persons Apparently Drowned were established which did save lives.
Depictions of drowning and asphyxiation have been presented in art and fiction. For example, in William Shakespeare's (1564 –1616), play, Hamlet, Hamlet cruelty rejects his former lover, Ophelia, by telling her to go to a "nunnery" (convent/brothel). Being rejected by the man she loves, she commits suicide by drowning in a stream. In the painting, Ophelia (c. 1851), by John Everett Millais (1829 –1896), Ophelia is shown dead lying on her back in the stream amidst flowers and greenery. The novel, Moby-Dick (1851), was written by American Herman Melville (1819 –1891). A great white whale named Moby Dick, bit off whaling boat Captain Ahab's leg. Ahab stalks the whale, harpoons it, but becomes entangled in the harpoon line and is pulled overboard by the whale and is drown.
Unusual Treatments
Various treatments and folk remedies have been carried out for centuries for drowning, choking, and asphyxiation. A few were successful, but most were not. In terms of drowning the Ancient Egyptians used a method that became popular again in the 1700s in Europe. When a person was pulled out of the water, they were hung by their feet to drain water from the lungs and pressure was exerted on their chest to foster breathing. This may have been effective in some cases.
By the early Middle Ages, warming the body became a technique to revive someone from drowning. It had been noticed that a body becomes cold when lifeless. Therefore, to bring the person back to life, they were put near the fire, laid in warm ashes, bathed in hot water, or placed naked between two people in bed. This was unlikely to revive a person who had asphyxiated from drowning or choking. Another method was flagellation or whipping the person to stimulate breathing which had little effect. By the 15th century, a fireplace bellows was used to blow hot air and smoke into the victim's mouth. Swiss physician Paracelsus (c. 1494 –1541) noted this method was occasionally successful.
In the early 18th century, blowing air or tobacco smoke into the rectum was advocated. In one method, tobacco smoke was first blown into an animal bladder. Then a tube was placed in the rectum and the smoke from the bladder was forced into the victim. This was not successful as the gut was not connected to the lungs. Later in the century, both the Amsterdam and English Rescue Societies placed fireplace bellows at intervals along the waterline so bystanders could attempt to resuscitate victims pulled from the water. Tobacco was often included with the bellows kit for a tobacco enema. Another procedure was lighting a pipe and blowing smoke directly into the victim's mouth or nostrils which sometimes may have worked as it was like the mouth-to-mouth technique.
By the 18th century, the victim was also rolled back and forth over a log; a large wine barrel was also used. This rolling action acted to compress the victim's chest cavity and forced the air and water out. When the log or barrel was rocked backwards, a release of pressure allowed the chest to expand resulting in air being draw into the lung and sometimes revived the victim. In other techniques, people rubbed the victim with ammonia, put snuff or smelling salts on the nose and tickled the back of the throat with a feather. Sometimes victims were revived if they were not completely asphyxiated.
Ivory "nostril pipes" were used by the Royal Society. A tube was inserted into a nostril and into the lower part of the larynx to prevent air from entering the esophagus. The tube was attached to bellows and air blown into the lungs. This may have occasionally worked. A Russian folk remedy in the early 19th century for drowning was covering the victim in snow or ice to reduce the body's metabolism. It usually did not work.
In the 19th century, lifeguard stations were equipped with a horse. When a drowning victim was recovered from the water, the lifeguard would put the person onto the horse and have it trot. Due to the bouncing of the body on the horse, alternate compression and relaxation of the chest cavity helped to expel air and water and aided inspiration. A French folk remedy recommended tongue stretching. The rescuer held the victim's mouth open while forcefully pulling the tongue rhythmically. Rarely was it effective.
Bellows had fallen out of favor by the mid-19th century which led the way to manual methods of resuscitation. In the 1850s, two English physicians developed different methods to resuscitate drowning victims that were commonly used into the early 20th century. Marshall Hall's (1790–1857) "Prone and Postural Respiration in Drowning," method alternately repositioned the patient 16 times a minute from lying on the side to lying face down. While the victim was prone, the chest expired air, when the victim was rolled onto his/her side, pressure was taken off the chest and inspiration would occur. In 1903 another London physician, Edward A. Schaefer (1850 –1935) developed a method used into the mid-20th century known as the "Prone-Pressure Method." The victim is placed prone with the arms above the head, and the face is turned to one side to let fluids drain out. Then the rescuer staddles the victim and pushes on the back with his/her arm extended to push out air. This is followed by the rescuer releasing the pressure which causes the lungs to expand and pull in air. These methods were sometimes successful.
Similar to these methods is the Holger Neilson technique developed by Danish athlete Holger Louis Nielsen (1866–1955) in 1932. In this procedure the victim is placed prone with the head to side resting on the palms of both hands. The rescuer applies upward pressure to the patient's elbows which raises the upper body which returns air to the lungs. The elbows are lowered which puts pressure on the chest which causes air to expire. This is done twelve to fifteen times a minute. These methods were also used for victims of electrical or gas accidents and sometimes for choking victims.
Over the centuries a few methods for choking were developed. In ancient Egypt, for instance, when a person was choking on a fish bone, an incantation was recited, and the victim was given a piece of cake or bread to force the bone into the stomach. Roman encyclopedist, Pliny the Elder (23 –79), in his Natural History, recommends the choking person immediately plunge his/her feet into cold water for a stuck fishbone. But if it was another type of bone, a bone was taken from the same dish and applied to the head. Bread was also put in the ears. These would not have been effective, and the person could have died. Byzantine Greek physician Paul of Aegina (c. 625 – 690), suggested sticking a finger or feather in the throat to induce vomiting. This could have caused the object to be pushed down into the trachea suffocating the person.
