Blowing Smoke Up Your Arse: Drowning, Resuscitation, and Public Health in Eighteenth-Century Venice

This article examines resuscitation practices in the second half of the eighteenth century, especially the new use of tobacco smoke enema machines on people who had been extracted from water with no signs of life. Drownings accounted for a small number and proportion of urban deaths, yet governments promoted resuscitation techniques at considerable expense in order to prevent such deaths. The visibility of drowning in religious, urban, and civic life encouraged engagement with new approaches. Analyzing the deployment of resuscitation practices illuminates three key features of premodern public health interventions: the focus of governments on the logistics of these interventions, the participation of physicians and surgeons at all levels of the professional hierarchy, and the importance of communication.

Drowning deaths between 1861 and 2000 in Victoria, Australia

OBJECTIVE

To identify the long-term patterns of drowning mortality in the state of Victoria, Australia, and to describe the historical context in which the decrease occurred.

METHODS

We obtained data on drowning deaths and population statistics from the Australian Bureau of Statistics and its predecessors for the period 1861 to 2000. From these data, we calculated drowning death rates per 100 000 population per year, by gender and age. We reviewed primary and secondary historical resources, such as government and newspaper archives, books and the Internet, to identify changes or events in the state that may have affected drowning mortality.

FINDINGS

From 1861 to 2000, at least 18 070 people drowned in Victoria. Male drowning rates were higher than those for females in all years and for all ages. Both sexes experienced the highest drowning rate in 1863 (79.5 male deaths per 100 000 population and 18.8 female death per 100 000 population). The lowest drowning rate was documented in 2000 (1.4 male deaths per 100 000 population and 0.3 female deaths per 100 000 population). The reduction patterns of drowning mortality occurred within a historical context of factors that directly affected drowning mortality, such as the improvement in people's water safety skills, or those that incidentally affected drowning mortality, like infrastructure development.

CONCLUSION

We identified patterns of reduction in drowning mortality, both in males and females and across age groups. These patterns could be linked to events and factors that happened in Victoria during this period. These findings may have relevance to current developing communities.

[TO CURE THE APPARENTLY DEAD. NOSOLOGY AND MEDICAL RESUSCITATION IN ITALY(XVIII CENT.)]

The first specific techniques and triages for medical resuscitation developed in the XVIII century, specifically to rescue the drowned persons. The topic of resuscitation in strictly connected to the theme of the apparent death, to the dread of the "buried alive", to the progress of forensic medicine and to the administrative and legislative policies. The contribute aims to focus on the contribution of the medical and pathologic nosology about the conception of the apparent death, read as asphyxia.

Prevention of childhood drowning on a Greek island in the 19th century: literal testimonies by two native writers

BACKGROUND

To present literal texts of two native writers about drowning during childhood, along witha successful simple preventive measure implemented by the community of a small Greek island.

MATERIALS AND METHODS

Review of the older Greek literal production as well as of the contemporary literatureon childhood drowning and related preventive measures.

RESULTS

Alexander Papadiamandis (1851-1911) from the island of Skiathos is a writer, who described,with intellectual language, the microcosm of his place of birth, which he always remembered with nostalgia.Alexander Moraitidis (1850-1929), his cousin, also from the same island, used a different style to describelife events in the small society. Both refer to tragic intentional and unintentional drowning events in wellsand the sea, which took place in their times or before and survived as local legends in their narrations.Both describe effective initiatives undertaken by families themselves to prevent childhood drowning byhiring, during the summer months, a guardian with a specific duty to closely supervise the children andenforce guidelines for swimming in the sea. Papadiamantis goes one step further to describe the dismalconsequences when the rules were not respected.

CONCLUSIONS

The literal testimonies of two Greek islander writers present the range of childhood drowningoccurring on the island and a primitive yet effective community initiative for accident and drowningprevention pertaining to better supervision by an ad hoc employed guardian; this sets the example of thesocial responsibility ethos on the part of local communities to safeguard children from drowning that couldserve as a good practice even in modern times.

Rescuing the drowned: cardiopulmonary resuscitation and the origins of emergency medicine in the eighteenth century

The concept of a medical emergency, i.e., a time when immediate action is required to stabilize and restore the vital functions, is absent in the tradition of ancient medicine, which seeks to cure the sick. The theoretical and conceptual development of a prompt medical assistance definitely owes much to the refinement of instruments and surgical techniques that were develop in the early modern age, allowing the extension of therapeutic action to "healthy" individuals who are suddenly life-threatened due to an accident or to some external events that affect their vital functions. But it is especially in the eighteenth century that the epistemic basis of medical emergency is structured, when the Enlightenment gave rise to the ethical and political imperative of public assistance that required the planning of first aid at multiple levels, and medicine developed the concept of life-saving treatment. In particular, eighteenth century medicine, studying systems to assure immediate relief to the victims of accidents-especially to the drowned-allowed the development of specific and methodological systems of resuscitation and emergency treatment.

The legacy of fear: is fear impacting fatal and non-fatal drowning of African American children?

African American children’s rates for fatal and non-fatal drowning events are alarmingly elevated, with some age groups having three times the rate as compared to White peers. Adequate swimming skills are considered a protective agent toward the prevention of drowning, but marginalized youth report limited swimming ability. This research examined minority children’s and parents/caregivers’ fear of drowning as a possible variable associated with limited swimming ability. Results confirmed that there were significant racial differences concerning the fear of drowning, and adolescent African American females were notably more likely to fear drowning while swimming than any other group. The “fear of drowning” responses by parents/ caregivers of minority children were also significantly different from their White counterparts.

Medical heroes at Postman's Park

An account of three doctors whose deaths while saving lives in danger are recorded on an unusual memorial in London.

Remembering the SIEV X: who cares for the bodies of the stateless, lost at sea?

The SIEV X was a tiny fishing vessel traveling from Indonesia to Australia in 2001, carrying around four hundred people seeking asylum after fleeing from the warfare and persecution predominantly in Iraq and Afghanistan. Many were women and children trying to enter Australia to join fathers and husbands already granted refugee status but not allowed to bring in family members because of new Australian laws on "Temporary Protection Visas". Of these, 353 drowned when the boat sank in international waters. The conservative Australian government denied responsibility, using the event in an election campaign to play on fears about illegal entry and border defense in the Islamophobic climate in the aftermath of 9/11. Yet many everyday Australians eventually became involved in a collaborative design process to create a memorial to those asylum seekers. This article discusses the debates around memorials for those lost at sea, and particularly for those who might be portrayed as enemies or "illegal immigrants" whose coming threatens national borders. It identifies the conditions under which the campaign to commemorate those who died on the SIEV X moved from being a minority interest to become a cause so widely supported by Australians across the country that the memorial was eventually erected in the heart of the national capital.

Edward Schafer (1850-1935) and artificial respiration

In 1861 the Royal Medical and Chirurgical Society of London set up a series of committees to examine different methods of manual artificial respiration for use in apparent drowning. In 1903 Edward Schafer, then Professor of Physiology at Edinburgh and chairman of the fourth committee, described his own prone-pressure method which, on the basis of recorded respiratory minute-volumes, was superior to other methods and subsequently was employed worldwide for nearly 50 years.

Dr William Hawes, MD (1736-1808)

William Hawes was an apothecary in London who took up the cause of resuscitating the nearly drowned in the river, and founded the Royal Humane Society. He became a physician at the age of 45 years and was active in charitable works and literary societies.

Towards an Australian Institute of Trauma Research: learning the lessons of history

Although medical research in Australia in the 20th century has resulted in a reduction of approximately 95% in the death rate from the infectious and parasitic diseases, there has been no such beneficial outcome in road traffic accidents which, it is here suggested, were out of control from 1948 until 1970. In 1970 several concerned community groups (spearheaded by the Royal Australasian College of Surgeons) campaigned for the introduction of mandatory seat belt wearing. As a consequence of that initiative, and the virtual plethora of subsequent research activities, the road traffic accident rate has declined substantially in the last three decades. The death rate from drownings to toddlers (children under 5) was essentially unchanged until the 1970s when research into toddler pool deaths and the implementation of those research findings resulted in a downturn in toddler drownings in the last two decades. These two examples demonstrate the value of accident research and the implementation of research findings. By analogy with the contributions of the large medical research institutes, the creation of an Australian Institute of Trauma Research seems desirable and is here proposed.

[Philippe-Nicolas Pia (1721-1799), creator of the first-aid service to rescue drowned people]

Ph.-N. Pia is known as a philanathropist. In 1770, this apothecary is elected at the board of the city of Paris. Then, he wishes to create a first-aid service to rescue drowned people. In wooden boxes, he gathers together the drugs and devices used at that time, as a fumigating machine to inject tobacco smoke into the intestine, bottles of spirit of camphor, ammonia, a long shirt of wool, wood canulas and flexible pipes made of thin sheep leather. In each of the fiveteen guard houses standing along the river, are deposited a box and a stretcher. As far as Pia is at the head of the military police, he is especially innovating when he decids to train the guards to apply the drugs and the resuscitation processes. With such a regulated way of functioning associated to medical education and granting of awards, within fiveteen years hundreds of people are rescued and resuscitated. Yearly, he publishes the results obtained in Paris and in several places in France, with comments on the situation in the Netherlands, Germany and Britain. In 1780, the king nominates him in the royal order of Saint-Michel. The Révolution supresses the Etablissement en faveur des noyés, and Pia died in 1799 as completely forgotten. In Paris, the first-aid services come back to their former efficiency around 1835, when Marc proposes a special medical training to the fire-men and the military police to form first-aid groups. In this field, the pionneering work of Pia is still of great value and can abe kept in mind as a worldwide reference.

[Haute-Vienne First Aid Service to drowned people in XVIIIth]

Ph.-N. Pia, an apothecary of the Paris City Council, created in 1772 a First-Aid-Service to drowned people. Within 15 years, a hundred people were rescued; that's why the Government decided to endow each french department with an identical service. The author describes here the Haute-Vienne First Aid Service to drowned people.

Regulation for "saving" the drowned in Italy (XVIII-XIXth century), with particular reference to the Republic of Venice

The author gives a brief chronological syntesis, starting from the XVIII century, of the various provisions issued in Italy, with particular reference to the Republic of Venice, relating to the saving of the drowned, as an introduction to the discipline of "Life-Saving" oriented swimming.

[Anesthesia and techniques for the resuscitation of drowned persons]

Close relations between anaesthesia and resuscitation technology are mutual. The concept of medical emergency took place around the history of respiratory resuscitation which allowed the growth of insuflation technology. The anaesthetist used those ways of respiratory resuscitation in order to interfer with anaesthesia complications; he introduced the artificial ventilation into the operating theatre and, later on, into future intensive care rooms.

Swimming pool immersion accidents: an analysis from the Brisbane Drowning Study. 1977

An analysis of a consecutive series of 66 swimming pool immersion accidents is presented; 74% of these occurred in in-ground swimming pools. The estimated accident rate per pool is fives times greater for in-ground pools compared with above-ground pools, where pools are inadequately fenced. Backyard swimming pools account for 74% of pool accidents. Motel and caravan park pools account for 9% of childhood immersion accidents, but the survival rate (17%) is very low. Fifty per cent of pool accidents occur in the family's own backyard pool, and 13.6% in a neighbour's pool; in the latter the survival rate is still low at only 33%. In only one of the 66 cases was there an adequate safety fence; in 76% of cases there was no fence or barrier whatsoever. Tables of swimming pool accidents by age, season, site, and outcome are presented.

[The evolution of respiratory reanimation as seen by the drowned]

In addition to anecdotal techniques born from Galen reasoning, the method of recovering apparently drowned persons in the XVIIIth century surprises by the use of present techniques of artificial respiration. However, for over a century, these techniques was left on behalf of manual methods until the sixteens. In the XVIIIth century, resuscitation involves two principles: stimulation and artificial respiration. Amid stimulation, in addition to warmth, the choice treatment was to blow tobacco smoke into the rectum, which was used until the beginning of the XXth century. Inflation of the lungs was practised with mouth-to-mouth, and endotracheal or nasal intubation or tracheostomy with bellows, pistons or bladders, and the use of oxygen. But J. Leroy d'Etiolles, in 1827, demonstrated to the académie des Sciences the iatrogen peril of the inflation of the lungs, and the risk to leave the people sophistical techniques without education. This transaction gave the alarm to the european philanthropic Societies which stood down the inflation of lungs in the method of recovering apparently drowned persons. Between 1830 and the sixteens, inflation was put in the place of "forced expiration" techniques: the famous Sylvester or Schaeffer methods. From the outset of the XXth century, oxygen is used widely by helpers, and physicians have elaborated subcutaneous and intravenous ways of infusion to this oxygen. It is only in 1958 that Safar and al. demonstrated mouth-to-mouth superiority in relation to chest compressions.