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The Tobacco Smoke Enema,One of the First CPR Techniques?

  • Writer: FibonacciMD
    FibonacciMD
  • 19 minutes ago
  • 4 min read

Explore the bizarre and true history of the tobacco smoke enema, an 18th-century resuscitation technique that paved the way for modern CPR and inspired a famous foul-mouthed idiom.



John Woodall’s Enema Fumosum (Smoke Enema)
John Woodall’s Enema Fumosum (Smoke Enema)

In 1585, Sir Walter Raleigh reportedly first brought tobacco from Virginia to England and colonial tobacco later grew to become a booming export business.  Native Americans used tobacco as medicine and are thought to have been the first practitioners of tobacco smoke enemas.  Word of this treatment eventually made its way from the American colonies to England.  The first described use of the procedure for medical treatment occurred in the 1600s, by John Woodall (1570-1643), in his book The Surgeon’s Mate.  Woodall was the first Surgeon-General of the East India Company.  Tobacco was known to be a stimulant and irritant, and warm tobacco smoke was thought to be useful for various medicinal purposes.



The Institution

In 1745, physician Richard Mead is credited as the first person to write about using tobacco smoke enemas for resuscitation of drowning victims.  In 1774, physicians William Hawes and Thomas Cogan founded The Institution for Affording Immediate Relief to Persons Apparently Dead, from Drowning in London, England.  This organization later became the Royal Humane Society, which still exists today as a charity that grants awards for acts of bravery in saving human life and for the restoration of life by resuscitation.  The Institution initially consisted of 34 volunteers who purchased boats and equipment for rescuing drowning victims and placed resuscitation kits along the Thames River.  They also created receiving houses where drowning victims could be cared for.  Aiming to save these victims, the Institute paid a reward to anyone who rescued a recently drowned victim or immediately brought them to the Institute for resuscitation. 


Paintings Commissioned by the Royal Humane Society in 1787 to Demonstrate a Successful Resuscitation from Drowning and Promote the Practice
Paintings Commissioned by the Royal Humane Society in 1787 to Demonstrate a Successful Resuscitation from Drowning and Promote the Practice

However, the leaders of The Institution were strong proponents of the resuscitative powers of tobacco smoke to restart respiration due to its warming and stimulating qualities.  Reportedly, Dr. Cogan wrote, “It is not only the admission of a kindly warmth into the internal parts of the body which in all cases must prove advantageous, but its stimulus connected with its warmth seems admirably adapted to excite irritability and to restore the suspended or languid peristaltic motion of the intestines.”


How Was It Performed? 

Tobacco Smoke Enema Resuscitation Kit with Bellows from 1774
Tobacco Smoke Enema Resuscitation Kit with Bellows from 1774

In Paris, in 1746, one of the earliest recorded instances of the practice involved a woman who was a drowning victim.  She was pulled from the water unconscious.  A sailor advised her husband to light a pipe filled with tobacco and insert the stem of the pipe into his wife’s rectum.  He then covered the bowl with paper that had holes pricked into it and blew into the lit end of the pipe, forcing smoke into her colon.  She reportedly awoke after the fifth puff.  Success stories such as this one spread widely and led to more credence for the procedure. 


Tobacco Smoke Enema Resuscitation Kit with Bellows from 1774


In London, if medical assistants from The Institution were at the scene of a drowning, they would attempt to warm the victim, insert a rectal tube, and blow tobacco smoke down the tube.  This was unsafe for the rescuer because the tube lacked a check valve to prevent fluid from flowing back up, potentially transmitting deadly diseases to the  rescuer.  With time, more sophisticated tubes, nozzles, and eventually, bellows were used for tobacco smoke enemas.  Mouth-to-mouth resuscitation at the time was generally avoided due to contagion fears, but bellows were used sometimes to inflate the lungs for resuscitation in drownings.  It was thought that tobacco smoke inserted rectally was more effective for resuscitation than smoke blown into the mouth and lungs.

 

Use Spreads to Other Ailments

Tobacco smoke enemas became a popular treatment in Europe for many conditions, including headaches, respiratory failure, colds, abdominal pain, typhoid fever, and cholera. 


The Procedure Becomes Discredited, but Lives on in Popular Culture

Some physicians began questioning the effectiveness of the tobacco smoke enema and its use ended around 1811.  The final blow for the procedure came when English scientist Benjamin Brodie, while performing animal experiments, discovered that the nicotine in tobacco smoke was toxic to the heart. 

It is believed that after the tobacco smoke enema was discredited as a therapeutic procedure and regarded as useless, the terms “blowing smoke” or “blowing smoke up your arse (ass)” started gaining popularity as idioms meaning insincere flattery or misleading information.


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References

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