Heimlich’s Maneuvers: My Seventy Years of Lifesaving Innovation
By Henry J. Heimlich
(Prometheus Books, 253 pages, $19.95)
Dr. Henry Heimlich is an American treasure. You undoubtedly know him from the Heimlich Maneuver, which probably saves the life of someone in America every couple of days. Dr. Norman Vincent Peale once called him “the man who has saved the lives of more human beings than any other person living” and the only question is who could possibly be in second place.
Consider this. By the time Dr. Heimlich gets around to explaining his discovery of the Heimlich Maneuver in his new memoir, he is on page 150. By that time, he has already saved the lives of thousands of soldiers with another invention you probably never heard of — the Heimlich valve, which he originally fashioned out of a 25-cent “Bronx cheer” noisemaker. It is now a staple in the medical kit of soldiers all over the world.
His is an amazing story. The only puzzle is why it isn’t better known — and perhaps why it’s taken as long as it has to tell it.
Heimlich started as the son of a working-class Bronx Jewish family struggling through the Depression. His father was a modestly rewarded but highly respected social worker who ended up counseling inmates in New York’s Sing-Sing Prison. As a child Henry and his talented older sister used to wander through the prison unescorted. When the state prison commissioner asked the warden how this could happen, the warden told him, “All the men know those are Phil Heimlich’s kids.”
Lifeguard-handsome at 20, Heimlich saved his first life on a trip back to New York from a summer as camp counselor in Massachusetts when the train derailed, pinning the fireman beneath one of the cars in a swamp. Heimlich held the man’s head above water for an hour until help arrived. The story made the New York Times. When his mother read it, she fainted.
As a young Jew trying to crack academia, he and his family were subject to all sorts of discrimination. His sister was denied the valedictorian award, Henry was passed over as drum major at Cornell, and he was constantly steered toward Jewish fraternities and organizations. But he resisted. He joined Navy ROTC in medical school and after being inducted in 1944 was sent on a top-secret mission to the Gobi Desert to establish a medical camp that would rush to the coast to treat American soldiers when the expected invasion of the Chinese mainland occurred in preparation for invading Japan.
While the other doctors whittled away the time, Heimlich began treating the local farmers. At first they were suspicious, but when he cured a young girl of a huge stomach abscess, Camp Four suddenly found itself facing a parade of Chinese peasants trooping to its door every morning seeking treatment for innumerable ailments. In the process, Heimlich soon recognized a local epidemic of trachoma, an eye infection that eventually causes blindness. He cured it by pulverizing a recently developed antibiotic and mixing it with shaving cream!
Back in the U.S. after the war, Heimlich had trouble finding a job because doctors who had stayed out of the military had already built huge practices. When he finally landed an internship with a thoracic surgeon, it wasn’t long before he took interest in a subset of patients who had had their esophagus burned out by drinking household lye (a common accident before the invention of child-proof bottles). He developed a procedure where he used a strip of the lower stomach to construct a new esophagus. Soon people who had spent most of their lives chewing their food and spitting it into a funnel leading into their stomachs were eating normally.
It was here that Heimlich also got his first taste of how professional organizations could react to innovators who went outside the mainstream.
Chiefs of surgery seemed to resent my work. At national surgical meetings, prominent surgeons bitterly spoke out against the procedure. Many years later, I realized that, in the case of the reverse gastric tube operation, I had committed a medical faux pas, for I had not included my chiefs of surgery as authors of most of my papers. The practice of tying others to one’s work, known as “academic slavery,” was customary, even though the secondary physicians had not actually contributed.
Heimlich’s greatest contribution to life-saving came, not with the Heimlich Maneuver, but when he became curious about the elaborate hospital equipment required to drain the fluid from injured chests to fend off a potentially fatal lung collapse. The old method involved an electrically powered suction machine that presented problems just moving from room to room. Heimlich noted that chest injuries drain naturally and wondered if there were some kind of valve that could prevent the deadly backflow.
He bought a flutter valve — a flexible “Bronx cheer” rubber tube — in a five-and-dime and attached it to a hypodermic inserted into the chest of a patient. Then he stayed up for two nights watching. The device worked. Within a few years Becton Dickinson had a manufactured product and when the Army saw it in 1965, they ordered thousands. By 1969 Becton Dickinson was running factories 24 hours a day and still couldn’t meet the demand. The Heimlich Valve became standard equipment in every soldier’s pack in Vietnam and saved tens of thousands of lives. Then when Dr. Heimlich visited Vietnam in 1999 he was astonished to find everybody knew his name. It turned out the Quakers had supplied North Vietnam with Heimlich Valves and it had saved thousands on that side as well. It was the most emotional experience of his life.
I won’t even go into detail about the invention of the Heimlich Maneuver. It’s too good a story to give away. Suffice to say, it probably saves someone’s life in America at least once a week. ESPN announcer Chris Fowler was rescued by former New York Giants quarterback Jesse Palmer last December. Clint Eastwood saved the director of the AT&T Pebble Beach Gold Tournament in February. And that’s just the celebrity stories.
But the Maneuver also turned out to be another lesson in institutional momentum. To this day the American Red Cross refuses to acknowledge the primacy of the Heimlich Maneuver and instead recommends a series of backslaps, even though pounding on someone’s back is just as likely to drive the object deeper into the throat. Unfortunately, after 40 years it is still difficult to conduct controlled experiments since you can’t go around sticking things down people’s throat and then experimenting with what works best at getting it out.
Nor does the controversy end there. Not long after the Maneuver was introduced in 1974, a few lifeguards spontaneously used it on drowning victims and found it worked almost miraculously. Water would be expelled from the lungs and a drowning victim with no pulse would begin breathing normally. It makes sense since mouth-to-mouth resuscitation involves trying to force air into lungs that may already be filled with water. Yet once again the professional associations resisted. Jeff Ellis & Associates, the nation’s largest professional lifeguard company, adopted the Maneuver for five years but gave it up under the threat of lawsuits. Once again, it is impossible to conduct controlled experiments since you can’t drown a person and then try to revive them. There have been instances where clumsy attempts to perform the Heimlich Maneuver have caused injury, but the same thing occurs with CPR.
In recent years, Heimlich has been at the center of yet another controversy when he proposed inoculating people with a mild form of malaria as a vaccination against AIDS. This may sound wildly improbable except that malaria therapy was the principal cure for syphilis before the invention of antibiotics. Unable to persuade the FDA to approve any tests, Heimlich took his experiment to China and has been inoculating AIDS victims, with inconclusive results. (Many such experiments are now being outsourced to China since you can’t do anything unusual in this country without running up against a government bureaucrat. Bill Gates took the Traveling Wave nuclear reactor to China because it was impossible to build an experimental model here.)
In recent years, Heimlich has had his problems. Peter, one of his four children, has become alienated from the family and, bizarrely, he and his wife shut down their small business in order to work full time at discrediting his father. In 2007, after almost a year of investigation, the New Republic gave full vent to Peter’s accusations, publishing it under the charming title, “The Choke Artist.” Peter claims: 1) His father didn’t really invent the Heimlich Maneuver, a colleague named Ed Patrick did (even Patrick failed to confirm this). 2) He didn’t invent the esophagus replacement, a Romanian doctor named Dan Gavriliu did it five years before him. (Heimlich freely admits this in the book but says he was unaware of Gavriliu’s work behind the Iron Curtain. His account of a sinister 1956 visit to Soviet-occupied Romania to perform a celebrated joint operation with Gavriliu makes up one of the more fascinating chapters of the book.) 3) His father is exploiting Chinese AIDS victims by infecting them with malaria. (Vaccination experiments have drawn criticism since Edward Jenner and Louis Pasteur. Even today there is a hysterical campaign in this country against childhood vaccinations.)
New Republic senior editor Jason Zengerle, who wrote the piece, generally took Peter’s side although he did find him a little fanatical. And in the end Zengerle couldn’t help being impressed watching Heimlich at a testimonial dinner being embraced by people who had been saved by the Heimlich Maneuver. In the liberal pantheon, however, it is always important to tear down people who have accomplished things. Remember, you didn’t build that.
Heimlich obviously has an ego. He hasn’t gotten his ideas into the public domain without a lot of vigorous self-promotion. But as he points out, introducing the Heimlich Maneuver through the usual peer-review process could have taken five to ten years. A lot of people would have died in the interim. In any case, whatever excesses he may have committed in the past are not on display here. The tone is genial and conversational, stripped free of jargon with the help of medical writer Andrea Sattinger.
The good doctor is now 94 and living in an assisted facility in Cincinnati. Jane, his wife of 62 years, who was the daughter of Arthur and Kathryn Murray, “the couple who taught America how to dance” in the 1950s, died last year. Yet Heimlich ends his book with this sentence: “I’m not done yet.”
Nor should America be done with honoring this peerless pioneer. I suggest President Obama make plans right now for awarding him the Presidential Medal of Freedom. It’s hard to think of anyone who deserves it more. And if at the White House dinner someone starts choking on a piece of meat, have the guests try implementing both backslaps and the Heimlich Maneuver. Let’s find out once and for all what works best.