Old school CPR

[Maykeith]

I just finished reading "Our Assassinated Presidents-the true medical stories" by Stewart Brooks. While discussing the events of the Lincoln assassination he tells of Dr. Leale's initial examination the the box. He notes that he initiated artificial respiration by straddling the president and forcefully inserted two fingers into Lincoln's mouth to hold down his tongue while 2 assistants manipulated Lincoln's arms up and down. Simultaneously Leale pressed the diaphragm upward. That is some crazy CPR......Does anyone know backstory on this method, when did they figure out about chest compressions and did the antiquated style ever actually save anyone's life?

Also interesting to note that in between rounds (not sure how long or how many) Leale was realeasing the clot in Lincoln's head and performing rescue breathing. I can't imagine the pandemonium in the box with Mary screaming, Rathbone bleeding profusely, Lincoln grasping at life and Leale trying to do all of his medical work. I can't imagine there was enough room for all that crazy.

[RobertLC]

I just re-read Leale’s 1865 account of arriving in the State Box and the immediate treatment that he provided to Lincoln. I did not find any mention of the treatment that Brooks identified. I also looked at Leale's letter to Dudley and found no comments about what you have included. Moreover, I re-read Taft’s 1865 account and found no mention of that procedure.

Leale, however, did mention, in his February 1909 speech to the Military Order of the Loyal Legion of the United States, the actions that Brooks identified. Quite a change, over 44 years, from his 1865 report, or so I think. Perhaps his memory had been tarnished by time or perhaps he had, by then, realized the importance of his role in treating Lincoln. Also, it is possible that in his 1865 account, Leale just failed to mention the artificial respiration, but that seems strange that he would not.

In general, Leale was very quiet over the years about his attending to Lincoln. But, in my opinion, his 1909 report is certainly more elaborate and perhaps even more self-serving than his original 1865 account.

I apologize that my response does not address your CPR question, but nevertheless, Leale’s account(s) are important.

Bob

[Leon Greene]

[attachment=2336]

(07-14-2016 05:22 PM)Maykeith Wrote:  I just finished reading "Our Assassinated Presidents-the true medical stories" by Stewart Brooks. While discussing the events of the Lincoln assassination he tells of Dr. Leale's initial examination the the box. He notes that he initiated artificial respiration by straddling the president and forcefully inserted two fingers into Lincoln's mouth to hold down his tongue while 2 assistants manipulated Lincoln's arms up and down. Simultaneously Leale pressed the diaphragm upward. That is some crazy CPR......Does anyone know backstory on this method, when did they figure out about chest compressions and did the antiquated style ever actually save anyone's life?

Also interesting to note that in between rounds (not sure how long or how many) Leale was realeasing the clot in Lincoln's head and performing rescue breathing. I can't imagine the pandemonium in the box with Mary screaming, Rathbone bleeding profusely, Lincoln grasping at life and Leale trying to do all of his medical work. I can't imagine there was enough room for all that crazy.

While I can't comment on the truth of Dr. Leale's application of CPR to President Lincoln, I can provide a summary of the "accepted" method of CPR published in the medical journal Lancet in 1856. The technique was indeed cumbersome. It was occasionally used in battlefield hospitals, at times continued for up to two hours, almost never successfully. The "successful" cases likely occurred in patients without a true cardiac arrest. [attachment=2336]

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(07-15-2016 01:12 AM)Leon Greene Wrote:  

(07-14-2016 05:22 PM)Maykeith Wrote:  I just finished reading "Our Assassinated Presidents-the true medical stories" by Stewart Brooks. While discussing the events of the Lincoln assassination he tells of Dr. Leale's initial examination the the box. He notes that he initiated artificial respiration by straddling the president and forcefully inserted two fingers into Lincoln's mouth to hold down his tongue while 2 assistants manipulated Lincoln's arms up and down. Simultaneously Leale pressed the diaphragm upward. That is some crazy CPR......Does anyone know backstory on this method, when did they figure out about chest compressions and did the antiquated style ever actually save anyone's life?

Also interesting to note that in between rounds (not sure how long or how many) Leale was realeasing the clot in Lincoln's head and performing rescue breathing. I can't imagine the pandemonium in the box with Mary screaming, Rathbone bleeding profusely, Lincoln grasping at life and Leale trying to do all of his medical work. I can't imagine there was enough room for all that crazy.

While I can't comment on the truth of Dr. Leale's application of CPR to President Lincoln, I can provide a summary of the "accepted" method of CPR published in the medical journal Lancet in 1856. The technique was indeed cumbersome. It was occasionally used in battlefield hospitals, at times continued for up to two hours, almost never successfully. The "successful" cases likely occurred in patients without a true cardiac arrest.

The attachment that I included doesn't seem to appear unless you click on the box at the end of my post. It's the figure from the 1856 Lancet article illustrating the CPR technique. And now the box itself has disappeared. Sorry about my computer skills. I'll try to figure out how to make it work.

[RJNorton]

I posted this in other threads but will post again here. Here is an opinion by a medical doctor.

In 2006 I had contact with a New Zealand intensivist who feels Leale did not actually use mouth-to-mouth artificial respiration. This doctor gives three main reasons for his opinion: (1) Leale makes no mention of mouth-to mouth artificial respiration in his 1867 report to Congress. Only in 1909, when Leale gave another account, do we first learn of his claim of artificial respiration and a crude form of closed chest cardiac massage. In 1909 Leale was 67 and trying to recall events from 44 years previous. (2) According to this doctor's study of the history of critical care and resuscitation, mouth-to-mouth artificial respiration was totally out of favor as a resuscitation maneuver in 1865. (3) None of the other people who rushed to Lincoln's aid, including the other doctors who arrived in the state box, independently corroborated Leale's claims.

Back in 1995, Dr. Richard A. R. Fraser, writing in "American Heritage," noted that "Leale’s account of the assassination submitted in 1867 made no mention of resuscitation, but in 1909 he delivered an address in New York giving a detailed description of practicing mouth-to-mouth resuscitation on Lincoln after he probed the wound. It is strange that Leale did not include this in his first account, which omitted no other important details of the President’s treatment. I am more inclined to give credence to this earlier version, recorded in Leale’s own hand the day Lincoln died."

Here is a capsule of the research this doctor sent me:

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"If I can go on to you about M-to-M (because that is what I will be writing about) then the chequered history is:

1. Used by midwives, apparently since antiquity
2. 1732 Re-introduced by Wm Tossach's effective demonstration
3. Mid C18, adopted by Humane Socs, including the late-founded ones in the USA (and endorsed in 1788 by Mass. Humane Soc [HS] and 1791 by Philadelphia HS). Yet
4. 1782. Advised against by [what later became] the Royal HS (London)
5. Condemned, in effect, by French Academy of Sciences, Paris, 1829, after they accepted their commissioned studies findings that all positive pressure ventilation was dangerous
6. 1837 Condemned by the Royal HS also
7. thereafter until "rediscovery" in the 1940s, virtually abandoned and forgotten except among midwives, some obstetricians and some C20 anaesthetists.

So we have CAL fitting in between 6 &7. Hence my surprise and wonderment as to however did he come by such an out-of-favour method of resus, being just medically qualified..."

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All of this is not meant to discredit Dr. Leale and his efforts on Abraham Lincoln's behalf. I certainly consider Dr. Leale a hero. However, it seems as least possible that he did not do everything he claimed to do (according to this New Zealand doctor).