How to Cure Drowning: The Tobacco Smoke Enemas of the 18th Century

In the late eighteenth century, a hot new craze was sweeping across Western Civilization: attempting to save drowning victims.

Previously, if you appeared to be drowned, usually you were left “stretched naked on the shore.” But beginning with Amsterdam’s Society for the Recovery of Persons Apparently Drowned in 1767, this started to change. After the successes reported by the Dutch, “humane societies” with similar appellations began to pop up across the major cities of Europe and the United States–most of which were port, river or canal-based cities, full of opportunities for drowning.

These societies published pamphlets on how to resuscitate a presumably-drowned person, and offered financial rewards to those who saved near-drowning victims. They also supplied equipment for resuscitation kits along riverbanks, kind of like the defibrillators you see stuck in the walls at airports. Except, back then, the equipment in question was a variety of “stimulating” medicaments and devices, including a collection of parts needed to administer an enema of tobacco smoke to a possibly-dead person’s rectum.

Getting tobacco smoke into the under-orifices of the allegedly dead was not the only means of resuscitation espoused by these humane societies. These groups recommended a wide array of techniques to stimulate and warm the body–replacing wet clothing with dry coats, putting warm bricks or bottles around the bodies, putting them near fires, shaking them bodily, blowing air into the mouth or nostrils, sticking feathers up people’s noses or down their throat, rubbing them vigorously with salt or lemon or vinegar or brine, and bloodletting (it was likely unimaginable to people at the time to not treat a malady with bloodletting), to name a few–but the tobacco smoke enema, for some decades, seemed to be a central focus of the overall drowning treatment plan.

But why? Why did so many great minds of the Western world decide to come together and enable the public to fumigate unconscious people’s buttholes with burnt nightshade byproduct? And…was it actually helpful, somehow?

For the answer, we’re going to take a look at London, because all of my attempts to learn a second language have been muy bu hao, as they* say, and I can only read primary source documents in English.

*no one says this

The Problem

In 18th century London, drowning was not the most likely way to die, but it was the likeliest of sudden ends after childhood. It topped the list of “casualties” — sudden deaths by violence or accident — in London’s Bills of Mortality for decades running, beating out murder, suicide, accidental falls, executions, being licked by a mad dog, or being smothered in bed (one of the many, many ways infants met their end, in those days).

Apparent drowning victims were often simply left for dead. In fairness, submersion in the river Thames can involve danger of hypothermia, which means that a body pulled out of the drink can be breathless, cold, wet, with dilated pupils and no reflexes, and very slowed-down cellular processes. Heartbeat and respiration might be depressed to undetectable levels, without quite getting to the level of “death.” A person can easily be almost dead, and appear to be dead, without being totally dead.

Being declared dead without actually being dead seemed to be a common enough occurrence back then that more than one treatise was written on the subject of “please stop declaring people dead when they aren’t, for the love of fuck” by someone who had actually experienced it. And the idea seemed to freak people out quite a lot.

Enter the humane societies of Europe, or, in London, the Society for the Recovery of Persons Apparently Drowned. These philanthropic societies asked themselves: how can we get people to attempt to bring a possibly-dead person back to life?

Which is a fun question, because it has both sociological and medical dimensions. The first part — the need to convince people to attempt to do it — was fairly simple: they offered money. But the second part — instructing people on how to accomplish it — was a little less straightforward.

On the face of it, the goal of treatment was not complicated. The solution for cold, wet, slow, reflexless, and breathless? Obviously, make warm, make dry, stimulate reflexes, and make the lungs do breathing things again.

But…how?

The Evidence

Medical Theory

In the eighteenth century, medical theories and doctrines were in music festival mode. Lots of shows, a few big headliners–but just because you were a fan of one band didn’t mean you didn’t go listen to others. There were fewer really effective drugs, of course, but not for lack of trying.

For centuries, the headliner medical doctrine for Europe had been Galen’s humoral theory, wherein illness was thought to be caused by an overabundance of one or more of the four “humors” in the body. But, though it still ruled medicine, Galenic theory started to suffer various hole-punchings in the Renaissance. Discoveries that ran counter to Galen’s teachings came left and right from medical men who were, unlike Galen, allowed to dissect human bodies, and also were willing to do some really horrific things to living animals to figure out how their organs worked.

In particular, William Harvey’s demonstration of blood circulation, which flew in the face of Galen’s “the liver makes a bunch of blood and then it just gets used up and stagnates” idea, really took a major shit in the Galenic bed. And in the demonstration of how the heart worked, Harvey, to his great Classicist chagrin, showed that life is sustained by “ceaseless motion” of the organs and the fluids they moved.

What this and other discoveries of the age meant, to a lot of people, is that the body’s mechanics–its motions, its contractions and relaxations–and whatever stimulated those mechanics, must be the thing critical to preserve human life. Variations on this notion then cropped up in the form of several medical doctrines focused on things like heat production, friction, contractions, excitations, irritability, sensibility, stimulation and sedation, and what might prevent or precipitate these things happening.

A nearly-drowned person, as outlined above, is probably the absolute nadir of not being stimulated or heated. So, it would follow to uh, fix that.

Heat

There are a lot of possible options for heating a body from the outside, and the Society for the Recovery of Drowned Persons suggested pretty much everything they could think of–proximity to a fireplace, warm baths, warm bricks, warm water bottles, rubbing with flannels, putting someone between two other people in a bed. But, if you want to heat a body from the inside–which is necessary in more than mild hypothermia cases–rectal fumigation, or a warm enema, would have been the handiest solution at the time. Other proposed means — such as injecting hot wine into the stomach through a catheter inserted in the esophagus — were, perhaps, more complicated and risky than would be recommended for the random citizen on the street.

Stimulate

As far as stimulation goes, I’m sure I don’t need to convince you that putting a pipe or other rigid cylindrical object in someone’s rectum might be a painful, and therefore stimulating, act.

The reason why tobacco smoke specifically was recommended is that tobacco is, itself, a stimulant. Or at least, it contains one (nicotine).

Tobacco was widely used by native peoples in the Americas for ritual purposes and as medicine. The tobacco smoke enema, in fact, is said to have come from Native Americans, and it is perhaps as simple as “Europeans stole the idea.” But, in European understanding, it would have made a great deal of sense.

Europeans took tobacco back to Europe in the 1500s after invading various places in the Americas, and over the next hundred years or so it was turned into a major industry. Even back then, there were those who warned of possible terrible health effects, but, as we know, most of these people were ignored for some time. As far as the majority knew, tobacco was one of the most powerful stimulants available that could be administered without a great deal of technical knowledge. The only thing that was perhaps more stimulating was careful electrocution.

“Electricity” was, actually, suggested as a last resort in some of the Royal Society’s pamphlets. The first use of something like a defibrillator did see the light of day in 1775. But this was not something that could be widely used amongst the masses, and carried significant risk. Tobacco up the pooper, really, was a lot safer (so they thought), and more readily administered.

The Nether-Route

Enemas were a well-known and long-used means of getting supposedly beneficial substances into a person’s body. Particularly if that person was vomiting, or unconscious, or if the body part that needed treatment was, you know, in the bottom half. And, in fact, depending on the drug, rectal administration may provide better and faster absorption than oral–so, it’s actually not a bad way to go. With the oral and inhalation routes not an option in drowned people, “rectally” was really the best choice to get medication inside someone.

But there was another reason to take aim at the intestines: to many physicians of the age, the goal here was to stimulate as many internal “fibres” into motion as they could, as soon as possible. It did not matter where they were, exactly: “the restoring and supporting the action of such a considerable portion of moving fibres as those of the intestines must contribute greatly to restore the activity of the whole system,” wrote William Cullen, noted 18th century physician. To the medical men of the day, getting any organs to resume their normal motions would induce the others to fall into place.

All Together Now

So you have a cold, wet, unconscious person. You are an eighteenth-century Learned Man in London (sorry), and, to the best of your understanding, you need instruct people how to warm and stimulate this person’s internal organs back into motion. All in all, blowing a warm smoke that contains a stimulating medication into a sensitive and readily available cavity attached to a large surface area of internal organ does seem like a pretty good idea. Other Europeans are doing it too, after all; the Dutch have reported success and saved lives with this exact slew of methods, burnt tobacco insufflation included–it is, as they say, well-supported in the literature.

But people on the internet in the 21st century are laughing at you. What you are doing is obviously weird and inane, to them. Why, though? It makes perfect sense…

The Mistakes

You probably already know that tobacco is not an advisable substance to put in any bodily orifice. But while giving someone a one-time enema of tobacco smoke when they are possibly dead may be a weird thing to do, it is maybe not the worst thing. However, if you’re doing that instead of getting air into their lungs, you may well miss the opportunity to save a life.

You may have noticed that among the procedures recommended for drowning victims above were several sensible approaches, like getting a person out of wet clothes, getting them somewhere warm–and “forcing the lungs into some movement by means of a bellows inserted into the nostril.” I put it this way because the main goal of this action seems to have been to get the lungs to move, though sometimes also to induce them to expel water or “noxious and stagnant vapors,” but not, precisely, to insert oxygen.

The seemingly simple equation of “person does not have air in lungs –> put air in lungs” may not be as straightforward as it sounds. After all, there is air right outside your face; if your lungs aren’t sucking it in, then, from a certain perspective, the problem is that your body is not doing the appropriate lung-related movements. And if you do shove more air in when the lungs are not inclined to have it–can you do it wrong? What if you blow in too much air, or accidentally give the other person tuberculosis, or poison them with your nasty carbon-dioxidey breath? Indeed, the question of shoving more air in the lungs without exploding them, and what kind of air, and by what means, and in what circumstances, was a point of many-varied contention for hundreds of years, and the answer still gets revised every once in a while. Mouth-to-mouth resuscitation, while it nearly gained widespread popularity in the late 1700s, fell out of favor soon after, and was not widely recommended again until 1959.

The Kiss of Life

In first response to drowning cases, these days, getting oxygen into someone is the first order of business. We now know a brain needs oxygen pretty quickly to not die, and we know we can exhale some oxygen. So the first thing we do, once the person is out of the water, is breathe into their mouths.

The possibly of reviving people with mouth-to-mouth breathing was not an entirely new idea in the 1700s — it had been used for god-knows-how-long, for example, by midwives on newborns, and in scattered instances of suffocation elsewhere. In France, it was officially recommended as the main remedy for the near-drowned by the Academy of Sciences in 1740. In Britain, however, it seemed every physician had their own opinion, and debate went on for some decades without definite consensus. Some considered it a first-line treatment, as important or even moreso than the tobacco enemas–but some considered it secondary, and later, actively harmful.

One of the problems with it then is one of the problems we still have with it today: it’s gross. Again, this is both a sociological and medical problem. People may not want to do it, because kissing a dead stranger is unpleasant for most of us, even excluding the problem of them potentially barfing up sewage-filled Thames water in our faces. And medically speaking, swapping spit and air molecules with an unknown entity can spread disease. Which is partially why, today, the mouth-to-mouth part of CPR is no longer recommended in cases of cardiac arrest, and the general public recommendation is to focus on mashing your fist into someone’s chest to the beat of Stayin’ Alive. (Mouth-to-mouth resuscitation is still highly recommended in cases of drowning and other cases of deoxygenation being the main cause of the problem.) It would have been even grosser in the toothpaste-deprived world of the 1700s. Medical theories at the time conflicted on how infectious disease was spread, but most would agree that mushing your wet slobbering mouth on the face of a rando and blowing in your stench-laden exhalations was not a healthful thing to do, generally speaking.

But another of the problems was actually…science. Recent discoveries in the realms of physics and chemistry had illuminated a lot for Europeans about the nature of gases–particularly, oxygen. While they didn’t fully understand the entire process of oxygenation in the body, they now had a sense of what oxygen was, and what carbon dioxide was, and that carbon dioxide could a) suffocate you and b) was exhaled by the lungs. Therefore, some argued–though not everyone thought this–exhaling into a someone’s mouth could potentially cause more harm than good. It wasn’t until we could measure gas quantities in peoples’ breath in the 1950s that it was determined this didn’t matter.

A compromise was suggested in the use of a bellows into the nose or the mouth, rather than another person blowing exhaled air directly into another. But concern eventually developed about whether or not the lungs can handle the pressure of a bellows, and then whether they could withstand any sort of pressure of being blown into at all. Mouth-to-mouth techniques, and anything else that involved shoving air into the lungs from the outside, were abandoned altogether for over a century. Favored methods focused on–again–simply getting the lungs to move. Later in the 19th century, these techniques became less about overall body stimulation than trying to force the diaphragm to do it usual diaphragm-like things via pushing or pulling on various body parts, which is why that one scene in Treasure of Sierra Madre looks the way it does.

But all that’s another story.

The Successes

Despite their errors, though, the humane societies’ efforts were largely beneficial. The resources they poured into organizing the saving of lives in cases of sudden death were impressive and well-thought-out: prepared kits distributed in the city, receiving-houses set up for rescue, pamphlets regularly updated with the newest recommendations on techniques, and research into the techniques themselves; rewards for rescue efforts — and with all this, they did save lives. The London Society for Persons Apparently Drowned reported in 1787 that 897 people were saved from drowning in the thirteen years since the inception of the organization.

Bigger than their effect in their own time, maybe, is the impact on society. The overall message of these societies was to do something to help, and, although their recommended medical methods weren’t entirely spot-on, the somethings they recommended were often miles better than no intervention at all. The debates about techniques and equipment fostered innovations and experiments in understanding how to address a frightening societal and medical problem. This was the first time there had been a concerted, widespread effort to encourage and enable a great number of people to act as rescuers in emergencies, and entered the concept of resuscitation into cultural consciousness.

They tried. And to some extent, they succeeded, even if they did needlessly violate countless unconscious wet people with carcinogenic intestinal fumigation in the process.