Historians today can look back as far as the year 800BCE to find references to attempting to resuscitate people who have drowned. A variety of techniques have been suggested and experimented throughout the centuries, and the technique we use today known as CPR, which is short for cardiopulmonary resuscitation, has its roots in the 1950s. However, the core idea of CPR, which combines resuscitation techniques, actually goes back 250 years.

Back in 1767 a group of rich and charitably-inclined members of society in Amsterdam established amongst themselves a group called the Society for Recovery of Drowned Persons. While individuals throughout history had suggested different methods before, this was the first time that a group had been officially organised to address the important issue of reviving people who had been rescued from drowning.

The society devised several techniques to use on people who needed resuscitation. An official list was produced by members of the society which recommended:

1. warming the victim
2. removing swallowed or inhaled water by positioning the victim’s head lower than their feet
3. applying manual pressure to the abdomen
4. giving respirations into the victim’s mouth, either using a bellows or a mouth-to-mouth method
5. tickling the victim’s throat
6. ‘stimulating’ the victim by such means as rectal and oral fumigation with tobacco smoke; bellows were used to drive tobacco smoke, a known irritant, into the intestine through the anus, as this was thought to be enough of a stimulant to engender a response in the ‘almost’ dead
7. bloodletting

Within four years of being founded, the society claimed to have saved 150 people from drowning by using these methods. In fact the first four of these techniques, or variations of them, are in still in use today.

Following the successes of this first society, rescue societies soon sprang up in most European capitals, all with the goal of finding a way of successfully resuscitating victims of sudden death. The theories produced by these societies proved so popular that in Hamburg in Germany an ordinance was passed in 1769 ruling that notices should be read in churches which described assistance for drowned, strangled, and frozen persons, and those overcome by noxious gases. This was most likely the first example of mass medical training. The Royal Humane Society in London, founded in 1774, served as the model for societies in New York, Philadelphia, and Boston in the United States of America. These rescue societies of the 18th century were the precursors of today’s emergency medical services.

These established techniques were developed as the years passed, and new discoveries and technologies in medicine meant more and more people were beginning to understand how to respond to a drowning emergency. In the 1950s, a doctor named James Elam promoted the use of a combination of chest compression and mouth-to-mouth breathing as a means of resuscitation. With Dr Peter Safar, they conducted numerous experiments and demonstrations to spread knowledge of this technique across the world. Dr Safar created the ‘ABC’ of resuscitation, standing for maintaining a patient’s ‘Airways, Breathing and Circulation’.

But how does this relate to a ‘death mask’ we have on display in our St John Ambulance Gallery?

In the late nineteenth century, the body of a young woman was pulled from the River Seine in Paris. The custom at the time with unknown bodies was to display them at the morgue so that friends or relatives of a missing person could visit and identify them. This body was no different and was put on public display in the Paris Morgue in the hope that she would be recognised.

As the story goes, a pathologist at this particular morgue was so taken with the beauty of this unknown lady that he commissioned from a professional moulder a ‘death mask’ of her face as a keepsake. However, it soon appeared that this pathologist was not the only person to be entranced by the beauty of this mysterious young woman. Numerous moulders had their workshops on the Left Bank area alongside the River Seine, and soon the same tranquil face appeared outside each one, marketed to the general public.

This face became a fashionable icon, with numerous sculptures and prints commissioned to decorate the homes, businesses and salons of Paris. She was a muse to Paris’s many artistic souls, who entertained themselves with rampant speculation as to the true identity of this mysterious young woman and what could have led to her drowning in the river. Called ‘l’inconnue de la Seine’, French for ‘the unknown of the Seine’, the youthful face and inscrutable expression inspired writers and painters from across the world, from German novelist Rainer Maria Rilke, to French poet Louis Aragon, even across the Atlantic to Americans like artist Man Ray and writer Vladimir Nabokov. No fashionable room was without a mask of the unknown woman.

The link between this mysterious lady and the invention of CPR is another drowning, roughly sixty years later.

In 1955 Asmund Laerdal, a toymaker in Norway, rescued his two-year-old son from drowning by pulling him from the water by the ankle and forcing the water he had swallowed out of his airways. To Laerdal’s great relief his son survived the ordeal and seemed to have no lasting injury from his near-drowning or from his method of resuscitation.

In 1958, Dr. Peter Safar presented his findings on the merits of combining chest compressions and mouth-to-mouth respiration at a conference of Scandinavian Anaesthesiologists in Gausdal, Norway. Also at this conference was a Norwegian man named Bjorn Lind, who worked at the Stavanger Hospital in Laerdal’s home town. Lind recognised the importance of this new first aid technique and wanted to help raise awareness and improve teaching methods. He was acquainted with Laerdal, who had achieved renown through his use of new soft plastics in toymaking, and decided he would be able to help design equipment to teach CPR. Lind made the introduction between Safar and Laerdal later that year.

When Laerdal was approached by Safar to design a manikin for use in CPR training and demonstration, he recalled seeing the death mask of the mysterious girl who drowned in the Seine in his grandparents’ house, and decided to model his design upon her. He considered her face to be pleasant and unthreatening, so that people learning CPR would not feel uncomfortable using it as a practice tool. At the time he was considered an unconventional choice, as he was well-known as a maker of children’s toys, rather than medical equipment. However, as Laerdal had experienced his own son nearly drowning and being saved by CPR a few years previously, he was determined to help promote this life-saving technique.

Laerdal’s design was a huge success and the face of the unknown young woman became known across the world through the CPR training manikin. She acquired the nickname ‘Resusci Anne’, which is still used today. The modern design of CPR manikins has changed a little since Laerdal first introduced the Resusci Anne to the world, so that current models have a design that is more neutral in expression and gender. However, the original face used by Laerdal is still widely recognised, and is known to some as the ‘most kissed face of all time’.

After these many years, the haunting face of the mysterious drowned girl in the Seine still endures in popular culture today as the Resusci Anne. Michael Jackson even memorably refers to her in his song ‘Smooth Criminal’ with the lyrics ‘Annie are you okay / Are you okay? / Are you okay Annie?’