Obituaries

Henry Heimlich

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j118 (Published 09 January 2017) Cite this as: BMJ 2017;356:j118
  1. Bob Roehr

Creator of the eponymous manoeuvre

Addison, Alzheimer, Creutzfeldt-Jakob, Parkinson, Tourette—the literature is replete with the names of those who made important medical contributions. Most are affixed to conditions for which diagnosis brings dread, a realisation that even the most skilled healer can do little to ameliorate the condition or its course.

Henry Heimlich was a happy exception in this pantheon. The inventor of the Heimlich manoeuvre created a phrase and procedure that quickly entered the popular lexicon and everyday life, saving thousands in the process. Unlike so much of modern medicine, it worked quickly and cheaply. It didn’t rely on expertise but simple training of the public and a modicum of awareness to recognise that someone was choking. The cost was minimal—it was arguably the cheapest and most effective contribution to modern medicine—and perhaps the only rival to vaccination. It brought joy, not grief. The wonder was that it had not been developed and popularised sooner.

Heimlich was born in Delaware but grew up in New Rochelle, a prosperous suburb just north of New York City; his father was a social worker in the state prison system. Heimlich graduated from Cornell and then its medical school in 1943. Commissioned a naval surgeon, he spent much of the war deployed with military advisers to the Chinese in the Gobi desert of Mongolia.

Innovative approaches

After the war, Heimlich returned to New York and trained as a thoracic surgeon. He proposed reconstructing a damaged oesophagus with tissue from a patient’s own stomach, testing it first on dogs and publishing the results in Surgery in 1955, before moving on to humans. Only later would he acknowledge that he had drawn on earlier work by a Romanian surgeon for what would become known as the Heimlich-Gavriliu reversed gastric tube operation.

The Heimlich chest drain valve came in the early 1960s. The simple one way valve, based on one found in a dime store noisemaker, soon replaced the cumbersome bottles and suction tubes that were then used to drain the pleural cavity.

Choking on food, toys, and other objects was the sixth leading cause of accidental death in the US in the 1960s. Heimlich, by then head of surgery at the Jewish Hospital in Cincinnati, Ohio, worried that the traditional response of slapping the victim on the back often did not work and sometimes lodged the object even further down the throat. He thought that the reserve of air in the lung might be used to dislodge the object, and worked with anaesthetised dogs to develop the manoeuvre, a quick upward thrust under the ribcage, before applying it to humans. Heimlich published his recommendation as a personal commentary, “Pop Goes the Café Coronary,” in the Journal of Emergency Medicine in 1974.

Medical groups largely ignored the manoeuvre—it lacked the imprimatur of a clinical study and a peer reviewed paper—but they overlooked the difficulty of conducting clinical trials for much of emergency medicine, especially when the window to perform it was mere seconds.

The public was less concerned with those standards of evidence. Soon after Heimlich’s demonstration of the manoeuvre on television, stories of viewers who had used it to rescue choking family members began to pour in. Anecdote was sufficient to convince the public of its value, as well as influential people such as the US Surgeon General C Everett Koop (read obituary: http://www.bmj.com/content/346/bmj.f1491). Eventually, often grudgingly, the medical community came around too.

Later in life Heimlich promoted “malariotherapy”—the controversial use of malaria infection to generate high fever and an immune response—to treat Lyme disease and HIV. In the early 1990s, when the AIDS pandemic was at its worst, he tapped gullible Hollywood celebrities for hundreds of thousands of dollars to pursue the therapy in a clinic in Mexico and later China, when the US Food and Drug Administration would not approve such a questionable experiment in the US.1

Journeyman tinkerer

Heimlich’s contributions to medicine were not those of an inspired leap of genius but more those of a journeyman tinkerer in a dogged quest to improve on what already existed. He coupled that with a zeal for self promotion, particularly on television, another fact that set him at odds with much of the medical establishment. It is likely that Heimlich drew inspiration, and perhaps even a few tips, from his father in law, Arthur Murray. Murray was a Jewish immigrant from eastern Europe, who reinvented himself in the early 20th century as a ballroom dancer and, through self promotion, built an international network of studios to teach that social grace.

Heimlich’s son Peter became estranged from his father and spent considerable effort documenting the senior Heimlich’s overreach and quackery.2 Despite such controversy, Heimlich received much recognition from his peers, including the Lasker award in 1984, the highest medical honour in the US.

Henry Judah Heimlich was born on 3 February 1920 and died from a heart attack on 17 December 2016 in Cincinnati, Ohio. He married Jane Murray in 1951; the marriage lasted until her death in 2012. He leaves two sons and two daughters.

Henry Judah Heimlich (b 1920; q Cornell University Medical School, New York, 1943), died from a heart attack on 17 December 2016

References

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