Henry J. Heimlich, the Cincinnati surgeon whose “bear-hug” maneuver has been credited with saving the lives of tens of thousands of choking victims but whose aggressive self-promotion and unorthodox medical ideas cast a shadow over his legacy, died Dec. 17 at a Cincinnati hospital. He was 96.
He had a heart attack, said a son, Phil Heimlich.
In a career spanning seven decades, Henry Heimlich zealously promoted lifesaving procedures and techniques he invented or refined. Besides the first-aid rescue maneuver introduced in 1974, these advances included a now-common surgical procedure he helped develop in the 1950s for people with severe esophageal damage and a valve for chest drainage that was widely used during field surgery in the Vietnam War and in emergency facilities.
Heimlich was a charismatic speaker with unshakable faith in his abilities. He repeatedly circumvented established practices such as publishing in peer-reviewed journals, and he presented himself as a medical David fighting an establishment Goliath when confronting skeptics.
And opposition was not unusual.
His attempts to make the Heimlich maneuver the chief or sole response in choking and drowning situations encountered resistance, and his later efforts to use malariotherapy – exposure to malaria – to treat illnesses including AIDS, cancer and Lyme disease were fiercely criticized.
“It’s the pattern,” he told The Washington Post in 1989. “First, they say it won’t work, then when it proves to work, they say it’s nothing new. Most people cannot accept some guy coming in who’s not totally involved in the politics of the field, coming up with an idea that they haven’t figured out in 50 years.”
He was colorful and combative when defending his most enduring contribution to medicine, the “bear hug” that became known as the Heimlich maneuver.
Ronald Reagan, on the campaign trail in 1976, and New York Mayor Edward I. Koch were reputed beneficiaries of the Heimlich maneuver. But the degree to which it entered the public consciousness did little to end his battle with medical associations that gave only qualified support to the Heimlich.
His research relied too much on anecdotal evidence and too little on quantitative data to persuade the American Red Cross, the National Academy of Sciences and the American Heart Association. “You can’t establish scientific truth with a popular vote,” Don M. Benson, then-anesthesiology chairman at Aultman Hospital in Canton, Ohio, told the Wall Street Journal in 1979.
In 1986, the American Red Cross recognized the Heimlich maneuver as a useful rescue technique in choking incidents. But the organization would not endorse it as the primary response in drowning cases, and Heimlich wrote the organization’s leaders, essentially accusing them of letting people die while they dawdled on research and bureaucracy.
By training, Heimlich was a thoracic surgeon, or a specialist in chest surgery. When he began developing the Heimlich, in 1973, he was the chief of surgery at the Jewish Hospital of Cincinnati.
Although the backslap was a common response to choking at the time, it sometimes caused an object to become lodged deeper in a victim’s throat. (Heimlich dismissed backslaps as “death blows.”) And physician-inventors had proposed gadgets such as the “Throat-E-Vac” (a vacuum device) and the “ChokeSaver” (nine-inch-long tweezers) without much success.
Heimlich knew that air remained in the lungs after an exhalation. That air, he believed, could be used to expel an object. He experimented on an anesthetized beagle and eventually realized that with an upward thrust into the soft tissue under the diaphragm, an object could be dislodged from the throat.
The maneuver is elementary, as the doctor wanted it to be. The rescuer stands behind the choking victim, with the rescuer’s arms around the victim’s waist and then delivers a sharp, upward abdominal thrust, just above the belly button.
He wrote about the first-aid technique in the June 1974 issue of Emergency Medicine. He explained how the maneuver worked and urged readers to send him success stories. He sent the article to science and health writers in the mainstream media and said that more than 2,000 stories of being saved by the maneuver came back within a year.
Heimlich parlayed that early publicity into popular support for his anti-choking technique. In 1984, he received the prestigious Lasker Award for public service. The next year, then-Surgeon General C. Everett Koop, who said he once performed the maneuver on a grandson, called the Heimlich maneuver “the only method that should be used for the treatment of choking from foreign body airway obstruction.”
In 1986, Koop’s pressure led the American Red Cross and American Heart Association to recognize the Heimlich maneuver as a useful rescue technique in choking. But the Red Cross also recommended that the Heimlich maneuver be used on drowning victims only if mouth-to-mouth resuscitation failed because of a “solid body” airway obstruction. Water in the airway is not considered a solid body obstruction.
Henry Jay Heimlich was born Feb. 3, 1920, in Wilmington, Del., and raised in New Rochelle, N.Y. He often accompanied his father, a social worker, on his rounds of New York state prisons.
After graduating from Cornell University in 1941 and its medical school in 1943, Henry Heimlich served as a Navy surgeon during World War II. He said he was the only doctor assigned to a Marine unit helping Chinese allies in the Gobi Desert in Mongolia, and he often operated in a field hospital without electricity.
In 1951, he married Jane Murray. His wife died in 2012.
Around the time of his marriage, Heimlich began working as a thoracic surgeon at New York City hospitals. He devoted his spare time to developing new medical devices and techniques. On a napkin, he sketched an idea for using a section of a patient’s stomach to construct a new esophagus to treat esophageal damage caused, for instance, by cancer or the ingestion of a caustic chemical.
The idea got the brushoff from several hospital executives, but he eventually secured a $300 grant and laboratory space and tested the procedure on dogs. He published his findings in the journal Surgery in 1955, and two years later, he successfully performed the operation on a human. Heimlich, for years, was credited as a prime developer of this “reversed gastric tube” procedure, which became standard in operating rooms.
In later decades, a dispute arose over whether Heimlich had purposely underplayed the contribution of a Romanian surgeon who performed the procedure on a person before he did. That doctor, Dan Gavriliu, called Heimlich a “liar and thief” when the Cincinnati Enquirer contacted him in 2003 for an investigative story about Heimlich’s career. Beyond dispute, however, was Heimlich’s role in popularizing the procedure.
The newspaper’s investigation found that Heimlich credited Gavriliu in a 1957 Surgery article but in later years gradually diminished Gavriliu’s role.
In the 1960s, Heimlich introduced a simple valve to drain severe chest wounds. He said he was motivated by his memory of the primitive conditions he worked under in Mongolia. He fashioned a prototype using a toy noisemaker, which functioned as a one-way flutter valve when attached to a drainage bottle.
Decades later, he said that he started a company to manufacture the valves in 1964 and that a doctor from a Navy medical research agency helped promote the device for use in Vietnam.
Both innovations – the reversed gastric tube and the chest valve – were variations of existing procedures, said Thomas Schlich, a medical historian at McGill University in Montreal.
Schlich said of the esophageal operation: “I don’t see that it had a great impact, nor was it really original.” The same is true of the chest valve; Schlich said Dr. Heimlich altered a device that already existed.
In the mid-1980s, Heimlich began experimenting with malariotherapy, in which a patient is intentionally given malaria in the hope that the high fevers caused by the disease will cure or relieve another infection. An Austrian psychiatrist, Julius Wagner-Jauregg, won a Nobel Prize in 1927 for malariotherapy of neurosyphilis. The usefulness of the strategy, however, has never been proved.
Heimlich believed that malariotherapy could treat HIV infection, among other illnesses. He took his clinical trials to Mexico and China before bowing to pressure and shutting down the project.
“He was grasping at straws and continued to push these ideas for so long,” said Paul Roepe, a malaria scientist at Georgetown University. “If something is not a legitimate proposal in the eyes of the broad medical community, then you don’t get funding, and that’s why he took it abroad.”
A group of scientists and doctors from the United States and Mexico had petitioned against the HIV project, which was funded by a group of Hollywood supporters including actresses Amy Irving and Estelle Getty, the New Republic reported.
“This exploits the AIDS crisis, exploits the generous and caring entertainment community, and it exploits the good that Heimlich himself has done in the past,” said Paul Bronston, national ethics chairman of the American College of Medical Quality and a petition supporter.
The doctor’s most vehement adversary was his estranged son, Peter, a fabric importer who had a website devoted to attacking his father. For more than a decade, he contacted hundreds of reporters (sometimes using pseudonyms) to denounce his father as a fraud who promoted dangerous medical treatments.
Heimlich largely remained silent on the matter of his son’s attacks. His three other children stood by their father and defended his work and character. A complete list of survivors was not immediately available.
After his contract at the Jewish Hospital of Cincinnati was not renewed in 1977, Heimlich spent about a decade as an advanced clinical professor at Cincinnati’s Xavier University. He remained through recent years the chief evangelist of the Heimlich maneuver and his own legacy.
This May, he received a flurry of attention for performing the Heimlich on an 87-year-old woman choking on a piece of meat at their senior residence in Cincinnati. Heimlich said it was the first time he had used the maneuver in an emergency, an assertion apparently contradicted by statements made to media outlets in the early 2000s.
(c) The Washington Post · Sindya H. Bhanoo