Heimlich's Maneuvers

by Henry J. Heimlich

  Then, one night, the sip went down into his stomach. He rushed in and told his wife that he had swallowed. But when he tried to demonstrate this feat, he spit up the liquid. However, the next morning, he was again able to keep a sip down. That afternoon, he ate some gelatin. It was painstaking work that took twenty minutes to complete. “I broke out in a sweat, I was working that hard at it,” Mr. Reiser recalled. After he had been home for a few weeks, he came to see me for a follow-up appointment. He had forgotten to bring his paper handkerchiefs for the one-hundred-mile trip to Cincinnati, but it didn’t matter. “I swallowed saliva the whole way,” remembered Mr. Reiser. During that visit, I was thrilled that he could swallow a small bit of water. We both were jokesters who were close in age. When he sputtered the second sip, I said, “See what happens when you show off?”

  Mr. Reiser’s swallowing continued to progress nicely. A few months later, he was eating perfectly normally. Today, at eighty-seven years, Mr. Reiser appreciates no longer being tethered to a tube to perform the simple act of eating. While he maintains a sense of humor about it all—referring to himself as a “Gerber baby for thirty years”—he also recognizes how reliant he was on his equipment. “It’s humbling to know I could have starved to death in a grocery store if I didn’t have the tube with me,” he said. When asked about her feelings regarding Mr. Reiser’s ability to eat again normally, his wife, Donna, expressed how nice it was for the two of them to go to a restaurant and eat together. Before learning how to swallow, he would have fed himself before leaving home and then just sat with her while she ate.

  I worked with other patients whose esophagi had been damaged in the same way, and they, too, relearned how to swallow. With this consistency of success, I presented my findings at the American Broncho-Esophagological Association conference in San Francisco in 1979, and the results were published in a major medical journal three years later.25

  The finger-sucking method was now known to the medical profession as a way to help more than just premature infants. But I was to learn that it could help even more patients—namely, those who had lost their ability to swallow due to stroke.

  After a stroke, loss of the ability to swallow results from permanent paralysis of muscles in the mouth and throat. This differs from what patients like Hayani and Mr. Reiser, who both had no paralysis but had forgotten how to swallow, experienced. Paralysis from a stroke is unilateral; it affects only one side of the body. If the stroke hits the left side of the brain, the right side of the body is paralyzed; if it hits the right side of the brain, the left side of the body is paralyzed.

  What do we do, I thought, when some muscles in an arm or a leg are paralyzed? The answer is obvious: we exercise the healthy muscles, strengthening them so they can compensate for the paralyzed muscles and duplicate their function. Since sucking is the first step to swallowing, could we exercise the healthy muscles on one side of the mouth and throat of stroke patients and strengthen those muscles to enable them to sufficiently carry out the act of sucking—despite paralysis of the muscles on the other side—using the finger-sucking method? If that could be accomplished, could we then work on teaching those patients how to swallow?

  To find out, I began working with stroke patients at various hospitals. I taught them the finger-sucking method and discovered that they could regain the ability to suck by exercising the mouth and throat muscles that were not paralyzed. I can only imagine what it was like for hospital visitors, seeing older patients sitting in wheelchairs in the hallways, sucking their fingers—let alone seeing me suck their fingers.

  Once the finger-sucking method helped these stroke victims regain their ability to suck, I had to teach them next how to swallow. So I conceived of a new procedure. To understand how it works, try this: Put your finger on your Adam’s apple (or, for those with less prominent Adam’s apples, such as females, place your finger in the middle of your neck, directly below your chin; you should feel the hard, ribbed trachea). Now hold your finger there while you swallow. You can feel your Adam’s apple move upward, then downward. In the same way, I had patients put their finger on my neck so they could feel my Adam’s apple while I swallowed. They felt the Adam’s apple rise up and come back down. Then they would try it on their own: each would put a finger on his or her own throat and tried to get the Adam’s apple to do the same thing. Repeated attempts to suck one’s finger followed by attempts to swallow strengthened the non-paralyzed muscles on one side of the patients’ throats. (As with any medical technique, patients should consult their doctors before trying out this method or the finger-sucking method.)

  From 1979 to 1982, I successfully treated seven consecutive stroke patients, aged fifty-six to seventy-one, in this manner. When I first saw them, they had not swallowed fluids or solids for a range of from five months to thirty-nine years following their strokes. Each progressed to eating all foods from ten to sixteen days after starting the Adam’s-apple exercises.26

  TREATING HIV AND AIDS WITH MALARIOTHERAPY

  I have long been fascinated with the potential of malariotherapy to cure disease. Malariotherapy involves inoculating patients with a curable form of malaria that induces fevers at a manageable temperature and last for about two weeks. After three weeks, the malaria is cured with antimalarial medication, such as quinine or chloroquine.

  For decades beginning in the early 1900s, malariotherapy was used to cure neurosyphilis. Neurosyphilis is an infection of the brain or spinal cord caused by a bacterium. It usually occurs in people who have untreated syphilis. Symptoms of neurosyphilis include blindness, unsteady gait, and eventually paralysis, dementia, and megalomania. Patients’ symptoms can worsen to the point that the brain is irreversibly damaged and the person may die.

  Around the turn of the century, neurosyphilis was the scourge of Europe. Mental institutions were filled with people who were in the final stages of neurosyphilis. In 1922, Dr. Julius Wagner-Jauregg, an Austrian doctor, published a study showing that malariotherapy cured neurosyphilis. While Wagner-Jauregg is not a hero in all aspects—he was anti-Semitic and a Nazi supporter—his medical research was commendable. In fact, he received the Nobel Prize in physiology or medicine in 1927 for his work with malariotherapy and neurosyphilis.27

  Other researchers picked up where Wagner-Jauregg left off. From 1931 to 1965, the US Public Health Service and Johns Hopkins Hospital laboratories provided malaria-infected blood to US hospitals to cure neurosyphilis, resulting in the curing of tens of thousands of patients. In fact, it was during these early years when I first learned about the efficacy of malariotherapy for neurosyphilis. I was in medical school at the time and observed patients being treated using this method. Years later, in 1984, a paper by the Harvard School of Public Health that was published in the Journal of Parasitology cited thirty-six references on malariotherapy for neurosyphilis and concluded that, while the literature reviewed on treating neurosyphilis patients is “scattered,” it appeared that “one-third of those treated with malaria went into full remission of variable duration.”28

  Around the 1940s, penicillin became the standard cure for syphilis. This treatment prevented the disease from morphing into neurosyphilis. As neurosyphilis cases declined, so did the need for malariotherapy.

  Still, just as malariotherapy cured neurosyphilis, I believe it has the potential to cure acquired immunodeficiency syndrome (AIDS).

  People with AIDS have the human immunodeficiency virus (HIV). About fifty thousand Americans get infected with HIV each year (in 2010, there were around 47,500 new HIV infections in the United States).29 About 1.1 million Americans were living with HIV at the end of 2009, the most recent year statistics were available.30 In the United States, about 15,500 people with AIDS died in 2010.31 Since 1981, 60 million people have contracted HIV, and 25 million have died of AIDS-related causes worldwide.32

  AIDS is costly to treat and research. In 2010, the United Nations stated that its 2009 budget of nearly $16 billion aimed at halting the spread of AIDS was $10 billio
n short of what was needed for the following year.33 In 2014, the US government will likely spend around $20 billion on AIDS alone.34 To put that into perspective, the average AIDS patient in America takes a combination of drugs that add up to around $14,000 a year.35

  Yet, despite the astounding loss of life and the huge costs, no one has yet been able to come up with a viable AIDS vaccine. It is time to seriously consider finding a cure for AIDS, and I believe that the answer could be malariotherapy.

  Consider two studies that I coauthored. Both looked specifically at whether giving malaria to patients with HIV could improve their health. The studies, published in 1997 and 1999, were conducted in China.*

  The first study followed two patients with HIV who were given malaria and then cured of that illness with antimalarial medication. Two years after the malaria was cured, the patients’ CD4 counts rose “significantly” and remained at “normal levels” without further treatment “of any kind.” (A CD4 count reflects white blood cells that fight infection. CD4-count tests determine how strong the immune system is and indicate the stage of a patient’s HIV disease.) Furthermore, over the two years after being cured of malaria, “the patients remained clinically well.” Another six HIV-positive patients were given malaria and were followed for six months, during which time they also “remained clinically well.”36

  The second study continued to monitor these eight HIV-positive patients over a two-year period. All eight patients “remained asymptomatic of HIV infection and felt stronger” after being cured of malaria. The study concluded that “malariotherapy basically is safe for HIV infection” in that the treatment seems to improve “some immunological parameters of HIV patients.” For example, CD4 levels increased in five of the eight patients.37

  Some skeptics have questioned whether it’s a good idea to give someone with a compromised immune system another disease. Of course, I share the same concern. However, I believe that if the right strain of malaria is chosen and is administered carefully, the treatment is safe. I draw this conclusion partly from the success that malariotherapy has had when administered to patients with neurosyphilis, but I also find promise in a 1991 study conducted by the US Centers for Disease Control and Prevention (CDC) and published in the New England Journal of Medicine.

  In the study, researchers followed for thirteen months 587 children who were in a hospital in Zaire. Some of the children were HIV positive, having been born to HIV-positive mothers, while others were not HIV positive. At the same time, some children in both groups had malaria. After monitoring the children, the study’s authors concluded that “malaria was not more frequent or more severe” in children who were HIV positive than those who were not HIV positive. Furthermore, malaria “did not appear to accelerate the rate of progression of HIV-1 [the most common strain of HIV] disease.”38

  These three studies are significant because they show that malariotherapy can have a positive effect on HIV patients. What’s more, giving malaria to patients with AIDS does not necessarily harm them. Given the positive effects that malaria has on patients with HIV, malariotherapy could be the answer to our finding a cure for AIDS.

  Using earlier-known medical innovations in new ways to help victims of drowning, asthma sufferers, stroke patients, and those with HIV and AIDS has been an encouraging and rewarding aspect of my career. I realize some of these concepts don’t sit well with some critics, but creative ideas are almost always attacked. Does such criticism bother me? Sometimes. But I don’t think it should stop me from talking about ideas that I believe could help people.

  The Athenian statesman Pericles wrote, “Having knowledge but lacking the power to express it clearly is no better than never having any ideas at all.” For me, that statement reflects the story of my life. I feel the urge to teach my ideas to others so that those ideas can be safely put into practice or at least researched.

  For many years, even my most widely used innovations have been criticized by my peers or simply dismissed. This kind of debate is healthy, but we also should not turn a blind eye to an approach just because it’s never been tried before. The goal is to expand our limits and capabilities toward the goal of improving public health and saving lives. As a progressive society, we have a duty to scientifically evaluate medical claims and innovations before accepting or rejecting them.

  That’s what creative medicine is all about.

  At the time of this writing, I am ninety-three years old and still working hard to come up with ways to improve people’s lives through medical innovation. I frequently get calls from journalists asking about my legacy. They want to know how I view my accomplishments. I often tell them that, when I look back over the more than seven decades of practicing medicine, I am inspired and humbled by the impact of my work. But my successes have also taught me about the importance of giving back to a world that has allowed me to touch people’s lives in ways I never could have imagined.

  This is especially true when I see how people have responded to learning the simple act known as the Heimlich Maneuver. For example, in June 2012, some forty thousand baseball fans joined me in a pregame ceremony to honor Cincinnati Reds third baseman Todd Frazier with a Save-A-Life Award. Mr. Frazier was being recognized for having used the maneuver to save the life of a man in a restaurant. When Mr. Frazier saw the restaurant patron choking, he did not hesitate. “I was the closest one, so I got over there,” Mr. Frazier told the audience. “I gave two pumps, and it came out.” When I got up to the microphone, I said that Frazier was amazing for having saved a life.1

  While other innovations of mine have not received the same kind of attention that the Heimlich Maneuver has, I am filled with joy to learn that the Heimlich Chest Drain Valve has been used by military forces in a multitude of countries, sometimes on both sides of a bloody conflict. For example, in the 1960s, I introduced the Heimlich Chest Drain Valve to the Israeli army at a time when Israel was ensconced in wars in the Middle East. Then, in 1977, I visited Israel, and the Israeli authorities honored me for my contribution. My guides showed me several underground hospitals. Once inside, they opened an emergency medical kit, and the Heimlich Chest Drain Valve was sitting right on top. They took me to a military base in the Sinai Desert, where, again, the valve was readily available inside emergency medical kits. The valves were placed this way so that soldiers who needed to save a buddy had quick access to them.

  As I stood in the middle of the desert, talking to these medical corpsmen and army doctors, I was mentally transported back to Camp Four in the middle of the Gobi Desert in 1945. I was vividly struck by the image of the Chinese soldier whose life expired before me due to a collapsed lung, a condition that could have been corrected by the Heimlich Chest Drain Valve. That dead soldier was the same age as my military guides. They wore similar khaki uniforms. I was so overwhelmed with emotion that I wept.

  I remember another incident in which I was overcome with emotion. It occurred in February 1993, when I was invited to accompany a team of twenty cardiac and thoracic surgeons to Vietnam, a trip arranged by the citizen ambassadors of People to People International, an organization founded by President Dwight D. Eisenhower that brings together groups of Americans with their colleagues from other countries. In Hanoi, our plane was met by a contingent of North Vietnamese cardiac and thoracic surgeons. The head of the Vietnamese delegation introduced each member of our team until he came to me.

  “Dr. Heimlich, you need no introduction,” I remember him saying. “Everyone in Vietnam knows your name.” I assumed he was talking about the Heimlich Maneuver, but, in fact, he was referring to the chest drain valve. “Your valve has saved tens of thousands of our people during the war, both civilian and military,” he said. I never knew the North Vietnamese had used the valve during the war. It had been supplied to them by the Quaker organization American Friends Service Committee. The next morning, at a meeting of American and Vietnamese doctors, the chairman opened his session saying, “Dr. Heimlich will live forever in the hearts of the Vi
etnamese people.” Hearing his words, I cried openly.

  RETURNING TO CHINA

  Thirty years after I had served as a navy doctor in Camp Four in Inner Mongolia during World War II, I returned to China. This first trip, which took place in 1984, and a subsequent visit in 1988 led me to fully appreciate what our medical crew had done for the Chinese soldiers and peasants when we treated their ailments for those eight months in 1945.

  On the first trip, Jane and I had been invited to China by the daughter of General Fu Tso-Yi, the warlord who had ruled over the area where I was stationed and who had offered his soldiers to assist us in running the clinic. Fu’s daughter, Fu-Dong, was famous for convincing her father to end the Chinese Civil War. At the age of twenty-two, Fu-Dong, who had been part of her father’s inner circle, convinced him that the Chinese people had suffered enough with war and famine and that any more fighting would destroy the beautiful, historic city of Peiping (now Beijing). Fu sent his daughter outside the wall of the city, where she met Mao Zedong’s forces and arranged a date when the gates of the city would be opened. As a result, Shanghai fell three months later and the war came to an end.

  Fu-Dong, then a woman of about sixty years, arranged for Jane and me to be welcomed at a dinner in the Great Hall of the People (located in Tiananmen Square). Many officers of General Fu’s army were present, and we had a jovial reunion. One officer remembered a basketball game between some Chinese soldiers and several of us Americans in which I, wearing clumsy army boots, fell head over heels to the ground. Others recalled the medical care I had given the patients at Camp Four.