James O. Elam MD, 1918-1995

The King Is Dead: Clark Gable's Heart Attack

Clark Gable was born in a small Ohio mining town and never finished high school. Stage struck as a young man, he did menial jobs while working his way up to movie stardom-his most famous role was in "Gone with the Wind." He married 5 times. During WWII, he enlisted in the Army Air Corps, flew a few combat missions as a gunner and won the Distinguished Service Cross. Personally, he was intermittently obese, a drinker, smoker, hypertensive and predictably in 1960, he suffered an acute myocardial infarction. His clinical course was benign until the 10th hospital day, when he died suddenly. No resuscitation was attempted. At the time of his death, preventive cardiology, mouth-to-mouth ventilation, closed chest cardiac massage, defibrillation and coronary care units were in their infancy. The history of these and subsequent therapeutic practices are reviewed, but Gable died a bit too early for their application.

The introduction of expired air resuscitation into Surf Life Saving Australia

Surf Life Saving Australia, which began in the early 1900s, initially adopted the indirect resuscitation methods used by the Royal Life Saving Society. As new indirect methods became available, both organisations adapted their resuscitation techniques and followed international developments closely. In the 1950s, accumulating evidence suggested that direct methods of resuscitation, such as mouth-to-mouth ventilation, might be more efficacious. Subsequently a number of investigations were carried out in Sydney at the Royal Prince Alfred Hospital on anaesthetised and paralysed patients. These experiments were recorded for an ABC documentary and reported at the International Convention on Life Saving Techniques held in Sydney in March 1960. Following the convention, Queensland Surf Life Saving conducted training sessions in cooperation with anaesthetists Roger Bennett and Tess Brophy (later Cramond), at St Andrew's Hospital in Brisbane. Two volunteers were anaesthetised and paralysed on two separate weekends to allow over one hundred people to gain experience in expired-air and bag-mask ventilation. One of the volunteers in these training exercises kindly provided much of the material that led to this paper, providing a first hand account of the experiments and an invaluable insight into the cooperation between anaesthetists and volunteer rescue associations.

The Self-Inflating Resuscitator – Evolution of an Idea

Based on animal experiments conducted in the sixteenth century by Vesalius, the Royal Humane Society recommended fireside bellows to resuscitate victims of drowning. In the mid-twentieth century, the bellows concept was adapted by Kreiselman and others, though none of these devices gained widespread popularity. However, in 1957 the “Ambu Bag” appeared and was an immediate success. The revolutionary design was the creation of Danish anaesthetist Dr Henning Ruben. A similar product was soon developed by Åsmund Laerdal of Norway, in collaboration with American anaesthesiologists Drs Elam and Safar. The self-inflating bag is such a simple device, yet it is extremely effective – it has enabled rescuers around the world to support life in virtually any environment, simply by squeezing a bag.