Blowing Smoke Up Your Arse: The Bizarre History of the Tobacco Smoke Enema
Today, finding an unconscious person beside the River Thames would set off a familiar chain of events: call the emergency services, check their breathing and begin CPR if necessary. In Georgian London, however, a rescuer might have been encouraged to reach for a pair of bellows, light some tobacco and prepare to put the smoke somewhere considerably removed from the victim’s lungs.
The tobacco smoke enema sounds like an invention designed to make modern medicine feel smug. Yet it was a genuine resuscitation technique, promoted during the late eighteenth century as a possible way of reviving people who had apparently drowned. Special equipment was supplied for the purpose, and resuscitation kits containing the necessary tubes and bellows were deposited at locations along the Thames.
This was not a practical joke. It was an earnest attempt to save lives – albeit one that required rescuers to become unusually well acquainted with their patients.
A Most Uncomfortable Rescue
The procedure was much as its name suggests. Tobacco was burned in a fumigator and the resulting smoke was pumped through a tube inserted into the patient’s rectum. Earlier versions could involve an ordinary smoking pipe, with somebody blowing through it. Purpose-made bellows eventually offered a more forceful method and, mercifully for the person administering the treatment, reduced the risk of receiving an extremely unpleasant mouthful should the air travel in the wrong direction.
Contemporary physicians believed that a person pulled unconscious from the water might not be irretrievably dead. The challenge was to warm and stimulate the apparently lifeless body before it was too late. Tobacco was already credited with numerous medicinal properties, while its smoke was considered warm, dry and powerfully irritating. Applying it to the bowels was therefore expected to produce a vigorous internal response that might encourage the heart and lungs to resume their work.
The idea was wrong but it was not entirely random. Nicotine does affect the nervous and cardiovascular systems. Eighteenth-century practitioners could readily observe tobacco causing sweating, nausea, coughing, dizziness and changes in the pulse. Without a modern understanding of oxygen deprivation, circulation or nicotine poisoning, such dramatic reactions could be mistaken for evidence of therapeutic stimulation.
Unfortunately, irritating a drowning victim’s rectum is no substitute for restoring oxygen to the brain.
The Humane Society Takes to the Thames
In 1774, the physician Thomas Cogan and apothecary William Hawes helped establish London’s Society for the Recovery of Persons Apparently Drowned. It later became the Royal Humane Society.
The organisation was founded on a genuinely progressive idea: a person who appeared dead after being pulled from the water might still be saved. Hawes had even offered rewards for bringing recently recovered drowning victims to him so that resuscitation could be attempted. At a time when an unresponsive casualty might simply be declared dead, encouraging immediate action was an important development.
The Society published instructions, recorded attempted rescues and distributed equipment. Resuscitation kits were placed at points along the Thames so that treatment could begin quickly. Surviving examples contain bellows, fumigators, syringes and assorted nozzles and tubes – including attachments intended to deliver tobacco smoke into the rectum.
These kits have sometimes been described as an early form of public first-aid equipment. That is broadly fair, although imagining neat boxes standing beside the river like modern defibrillators may be misleading. Equipment was commonly held at receiving houses, boathouses and other accessible locations where rescuers could obtain it.
Was It the Georgian Version of CPR?
Not quite.
Tobacco fumigation was one of several measures recommended for apparently drowned people, rather than the single, universal first response. Rescuers might also warm the body, rub the limbs, remove wet clothes, shake the patient, administer stimulants or attempt artificial respiration. Some instructions recommended blowing air into the lungs with bellows. Mouth-to-mouth breathing was also known, although concerns about cleanliness, contagion and propriety discouraged its use.
Other treatments were considerably less helpful. Depending upon the period and the practitioner, a casualty might be bled, hung upside down, rolled over a barrel, tickled with feathers or subjected to strong smells and electrical shocks. The unfortunate patient could therefore regain consciousness only to discover that drowning had been the least undignified part of the afternoon.
Modern CPR — combining effective chest compressions with ventilation according to tested procedures — did not emerge until the twentieth century. Describing the tobacco smoke enema as “CPR before CPR” makes an irresistible headline, but it conceals a messier truth: it belonged to an experimental collection of techniques, some sensible in principle and others dangerous or useless.
A European Fashion
The practice was not confined to London. Humane societies dedicated to recovering drowning victims appeared across Europe during the second half of the eighteenth century, beginning with an Amsterdam society in 1767. Similar organisations and official schemes promoted resuscitation in cities including Hamburg, Paris and Venice.
Tobacco fumigation became well known within this movement and was taken seriously by many medical practitioners. Nevertheless, claims that it was the standard treatment throughout Europe should be treated cautiously. Recommendations differed between countries, institutions and periods, and tobacco smoke was normally only one part of a wider resuscitation programme.
It is also more accurate to say that smoke was delivered into the rectum than “blown into the intestines”. The latter description is not entirely meaningless — physicians hoped to stimulate the bowels — but it makes the tube’s journey sound rather more adventurous than it was.
When the Smoke Cleared
Doubts about tobacco fumigation appeared even while it was in use. During the early nineteenth century, experiments increasingly demonstrated that tobacco could depress or stop vital bodily functions rather than restore them. Nicotine is toxic, and administering tobacco rectally allows its chemicals to be absorbed through delicate tissue. Far from restarting the heart, a sufficiently large dose could help to stop it.
As knowledge of respiration and circulation improved, tobacco enemas gradually disappeared from resuscitation advice. By the 1830s, the rectal fumigation technique had largely fallen out of favour, although tobacco continued to enjoy an undeserved medical reputation in other treatments.
The story is occasionally said to have given rise to the expression “blowing smoke up someone’s arse”, meaning to flatter or deceive them. It is a delightful connection, but there is no convincing evidence that the phrase originated with the medical procedure. The historical treatment was strange enough without attaching an unsupported etymology to it.
Foolish Medicine — or an Important Beginning?
It is easy to laugh at the tobacco smoke enema, and admittedly very difficult not to. Judged by modern standards, it was ineffective, invasive and potentially poisonous. No one should ever attempt it.
Yet the movement surrounding it deserves more than ridicule. The humane societies helped popularise the belief that prompt intervention could save people who seemed beyond recovery. They placed rescue equipment near dangerous waterways, trained volunteers, collected evidence and encouraged the public to act rather than give up. Among the alarming tubes, smoking bellows and bottles of questionable stimulants were the beginnings of organised emergency medicine.
The tobacco smoke enema was therefore both absurd and historically significant: a spectacularly mistaken treatment employed in pursuit of a remarkably modern ambition. Georgian rescuers did not yet understand how to revive a drowning casualty, but they had begun to understand something equally important — that it was worth trying.
Sources and Further Reading
Science Museum: “Saving Lives with a Puff of Smoke?”
Wood Library-Museum of Anesthesiology: “Tobacco Resuscitator”
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