Not many people knew how to swim 250 years ago, and drownings were a leading cause of death, especially in the canals of Venice and the river Thames in London. Had you lived in those locations back then and were unfortunate enough to fall into the water and lose consciousness, chances were pretty fair that someone would try to resuscitate you with a tobacco smoke enema.

Imagine waking to that procedure. Perhaps it was established as much to dissuade people from inattentive conduct near the water as it was to revive them. In the 1970s, the movie Jaws contributed to keeping people out of the water. In the late 1700s, it was tobacco smoke enemas. Many people, it may be surmised, would sooner risk the shark.

You may be wondering how something as bizarre as a smoke enema originated. It seems unlikely that it started as a recreational activity whose medicinal advantages were noted only later. No, it was developed as a medical treatment and never attained favor as entertainment.

Tobacco had already been employed medicinally for 2500 years before. From the Mayans onward, tobacco was medicinal and ceremonial among the indigenous people of the Americas, and when it was brought to Europe, doctors fell in love with it. Yes, doctors loved tobacco. How things have changed.

The use of tobacco for medical purposes spread through Europe. Tobacco was smoked, chewed, taken nasally as a powder, and applied as poultices, unguents, and salves to treat coughs, tumors, asthma, convulsions, hernias, stomach cramps, gout, "women's diseases," open wounds, and just about anything else that seemed feasible — even drowning.

Medicine 300 years ago was based on humorism, which has nothing to do with stand-up comics. It's based on principles proposed by Hippocrates, also known as the Father of Medicine. The four humors were black bile, yellow bile, phlegm, and blood, and the theory was that they had to be well-balanced to achieve good health.

From the Mayans onward, tobacco was medicinal and ceremonial among the indigenous people of the Americas

It was thought that drowning victims could be revived with tobacco enemas by balancing the humors. The introduction of dryness associated with tobacco would counteract the water and its properties as an irritant was thought to stimulate the organs back to life.

The irritant part was probably the most effective aspect. The procedure became accepted because, in a few early cases, the victims actually revived in response, and whenever it worked, it supported further employment and an onward spiral of enamazation. In a 2020 article, A. Bamji wrote:

Another successful case was that of Anne Greene. In 1850, she was tried and hanged for infanticide. She was innocent: it was a stillbirth. Still, she was hanged, but when she was removed from the gallows, doctors discovered that she still had faint signs of life. A tobacco enema helped revive her, and she was pardoned.

The introduction of dryness associated with tobacco would counteract the water

The pricked paper refers to a piece of paper with perforations. Pipes of that era were clay, and as we know, the bowls of clay pipes become very hot when lit, so some mouth protection was necessary. Paper is better than nothing, though it isn't a great insulator. Nobody could wrap their lips around an unprotected clay bowl, no matter how life-saving the gesture. Later recommendations advised perforated handkerchiefs rather than paper, perhaps to alleviate the lip burns that must have accompanied paper insulation. Anal tobacco insufflation, as it was called, was not an application for the uncommitted or faint-hearted.

It was known or suspected at the time that mouth-to-mouth resuscitation worked almost as well as tobacco enemas, but mouth-to-mouth was considered unsanitary and repellent in contrast to enemas. Times change:

Later recommendations advised perforated handkerchiefs rather than paper, perhaps to alleviate the lip burns that must have accompanied paper insulation

Tobacco enemas were not restricted to drowning resuscitation attempts. They were widely accepted by the medical community in the 18th and early 19th centuries to treat hernias, bowel obstructions, convulsions, cholera, constipation, and many other daily complaints. Their administration for drowning victims became not only popular but also legally required in Venice. Fines were established for failing to pursue a tobacco enema when a drowned person was discovered. It was thought at the time that drowning victims could be resuscitated even 12-24 hours after submersion.

Dozens of stations including smoke enema devices with special bellows and pipes were erected along the Thames River in the 1780s for use on drowning victims. In Vienna, victims were taken to bakeries where tobacco enema kits were required equipment, and a medical professional summoned, but in London it was expected that any citizen should perform the procedure. Long, detailed instructions were provided with each kit, but since only about a third of the population could read, there may have been missteps. The practice fell out of favor when animal experiments demonstrated the danger of pure nicotine on the heart. Animals died. It became recognized as a poison and an object of medical scorn, reflected by the advent of the phrase, "blowing smoke up one's ass" to indicate being lied to by someone through flattery.

Fines were established for failing to pursue a tobacco enema when a drowned person was discovered

Tobacco enemas were widely employed as a cholera treatment, with one doctor writing that they were at least as effective as blood letting, which is the practice of removing blood from a patient by cutting them or applying leeches. From a modern perspective, we have to admit that he wasn't wrong. Blood-letting was enormously popular with the medical profession, so such a comparison was high praise.

It isn't widely known that George Washington was treated in 1799 for laryngitis by removing five pints of his blood. He died the next day. Perhaps tobacco could have saved him.

Blood-letting was enormously popular with the medical profession

Tobacco was very popular in Europe 300 years ago — perhaps too popular. It was used for everything, but should probably have been left to smoking and snuff. It's interesting that the plant was so widely heralded for its benefits. Tobacco enemas are perhaps the strangest of these employments and make a fascinating footnote in the history of smoking.

Bibliography

• "Blowing Smoke Up Your Arse: Drowning, Resuscitation, and Public Health in Eighteenth-Century Venice" Bulletin of the History of Medicine, 94 (1). pp. 29-63, 2020 Johns Hopkins University Press
• McCrary-Ruiz-Esparza. Emily. "Before Modern CPR, There Were Tobacco-Smoke Enemas," Discover, Oct 9, 2023.
• Bamji, A (2020) Blowing Smoke Up Your Arse: Drowning, Resuscitation, and Public Health in Eighteenth-Century Venice.