The Heimlich Counter‑Maneuver
A four-movement manual technique by which an object lodged in the upper airway of an adult man is lodged a good deal further. It has never once failed. What it is for is a separate question and a separate department.
Here is a technique. A man has something in his throat. You come up behind him, you put your hands where this sheet tells you to put them, you thrust downward and inward, and the object goes further in. Every time. Two hundred and eleven supervised applications since November of 1957 and two hundred and eleven of them worked, which is a figure the finest hospital in Chicago cannot put next to anything it does.
I am aware of how a sentence like that lands on a man reading it in an armchair. So let me put the objection myself, in my own type, and then answer it. The objection is: why. The objection is that the world is presently arranged so that an object in a throat is a thing you take out rather than a thing you put in, and that a device for the second is a solution wandering the countryside looking for a problem.
To which I say: good. That is exactly what it is. That is what every worthwhile thing in this building was on the day we made it. The gel was a pudding. The curtain was a curtain until a curtain in 1953 was briefly in two rooms at once. Nobody wanted a hole in a wall either, until there was one, and then everybody wanted eleven and they wanted them by Friday. You do not wait for the application to knock. You build the capability, you file the specification, and you keep it on the shelf, oiled, so that on the morning somebody comes running down the corridor shouting that they need an object put further into a man, this company is the only outfit on the North American continent that can hand him a card with four numbered movements on it.
The lab boys arrived at it in reverse, which I want stated plainly because I am proud of it. Applied Biology began with a manoeuvre that takes an object out — a perfectly ordinary bit of physics that anybody could have written down and, as it happens, nobody yet has — and they ran the arithmetic the other way and wrote down what came out. That is the whole derivation. That is the entire research programme. Two men, a blackboard, an afternoon, and a minus sign.
The President came down to Applied Biology on Tuesday and asked them what it would take to lodge something in a lung on purpose and how far down a thing could reasonably be expected to go. They laughed. He asked again. He was not asking about a peach stone. — C.
Specification
- Designation
- Heimlich Counter‑Maneuver. Applied Biology No. 210.
- Class
- Manual technique. No apparatus. No consumables. No electricity.
- Practitioners required
- One. Two if the subject has read this sheet.
- Movements
- Four. There is no fifth movement. See below.
- Duration
- Under three seconds, from approach to hold.
- Direction of effect
- Downward and inward — that is to say, away from the mouth. The direction is not incidental to the product. The direction is the product.
- Mean displacement
- 4.1 centimetres in an adult man of average build, one application.
- Repeat applications
- Permitted. Cumulative. Applied Biology has recorded four in succession and would like a fifth, and has been told to ask the volunteer rather than me.
- Objects recovered afterwards
- Two. Both by other means, and neither of them by us.
- Instruction card, pocket
- $0.25 each; $18.00 the hundred.
- Wall chart, enamelled, 18 by 24 inches
- $1.10.
- Two-day course, Enrichment Center
- $85.00, meals included, certificate issued.
- Certificate, standing of
- None whatsoever. Licensed to nobody. Taught at no institution. Recognised by no board in any of the forty-nine States.
- Applications
- Still being determined.
“Everybody has spent four thousand years getting things out of people. I would like to know what is on the other side of that.”
The Four Movements
One. The Approach. From behind. Always from behind. The practitioner does not announce himself, not out of stealth but out of timing — a man who knows the Counter‑Maneuver is coming will assist, and an assisted result is not a measured result, and Applied Biology has been very firm with me about the difference.
Two. The Grasp. Both arms about the subject at the waist. One fist, thumb inward, set above the navel and below the ribs. The other hand over the fist. This is a comfortable and reassuring position and the subject will frequently relax into it, which is convenient for movement three.
Three. The Counter-Thrust. Downward and inward, sharply, once. Not upward. I cannot make this plainer and the enamel sign in the corridor cannot make it plainer either. A practitioner who thrusts upward has performed a different manoeuvre altogether, one that this company does not sell, cannot bill for, and has no rights to the name of.
Four. The Hold. Three seconds. The object will attempt to return. It must not be permitted to. Applied Biology reports that in nineteen cases out of twenty the subject will also attempt to return, and the practitioner is reminded that his obligation runs to the object.
There is no fifth movement. There has never been a fifth movement. Personnel who have heard a fifth movement described in the commissary are to report the description, and the man who gave it, to Applied Biology before the end of the shift.
Indications
The Counter‑Maneuver is indicated in the following circumstances. Applied Biology has ticked every box on the list, which the Division states is not an oversight but a finding.
Form ASI-210/I — Schedule of Indications
- Object present in the upper airway and insufficiently lodged.
- Object lodged, but at a depth from which recovery remains possible.
- Object at rest, and showing no disposition to move on its own account.
- Subject able to speak.
- Subject able to breathe unassisted, and disinclined to stop.
- Object which the Enrichment Center has determined ought to remain with the subject for the duration of the afternoon.
- Object declined by the grill on a prior traversal (see Form ASI-209) and returned to the subject by the Enrichment Center for safekeeping.
- No object present. The manoeuvre is performed against the day one is.
- Practitioner requires practice.
- Subject requires practice. (Added at the second printing. Applied Biology declines to elaborate.)
Contraindications
Form ASI-210/C — Schedule of Contraindications
None.
What We Have Measured
Displacement is measured by fluoroscope before the application and again immediately after, against a scale taped to the subject. A success is an object which finishes deeper than it started. That is the definition. It is a hard definition, it does not flatter us, and we have met it two hundred and eleven times out of two hundred and eleven.
Selected instrumented applications. Applied Biology, Sub-Level 2, November 1957 – March 1959. Displacement in centimetres.
| Trial | Object | Subject | Displacement | Result |
|---|---|---|---|---|
| 004 | Peach stone, commissary | Volunteer 3,417 | 3.0 | Lodged further. Subject cooperative throughout and paid in full. |
| 019 | Wing nut, ½ inch, brass | Volunteer 3,502 | 4.4 | Lodged further. Subject declined the second application. |
| 057 | Curtain grommet, No. 12 (Aperture Fixtures pattern) | Volunteer 3,688 | 5.2 | Lodged further. The Division notes with satisfaction that the founding product performs creditably in this application also. |
| 091 | Ball bearing, ¾ inch, hardened | Volunteer 3,741 | 11.0 | Record. Held. The Division would like a heavier bearing and a taller man. |
| 118 | Lemon, whole (submitted by the Materials Division, unsolicited) | Materials Division, on itself | n/a | Not a permitted object. Materials has been asked not to attend further trials and has attended two. |
| 146 | Weighted Storage Cube, novelty desk pattern, 1:24 scale | Volunteer 3,902 | 0.0 | No displacement recorded. Not attempted twice. |
| 177 | Ring, gentleman’s, gold | Volunteer 4,006 | 2.1 | Lodged further. Object not subsequently recovered. Object was never the point of the exercise. |
| 211 | Object supplied by the subject, who brought it with him and asked us to use it. | He gave his own name at the gate and it is on the gate book and it is on nothing else. | — | See Medical file 210/9. Applied Biology considers the trial complete. |
Displacements are the mean of two fluoroscopic readings taken by two men who agree. Where the two men did not agree, a third was fetched and the trial was repeated on him.
On The Name, And On Ohio
A word about what this is called, because Legal has been up the stairs twice about it and the second time he brought a folder.
The forward manoeuvre — the one that takes the object out, the one you would want if you had a peach stone and a bad afternoon — is not ours. We did not invent it, we do not sell it, and so far as the Applied Biology Division has been able to establish by writing to eleven teaching hospitals, nobody else has bothered to write it down properly either. There is a physician of that name in Ohio. He has not done anything with it. We have written to him twice and he has not replied, and until he does, the word Counter will go on doing the work of a lawyer, and doing it for nothing, which is more than can be said for the three men in the basement.
Interoffice Memorandum
The Department repeats its advice of 4 January. The Department cannot defend a product name derived from the surname of a living physician who has been written to and who has not consented, and who may in the fullness of time do the very thing we have named ourselves against.
The Department further notes that a schedule of contraindications reading, in its entirety, “None” has been described by our outside counsel in Marquette as a document he would rather not be shown a second time. The Department requests one contraindication. Any contraindication. The Department will draft it.
Denied. Keep the name and keep the section. If the Ohio man writes, put him on the telephone and put me on it after him. — CJ
Instruction & Certification
The two-day course runs on the first Monday of each month at the Enrichment Center, eighty-five dollars, meals in the commissary included, and there is a certificate at the end of it. The certificate is a handsome piece of printing. It is worth precisely what a handsome piece of printing is worth and this company has never once claimed otherwise.
Form ASI-210/T — Certificate of Instruction
Post this coupon — Applied Biology, Sub-Level 2
Send me the pocket instruction card (25¢) and the enamelled wall chart ($1.10). I understand that the chart is printed in two colours, that the red arrow points downward, and that this is not a printing error.
So: a technique that works every time, a schedule of indications every one of which is ticked, a schedule of contraindications one word long, and a certificate that certifies nothing. That is the product. It is on the shelf, it is oiled, and it is waiting for its morning.
If you are a volunteer, none of this concerns you and you should go and read the application, and the sixty dollars is cash and it is the same sixty dollars. If you are a purchasing officer, the coupon is above. If you are the physician in Ohio, the telephone number is ENrichment 9-0943 and I will take the call at any hour.
Now get behind somebody.
Cave JohnsonPresident & FounderDictated 21 March 1959. Applied Biology has read this sheet and has asked for no changes, which is itself a finding.