Sara Tor reveals the origins of the first-aid movement in the 18th and 19th centuries
“Annie, are you OK? Are you OK, Annie?” Fans of Michael Jackson will recognise these words as the refrain of his 1988 hit Smooth Criminal, yet they will also sound familiar to those trained in cardiopulmonary resuscitation (CPR). Resusci Annie – or Rescue Annie as she is sometimes known – is the doll used in first-aid and resuscitation training. Those learning how to administer CPR are taught that the very first step is to ask the individual if they are OK. The result: “Annie are you OK?” But where does Annie come from?
In the late 19th century, a young woman drowned in the Seine. Her body was placed on display in a Paris morgue in the hope that a relative would visit and identify her. Her beautiful, serene face, however, attracted more than just family. Artists entranced by her beauty took moulds of her face, creating death masks, sculptures and prints that soon populated every fashionable house in Paris. Eventually her face made it through Europe and even to the USA.
In 1958, when Norwegian toymaker Asmund Laerdal was approached to create a dummy that would help teach the basics of CPR, he remembered seeing a death mask of the drowned woman’s face in his grandparents’ house. He decided that her face would make the doll less threatening, and Resusci Annie was born. She remains very much alive today, although her face has been altered slightly to make her more gender-neutral.
Aid From Civilians
In the history of first aid, the notion of mouth-to-mouth resuscitation is extremely important. While physicians have long treated battle injuries – such behaviour is mentioned in the Bible and is visible within ancient Greek and Roman friezes – the idea of a civilian providing immediate assistance to prevent the loss of life, be it in war or peacetime, is a relatively new concept. The earliest known instance of mouth-to-mouth resuscitation occurred in 1732 in Scotland, performed by Dr William Trossach on James Blair. Blair had entered a coal mine following a fire and had been overcome by fumes.
The novel technique was soon picked up by two London doctors, William Hawes and Thomas Cogan, who felt that it could be applied to rescue those who had seemingly drowned in the Thames. The London docks throughout the 18th century were extremely active at a time when few people could swim, so drowning had become one of the most common causes of death. On 18 April 1774, Hawes and Cogan invited 15 friends to the Chapter Co ee House in St Paul’s Churchyard. Believing that by spreading the technique of resuscitation they could restore “a father to the fatherless, a husband to the widow, and a living child to the bosom of its mournful parents”, they set up the Society for the Recovery of Persons Apparently Drowned.
Monetary Rewards
The society aimed to publish information explaining how to save a person from drowning and provide basic lifesaving equipment to volunteer medical assistants, as well as o er a monetary reward to those who helped rescue another. Hawes had already been offering a small reward to anyone who notified him of a drowned person between London and Westminster Bridges. According to the society, two guineas would be offered to anyone “attempting a rescue in the Westminster area of London”; four guineas to anyone “successfully bringing someone back to life”; and one guinea to “anyone allowing a body to be treated in his house”, which was often a pub landlord.
One guinea at the time was worth around £140 today. In 1776 the society became the Humane Society, and in 1787 the Royal Humane Society. Yet the training of civilians to provide immediate, lifesaving help in both peace and wartime did not fully take off until the 19th century.
In 1863, the International Red Cross movement was founded in Geneva by five individuals, including Swiss businessman Henri Dunant. Motivated by the suffering of many soldiers during the Battle of Solferino in northern Italy in 1859, Dunant wished to create a society of neutral volunteers who could provide relief to all parties in war.
In 1870, following the outbreak of the Franco-Prussian conflict, Colonel Robert Loyd-Lindsay wrote to The Times, asking for a similar society to be established in Britain. A public meeting was held and the British National Society for Aid to the Sick and Wounded in War was founded. It quickly began providing aid to both French and Prussian armies, and in 1905 was renamed the British Red Cross.
The Order of St John and the affiliated St John Ambulance Association were also key to the first-aid movement. The Order of St John began in 1080 as a hospital in Jerusalem run by monks to treat pilgrims. Although a British headquarters was set up in the 1140s, the order in Britain was dissolved 400 years later by Henry VIII and, despite a brief revival by Mary I, was suspended for good under Elizabeth I. It was not until the 1820s that the British Order reformed – albeit unoffcially. It became official, receiving a royal charter from Queen Victoria, in 1888.
First-Aid Training
With an increase in industrial activity leading to an increase in workplace accidents throughout the 19th century, the order saw a need for training civilians in first aid. The St John Ambulance Association was created in 1877, led by Sir John Furley (see the box) and several other members frustrated at the length of time it was taking for the British Red Cross to become established.
The association approached the War Office for assistance in creating a course that would provide the necessary lifesaving training. Scottish Surgeon-Major Peter Shepherd, a military doctor with an interest in the early treatment of injury, was chosen to develop the programme.
Shepherd not only introduced an end-of-course competence test and certificate, he also brought in a requirement for regular refresher training. The association established 12 training centres in six months and by the end of the first year had taught 1,000 people basic lifesaving skills.
The inaugural public first-aid class was given in Woolwich in January 1878. Material taught ranged from the use of bandages to the treatment of burns and gas-poisoning plus an exercise on using a stretcher. The first classes were segregated by gender, with women taking part at the home of one of Shepherd’s colleagues while the men met in a school hall.
Within months, both the Ambulance Association and the course proved crucial. In March 1878, a shed being built by 160 men at Woolwich Dockyard collapsed, burying many of the workers. Those with injuries were quickly taken to hospital by the St John Ambulances, prompting the Daily Telegraph to state that “the accident a orded admirable evidence of the advocacy of training in such help as is necessary in such emergencies”. In September 1878, another major incident occurred when the pleasure boat Princess Alice sank in the Thames following a collision; trained civilians were able to provide medical treatment to those pulled out of the water.
Although 600 lives were lost, it was thought that the number would have been far greater without their intervention. The St John Ambulance Brigade was o cially established by the association nine years later.
Aid In The World Wars
The First and Second World Wars led to a huge increase in the number of people taking first-aid courses and applying their knowledge. About 90,000 volunteers provided assistance throughout the First World War as part of groups known as Voluntary Aid Detachments (VADs). VADs were organised by both the British Red Cross and the St John Ambulance Association via the Joint War Committee, formed in 1914 after some tensions between the two societies. The association states that, of their volunteers, approximately 1,077 lives were lost by 1918. Those who gave their lives to the war effort are recorded on a Roll of Honour that is still held by the association today, and is freely available online at museumstjohn.org.uk/collections/roll-of-honour.
The cooperation between the British Red Cross and the St John Ambulance Association was repeated in 1939, this time forming the Joint War Organisation. The association had already been providing the public with first-aid and anti-gas training at the request of the Government since 1935, and by 1940 had issued 298,343 certificates.
Following the world wars, the importance of first-aid training grew. In 1974, US surgeon Henry Heimlich developed the Heimlich manoeuvre, transforming the way that choking is treated.
Then the 1981 Health and Safety (First-Aid) Regulations Act introduced the requirement for employers to provide “adequate and appropriate equipment, facilities and personnel to ensure their employees receive immediate attention if they are injured at work”. Finally, since 2020 all British state primary and secondary schools are required to teach first aid to pupils as part of health education. Therefore, building on the foundations laid by the Royal Humane Society, the British Red Cross and the St John Ambulance, as well as the face of Resusci Annie, first aid will soon become common knowledge throughout Britain.
SARA TOR is a freelance journalist and columnist for The Times and other outlets
Sir John Furley 1836–1919
How one pioneer’s work saved countless lives
Sir John Furley was a founding member of both the British Red Cross and St John Ambulance Association. He also developed many inventions that helped improve the first-aid movement. In 1879,
Furley created the original first-aid kit – then known as the ambulance hamper – with equipment necessary for the immediate treatment of the injured. He also designed two types of stretcher – the Furley Stretcher in 1880 and the Ashford Litter in 1881 – having realised the existing stretchers were not suitable for civilian use.
Consisting of canvas pulled across two poles with props to elevate the patient from the ground, the Furley Stretcher formed the basis for stretchers used in the open today. The Ashford Litter was a two-wheeled, cart-like device which the Furley Stretcher could fit on, making it easier to transport a patient when carrying was not an option. It soon became known and used across the world.
Furley stayed active in the field of first aid until the end of his life. During the First World War he advised on hospital trains, oversaw the building of hospital huts and even travelled to France and Switzerland in 1916, just three years before his death aged 83.
Resources
Take your research further
BOOKS
In Peace and War
Sir John Furley
Smith, Elder & Co., 1905
Furley’s autobiography can be downloaded for free from the Internet Archive (archive.org) at tinyurl.com/arch-furley.
The History of the British Red Cross, 1870–2020
Dr Rosemary Cresswell
Bloomsbury, 2023
The first full history of the British Red Cross will be out next year.
MUSEUMS
THE BRITISH RED CROSS MUSEUM
a 44 Moorfields, LondonEC2Y 9AL
museum@redcross.org.uk
tinyurl.com/cross-muse
You can book a visit to the museum via email. You can also learn more about the organisation at redcross.org.uk/about-us/our-history.
THE MUSEUM OF THE ORDER OF ST JOHN
St John’s Gate, St John’s Lane, Clerkenwell, London EC1M 4DA
020 7324 4005
museumstjohn.org.uk
The museum is open Thursday to Saturday. Its website includes a number of blogs on the association and the Order of St John. It has also made issues of the monthly magazine for members of the British Red Cross and St John Ambulance Association from 1912–1920 and 1940–1946 available online at issuu.com/museumoftheorderofstjohn.
WEBSITE
THE ROYAL HUMANE SOCIETY
tinyurl.com/royal-humane
Discover the full history of the society instrumental to the early first-aid movement.