To the Editor:—

Marshall Hall in 1856 was the first to describe pharyngeal obstruction and suffocation by the tongue falling back during deep chloroform anesthesia, 1an explanation that Snow had previously rejected. 2Hall advised turning the patient to the prone position to relieve the obstruction. Shortly thereafter, pulling the tongue outward became common practice to treat such obstruction, and various forceps were designed to grasp the tongue without damaging it. 3,4 

The “jaw thrust,”i.e. , pulling the mandible upward and forward with the head slightly extended to retract the tongue from the posterior pharyngeal wall, was described by the noted German surgeon, F. von Esmarch, in his 1877 textbook of military surgery. 5On the Continent, Esmarch is generally regarded as the maneuver's inventor, and the jaw thrust is often called “Esmarch's maneuver” (Esmarchs Handgriffe). 3,4 

However, in 1992, D. J. Wilkinson reported 6that Jacob M. Heiberg, a professor of surgery in Christiansen (now Oslo), Norway, had already described the jaw thrust in a British medical journal in 1874, 7thus preceding Esmarch by 3 years. A British textbook of anesthesia now cites Heiberg as the technique's inventor. 8 

The complete history of the discovery of the jaw thrust is even more intricate and complex. In the same year (1874) in which Heiberg reported his maneuver in Great Britain, he published an identical article in the Berliner Klinische Wochenschrift , a widely read German medical weekly. 9His paper prompted C. Langebuch, a German surgeon, to write to the journal's editor. 10Langebuch disputed Heiberg's priority and claimed to have learned the technique from Esmarch in 1866 when he was a student in Kiel. Heiberg answered Langebuch's letter in a later issue of the Berliner Klinische Wochenschrift . 11He had, he said, written to Esmarch to apologize for his hasty and mistaken claim. Esmarch had answered that he had indeed used the jaw thrust since 1866 but that he was not its inventor. He had learned it from J. S. Little, a British surgeon who had visited him in Kiel in 1866, before leaving for India in 1868. Esmarch's letter may have prompted O. Kappeler to mention “a Dr. Little (?)” as the possible inventor of the technique in his textbook Anaestetica , published in 1880. 3 

An extensive search of the British medical directories and rosters of the surgical colleges has failed so far to identify a J. S. Little answering to Esmarch's description.

In fact, a few years before Esmarch or Heiberg, Joseph T. Clover had described the jaw thrust in minute detail in an 1868 lecture to London dentists. 12He emphasized its importance to anesthetists in later articles in 1871 and 1874. 13,14 

Who was first?  So far, one must view J. T. Clover or J. S. Little as the discoverer of the jaw thrust. Little, of course, may well have been a student of Clover. Thus, who was first remains unclear, but it certainly was not Esmarch or Heiberg.

Hall M: Asphyxia, its rationale and its remedy. Lancet 1856; 1: 393–4
Snow J: On Chloroform and Other Anaesthetics: Their Action and Administration. London, J. Churchill, 1848, p 245
Kappeler O: Anaesthetica. Stuttgart, F. Enke, 1880, pp 125–6
Killian H: Narkose zum Operativen Zwecken. Berlin, Springer, 1935, p 240
Esmarch F: Handbuch der kriegschirurgischen Technik. Hannover, C. Rumpler, 1877, pp 115–7
Wilkinson DJ: Keeping the airway open: Esmarch's maneuver or Heiberg's heave? Third International Symposium of the History of Anesthesia. Edited by Fink BR, Morris, LE, Stephen, CR. Park Ridge, Illinois, Wood Museum Library, 1992, pp 443–6
Heiberg J: A new expedient in administering chloroform. Med Surg Gaz 1874; 1: 36
Atkinson RS, Rushman GB, Davies NJH: Lee's Synopsis of Anaesthesia, 11th edition. Oxford, Butterworth-Heineman 1993, pp 261–2
Heiberg J: Zum neuen Handgriff bei der Chloroformirung. Berlin Klin Wochenschr 1874; 11: 49
Langebuch C: Zum neuen Handgriff bei der Chloroform-Narkose. Berlin Klin Wochenschr 1874; 11: 529
Heiberg J: Zum neuen Handgriff bei der Chloroformirung. Berlin Klin Wochenschr 1874; 11: 657–8
Clover JT: On the administration of chloroform in dental operations. Br J Dental Sci 1868; 11: 123–41
Clover JT: Chloroform accidents. BMJ 1871; 2: 33–4
Clover JT: Remarks on the production of sleep during surgical operations. BMJ 1874; 1: 200–3