Foreword: This is probably the only article I have ever written that I implore my readers not only to read but to read in depth. Although I have started the piece on several humorous notes, there is nothing at all funny about the potential that we all have of saving a human life, and that is precisely what this piece deals with.

There is no love more sincere than the love of food
- G.B. Shaw


There are all sorts of things that can stick in one's throat during dinner. When Queen Victoria was celebrating her Golden Jubilee, one of her guests was Princess Liliuokalani of Hawaii. During dinner, the Polynesian princess told Victoria: "Your Majesty, I thought you would like to know that I am a blood relative of yours." The astonished Queen asked how that could be. "My grandfather ate your Captain Cook" was the reply.

Such dangers exist even at breakfast. When Winston Churchill was breakfasting at Blenheim Palace, he entered into an acrimonious argument with Nancy Astor. In a pique, Nancy snapped: "Winston, I were married to you, I'd put poison in your coffee." Churchill retorted: "Nancy, if I were married to you, I'd drink it". And then there was the Marquis of Blandford who looked forward eagerly to his daily breakfast of bacon and eggs. One can imagine his dismay when one morning he lifted the cover of the silver dish which usually contained them and found in their place a tiny baby doll, all dressed in pink. The doll had been placed there by his wife to let him know that she had discovered that he had just fathered a new addition to the family of their friend Lady Aylesford.

The anecdotes are amusing but Nancy Astor, Princess Liliuokalani and the Marquis of Blandford have something far more tragic in common. Each of them died by choking to death while eating.

Food is marvelous - of that there can be no question. But choking can kill. In fact, choking is the sixth major cause of accidental death in the world today. The saddest part of this story is that most of these deaths could have been prevented. In 1974, Dr. Henry Heimlich discovered a simple maneuver that could save the lives of choking people. Although the technique is taught in nearly all first aid courses in the United States and throughout Europe, there are still far too many of us who are not familiar with it.

The first important thing is to recognize the choking victim. The person who is choking can neither breathe nor speak. After a short time the victim's face starts to turn blue and a hand reflexively goes to the throat. When asked if they are choking, nearly all victims will nod affirmatively. From the time one starts to choke you have four minutes to avert unconsciousness, brain damage and death.

A pamphlet published by the United States Department of Public Health suggests that too many people waste time wondering if the person is having a heart attack. Nearly all doctors concur that in case of doubt you should try the Heimlich maneuver first, and only then go on to give the kiss of life. In a recent English survey of 56 restaurant deaths, 55 were found to have choked and only one had a heart attack.

To use the maneuver on a standing victim, get behind the person, put your arms around him, make a fist and put it on the victim's stomach, below the bottom of the rib cage and above the navel. Grasp your fist with the other hand and thrust it sharply upwards into the victim's abdomen. You may have to repeat this up to six times, but in most cases the obstruction will pop out of the mouth after one or two thrusts. Take care not to squeeze the ribs themselves, as this could actually fracture a bone.

Although most people who realize they are choking tend to stand up, some remain seated. The Heimlich technique can still be used, simply thrusting from behind the victim's chair. With children (or adults who have already lost consciousness), it is best to put the victim on his or her back, with the head straight (sideways might block the escape of the offending object). Kneel astride the victim, position your hands and thrust in an upward direction. Take care in such cases not to thrust from the side as this could harm the liver or spleen.

In the event that you are the person choking, there are two ways to use the technique. Try punching your own paunch or, if that does fails, stand alongside a table or the back of a chair and jab your abdomen against it.

There are several actions that are not only useless but also potentially harmful. Slapping a choking victim on the back or poking fingers in the victim's mouth can waste valuable time and can drive the object further in. Nor should you let anyone who might be choking leave the room alone, as they might lose consciousness and die in the lavatory.

None of this knowledge should put a damper on the love of good dining. Several years ago, Dr. Heimlich, who dines frequently at Frank's Trattoria in New York wrote that his own favorite meal consists of raviolis stuffed with mushrooms, minestrone soup, veal scallopini with fried peppers and biscuit tortoni.

Heimlich Specifically for Babies

If an infant or baby up to 1 year old is choking on food or some other swallowed object, do not try to take the object out of its mouth by forcing the mouth open and looking into it, as this may lodge the object more firmly in the throat. If the child is crying or coughing forcibly, do not give first aid, as these are the most effective tools for dislodging the stuck object. If the child stops coughing but continues to choke, take thefollowing steps:

1. Place the baby, face down, on your palm, with the palm supporting the baby's head, making sure that the baby's head is lower than its chest.

2. With the heel of your palm, hit the baby between the shoulders 4 times.

3. Put your free palm behind the baby's head and, holding the baby between both of your palms, turn it to a position where he or she will be face upward. Be sure that the head is still lower than the chest.

4. Place the tips of any two fingers on the baby's chest, between the nipples and press quickly and
forcefully 4 times.

5. If the baby is still choking, have someone immediately call the emergency service in your city and then repeat the first 4 steps. Do not give up. In nearly all cases, the object will be dislodged after two or three cycles. If the baby stops breathing, and if you are well trained in the technique, give the baby the kiss of life.

© Daniel Rogov