How the CPR Doll Developed From a Famous Parisian Death Mask

Almost 150 years ago, the lifeless body of a beautiful young woman was pulled from the river Seine in Paris. The nameless girl, believed to have committed suicide by leaping from a nearby bridge, was brought to the Paris morgue, where unidentified corpses were laid out for public viewing (and macabre entertainment).

At the morgue, a medical assistant was struck by the girl's serene expression and tragic beauty. He sent for a mouleur or molder to cast her face in plaster — an object known as a death mask. Without explanation, the plaster mask of the young woman's half-smiling face was mass-produced and became a sensation in turn-of-the-20th-century Europe. Artists, poets and intellectuals hung the mask on their studio walls and dubbed her L'Inconnue de la Seine ("the unknown woman of the Seine"). She inspired paintings and tragically romantic stories. The French philosopher and author Albert Camus called her a "drowned Mona Lisa."

Some doubt that the mask was really modeled on a drowned woman because the face looks so smooth and perfect. But as you'll see, this isn't the strangest thing about the tale. The muse of Bohemian artists provided a very different kind of inspiration for the medical profession. In the late 1950s, the "unknown woman of the Seine" became the unlikely face of CPR Annie, the world-famous CPR training mannequin.

The Early Days of CPR - Broken Ribs and Squished Spleens

In 1956, the anesthesiologists Peter Safar and James Elam met at a conference in Kansas City, Missouri, where Elam told Safar about a promising new technique called "mouth-to-mouth ventilation" for resuscitating patients who had stopped breathing.

Safar was intrigued, and over the next few years, the two men developed a three-step system (tilt the head back, chest compressions, mouth-to-mouth) for keeping patients alive who had suffered a massive heart attack. They called it cardiopulmonary resuscitation or CPR.

To practice this new technique, Safar and Elam recruited coma patients (with the family's consent) or sedated volunteers, including colleagues. But CPR, when done correctly, is violent enough to break bones.

"You will actually feel the ribs break underneath your hands," says Sarah McKernon, a senior lecturer in oral surgery at the Liverpool University Dental Hospital, who also trains students in CPR. "The fact that they were practicing CPR on each other with the added risk of damage to the spleen, it's incredible, but that was an accepted practice for a long time."

The Norwegian Toymaker Connection

Rescusi Annie — A Resusci Anne mannequin lies in a storage case. aorta/Wikipedia/CC BY 2.0

Bjørn Lind was one of only 13 practicing anesthesiologists in Norway when he attended a 1958 medical conference and heard a presentation by Peter Safar on mouth-to-mouth ventilation. Home to a vibrant maritime culture, Norwegians had long searched for the best way to revive a drowning victim, and CPR looked promising.

Back at his hospital in the small Norwegian city of Stavanger, Lind and his colleagues ran into the same challenge as Safar and Elam, finding willing volunteers on which to practice and teach CPR. Lind once recruited his own wife (sedated, thankfully) for a CPR demonstration.

In the 1950s, one of the biggest toymakers in Europe was a Norwegian company called Laerdal, founded in Stavanger, the same small city where Bjørn Lind practiced anesthesia. Laerdal's best-selling toys were the Tomte line of soft-plastic cars and trucks, and a baby doll named Anne.

Laerdal was a pioneer in soft plastics and the company soon drew attention for more than toys. First, the Norwegian Civil Defense asked Laerdal to create realistic-looking plastic models of wounds for training military medics. The result was the Practoplast kit of 33 adhesive wounds complete with pumps for squirting out fake blood.

Then Asmund Laerdal, the company's founder, heard through the Red Cross about the work being done by Lind and the Americans with CPR. Just a few years earlier, Asmund had resuscitated his young son after he nearly drowned. Laerdal saw an opportunity to help. He called Lind and offered to make a life-size, adult Anne doll on which CPR trainees could safely practice their life-saving new technique.

"This [call] decided the track of my career," said Lind, according to a paper published in JAMA in 2005.

Together, Lind and Laerdal designed the world's first CPR training mannequin, which they named Resusci Anne. In 1960, they brought their prototype to the U.S. to show it to Safar and another CPR pioneer Archer Gordon. It was Safar's idea to put a metal spring in the mannequin's chest to practice chest compressions.

McKernon at the Liverpool University Dental Hospital finds it remarkable that these CPR pioneers from different countries connected with a Norwegian toymaker to invent the CPR doll.

"They were ahead of their time in that they recognized this was even an option," says McKernon, who co-authored a paper in the British Medical Journal about the mannequin's unusual history. "This was way before the internet. The odds of that happening and the fact that we ended up with this mannequin is quite incredible."

'The Most-kissed Face in the World'

Red Cross, CPR, CPR Annie — A Red Cross instructor trains people on CPR in Ukraine using a version of "CPR Annie." Halinskyi Max/Shutterstock

From the start, Laerdal and Lind decided that the CPR mannequin should be a female — nearly all doctors at the time were male and would be more comfortable "kissing" a female doll, says McKernon. But what should this female doll look like?

Here comes the creepy part.

Laerdal was visiting some relatives when he spotted the serenely smiling death mask of the "unknown woman of the Seine" on their wall. It struck him as the perfect visage for the CPR doll. So, with some small modifications — slightly parted lips and a head of fake hair — he created a CPR mannequin with the face of a dead 19th-century French girl.

Laerdal is now the largest manufacturer of medical simulation mannequins in the world — including baby-sized CPR dolls, interactive patient simulators and mannequins that give birth. Laerdal has sold millions of Resusci Anne CPR mannequins, also known as CPR Annie.

If you've ever taken a CPR training class, you probably locked lips with CPR Annie, prompting some to call the mannequin the most-kissed face in the world.