If you’ve heard Michael Jackson’s familiar refrain “Annie, are you OK?,” you know one of the first steps of performing CPR: assessing whether the other person is responsive. And that’s not a coincidence.
It’s said that this particular lyric was directly inspired by Resusci Anne — the name given to the anatomical manikin found in first aid classes around the world. And she’s far more than just a pretty face.
Receiving cardiopulmonary resuscitation, or CPR, can double or triple the odds of survival during cardiac arrest; thanks largely to the creators of Resusci Anne, 65 percent of people in the U.S. say they’ve received CPR training and thousands of lives are saved each year.
But for a manikin whose ultimate purpose is to help keep people alive, Resusci Anne’s origin story is a macabre one. It begins at a Paris mortuary in the late 19th century.
Who Was L’Inconnue de la Seine?
During the 1880s, the body of a young woman was pulled from the River Seine and brought to a mortuary. As was common practice at the time, the body was placed on public display in hopes that someone might identify her.
More than a dozen unknown corpses might have been laid out in a chilled room at a time, visible to curious passersby through a large glass window. As a volume of engravings from Unknown Paris (1893) put it, “There is not a single window in Paris that attracts more onlookers than this.”
When a pathologist performed a routine autopsy on the young woman, he determined that she was around 16 years old. He then created a death mask of her face out of plaster; this was not routine, and perhaps done in hopes of establishing her identity in the distant future.
Whatever the reason, her immortalized expression of extreme serenity became extremely popular.
The mask was replicated and sold, again and again, inspiring artwork and stories. The French novelist Albert Camus dubbed her a “drowned Mona Lisa,” though most people came to know her as L’Inconnue de la Seine — the unknown woman of the Seine.
Read More: Can Science Explain Near Death Experiences?
When Was CPR Invented?
Fast-forward to the 1950s, and the American physician James Elam has just introduced to Austrian-Czech physician Peter Safar a promising new resuscitation technique called “mouth-to-mouth ventilation” at a conference in Kansas City.
The two spent the next few years improving Elam’s method, eventually adding other steps like chest compressions and tilting the head back for increased air flow. But there was one issue the anesthesiologists couldn’t work around: Chest compressions are incredibly violent, often leading to broken rib bones when done correctly, and therefore incredibly difficult to practice.
The solution came from across the Atlantic.
When Norwegian toymaker Asmund Lærdal heard through the American Red Cross about the work being done with CPR, he recognized it as an opportunity. A life-size manikin would save medical students from the pain that came with practicing the technique on one another — and Lærdal had already created plastic models of wounds for military medics in the Norwegian Civil Defense in the past.
How much more difficult could crafting a realistic-looking CPR doll be?
Read More: How a Heart Can Stop After a Forceful Impact
Where Does the CPR Doll Face Come From?
Lærdal recruited Bjørn Lind, a local anesthesiologist who was also interested in CPR, for the task. They immediately concluded that the manikin would present as female — as most doctors at the time were male and more comfortable locking lips with a “woman” — but choosing a specific face was more difficult.
It was only when Lærdal visited a relative’s house and spied a reproduction of the L’Inconnue de la Seine death mask on a wall that he decided to give his CPR doll the very same face.
This first version of Resusci Anne, sculpted by Norwegian-Danish sculptor Emma Matthiasen, was unveiled at the First International Symposium on Resuscitation at Stavanger, Norway, in 1960. It boasted a soft plastic exterior, parted lips and a collapsible chest.
Elam and Safar, who both attended the conference in Stavanger, joined Lærdal in refining the design further.
Read More: The Origins of Organ Transplantation
Has the Annie CPR Doll Changed Over Time?
In later versions, an instructor could unfold and inflate the body with a foot pump prior to use, and successful CPR performance was judged via handy, built-in gauges that measured the pressure within the plastic “lung.” Instructors could even mimic a heart rate using a handheld bulb attached to the manikin.
Today, the advanced manikins produced by Lærdal Medical can even score CPR performances themselves using an algorithm designed in collaboration with the American Heart Association.
Who knows what other tricks the "Mona Lisa of the Seine" will have up her sleeve in the future?