Death at Dinner

The executive on the phone to Manhattan Internist John Prutting was in a state of panic. His sister-in-law had suddenly leaped from the dinner table in his apartment. She was speechless, her hands were clutching at her chest, she was becoming faint and turning blue. What could he do? The symptoms were all too familiar to Prutting. He calmly advised his caller to lean the woman over a chair, pound her on the back and reach down her throat with his middle and index fingers to dislodge the obstruction. The doctor heard loud thumping sounds, and soon a relieved voice came back on the Line. "It was only a piece of beef," said the executive. "She's fine now!"

The stricken woman was a victim of "food inhalation," an often fatal accident that is so often misdiagnosed as a heart attack that it has come to be called the cafe coronary. Partly as a result of these incorrect diagnoses, Florida Physicians WilLiam C. Eller and Roger K. Haugen report in the New England Journal of Medicine, choking on food is the sixth leading cause of accidental death in the country. Because, according to the National Safety Council, nearly 2,500 persons die while dining each year, the cafe coronary outranks aircraft accidents, firearms, lightning and snakebite as a cause of death.

The food most responsible for death by choking is steak, according to a study by the office of New York's chief medical examiner; it accounts for some 90% of the fatalities. Other killers are lobster tail, hard-boiled eggs, clams, sausage, turkey and even bread. The sheer volume of the fatal mouthful is often breathtakingly large: the average chunk of food extracted from the windpipe of victims, Eller and Haugen say, is about the size of a cigarette pack; in one case, they report, the piece was over 7 in. long. The temptation to swallow such unmanageable amounts seems to be greatest among those with poor teeth or dentures, although a few drinks make eaters of any age more careless about their chewing. Alcohol also slows the normal gagging reaction, allowing food to lodge far down the windpipe, with often fatal results. The typical victim is over 50 years old and usually white.

Choke Saver. Food inhalation has been a killer for centuries--all the more reason, Eller and Haugen say, for modern doctors to be familiar with the symptoms. A son of the Roman Emperor Claudius I is said to have choked to death on a pear he tossed playfully into the air and then swallowed. More recently, Mrs. Joan Skakel, Ethel Kennedy's sister-in-law, died after inhaling a chunk of meat in 1967. T.V. Soong, the brother of Madame Chiang Kaishek, choked to death in 1971 while dining, as did ex-Baseball Slugger Jimmy Foxx in 1967.

All food inhalation shows symptoms that are easy to recognize, if a doctor or bystander knows what to look for. The hapless diner is suddenly unable to breathe, talk or cough. A panicky struggle may ensue, as he tears at the lower throat or upper chest. He quickly becomes blue in the face and collapses to the floor or into his plate. Without proper help, death--from lack of oxygen--occurs in four or five minutes.

Eller and Haugen estimate that 90% of dinner-table fatalities could be prevented, if doctors and laymen alike would not immediately assume that the victim is suffering from coronary thrombosis. The combination of eating and the inability to talk or breathe is a sure tipoff, they say; a genuine heart attack victim can usually speak. Backslapping is a waste of time, unless the victim is upside down, and mouth-to-mouth resuscitation is like "trying to pour water into a corked bottle." The food must be retrieved--with fingers or, if necessary, with a pair of tweezers. After a year of testing in Florida, Eller and Haugen now recommend that a 9-in. plastic tweezer-like device called Choke Saver be kept at the ready in every restaurant. It has already been used by a city first-aid unit in Jacksonville, Fla., to save the lives of three victims. Using either his fingers or the Choke Saver, a clumsy amateur may bruise a victim's throat while wrestling with the obstructing clump of food. But, the Florida doctors note, "a sore throat is to be preferred to a dead patient."

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