The earliest known depiction of a tracheotomy is found on two
Egyptian
tablets dating back to circa 3600 BC. The 110-page
Ebers Papyrus, an
Egyptian medical papyrus that dates to around 1550 BC, also refers to the tracheotomy. Tracheotomy was described in an ancient Indian scripture, the
Rigveda: the text mentions "the bountiful one who, without a ligature, can cause the windpipe to re-unite when the cervical cartilages are cut across, provided they are not entirely severed." The
Sushruta Samhita () is another text from the
Indian subcontinent on ayurvedic medicine and surgery that mentions tracheotomy. The
Greek physician
Hippocrates (–) condemned the practice of tracheotomy. Warning against the unacceptable risk of death from inadvertent laceration of the
carotid artery during tracheotomy, Hippocrates also cautioned that "The most difficult
fistulas are those that occur in the cartilaginous areas."
Homerus of Byzantium is said to have written of
Alexander the Great (356–323 BC) saving a soldier from
asphyxiation by making an incision with the tip of his sword in the man's trachea. Despite the concerns of Hippocrates,
Galen of
Pergamon (129–199) and
Aretaeus of
Cappadocia (both of whom lived in
Rome in the 2nd century AD) credit
Asclepiades of Bithynia (–40 BC) as being the first physician to perform a non-emergency tracheotomy. However, Aretaeus warned against the performance of tracheotomy because he believed that incisions made into the tracheal
cartilage were prone to secondary
wound infections and therefore would not heal. He wrote that "The lips of the wound do not coalesce, for they are both cartilaginous and not of a nature to unite".
Antyllus, another Greek surgeon who lived in Rome in the 2nd century AD, was reported to have performed tracheotomy when treating oral diseases. He refined the technique to be more similar to that used in modern times, recommending that a
transverse incision be made between the third and fourth tracheal rings for the treatment of life-threatening airway obstruction. Antyllus wrote that tracheotomy was not effective however in cases of severe
laryngotracheobronchitis because the
pathology was distal to the operative site. Antyllus' original writings were lost, but they were preserved by
Oribasius (–400) and
Paul of Aegina (–690), both of whom were Greek physicians as well as historians. Galen clarified the anatomy of the trachea and was the first to demonstrate that the larynx generates the voice. Galen may have understood the importance of artificial ventilation, because in one of his experiments he used bellows to inflate the lungs of a dead animal. Circa 1020,
Ibn Sīnā (980–1037) described the use of tracheal intubation in
The Canon of Medicine to facilitate
breathing. In the 12th century medical textbook
Al-Taisir,
Ibn Zuhr (1091–1161) of Al-Andalus (also known as Avenzoar) provided an anatomically correct description of the tracheotomy operation. The
Renaissance saw significant advances in anatomy and surgery, and surgeons became increasingly open to surgery on the trachea. Despite this, the mortality rate failed to improve. From 1500 through 1832 there are only 28 known descriptions of successful tracheotomy in the literature. The first detailed descriptions on tracheal intubation and subsequent
artificial respiration of animals were from
Andreas Vesalius (1514–1564) of Brussels. In his landmark book published in 1543,
De humani corporis fabrica, he described an experiment in which he passed a
reed into the trachea of a dying animal whose
thorax had been opened and maintained ventilation by blowing into the reed intermittently. Vesalius wrote that the technique could be life-saving.
Antonio Musa Brassavola (1490–1554) of
Ferrara treated a patient with
peritonsillar abscess by tracheotomy after the patient had been refused by
barber surgeons. The patient apparently made a complete recovery and Brassavola published his account in 1546. This operation has been identified as the first recorded successful tracheostomy, despite many ancient references to the trachea and possibly to its opening. ,
Operationes chirurgicae, 1685 Towards the end of the 16th century, anatomist and surgeon
Hieronymus Fabricius (1533–1619) described a useful technique for tracheotomy in his writings, although he had never actually performed the operation himself. He advised using a vertical incision and was the first to introduce the idea of a tracheostomy tube. This was a straight, short
cannula that incorporated wings to prevent the tube from advancing too far into the trachea. Fabricius' description of the tracheotomy procedure is similar to that used today.
Julius Casserius (1561–1616) succeeded Fabricius as professor of anatomy at the University of Padua and published his own writings regarding technique and equipment for tracheotomy, recommending a curved silver tube with several holes in it.
Marco Aurelio Severino (1580–1656), a skillful surgeon and anatomist, performed multiple successful tracheotomies during a
diphtheria epidemic in
Naples in 1610, using the vertical incision technique recommended by Fabricius. He also developed his own version of a trocar. In 1620 the French surgeon
Nicholas Habicot (1550–1624), surgeon of the
Duke of Nemours and anatomist, published a report of four successful "bronchotomies" he had performed. One of these is the first recorded case of a tracheotomy for the removal of a foreign body, in this instance a blood clot in the larynx of a stabbing victim. He also described the first known tracheotomy performed on a
pediatric patient. A 14-year-old boy swallowed a bag containing 9 gold coins in an attempt to prevent its theft by a
highwayman. The object became lodged in his
esophagus, obstructing his trachea. Habicot suggested that the operation might also be effective for patients with inflammation of the larynx. He developed equipment for this surgical procedure that are similar in many ways to modern designs.
Sanctorius (1561–1636) is believed to be the first to use a trocar in the operation. He recommended leaving the cannula in place for a few days following the operation. Early tracheostomy devices are illustrated in Habicot's
Question Chirurgicale and Julius Casserius' posthumous
Tabulae anatomicae in 1627. Thomas Fienus (1567–1631), Professor of Medicine at the
University of Louvain, was the first to use the word "tracheotomy" in 1649, but this term was not commonly used until a century later. Georg Detharding (1671–1747), professor of anatomy at the
University of Rostock, treated a drowning victim with tracheostomy in 1714. Fearful of complications, most surgeons delayed the potentially life-saving tracheotomy until a patient was moribund, despite the knowledge that irreversible organ damage would have already occurred by that time. This began to change in the early 19th century, when the tracheotomy finally began to be recognized as a legitimate means of treating severe airway obstruction. In 1832, French physician
Pierre Bretonneau (1778–1862) employed tracheotomy as a last resort to treat a case of
diphtheria. In 1852, Bretonneau's student
Armand Trousseau (1801–1867) presented a series of 169 tracheotomies (158 of which were for
croup and 11 for "chronic maladies of the larynx"). In 1871, the German surgeon
Friedrich Trendelenburg (1844–1924) published a paper describing the first successful elective human tracheotomy performed to administer general anesthesia. After the death of German Emperor
Frederick III from
laryngeal cancer in 1888, Sir
Morell Mackenzie (1837–1892) and the other treating physicians collectively wrote a book discussing the then-current
indications for tracheotomy and when the operation is absolutely necessary. In the early 20th century, physicians began to use the tracheotomy in the treatment of patients affected by paralytic
poliomyelitis who required mechanical ventilation. The currently used surgical tracheotomy technique was described in 1909 by
Chevalier Jackson (1865–1958), a professor of laryngology at
Jefferson Medical College in Philadelphia. However, surgeons continued to debate various aspects of the tracheotomy well into the 20th century. Many techniques were employed, along with many different surgical instruments and tracheal tubes. Surgeons could not seem to reach a consensus on where or how the tracheal incision should be made, arguing whether the "high tracheotomy" or the "low tracheotomy" was more beneficial. Ironically, the newly developed
inhalational anesthetic agents and techniques of general anesthesia actually seemed to increase the risks, with many patients with fatal postoperative complications. Jackson emphasised the importance of postoperative care, which dramatically reduced the mortality rate. By 1965, the surgical anatomy was thoroughly and widely understood,
antibiotics were widely available and useful for treating postoperative infections and other major complications of tracheotomy had also become more manageable. ==Endoscopy==