Ancient history Tracheotomy was first potentially depicted on
Egyptian artifacts in 3600 BC.
Hippocrates condemned the practice of tracheotomy as incurring an unacceptable risk of damage to the
carotid artery. Warning against the possibility of death from inadvertent laceration of the carotid artery during tracheotomy, he instead advocated the practice of
tracheal intubation. Despite the concerns of Hippocrates, it is believed that an early tracheotomy was performed by
Asclepiades of Bithynia, who lived in Rome around 100 BC.
Galen and
Aretaeus, both of whom lived in Rome in the 2nd century AD, credit Asclepiades as being the first physician to perform a non-emergency tracheotomy.
Antyllus, another Roman-era Greek physician of the 2nd century AD, supported 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. In 1000,
Abu al-Qasim al-Zahrawi (936–1013), an Arab who lived in
Arabic Spain, published the 30-volume
Kitab al-Tasrif, the first illustrated work on surgery. He never performed a tracheotomy, but he did treat a slave girl who had cut her own throat in a suicide attempt. Al-Zahrawi (known to Europeans as
Albucasis) sewed up the wound and the girl recovered, thereby proving that an incision in the larynx could heal. Circa AD 1020,
Avicenna (980–1037) described tracheal intubation in
The Canon of Medicine in order to facilitate
breathing. The first clear description of the tracheotomy operation for treating asphyxiation was given by
Ibn Zuhr (1091–1161) in the 12th century. According to Mostafa Shehata, Ibn Zuhr (also known as Avenzoar) successfully practiced the tracheotomy procedure on a goat, justifying Galen's approval of the operation.
16th–18th centuries (1533–1619) was the first to introduce the idea of a tracheostomy tube The European
Renaissance brought with it significant advances in all scientific fields, particularly surgery. Increased knowledge of anatomy was a major factor in these developments. Surgeons became increasingly open to experimental surgery on the trachea. During this period, many surgeons attempted to perform tracheotomies, for various reasons and with various methods. Many suggestions were put forward, but little actual progress was made toward making the procedure more successful. The tracheotomy remained a dangerous operation with a very low success rate, and many surgeons still considered the tracheotomy to be a useless and dangerous procedure. The high mortality rate for this operation, which had not improved, supported their position. From the period 1500 to 1832 there are only 28 known reports of tracheotomy. In 1543,
Andreas Vesalius (1514–1564) wrote that tracheal intubation and subsequent
artificial respiration 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. In 1620 the French surgeon
Nicholas Habicot (1550–1624), surgeon of the
Duke of Nemours and anatomist, published a report of four successful "bronchotomies" which 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 tracheotomy to be 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 which displayed similarities to modern designs (except for his use of a single-tube cannula).
Sanctorius (1561–1636) is believed to be the first to use a trocar in the operation, and he recommended leaving the cannula in place for a few days following the operation. Early tracheostomy devices are illustrated in Habicot's
Question Chirurgicale 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.
19th century In the 1820s, the tracheotomy began to be recognized as a legitimate means of treating severe airway obstruction. In 1832, French physician
Pierre Bretonneau employed it as a last resort to treat a case of
diphtheria. In 1852, Bretonneau's student
Armand Trousseau reported a series of 169 tracheotomies (158 of which were for
croup, and 11 for "chronic maladies of the larynx") In 1858, John Snow was the first to report tracheotomy and cannulation of the trachea for the administration of chloroform anesthesia in an animal model. In 1871, the German surgeon
Friedrich Trendelenburg (1844–1924) published a paper describing the first successful
elective human tracheotomy to be performed for the purpose of administration of general anesthesia. In 1880, the Scottish surgeon
William Macewen (1848–1924) reported on his use of orotracheal intubation as an alternative to tracheotomy to allow a patient with glottic edema to breathe, as well as in the setting of general anesthesia with
chloroform. At last, in 1880
Morell Mackenzie's book discussed the symptoms indicating a tracheotomy and when the operation is absolutely necessary.
20th century In the early 20th century, physicians began to use the tracheotomy in the treatment of patients affected by paralytic
poliomyelitis who required
mechanical ventilation. However, surgeons continued to debate various aspects of the tracheotomy well into the 20th century. Many techniques were described and 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. The currently used surgical tracheotomy technique was described in 1909 by
Chevalier Jackson of
Pittsburgh,
Pennsylvania. Jackson emphasised the importance of postoperative care, which dramatically reduced the death 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 had also become more manageable. ==Society and culture==