The Early History of the Tracheotomy


"A Futile and Irresponsible Idea": The Tracheotomy in Ancient and Medieval Times


The tracheotomy first appears as an emergency procedure for bypassing a blocked airway.  Its early history is sketchy and somewhat legendary.  Coelius Aurelianus, writing in the fifth century A.D., refers to tracheotomy as "a fantastic operation" and "a futile and irresponsible idea."

 

The earliest known depiction of a tracheotomy is found on Egyptian tablets dating back to circa 3600 B.C., during the First Dynasty.  Each of the two slabs depicts what scholars interpret to be a tracheotomy operation.  To the untrained eye, the pictures may appear to be of a ritual execution, but the angle of the knife and the relative positions of the knife-wielder and patient indicate a surgical procedure instead.  Eber's Papyrus, an Egyptian text which dates to circa 1550 B.C., references an incision in the throat.

 

Evidence of the tracheotomy also appears in ancient India.  The Rig Veda is a sacred book of Hindu medicine, written as early as 2000 B.C.  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 Greeks also have a long history relating to the tracheotomy, although some of it is based in legend.  The poet Homer is said to have made a reference to the procedure in the eighth century B.C.  He supposedly referred to an operation whereby one could relieve a choking person by cutting open the windpipe.  The Greek ruler Alexander the Great is rumored to have performed a tracheotomy himself.  In the fourth century B.C., he allegedly used the tip of his sword to open the trachea of a choking soldier.

 

The medical writers Galen and Aretaeus, both of whom lived in the second century A.D., credit Asclepiades of Bithynia (c. 124-40 B.C.) with being the first individual to perform an elective (non-emergency) tracheotomy, in the first century B.C.  However, Aretaeus condemned the operation in his writings, for he believed, like many of that time, that incisions made into the cartilage of the trachea could not heal.

 

The second-century Greek surgeon, Antyllus, may also have performed the surgery.  He is one of the first advocates of the procedure.  The writings of Antyllus, quoted by Paul of Aegina (625-690 A.D.), provide a description of the surgery, although Antyllus referred to it as pharyngotomy.  Paul of Aegina provides us with the earliest written account of a tracheotomy and is another early supporter of the operation.

 

While the rest of Europe suffered the drought of scientific discovery that was the Middle Ages, the scientific culture in Arabic Spain flourished. El Zahrawi (936-1013 A.D., known to Europeans as Albucasis), an Arab who lived in Andalusia , published 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.  Albucasis sewed up the wound and the girl recovered, thereby proving that an incision in the larynx could heal. Ibn Zuhr (1091-1161 A.D., also known as Avenzoar) successfully practiced the tracheotomy procedure on a goat, justifying Galen's approval of the operation.

 
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