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Saturday, May 24, 2014

4000-2000 B.C: The birth of tracheotomy

Perhaps as back as 4,000 years before the birth of Christ some mother grappled for something to do as she watched her child struggle for breath and stop breathing.  She had already chanted incantations, and even called the medicine man, so she placed her mouth over the boy's mouth, and exhaled.  She watched as his chest expanded.  This would have been the first attempts at mouth to mouth breathing.

This first effort probably failed, although it would have at least given the child a chance, albeit a small a small chance.  The medicine man watching this was touched by the mother's efforts, and he used it on a child a year later, only this time it worked.  Yet it never worked again.  Still, he shared this information with his son, who passed it along to his children.

The above story is fictional, although it shows how such wisdom may have been obtained and shared through the annals of time. Such stories, and such medical knowledge, would have been recorded as soon as a written language was invented, first in ancient Mesopotamia and later in Egypt.  Now, for the first time ever, such wisdom could be taught in schools, and later expounded upon.

There is some written evidence that tracheotomies were performed as early as 4,000 B.C. (1, page 222) This is a procedure where a small opening was cut into the trachea of a person who was suffocating, usually due to an upper airway obstruction.  The procedure was usually a last ditch effort to help someone breathe better.

In 2000 B.C. Ancient Hindu medicine mentioned "throat incision," and about 1500 B.C. the ancient Egyptiann architect, scribe and physician Imhotep became the first mention the procedure in writing. While his original works are lost to history, we learn about his thoughts by later writers who would have had access to his original works.  (1, page 222)

This operation would have been among the first ever performed, although chances are there was a low success rate.  Patients who survived the operation probably died later on due to the unintentional introduction of pathogens into the blood stream.  Still, if nothing was done the patient would have died anyway, so this at least gave the patient a fighting chance, albeit a small one.

  1. Szmuk, Peter, eet al, "A brief history of tracheostomy and tracheal intubation, from the Bronze Age to the Space Age," Intensive Care Medicine, 2008, 34, pages 222-228
  2. Price, J.L., "The Evolution of Breathing Machines,Medical History, 1962, January, 6(1), pages 67-72; Price references The Bible, Kings, 4: 34 
  3. Fourgeaud, V.J, "Medicine Among the Arabs," (Historical Sketches), Pacific medical and surgical journal, Vol. VII, ed. V.J. Fourgeaud and J.F. Morse, 1864, San Fransisco, Thompson & Company,  pages 193-203  (referenced to page 198-9)
  4. "Biographical Dictionary of the society for the diffusion of useful knowledge," Longman, Brown, Green and Longmans, volume III, 1843, A. Spottingwood, London, page 124-5
  5. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1922, Philadelphia, W.B. Saunders Company
  6. Lee, W.L., A.S. Stutsky, "Ventilator-induced lung injury and recommendations for mechanical ventilation of patients with ARDS," Semin. Respit. Critical Care Medicine, 2001, June, 22, 3, pages 269-280
  7. Tan, S.Y, et al, "Medicine in Stamps:  Paracelsus (1493-1541): The man who dared," Singapore Medical Journal,  2003, vol. 44 (1), pages 5-7
  8. Ball, James B, "Intubation of the Larynx," 1891, London, H.K. Lewis
  9. Hill, Leonard, Benjamin Moore, Arthur Phillip Beddard, John James Rickard, etc., editors, "Recent Advances in Physiology and bio-chemistry," 1908, London, Edward Arnold
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