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Saturday, April 11, 2015

124-200 A.D.: Roman physicians describe tracheotomies

Knowledg of mouth to mouth breathing and the operation of tracheotomy was carried from ancient Greece to ancient Rome by the physician Asclepiades of Bythinia. (124-40 B.C.).

Prior to Asclepiades the Romans had a negative view of the harsh medicine of the Greeks, although Asclepiades was able to convince the Romans that Greek medicine could be useful for saving lives and soothing the minds of the sick.

Once again I quote Renouard:
Asclepiades of Bythinia, had the idea of opening a passage for the air, by making an incission into the larynx or trachea; but the authors who report this fact do not describe the operation he adopted. After him, no one dared attempt tracheotomy until Antyllus, who practiced it several times, and described his mode of operating.  (1, pages 448-449)
Antyllus, a Greek physician who lived in Rome sometime between the birth of Jesus and the 4th century (and probably in the 2nd century), had a fragment of his writings preserved by Paulus Aegineta (625-690), some of which provides one of our first accounts of the surgical procedure:  
"The incision should be made in the trachea, under the larynx, about the third or fourth ring. This situation is most eligible, because it is not covered by any muscles, and no vessels are near it. The patient's head must be kept back, in order that the trachea may project more forward. A transverse cut is to be made between two of the rings, so as not to wound the cartilage, only the membrane." (2)(3)(also see 5, page 521)
The GrecoRoman physician Galen (120-200 A.D.) stated that Aesculapius (around 100 A.D.) was the first to recommend tracheotomy, so we may speculate Galen also used it.   Both Aeretaeus (130-200 A.D) and Caelius-Aurelianus (5th century) mention the recommendation by Aesculapius, although Aeretaeus condemned the procedure out of fear the cartilage would not heal, and Caelius talked of it as a rash procedure never put into practice.  (2)(5, page 521)

Galen also described tracheostomies, and described inflating lungs with bellows through a hole in the trachea.  (4) 

Chances are Galen performed his experiments on animals, probably pigs, dogs or apes.  Yet even if he never performed it on a human, his efforts may have been the first mechanical breaths. 

So, like ancient Greek physicains, ancient Roman physicians were knowledgeable of the operation of tracheotomy, and performed experiments that would be picked up by later physicians who would have had better knowledge of anatomy.   

  1. 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
  2. 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)
  3. "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
  4. 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
  5. Mackenzie, Morrell, "Diseases of the throat and nose, Volume I, 1880, Philadelphia, Presley Blakiston
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