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Friday, April 10, 2015

800-400 B.C.: Greeks define tracheotomy

Knowledge of mouth to mouth breathing and the surgical procedure of tracheotomy would have made it's way from ancient Egypt to ancient Greece. There were many Greek philosophers who studied medicine at one of Egypts fine schools, probably at Heliopolis early on and Alexandria later. The procedure more than likely made it's way to Greece by this means. 

So this knowledge must have appeared via a dream to a priest at the Asclepion at Cos, who must have used it successfully at some point early in Greek's history. Details of the procedure and the diagnosis it was used for would have been surreptitiously etched onto a stone slab that was kept at the temple for future reference. The slabs may also have been used as early medical texts, as such temples also served as schools. 

Sometime around 450 B.C. a boy by the name of Hippocrates (460-370 B.C.) sat with his father, a physician, at the temple, learning as much as he could about medicine, perhaps using the stone slabs as texts. Hippocrates grew to become the greatest physician of the ancient world, and would become the first to write about the procedure in his Hippocratic Corpuus.  He wrote:
"A tube should be inserted into the throat, along the jaws, so that the air may be attracted to the lungs."  (1) 
The procedure is perhaps best detailed by historian Pierre Victor Renouard in his 1867 history of medicine:
When the air passage is stopped by any obstacle, the anguish is extreme, the suffocation iminent, and the patient speedily dies, unless promptly succored. This accident has sometimes occurred in a violent quinsey, but more frequently in the fibrinous effusion in children, called croup. The Hippocratic works indicate as the only resource in this extremity, to pass a leek leaf, or any elastic tube, into the throat of the patient; but this agent is very diflicult of application, and I doubt whether it was ever done advantageously.(2, pages 448-449)
The ancient Greeks would have referred to this procedure as a tracheotomy.  The term, according to, comes from a combination of the Greek terms for "windpipe" (arterios trakheia) and "to cut into" (tom).  It means to cut into the trachea.

Another term, tracheostomy, comes from the combination of the Greek terms for "windpipe" (arterios trakheia) and "mouth, opening, or orifice" (stoma).  It is the creation of an opening in the trachea.  The opening is often referred to as a stoma, which comes from the Greek term for mouth, opening, orifice.  It is the opening created in the trachea or, simply, the hole in the trachea.

However, it should be understood here that, according to Dr. Morrell Mackenzie in his 1880 book "Disease of the nose and throat," the term tracheotomy was first used by Lorenz Heister (1683-1758).  Prior to him the procedure was actually called a bronchotomy.  Mackenzie defined bronchotomy as "the various operations by which the air-passages are laid open."  (3, pages 520,522)

For simplicities sake, I will simply refer to the procedure as a tracheotomy for the purposes of this history.

So while the ancient Greeks definitely didn't invent the procedure, they gave it a name and an identity.

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