Tracing the tracheostomy

The evolution of tracheostomy can be divided into five stages. The first and longest period (covering roughly 3,000 years from 1500 BC to 1500 AD) begins with references to incisions into the “wind pipe” in the Ebers Papyrus and the Rig Veda. However, Alexander the Great, Asclepiades, Aretaeus and Galen are all recorded as having used this operation. Between 1546 with the writings of Brassarolo until 1883, the procedure was considered futile and irresponsible and few surgeons had the courage to perform it. The third period starts with Trousseau's report of 200 cases in the therapy of diphtheria in 1833. Tracheostomy became a highly dramatized operation for asphyxia and acute respiratory obstruction. In 1932 Wilson suggested its prophylactic and therapeutic use in poliomyelitis. Tracheostomy was then recommended for a large variety of assorted maladies. This started a tremendous period of enthusiasm. Finally, the present era starting in 1965 comes as a period of rationalization. Complications, indications and interrelation with endotracheal intubation are clearly outlined. Tracheostomy has found its place.