Hektoen International

A Journal of Medical Humanities

A “semi-slaughter and a scandal of surgery”: The first documented tracheostomy in history

Matthew Turner
Hershey, Pennsylvania, United States

Antonio Musa Brasavola. National Library of Medicine.

Surgical tracheostomy has been known to humans for thousands of years. The ancient Hindu book of medicine, the Rig Veda, dating to approximately 2000 BC, discusses the healing of throat incisions; the ancient Egyptians may have been aware of the technique as well. According to legend, Alexander the Great used his sword to perform a crude tracheostomy on a choking soldier.1

However, the first documented, successful tracheostomy in human history occurred in 1546, performed by the Italian physician Antonio Brasavola.1 Angina—defined at the time as an inability to breathe due to a tightness of the throat—was considered extremely dangerous. While the theory of tracheostomy was well-known, it was considered an extremely dangerous procedure, and proposed techniques varied considerably, including performing incisions in the mouth itself.2 One medieval source referred to it as a “semi-slaughter and a scandal of surgery,”1 and Dante described it as a punishment for sinners in Hell.3

Brasavola, born to a patrician family in Ferrara in 1500, is a fascinating figure. A well-respected lecturer and expert on botany (he documented over 2,000 plants in his lifetime), theology, and pharmacology, his teaching career began in 1519, a full two years before he graduated with a degree in medicine. He quickly found work in the royal court, where he treated patients that ranged from local outbreaks of dysentery to curing a nobleman’s pet ostrich of a neck tumor.4 As reward for treating the beloved pet, he was given several ostrich eggs, which he somewhat humorously described as being nearly inedible.4 He was also a prolific author and a well-regarded teacher at the University of Ferrara.4

In 1546, Brasavola accepted a patient suffering from an “abscess in the windpipe,” reportedly on the verge of death3; of note, a number of local barber-surgeons had refused to treat the patient.5 He described his anginae curatio (“cure for angina”) as “We made the incision with these hands in a person who was about to expire…and the patient recovered.”2 Despite Brasavola’s publication of the procedure in Libris de ratione victus in morbis acutis, etc,6 the procedure remained exceedingly rare for decades. From 1500 to 1833, there are only twenty-eight successful documented tracheostomies in the historical record.1 Although it remained well-known, the technical difficulties of the procedure continued to make it extremely daunting for physicians. Of note, one of the physicians attending George Washington in 1799 admitted to being aware of tracheostomies but declined to perform one on the dying president due to concerns about its feasibility. As a result, Washington died of airway compromise secondary to bacterial epiglottis.1 Perhaps if the physician had been more aware of Brasavola’s technique, the sixty-seven-year-old former president would have lived to see the nineteenth century.

References

  1. Szmuk P, Ezri T, Evron S, Roth Y, Katz J. A brief history of tracheostomy and tracheal intubation, from the Bronze Age to the Space Age. Intensive Care Medicine 2008 Feb;34:222-8.
  2. Missori P, Brunetto GM, Domenicucci M. Origin of the cannula for tracheotomy during the middle ages and Renaissance. World Journal of Surgery 2012 Apr;36:928-34.
  3. Pratt LW, Ferlito A, Rinaldo A. Tracheotomy: historical review. The Laryngoscope 2008 Sep;118(9):1597-606.
  4. Nutton V. The rise of medical humanism: Ferrara, 1464–1555. Renaissance Studies 1997 Mar 1;11(1):2-19.
  5. Grillo HC. Development of tracheal surgery: a historical review. Part 1: Techniques of tracheal surgery. The Annals of Thoracic Surgery 2003 Feb 1;75(2):610-9.
  6. Borman J, Davidson JT. A history of tracheostomy:: Si spiritum ducit vivit (cicero). British Journal of Anaesthesia 1963 Jun 1;35(6):388-90.

DR. MATTHEW DAVID TURNER is a current second-year resident in Emergency Medicine. He has long been fascinated by the intersection of medicine and history. 

Winter 2025

|

|

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.