Monday, June 26, 2017
   
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History of Trachs

Antonio Musa Brasavola, an Italian physician, performed the first documented case of a successful tracheotomy. He published his account in 1546. The patient, who suffered from a laryngeal abscess and recovered from the procedure.

The tracheotomy has gone by several different names, including pharyngotomy, laryngotomy, bronchotomy, tracheostomy and tracheotomy. The word tracheotomy first appeared in print in 1649, but was not commonly used until a century later. Tracheostomy refers to the opening created by the tracheotomy procedure. Sometimes this term is used interchangeably, but tracheotomy usually refers to the operation itself.

Tracheotomies were originally used for emergency treatment of upper airway obstruction, but with little success. Upper airway obstruction in children was first discussed as a clinical entity in 1765. It was suggested that a tracheotomy be performed as an emergency treatment to prevent children from suffocating due to throat inflammation.

In 1799, George Washington died of an upper airway obstruction, probably due to acute epiglottitis or an abscess. Washington's physician was familiar with the tracheotomy procedure, but had not actually performed one himself. He apparently was unwilling to do his first tracheotomy on a person of Washington’s stature.

In 1909, a lower tracheotomy technique was introduced in which the tracheal incision extends to the 4th or 5th tracheal ring. This operative technique was refined by Chevalier Jackson when faced with the challenge of the polio epidemic of the 1940's. This technique is basically the same today.

Here are some URL's that will give you a history of Tracheotomies.  I have also put the text below the link since sometimes the links cease to work.

A Brief History of the tracheotomy
The early history of the tracheotomy is sketchy and somewhat legendary. The earliest known depiction of a tracheotomy is found on Egyptian tablets dating back to circa 3600 B.C.E., during the First Dynasty. However, it was not readily accepted. Coelius Aurelianus, writing in the fifth century C.E., refers to it as "a fantastic operation" and "a futile and irresponsible idea." Therefore, it wasn't until the Renaissance, when interest in scientific study increased, that surgeons grew more open-minded about experimenting with surgery on the trachea and performed tracheotomies for a variety of reasons.

Introduction to Tracheotomy
The tracheotomy — a medical procedure in which a tube is inserted through an incision in the windpipe to create an airway — has been performed by physicians for over five thousand years.  When done properly, it can save lives; yet the tracheotomy was not readily accepted by the medical community.

The tracheotomy began as an emergency procedure, used to create an open airway for someone struggling for air.  For most of its history, the tracheotomy was performed only as a last resort and mortality rates were very high.  Only in the past century has the tracheotomy evolved into a safe and routine medical procedure.

One famous American whose life could have been saved by a tracheotomy was President George Washington.  At the end of the 18th century, however, the procedure was still considered too risky.  In December of 1799, Washington lay in his bed at Mount Vernon , Virginia , suffering from a septic sore throat and struggling for air.  The youngest of his three doctors, Elisha C. Dick, recommended that a tracheotomy be performed to create an unobstructed airway.  He was vetoed by the other two physicians, who preferred more traditional treatment methods like bleeding.  Washington died that night.

What Is a Tracheotomy?
The tracheotomy is a procedure in which an incision is made into the windpipe, or trachea, through the front of a person's neck.  When a person's upper airway is blocked, a laryngologist can perform a tracheotomy to create an alternate airway.  Air can then be drawn into the lungs via an opening in the trachea, bypassing foreign bodies, secretions, or swelling.  This opening may be temporary or permanent, depending on the needs of the individual patient. Over time, the tracheotomy has gone by several different names, among them pharyngotomy, laryngotomy, bronchotomy, tracheostomy, and tracheotomy.  The word tracheotomy first appeared in print in 1649, but was not commonly used until a century later.  Tracheostomy refers specifically to the opening, or stoma, created by the tracheotomy procedure.  Sometimes this term is used interchangeably with tracheotomy to refer to the operation itself.

The Early History of the Tracheotomy-Part One
"A Futile and Irresponsible Idea": The Tracheotomy in Ancient and Medieval Times

The tracheotomy first appears as an emergency procedure for bypassing a blocked airway.  Its early history is sketchy and somewhat legendary.  Coelius Aurelianus, writing in the fifth century A.D., refers to tracheotomy as "a fantastic operation" and "a futile and irresponsible idea."

The earliest known depiction of a tracheotomy is found on Egyptian tablets dating back to circa 3600 B.C., during the First Dynasty.  Each of the two slabs depicts what scholars interpret to be a tracheotomy operation.  To the untrained eye, the pictures may appear to be of a ritual execution, but the angle of the knife and the relative positions of the knife-wielder and patient indicate a surgical procedure instead.  Eber's Papyrus, an Egyptian text which dates to circa 1550 B.C., references an incision in the throat.

Evidence of the tracheotomy also appears in ancient India.  The Rig Veda is a sacred book of Hindu medicine, written as early as 2000 B.C.  The text mentions "the bountiful one who, without a ligature, can cause the windpipe to re-unite when the cervical cartilages are cut across, provided they are not entirely severed."

The Greeks also have a long history relating to the tracheotomy, although some of it is based in legend.  The poet Homer is said to have made a reference to the procedure in the eighth century B.C.  He supposedly referred to an operation whereby one could relieve a choking person by cutting open the windpipe.  The Greek ruler Alexander the Great is rumored to have performed a tracheotomy himself.  In the fourth century B.C., he allegedly used the tip of his sword to open the trachea of a choking soldier.

The medical writers Galen and Aretaeus, both of whom lived in the second century A.D., credit Asclepiades of Bithynia (c. 124-40 B.C.) with being the first individual to perform an elective (non-emergency) tracheotomy, in the first century B.C.  However, Aretaeus condemned the operation in his writings, for he believed, like many of that time, that incisions made into the cartilage of the trachea could not heal.

The second-century Greek surgeon, Antyllus, may also have performed the surgery.  He is one of the first advocates of the procedure.  The writings of Antyllus, quoted by Paul of Aegina (625-690 A.D.), provide a description of the surgery, although Antyllus referred to it as pharyngotomy.  Paul of Aegina provides us with the earliest written account of a tracheotomy and is another early supporter of the operation.

While the rest of Europe suffered the drought of scientific discovery that was the Middle Ages, the scientific culture in Arabic Spain flourished. El Zahrawi (936-1013 A.D., known to Europeans as Albucasis), an Arab who lived in Andalusia , published the first illustrated work on surgery.  He never performed a tracheotomy, but he did treat a slave girl who had cut her own throat in a suicide attempt.  Albucasis sewed up the wound and the girl recovered, thereby proving that an incision in the larynx could heal. Ibn Zuhr (1091-1161 A.D., also known as Avenzoar) successfully practiced the tracheotomy procedure on a goat, justifying Galen's approval of the operation.

The Early History of the Tracheotomy-Part Two
The European Renaissance brought with it significant advances in all scientific fields, particularly surgery. Increased knowledge of anatomy was a major factor in these developments. The tracheotomy remained a dangerous operation with a very low success rate, but as interest in scientific study increased, surgeons grew more open-minded about experimenting with surgery on the trachea. During this period, many surgeons attempted to perform tracheotomies, for various reasons and with various methods. Many suggestions were put forward, but little actual progress was made toward making the procedure more successful. The majority of these suggestions, some of them very useful, fell by the wayside, ignored or unheard by the medical community at large.

Many surgeons still considered the tracheotomy to be a useless and dangerous procedure, and the statistics for this era do not disagree. For the period from 1500 to 1833, we have reports of a paltry twenty-eight successful tracheotomies.

An Italian physician, Antonio Musa Brasavola (1490-1554), performed the first documented case of a successful tracheotomy, and he published his account in 1546. The patient, who suffered from a laryngeal abscess, recovered from the surgical procedure.

Sanctorius (1561-1636) is believed to be the first to use a trocar in the operation, and he recommended leaving the cannula in place for a few days following the operation. Marco Aurelio Severino (1580-1656) used the tracheotomy to save multiple lives during the 1610 diphtheria epidemic in Naples; he also developed his own version of a trocar.

The studies of anatomists such as Hieronymus Fabricius ab Aquapendente (1537-1619) and his successor Julius Casserius (1561-1616) contributed much to the field of surgery. Fabricius, an anatomist and surgeon in Padua, never performed a tracheotomy, but his writings include descriptions of the surgical technique. He favored using a vertical incision and a straight, short cannula with wings (to prevent the tube from disappearing into the trachea), but he recommended the operation only as a last resort. He called the tracheotomy a "scandal," although he later relented in his condemnation and advocated the procedure in cases of blockage by foreign bodies or secretions. Fabricius' description of the tracheotomy procedure is similar to that used today. Casserius succeeded Fabricius as professor of anatomy at the University of Padua and published his own writings regarding technique and equipment for tracheotomy. Casserius recommended as a cannula a curved silver tube with several holes in it.

In 1620 the French surgeon Nicholas Habicot (1550-1624) published a report of four successful "bronchotomies" which he had performed. One of these is the first recorded case of a tracheotomy for the removal of a foreign body, in this instance a blood clot in the larynx of a stabbing victim. Habicot suggested that the operation might also be effective for patients suffering from inflammation of the larynx. He developed equipment for this surgical procedure which displayed similarities to modern designs (except for his use of a single-tube cannula).

As the Renaissance came to a close, surgeons continued to experiment with tracheotomy methods and equipment. Lorenz Heister (1683-1758) reintroduced the term tracheotomy in 1718 and campaigned for its usage. He described the tracheotomy operation in 1739 and recommended the use of a straight tube and trocar.

George Martine (1702-1743), the earliest known British tracheotomist, in 1730 published the first recorded case of a tracheotomy with a double cannula. He recommended the double tube because the inner tube could be removed for cleaning without disturbing the patient.

In 1765 Francis Home, a Scottish physician, advocated the use of tracheotomy for the relief of upper airway obstruction caused by croup. Jean Charles Felix Caron (1745-1824) performed the earliest known tracheotomy on a small child in 1776; the patient was a seven-year-old boy with a bean caught in his throat.

The Early History of the Tracheotomy-Part Three
All in the Timing: Nineteenth Century

It was not until the 1820s that tracheotomy began to gain widespread acceptance as a legitimate surgical procedure. Pierre Bretonneau (1778-1862) accomplished this in 1826, when he published his description of diphtheria (previously known as croup) and reported his successful use of the tracheotomy to relieve diphtheritic obstruction of the larynx. After this report more and more surgeons performed tracheotomies on their patients, but only as a last resort.

The problem with waiting until the last possible moment is that, by that point, irreversible damage to the body has already occurred due to lack of oxygen. Yet surgeons continued to postpone the tracheotomy, often until it was too late to do any good. It was considered a dangerous procedure, and not one to be attempted unnecessarily. Morrell Mackenzie’s 1880 textbook on laryngology addresses the issue of how a surgeon must determine “whether the symptoms are sufficiently urgent to render the operation necessary.”

Bretonneau’s pupil, Dr. Trousseau, kept records of the hundreds of tracheotomies performed under his leadership at the Hopital des Enfans in the 1850s. His 73% mortality rate was judged “very satisfying” by one reporter. This is partly due to the timing of the procedure and its use as a last-ditch effort instead of an early treatment.

Aside from the issue of timing, laryngologists and surgeons in the nineteenth century were debating other aspects of the tracheotomy procedure. Varying techniques were used, as well as varying pieces of equipment. Doctors did not even agree on where the incision should be made; they argued the merits of “high tracheotomy” versus “low tracheotomy.” General anesthesia, particularly on patients with suppressed respiration, was still quite dangerous. And many patients survived successful tracheotomy procedures, only to die from post-operative complications.

During this time period other physicians were looking into non-surgical methods of relieving airway obstruction. Joseph O’Dwyer (1841-1898) performed the first successful intubation of the larynx in 1885. He developed the technique of intubation to aid in the treatment of diphtheria, at this time a major killer of children.

Great Contributions: 1860-1880
In 1860, Abraham Lincoln was elected President of the United States on an anti-slavery platform. Within three months seven Southern states, led by South Carolina, seceded from the Union. These states formed the Confederate States of America, plunging the country into the Civil War. Virginia's loyalties were with the South, but in May 1861 Alexandria was invaded by federal troops and was occupied for the duration of the war. The city became the base for the invasion of Union troops into Richmond, Virginia, the Confederate capital.

The Civil War claimed the lives of six hundred thousand Americans, both white and black. The suffering of the wounded was eased by ether anesthesia, discovered in 1842 by Dr. Crawford Long. Amputation was the most common surgical procedure of the war and was considered the best way to save the lives of soldiers with bullet wounds in an extremity. Other common medical procedures included bullet extraction, ligation (sewing of an artery to stop bleeding), trephine (drilling a hole in the skull to relieve the pressure of a hemorrhage), and the administration of opium or morphine to kill pain. It was at this time that Dr. Jacob Solis-Cohen (1838-1927) championed laryngology in America.

Dr. Solis-Cohen, considered a founding father of the specialty, completed his medical education at the University of Pennsylvania in 1860. He served in the Civil War as a surgeon from 1861 to 1864. Throughout his career, Dr. Solis-Cohen developed lifesaving surgical techniques for the management of illness and disease associated with the air and food passages. One such technique he developed was the complete removal of the larynx (voice box), called a total laryngectomy. This procedure is most often performed to treat a well-established cancer of the vocal cords and associated organs.

Without a larynx, breathing through the mouth and nose or speaking normally is impossible. Dr. Solis-Cohen's technique for total laryngectomy allowed patients to develop speech utilizing the esophagus. His procedure also permitted the patient to breathe through a tracheotomy that did not require a tube. Tracheotomy is a surgical practice calling for cutting into the front of the neck, making an opening in the trachea (windpipe) and usually inserting a silver tube to act as the new airway.

Great Contributions: 1880-1900
After the Civil War, America recovered from her wounds and began to grow. For a decade afterward, the South was occupied by the North and slowly allowed back into the Union upon the ratification of both the Fourteenth and Fifteenth Amendments to the Constitution. These amendments, guaranteeing the freedom of African-Americans, were important stepping stones toward the goal of equality. This progress was exemplified by Dr. Albert Johnson, who in 1885 became the first licensed African American doctor in the city of Alexandria.

During the same year Dr. Johnson began to practice in Alexandria (1885), the first successful intubation of the larynx was performed by Dr. Joseph O'Dwyer. Dr. O'Dwyer (1841-1898) developed the technique of intubation to aid in the treatment of diphtheria, once a major killer of children. During his employment at the New York Foundling Asylum, he witnessed the heartbreaking deaths of many children from this deadly disease. Until the mid-1890s, when antitoxin therapy became available, treatment for diphtheria was very limited. Physicians could either allow the disease to run its course or they could perform a tracheotomy.

During acute phases of diphtheria, a membrane often forms over the throat, stopping the patient from breathing. Tracheotomy is an invasive surgical practice in which the physician cuts into the front of the neck, makes an opening in the trachea (windpipe) and inserts a silver tube to act as the new airway. Children under four years of age had a one-in-ten chance of surviving the operation. From 1873 to 1880 not one recovery had been recorded at the New York Foundling Asylum where O'Dwyer worked. If the disease progressed without any intervention, the child had virtually no chance of survival.

Dr. O'Dwyer's method of intubation is a non-surgical technique that provides the patient with an airway. In essence, a tube is placed within the patient's throat, going through the mouth to rest in the larynx. American physicians quickly adopted this new procedure and intubation became the preferred treatment, replacing tracheotomy by 1891. Intubation was popular because it could be performed quickly without anesthesia and without the risks associated with surgery.

The period after the Civil War produced a surge in industrialization. During the 1876 Centennial Exposition in Philadelphia, Americans celebrated one hundred years of independence by marveling at such inventions as Thomas Edison’s "multiplex" telegraph system, Alexander Graham Bell’s telephone, and Christopher Schole’s typewriter. One of these inventions, the carbon transmitter, was enlisted for uses such as the telephone and the electric hearing aid, which became commercially available in 1898. Hearing aids make sounds louder, either by mechanically funneling sound to the ear more directly or by electronic magnification. The first amplified hearing devices contained a battery-operated carbon transmitter and earphones. In 1898 the Akouphone Company marketed the "Akoulallion" (from the Greek verbs: to hear, to speak), a carbon table model hearing aid that sold for $400. The carbon-type hearing aids gave amplification near the low end and the middle speech frequency range. The carbon transmitter was replaced by the vacuum tube in the 1920s, and later by the transistor.

Finally, the period after the Civil War saw the creation of a new medical association. In 1896, a group of physicians practicing ophthalmology and/or otolaryngology in the central and southern part of the United States gathered in Kansas City at the invitation of Dr. Hal Foster. A two-day program of scientific papers was held, followed by the formation of a new society, the Western Ophthalmological, Otological, Laryngological and Rhinological Assocation. The society name changed to the Western Ophthalmologic and Otolaryngologic Association in 1898.

By 1903, the society was becoming more national in character; to reflect this, the name was changed to the American Academy of Ophthalmology and Otolaryngology. This organization prospered for seventy-five years. By 1978, the diverging interests of the two specialty areas reached a stage where separation seemed inevitable. A planned and orderly separation was carried out with the formation of two new organizations: the American Academy of Ophthalmology and the American Academy of Otolaryngology. In 1980, the American Academy of Otolaryngology added "Head and Neck Surgery" to its name. In 1982, the Academy merged with the American Council of Otolaryngology—Head and Neck Surgery. The new Academy and Foundation assumed the missions of both predecessor organizations, the socioeconomic and government relations responsibilities of the Council, and the educational responsibilities of the old Academy. 

The Academy and its predecessor organizations have made many contributions to American medicine. The largest two were the creation of the first medical specialty boards and the development of formal instruction courses during the annual meetings of medical societies. Both of these innovations have long since been accepted throughout American medicine and have proven to be pivotal factors in the development of continuing medical education in this country. 

Standardization and Alternative Methods for Tracheotomy
A key turning point in the history of the tracheotomy came early in the twentieth century with the work of Chevalier Jackson (1865-1958). His pioneering methodologies in laryngology helped to pave the way for high standards and low mortality rates in tracheotomy procedures.

While Chevalier Jackson's work greatly decreased the dangers associated with the tracheotomy, other developments in medicine reduced the need for the procedure. The development of an antiserum in 1893 decreased the occurrence of diphtheria, which caused a swelling of the throat. After 1913 it was no longer considered a serious threat. Sulfonamides also aided in the treatment of upper respiratory infections. Tracheotomies did regain popularity in the twentieth century as a treatment for respiratory obstruction caused by poliomyelitis, commonly known as polio, but this was eliminated by Jonas Salk's polio vaccine.

Morell Mackenzie and the nineteenth century tracheotomy of Crown Prince Frederick of Prussia and Germany.
.... While in Budapest, his interest in laryngoscopy was piqued by Johann Czermak. Czermak showed the young man how to use a new invention, the laryngoscope, which was only five years old at the time.  Morell Mackenzie returned to England and began to study medicine and write about laryngology in earnest. In 1861 he graduated from London University with his Bachelor of Medicine. A year later, he earned his Medicinae Doctor and opened his private practice as a physician laryngologist......
.......The story of Crown Prince Frederick begins several months before Dr. Mackenzie had been called from London. In 1887 Dr. Gerhardt, Professor of Clinical Medicine at the University of Berlin, attempted to remove what he diagnosed as a polyp from the throat of the 56 year old Prince. Dr. Gerhardt first employed a snare and finally used galvano-electric cautery to remove the "polyp". After thirteen of these procedures, Crown Prince Frederick felt better but his symptoms of hoarseness and vocal cord sluggishness soon returned.......
......November of 1887, Mackenzie was called to San Remo, Italy, where Crown Prince Frederick was spending his winter. Upon arrival Dr. Mackenzie discovered that Frederick's condition had worsened. In particular he found a new growth in the Prince's throat: "its appearance was altogether unlike that of the one which I had destroyed...it had in fact a distinctly malignant look." Mackenzie informed his patient that the diagnosis was most likely laryngeal cancer and told Crown Prince Frederick that he must decide how he wished his illness to be treated.

The Crown Prince was presented with two treatment options: excision of the larynx or tracheotomy. Frederick decided that when it became necessary, a tracheotomy would be performed. Mackenzie and the other consulting physicians issued an official report to Chancellor Bismark and Emperor William I on the Crown Prince's condition. The German press got ahold of the letter and broke the story of the Crown Prince's illness in all the national newspapers. Mackenzie was the leading physician treating Frederick at this time, but he was able to offer the ailing prince little more than constant checking of his condition and attempts to make him more comfortable. As the news of the Prince's condition spread, the press began to criticize Dr. Mackenzie's treatment of the patient and accused him of mismanaging the case.

In January of 1888 Frederick's condition worsened still and he required the palliative tracheotomy which he had approved as treatment for himself. The procedure was performed by a German physician, Dr. Bramann. Morell Mackenzie was retained as a member of the team of physicians monitoring the Crown Prince's health, but was no longer the leading physician in the case. Dr. Bramann and a colleague, Professor Geheimrath von Bergmann, were now in charge, monitoring the Prince's health and managing the tracheotomy tube. Of these two Dr. Mackenzie wrote: "[i]t certainly appeared to me that neither Professor von Bergmann nor Dr. Bramann, well-informed surgeons though they doubtless are in many matters, had had much experience in the sort of work they had now taken upon themselves to do."....
........It would be nearly a year before Mackenzie would publish his private feelings about the case in his book, The Fatal Illness of Frederick the Noble. Complaints regarding the suitableness of his fellow physicians was just one aspect of the book. Dr. Mackenzie further made a much more serious charge of malpractice. It was Mackenzie's belief that the incision made by Dr. Bramann when performing the tracheotomy was not centered properly. Combined with his accusation that the trachea tube inserted by Dr. Bramann was too large, Dr. Mackenzie states that the Crown Prince suffered irritation of the trachea and eventual complications in his condition that lead to his death.

Between January and March of 1888 the physicians surrounding the Crown Prince bickered regarding the Bramman tachea tube. The result was that Frederick was constantly being fitted with new trachea tubes and canulae. Seven trachea tubes and canulae of five different designs were used in all. One was designed by Dr. Mackenzie himself and named the San Remo canula after the city it was manufactured in. The results of these tubes were universal discomfort for the Crown Prince, coughing, and bleeding. Dr. Mackenzie noted that because the tracheotomy had been off-center, "a moderate-sized tube would have been likely to have wounded the walls of the trachea under the circumstances, but an enormous tube such as that (first) used by Bramann, would have been sure to have done so."

Two months after the operation, in March, Crown Prince Frederick's father, William I, died. This prompted Frederick to return from San Remo to Berlin. While he felt too ill to be present at the funeral he was crowned Emperor Frederick III of Prussia and Germany soon after. Emperor Frederick III was ill during his entire reign and Morell Mackenzie never left his side. On March 6th the Emperor restored Mackenzie as leading physician in the case, but as Mackenzie himself noted, "[the Emperor] was now a complete invalid."

On March 12th Morell Mackenzie felt that the tracheotomy tube needed, once again, to be replaced. As a matter of courtesy, Mackenzie agreed to allow Professor von Bergmann to replace the tube. Bergmann's attempt, however, was unsuccessful. Bergmann missed the tracheotomy hole and plunged the tube, instead, into the front of the Prince's neck creating what Mackenzie named "a false opening". This injury to the Emperor caused him much pain and quickly became infected. According to Mackenzie the infection drained the last of the Emperor's strength.......

Bibliography:
Otolaryngology: An Illustrated History Neil Weir, Butterworths, 1990.
Biographical History of Medicine John H. Talbott, 1970.
"Sir Morell Mackenzie Revisited" Ned I. Chalat Laryngoscope, Vol. 94 no. 10, 1984.
Morell Mackenzie R. Scott Stevenson, William Heinmann Medical Books, Ltd., London, 1946.
The Fatal Illness of Frederick the Noble Morell Mackenzie, Sampson Low, Martson, Searle, and Rivington, Ltd., London, 1888.

Link to 1892 tracheotomy article found below.
Diphtheria, which had been the subject of Dr. Middleton's prophetic lecture and which had brought me my first consultation call, also gave me one of the most tragic experiences in my early career.

It was in 1892 that I was called out into the night, a few miles in the country, to see a "little boy who was choking to death." Arriving I found a seven-year-old lad with membranous diphtheritic croup (in which the membrane forms in the windpipe instead of in the throat). The child was near death unless some immediate relief was given. But since the family doctor had prescribed whiskey I suggested perhaps that better be tried.

I left the home. Three hours later I was called back. The child was worse. Antitoxin, in this advanced case, would be of no avail. I told the family that the infection of the disease had progressed to such a stage that I feared nothing could be done to save his life; but that I could give him temporary relief by the insertion of a tracheotomy tube.

The little fellow was turning blue as I spoke. He was fighting, gasping for breath. His parents begged that I hurry, that I perform the operation without delay.

I had only a pocket instrument case and a tracheotomy tube that I had brought from the office. But there was no time to waste; so I proceeded. By the time I had scrubbed and had boiled the instruments the boy was practically unconscious.

His father held the kerosene lamp over the bed; it was the only light. His mother helped as I directed. Without any local anesthetic or anesthesia I opened the trachea and succeeded in inserting the tube. Then, with my own mouth, I sucked out that choking membrane through the tube.

As if by miracle, the child began breathing normally through the tube; his natural color returned; he became conscious and smiled wanly, albeit a bit puzzled.

The mother, sobbing with joy at this relief, clutched my arm. "Oh, doctor, even if he doesn't get well, you must know that I will always be thankful for what you have done."

The poor boy went out from his infection about a week later. He died with the tube still in his throat. His case is typical of what faced the country doctor in those days; twice pitiful in retrospect because with today's knowledge and equipment that life could have been saved.

Those who could have been saved by Tracheotomies:

George Washington
...........Dr. Dick made the plea that the General should not be depleted of more of his blood but should undergo tracheotomy for what he thought was an inflammation of the throat membranes (acute epiglottitis) rather than either quinsy (peritonsillar abscess) or cynanche trachealis (croup). Although unknown as a treatment in the United States, tracheotomy/tracheostomy was a well-accepted procedure in Europe since 1718 to relieve breathing distress. Ancient Eqypt (4400-4166 B.C.) was known to have used it as treatment! The two senior physicians were certainly concerned about treating their famous patient and did not want to perform any type of treatment never attempted in this country.
.................On Monday Dr. William Thornton, architect of the Capitol and well-trained physician originally from England dispatched a message to Mount Vernon requesting of Martha Washington that he be permitted to warm the corpse of Washington and perform a tracheotomy in an effort to restore Washington's life! Appropriately Mrs. Washington refused.

Ulysses S. Grant
Ulysses S. Grant was a man most commonly known for his victorious leadership in the Civil War, which was only comparable to his efforts to help mend a divided Union as the 18th President.

However, many do not know that Ulysses S. Grant was the only U.S. president to die of cancer. He was a popular general who enjoyed smoking cigars. He had begun this chronic habit at an early age, and once admitted to smoking as many as 12 cigars in one day.

This bad habit finally took its toll when Grant was diagnosed with a carcinoma of the right tonsillar pillar in early June 1884. The cancer was at the base of the tongue and was described as a malignant squamous epithelioma, which was a scaly, invasive, metastasizing growth. At the onset of his cancer, surgical and technological movements were not advanced enough to effectively control the carcinoma. Only meager topical applications of cocaine hydrochlorate solution or iodoform powder could be used to help suppress the pain.

Despite devoted care from his personal physician John H. Douglas, who tried desperately to keep Grant alive to finish his memoirs, he suffered a slow and painful illness until his death in 1885. Today, Grant's carcinoma could be treated in several fashions with the inventions of the aspiration pump, radiotherapy, tracheotomy, and surgery.

 

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