The authors review the ancient history of tracheotomy and bring the subject up to date (2008) by including the modern history of this procedure. In the past 60 years, there have been many advances in the knowledge of respiratory function that have been utilized to expand applications of the tracheotomy procedure. Improvements in the care of tracheotomized patients and the application of modifications in the available variety of tubes and ancillary equipment and procedures have made this a much more effective and widely utilized way of caring for the pulmonary cripple as well as utilizing it in the classical fixed obstruction of the upper airway.