Chapter 1 – Early History of Respiratory Care

Learning Objectives

(1 of 2)

• Define respiratory care and its scope.

• Summarize major scientific and medical events that directly shaped modern respiratory care.

• Explain how the respiratory-care profession originated.

• Describe historical development of each clinical area in respiratory care.

• Name key historical figures whose work influenced respiratory care.

(2 of 2)

• Identify modern respiratory-care educational, credentialing, and professional associations.

• Explain how these organizations began and evolved.

• Describe the growth of respiratory-care education programs.

History of Respiratory Medicine & Science

Ancient Times

• Early civilizations created herbal remedies for pulmonary disease.

• Foundation of modern medicine attributed to Hippocrates (Greek, 5^{th} – 4^{th} centuries BC).

• Hypothesized four body fluids: phlegm, blood, yellow bile, black bile.

• Believed air contained an essential substance delivered throughout the body via the heart.

• Ethical legacy: Hippocratic Oath—guides physicians’ moral conduct.

• Other notable thinkers:

  • Aristotle (342–322 BC): first comprehensive biologist.

  • Erasistratus (330–240 BC): advanced pneumatic theory of respiration (Egypt).

  • Galen (130–199 AD): anatomic studies; insisted that air carried a vital life force.

Middle Ages

• Fall of Rome (476 AD) slowed scientific progress.

• Intellectual rebirth began 12^{th} century.

• Leonardo da Vinci (1453–1519): Demonstrated lungs inflate via sub-atmospheric pressure.

• Andreas Vesalius (1514–1564): Performed human dissections; experimented with resuscitation techniques.

Enlightenment Period

• Joseph Black (1754): Characterized CO₂ (“fixed air”).

• Joseph Priestley (1774): Isolated O₂ (“dephlogisticated air”).

• Lazzaro Spallanzani: Described tissue respiration.

• Jacques Charles (1787): Related gas temperature ➔ volume (→ Charles’ Law).

• Thomas Beddoes (1778): Applied O₂ therapy at the Pneumatic Institute.

19^{th} & Early 20^{th} Centuries

• John Dalton (1801): Law of partial pressures (Dalton’s Law).

• Joseph Louis Gay-Lussac (1808): Gas temperature ↔ pressure relationship.

• Thomas Graham (1831): Law of diffusion for gases.

• Inventions:

  • 1846: Spirometer & ether anesthesia.

  • Louis Pasteur (1865): Germ theory—microorganisms cause disease.

  • Robert Koch (1882): Isolated tubercle bacillus; formulated Koch’s postulates.

  • William Roentgen (1896): Discovered x-rays ⇒ birth of radiology.

Development of the Respiratory-Care Profession

Chronology of the Profession

• 1940s: “O₂ technicians” transported cylinders & applied simple devices.

• 1950s: Positive-pressure breathing devices enter clinical use.

• 1960s: Formal inhalation-therapy education programs; advent of sophisticated mechanical ventilators ➔ larger RT role.

• Laboratory responsibilities added (arterial blood gases, pulmonary-function testing).

• 1974: Title “Respiratory Therapist (RT)” standardized.

• Profession expands beyond U.S./Canada; 1980: Respiratory Care Week established nationwide.

Oxygen Therapy

• 1907: Karl von Linde enables large-scale O₂ production.

• 1910: First oxygen tents.

• 1918: Introduction of O₂ masks.

• 1940s: Widespread prescription of O₂ therapy.

• Technological milestones:

  • Clark electrode (1960s): Direct P{aO2} measurement.

  • Ear oximeter (1974).

  • Pulse oximeter (1980s).

  • Venturi (Venti) mask (1960): Precise F{iO2} delivery.

  • Portable liquid O₂ systems for LTOT (1970s).

  • 21^{st}-century: Home concentrators w/ pressure boosters (self-refilling), lightweight portable concentrators.

Aerosol Medications

• 1910: Aerosolized epinephrine relieves asthma.

• Bronchodilators: Isoproterenol (1940), Isoetharine (1951).

• 1971: Aerosolized steroids for acute asthma.

• 1980: Albuterol (sulfate) released—still first-line SABA.

• 2000: Levalbuterol introduced (isomer-specific).

• Device innovation: Dry-powder inhalers (DPIs), advanced small-volume nebulizers (SVNs).

Mechanical Ventilation

• Negative-pressure era:

  • Philip Drinker’s Iron Lung (1928).

  • Jack Emerson improves design (polio epidemics, 1940s–1950s).

  • Chest cuirass & wrap ventilators (1950s).

• Positive-pressure lineage:

  • Dräger Pulmotor (1911), Spiropulsator (1934).

  • Bennett TV-2P (1948), Bird Mark 7 (1958).

  • Volume-cycled ventilators (1960s): Bennett MA-1, Ohio 560, Engström 300.

  • 1970s: Servo 900, Bourns Bear I/II, MA II.

  • 1980s: First microprocessor-controlled unit—Bennett 7200.

  • 21^{st}-century: Multimode, closed-loop ventilators.

  • Patient-safety insight: Endotracheal tubes increase risk of ventilator-associated pneumonia (VAP); non-invasive ventilation (NIV) mitigates risk when feasible.

Airway Management

• William MacEwen (1880) places first successful endotracheal tube.

• Laryngoscope invented (1913).

• First suction catheter described (1941).

• Low-pressure cuffs for ETTs introduced (1970s) to decrease tracheal injury.

Cardiopulmonary Diagnostics & PFT

• 1679: First measurement of deep-breath lung volume.

• 1800: Determined residual volume.

• John Hutchinson (1846): Water-sealed spirometer.

• Rapid ABG analyzers available (1967).

• Polysomnography routine by 1980s (sleep-disorder diagnostics).

Professional Organizations

Evolution of the Association

• Inhalational Therapy Association (ITA) founded 1947, Chicago.

• Renamed American Association for Inhalation Therapists (AAIT) 1954.

• Became American Association for Respiratory Therapy (AART) 1973.

• Current American Association for Respiratory Care (AARC) since 1982.

• Membership reached 50{,}000 by 2014.

Credentialing & Licensure

• National Board for Respiratory Care (NBRC): Administers entry-level (CRT) & registry (RRT) exams.

• State licensure (began 1980s) mandates:

  • Passing NBRC exam(s).

  • Minimum education standards.

  • Ongoing continuing-education units (CEUs) for renewal.

AARC Functions

• Advocacy with legislators, regulators, insurers, public.

• Continuing education: Conferences, online learning (earn CEUs).

• Publications: Respiratory Care (scientific journal) & AARC Times (news magazine).

• Specialty Sections: 10 subspecial-interest groups.

• Tripartite Support (AARC–NBRC–CoARC, 2002): Urged all RTs to achieve RRT credential.

Honors & Subsidiary Bodies

• FAARC (Fellow of AARC): Recognizes superior professional achievement & volunteerism.

• Board of Medical Advisors (BOMA): Physician advisory panel.

• American Respiratory Care Foundation (ARCF): Non-profit funding research & advanced training.

• International Council for Respiratory Care (ICRC): Promotes global standards & collaboration.

Professional Events

• Respiratory Care Week: Third week of October (annual).

• Raises public lung-health awareness.

• Showcases RT contributions across care settings.

• Opportunity for RT students to act as ambassadors on campus.

Respiratory-Care Education

Historical Growth

• First formal program: Chicago, 1950.

• 1960s: Rapid expansion—mostly hospital-based schools.

• Current U.S. landscape (approx.):

  • 443 associate-degree programs.

  • 1 in Puerto Rico.

  • 11 graduate-degree programs.

  • International programs: Canada, Mexico, South America, Japan, India, Taiwan, Qatar, others.

• AARC 2003 White Paper: Encouraged more baccalaureate & graduate programs.

Workforce Demand & Educational Imperative

• Aging “baby-boomer” cohort: Greater prevalence of asthma, COPD, cardiopulmonary disease.

• Technological complexity ⇒ RTs need advanced knowledge & skills.

• Tripartite Statement (2002): Endorsed universal pursuit of RRT credential.

Ethical, Philosophical & Practical Implications

• *Hippocratic

###### History of Respiratory Medicine & Science Ancient Times - Early civilizations created herbal remedies for pulmonary disease. - Foundation of modern medicine attributed to Hippocrates (Greek, 5^{th} – 4^{th} centuries BC). - Hypothesized four body fluids: phlegm, blood, yellow bile, black bile. - Believed air contained an essential substance delivered throughout the body via the heart. - Ethical legacy: Hippocratic Oath—guides physicians’ moral conduct. - Other notable thinkers: - Aristotle (342–322 BC): first comprehensive biologist. - Erasistratus (330–240 BC): advanced pneumatic theory of respiration (Egypt). - Galen (130–199 AD): anatomic studies; insisted that air carried a vital life force. Middle Ages - Fall of Rome (476 AD) slowed scientific progress. - Intellectual rebirth began 12^{th} century. - Leonardo da Vinci (1453–1519): Demonstrated lungs inflate via sub-atmospheric pressure. - Andreas Vesalius (1514–1564): Performed human dissections; experimented with resuscitation techniques. Enlightenment Period - Joseph Black (1754): Characterized CO₂ (“fixed air”). - Joseph Priestley (1774): Isolated O₂ (“dephlogisticated air”). - Lazzaro Spallanzani: Described tissue respiration. - Jacques Charles (1787): Related gas temperature ➔ volume (→ Charles’ Law). - Thomas Beddoes (1778): Applied O₂ therapy at the Pneumatic Institute. 19^{th} & Early 20^{th} Centuries - John Dalton (1801): Law of partial pressures (Dalton’s Law). - Joseph Louis Gay-Lussac (1808): Gas temperature ↔

pressure relationship. - Thomas Graham (1831): Law of diffusion for gases. - Inventions: - 1846: Spirometer & ether anesthesia. - Louis Pasteur (1865): Germ theory—microorganisms cause disease. - Robert Koch (1882): Isolated tubercle bacillus; formulated Koch’s postulates. - William Roentgen (1896): Discovered x-rays ⇒ birth of radiology.

###### Development of the Respiratory-Care Profession Chronology of the Profession - 1940s: “O₂ technicians” transported cylinders & applied simple devices. - 1950s: Positive-pressure breathing devices enter clinical use. - 1960s: Formal inhalation-therapy education programs; advent of sophisticated mechanical ventilators ➔ larger RT role. - Laboratory responsibilities added (arterial blood gases, pulmonary-function testing). - 1974: Title “Respiratory Therapist (RT)” standardized. - Profession expands beyond U.S./Canada; 1980: Respiratory Care Week established nationwide. Oxygen Therapy - 1907: Karl von Linde enables large-scale O₂ production. - 1910: First oxygen tents. - 1918: Introduction of O₂ masks. - 1940s: Widespread prescription of O₂ therapy. - Technological milestones: - Clark electrode (1960s): Direct P
*aO*2 measurement. - Ear oximeter (1974). - Pulse oximeter (1980s). - Venturi (Venti) mask (1960): Precise F
*iO*2 delivery. - Portable liquid O₂ systems for LTOT (1970s). - 21^{st}-century: Home concentrators w/ pressure boosters (self-refilling), lightweight portable concentrators. Aerosol Medications - 1910: Aerosolized epinephrine relieves asthma. - Bronchodilators: Isoproterenol (1940), Isoetharine (1951). - 1971: Aerosolized steroids for acute asthma. - 1980: Albuterol (sulfate) released—still first-line SABA. - 2000: Levalbuterol introduced (isomer-specific). - Device innovation: Dry-powder inhalers (DPIs), advanced small-volume nebulizers (SVNs). Mechanical Ventilation - Negative-pressure era: - Philip Drinker’s Iron Lung (1928). - Jack Emerson improves design (polio epidemics, 1940s–1950s). - Chest cuirass & wrap ventilators (1950s). - Positive-pressure lineage: - Dräger Pulmotor (1911), Spiropulsator (1934). - Bennett TV-2P (1948), Bird Mark 7 (1958). - Volume-cycled ventilators (1960s): Bennett MA-1, Ohio 560, Engström 300. - 1970s: Servo 900, Bourns Bear I/II, MA II. - 1980s: First microprocessor-controlled unit—Bennett 7200. - 21^{st}-century: Multimode, closed-loop ventilators. - Patient-safety insight: Endotracheal tubes increase risk of ventilator-associated pneumonia (VAP); non-invasive ventilation (NIV) mitigates risk when feasible. Airway Management - William MacEwen (1880) places first successful endotracheal tube. - Laryngoscope invented (1913). - First suction catheter described (1941). - Low-pressure cuffs for ETTs introduced (1970s) to decrease tracheal injury. Cardiopulmonary Diagnostics & PFT - 1679: First measurement of deep-breath lung volume. - 1800: Determined residual volume. - John Hutchinson (1846): Water-sealed spirometer. - Rapid ABG analyzers available (1967). - Polysomnography routine by 1980s (sleep-disorder diagnostics).

###### Professional Organizations Evolution of the Association - Inhalational Therapy Association (ITA) founded 1947, Chicago. - Renamed American Association for Inhalation Therapists (AAIT) 1954. - Became American Association for Respiratory Therapy (AART) 1973. - Current American Association for Respiratory Care (AARC) since 1982. - Membership reached 50{,}000 by 2014. Credentialing & Licensure - National Board for Respiratory Care (NBRC): Administers entry-level (CRT) & registry (RRT) exams. - State licensure (began 1980s) mandates: - Passing NBRC exam(s). - Minimum education standards. - Ongoing continuing-education units (CEUs) for renewal. AARC Functions - Advocacy with legislators, regulators, insurers, public. - Continuing education: Conferences, online learning (earn CEUs). - Publications: Respiratory Care (scientific journal) & AARC Times (news magazine). - Specialty Sections: 10 subspecial-interest groups. - Tripartite Support (AARC–NBRC–CoARC, 2002): Urged all RTs to achieve RRT credential. Honors & Subsidiary Bodies - FAARC (Fellow of AARC): Recognizes superior professional achievement & volunteerism. - Board of Medical Advisors (BOMA): Physician advisory panel. - American Respiratory Care Foundation (ARCF): Non-profit funding research & advanced training. - International Council for Respiratory Care (ICRC): Promotes global standards & collaboration.

###### Professional Events - Respiratory Care Week: Third week of October (annual). - Raises public lung-health awareness. - Showcases RT contributions across care settings. - Opportunity for RT students to act as ambassadors on campus.

###### Respiratory-Care Education