Pleural effusion historical perspective

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2]; Nate Michalak, B.A.

Historical Perspective

  • Pleural infection was first described by Hippocrates circa 460-370 B.C.[1] During this time open chest drainage was the sole treatment modality and was associated with high mortality.
  • In 1300s, Guy de Chauliac also called Guido or Guigo de Cauliaco, a surgeon of medieval France, commented with surprise on the lack of ancient writings concerning thoracic wounds and the disagreements on the treatment of these wounds. Lanfranc of Paris, William of Bologna, and Roland of Parma advocated that open treatment of penetrating thoracic wounds using tents and drains allow blood and decaying organic materials to escape. However, Henri de Mondeville debated that immediate closure of wounds helps to prevent heat loss and air entry.[2]
  • During the early 1500s, Giovanni da Vigo, an Italian surgeon and physician of Pope Julius II, was one of the first surgeons to discuss firearm wounds to the chest.[2]
  • In 1873, Playfair gave the first description of a water-seal chest drainage system in the treatment of a child with thoracic empyema.[3]
  • In 1875, Gotthard Bülau a German internist described the use of closed water-seal chest drainage to treat an empyema as an alternative to the standard rib resection and open tube drainage. He punctured the pleural membrane with trocar and introduced a rubber catheter into the pleural cavity. The free end of the catheter inserted in a bottle one-third full of solution allowing pus to flow freely from the chest into the bottle.[4][5]
  • Closed chest tube drainage was experimentally practiced during the influenza epidemic in 1917–19 when open surgical drainage was associated with a high mortality rate. This coincided with World War I and the resultant crisis of streptococcal pneumonia and empyema.[6]
  • In 1950, Vincenzo Monaldi an Italian pulmonologist suggested draining the thoracic cavity with a more superior approach at the second or third intercostal space.[7]
  • The modern three chamber thoracic drainage system was first described by Howe in 1952 but not widely employed at the time.[8]
  • Closed chest tube drainage became the standard of treatment from late 1950.[9]


  1. FRANCE, JOHN (2010). [URL: Journal of Medieval Military History: Volume VIII] Check |url= value (help). Boydell Press, Boydell & Brewer. p. 206. ISBN 9781843835967.
  2. 2.0 2.1 LINDSKOG GE (1961). "Some historical aspects of thoracic trauma". J Thorac Cardiovasc Surg. 42: 1–11. PMID 13762404.
  3. Munnell ER (1997). "Thoracic drainage". Ann Thorac Surg. 63 (5): 1497–502. PMID 9146363.
  4. Meyer JA (1989). "Gotthard Bülau and closed water-seal drainage for empyema, 1875-1891". Ann Thorac Surg. 48 (4): 597–9. PMID 2679468.
  5. Van Schil PE (1997). "Thoracic drainage and the contribution of Gotthard Bülau". Ann Thorac Surg. 64 (6): 1876. PMID 9436605.
  6. Peters RM (1989). "Empyema thoracis: historical perspective". Ann Thorac Surg. 48 (2): 306–8. PMID 2669652.
  7. Knobloch K (2008). "eComment: A tribute to Gotthard Bulau and Vincenzo Monaldi". Interact Cardiovasc Thorac Surg. 7 (6): 1159. doi:10.1510/icvts.2008.181750A. PMID 19029391.
  8. HOWE BE (1951). "Evaluation of chest suction with an artificial thorax". Surg Forum: 1–7. PMID 14931188.
  9. Monaghan SF, Swan KG (2008). "Tube thoracostomy: the struggle to the "standard of care"". Ann Thorac Surg. 86 (6): 2019–22. doi:10.1016/j.athoracsur.2008.08.006. PMID 19022041.

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