A History of Thoracic Drainage: From Ancient Greeks to Wound Sucking Drummers to Digital Monitoring

Tube thoracostomy is often the first step in the treatment of pneumothorax, hemothorax, hemopneumothorax, empyema, and pleural effusion. Although tube thoracostomy was not accepted as the standard of care for pneumothorax and hemothorax until the late 1950s (1), the idea of draining substances from the thoracic cavity has been documented for thousands of years (2, 3). For cardiothoracic surgeons today this basic skill is taken for granted and considered the simplest of the procedures now performed. There is little thought given to, or the awareness of, the rich history and gradual progression of this skill over the course of centuries that has brought us to our current understanding in the management of the chest tube. A review of this evolution provides us with a deeper appreciation of our specialty, and a new respect for the surgeons who have brought us this far. The oldest known reference to thoracic drainage dates back to the fifth century B.C.E. Hippocrates (c. 460-370 B.C) (3) was a pioneer of a rational view of disease, in which the four humors of the body – blood, phlegm, black bile, and yellow bile – must be in balance to preserve health (4). In the Hippocratic texts “empyemas” could occur in any part of the body and were not distinguished from abscesses, although the “empyemas” located in the thorax were described most often. Conservative treatment with medications composed of plant materials and physiotherapy exercises was attempted first. If the patient did not improve, open evacuation of the empyema was undertaken (4): First, cut the skin between the ribs with a bellied scalpel; then wrap a lancet with a piece of cloth, leaving the point of the blade exposed a length equal to the nail of your thumb, and insert it. When you have removed as much pus as you think appropriate, plug the wound with a tent of raw linen, and tie it with a cord; draw off pus once a day; on the tenth day, draw all of the pus, and plug the wound with linen. Then make an infusion of warm wine and oil with a tube, in order that the lung, accustomed to being soaked in pus, will not be suddenly dried out. When the pus is thin like water, sticky when touched with a finger, and small in amount, insert a hollow tin drainage tube. When the cavity is completely dried out, cut off the tube little by little, and let the ulcer unite before you remove the tube. (5) Despite the fact that the incision would have to be deeper than the length of a thumbnail to remove pus comprising an em