HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): John A. Meyer Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Meyer, J. A. Search for Related Content PubMed PubMed Citation Articles by Meyer, J. A.

Ann Thorac Surg 1989;48:597-599
© 1989 The Society of Thoracic Surgeons

---

Articles

Gotthard Bülau and Closed Water-Seal Drainage for Empyema, 1875–1891

Department of Surgery, State University of New York Health Science Center, Syracuse, New York

^* Address reprint requests to Dr Meyer, 750 E Adams St, Syracuse, NY 13210

Optimal treatment of pleural empyema remains controversial to the present day. In the preantibiotic era, surgical thinking favored early and aggressive drainage of closed-space infections, but the dynamics of the pleural space were poorly understood and open pneumothorax generally was considered the necessary price of surgical drainage. Against bitter opposition, revision of the dogma of early open drainage was achieved in 1918 by Evarts Graham and his associates on the US Army's Empyema Commission. Unacceptable mortality rates for early drainage were brought under control through a treatment program of repeated tapping, with surgical drainage only after loculation had occurred. Paradoxically, closed water-seal drainage for empyema had been used by a German internist, Gotthard Bülau, as early as 1875. His technique was published in 1891, 27 years before the report of the Empyema Commission. As a closed system, it would have been suited to empyema drainage in either the early diffuse or the loculated stages. Thoracotomy was not possible at the time, and Bülau probably could not foresee the future importance of his method to surgery.

This article has been cited by other articles:

				N. M. Rahman and N. A. Maskell Pleural infection on the increase but with a better evidence base to inform clinical care Thorax, August 1, 2011; 66(8): 649 - 650. [Full Text] [PDF]

				H. E. Davies, R. J. O. Davies, C. W. H. Davies, and on behalf of the BTS Pleural Disease Guideline Gro Management of pleural infection in adults: British Thoracic Society pleural disease guideline 2010 Thorax, August 1, 2010; 65(Suppl_2): ii41 - ii53. [Full Text] [PDF]

				S. Mattioli, R. G. Berrisford, M. L. Lugaresi, and B. Aramini Survey on chest drainage systems adopted in Europe Interact CardioVasc Thorac Surg, December 1, 2008; 7(6): 1155 - 1159. [Abstract] [Full Text] [PDF]

				C W H Davies, F V Gleeson, and R J O Davies BTS guidelines for the management of pleural infection Thorax, May 1, 2003; 58(90002): ii18 - 28. [Full Text]

				F. C. Aboud and A. C. Verghese Evarts Ambrose Graham, Empyema, and the Dawn of Clinical Understanding of Negative Intrapleural Pressure Clinical Infectious Diseases, January 15, 2002; 34(2): 198 - 203. [Abstract] [Full Text] [PDF]

				E. Jadczuk Postpneumonectomy empyema Eur J Cardiothorac Surg, August 1, 1998; 14(2): 123 - 126. [Abstract] [Full Text] [PDF]

				P. E. Van Schil and E. R. Munnell Thoracic Drainage and the Contribution of Gotthard Bulau Ann. Thorac. Surg., December 1, 1997; 64(6): 1876 - 1876. [Full Text]