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Ann Thorac Surg 1997;64:1876
© 1997 The Society of Thoracic Surgeons

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Correspondence

Thoracic Drainage and the Contribution of Gotthard Bülau

Division of Thoracic and Vascular Surgery, Department of Surgery, University Hospital of Antwerp Wilrijkstraat 10, B-2650 Edegem, Belgium e-mail: vanschil{at}uia.ua.ac.be

To the Editor:

I read with great interest the collective review by Dr Munnell [1] giving an interesting and detailed review about the history and principles of thoracic drainage systems.

In Europe we often use the term "Bülau drainage" when talking about thoracic drainage, and the important contribution of Gotthard Bülau should be mentioned. This German internist for the first time used the principle of closed chest drainage in 1875 to treat a pleural empyema in a 35-year-old carpenter admitted with a pleuropneumonia. Bülau introduced a catheter into the pleural space after puncturing it with an external trocar. The catheter was subsequently connected to a siphon apparatus to drain the empyema. Bülau also stressed the importance of a negative intrapleural pressure for reexpansion of a collapsed lung. His technique was published in 1891 [2], and in 1989 The Annals dedicated a Classic in Thoracic Surgery to him, acknowledging the important contribution of this German internist to our current daily practice of thoracic surgery [3].

References

1. Munnell ER. Thoracic drainage. Ann Thorac Surg 1997;63:1497–502.[Abstract/Free Full Text]
2. Bülau G. Für die Heber-Drainage bei Behandlung des Empyems. Z Klin Med 1891;18:31–45.
3. Meyer JA. Gotthard Bülau and closed water-seal drainage for empyema, 1875–1891. Ann Thorac Surg 1989;48:597–9.[Abstract]

Reply

Section of Cardiothoracic Surgery, University of Oklahoma Health Sciences Center, Po Box 26901, Oklahoma City, OK 73190

To the Editor:

It is beneficial that Dr Van Schil has identified the early work of Gotthard Bülau on chest drainage in Europe.

It is most likely closed drainage of the pleural space originated in England. The reported sequence is as follows: G. E. Playfair operated on June 27, 1873, and published in 1875 [1]; and F. Cresswell Hewett reported a case in 1876 [2]. It is also likely Gotthard Bülau was not aware of Playfair's work and thus acted independently on May 4, 1875 (published in 1891) [3].

In early drafts of my article on thoracic drainage a lengthy historical section recognizes both Hewett and Bülau. However, for easier reading and because of publishing constraints, shortening of the collective review was necessary.

References

1. Playfair GE. Case of empyema treated by aspiration and subsequently by drainage: recovery. Br Med J 1875;1:45.[Free Full Text]
2. Hewett FC. Thoracentesis: the plan of continuous aspiration. Br Med J 1976;1:317.
3. Bülau G. Für die Heber-Drainage bei Behandlung des Empyems. Z Klin Med 1891;18:31–45.

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