The history of ventilation in the evolution of thoracic surgery.

The intrusion into the pleural space by surgeons was hindered for several hundred years by the realization that there were major pathophysiological alterations in ventilation and in circulation. The nature of this abnormality, although described very early on in history, went unrecognized until the end of the nineteenth century. The performance of thoracic surgery prior to that time and the development of different modes of ventilatory support are testimony to the intuition and inventiveness of the surgeons of that day. It is hard for the modern thoracic surgeon to fully comprehend the challenges that faced the early surgeon back when there was no such thing as positive pressure ventilation or unilateral lung ventilation. This article traces the origins of ventilation in man and their application to the development of thoracic surgery.