When one considers the modern surgical optimism regarding the treatment for pyoperitoneum and pyothorax, the reluctance which has characterized surgical drainage of purulent exudate from the pericardial sac seems difficult to appreciate. In a masterly treatise on this subject, Winslow and Shipley1 were able to collect only 118 recorded cases from the world's literature dealing with this subject.
Drainage of exudate contained in the pericardial sac was probably first suggested by Riolanus,2 in 1648. It was not until 1855, however, that drainage of the pericardial sac through an opening in the sternum was first practiced by the Frenchman, Malle.3 Larrey,4 in 1829, first successfully employed the xiphocostal route. It remained for Hilsmann, in 1844, to cure a patient of pyopericardium by the performance of pericardotomy. Little attention was paid to the procedure until 1879, when the classic report of Rosenstein focused attention on the possibilities of