The evacuation of empyemas first performed centuries ago, marked the beginning of thoracic drainage. The subsequent acquisition of a greater knowledge of the anatomy, physiology, and pathology of the pleural space directed the design of thoracic catheters and drainage systems and the development of the methods by which they are used. Furthermore, a better understanding of the physics of vacuum and air flow brought about improvements in the use of suction with drainage. Today, thoracic catheters, chest drainage systems, and most vacuum sources are well designed and well made and incorporate components needed to achieve the best care of the pleural-mediastinal space. This review covers the development and important considerations in the current use of thoracic drainage.