In accepting the invitation to deliver the Frank Billings lecture, I do so with humility and deep appreciation. The honor is the more highly valued because, in an association of over thirty years with Dr. Billings, I owe so much to the influence of his teaching, his example and his inspiring personality.
In all operative procedures involving the pleural cavity, whether pneumothorax therapy, draining an empyema, the withdrawal of fluid by means of an aspirating needle or merely an exploratory thoracentesis, there lurks the danger of so-called pleural shock. This may take the form of faintness, or at times loss of consciousness with a pulse that becomes weaker and weaker until it can no longer be detected by the finger. Rarely convulsions occur and death. When the patient recovers, there may be a transitory hemiplegia or weakness on one side.
It is my purpose in this paper to consider the