A Letter from William Hallett, M. D. to Henry Pemberton, M. D. F. R. S. & Chem. Prof. Gresham; Containing the Case of a Lad, Who was Shot through the Lungs; Drawn up by Mr. Nich. Peters Junior, Surgeon

V. A Letter from William Hallett, M.D. to Henry Pemberton, M.D. F.R.S. & Chem. Prof. Gresham; containing the Case of a Lad, who was shot through the Lungs; drawn up by Mr. Nich. Peters junior, Surgeon. To Dr. Pemberton. Dear Sir, Exeter, Sept. 21. 1744. I have now sent you the remarkable Case, which I shew'd you lately when you were at my House, of a Lad who was shot in the Lungs. It is drawn up by Mr. Peters, his Surgeon; and you have it under, in his own Hand. To Dr. Hallett, at Exeter. SIR, Topsham, Sept. 12. 1744. According to your Request, I send you the Case of James Channon; which, as it was pretty remarkable from the Beginning, I then noted down; so that you have the Symptoms related not barely from Memory, but as they were in Fact when they occurr'd. I am, SIR, Your most humble Servant, Nich. Peters, junior. Dec. 28. 1737. James Channon, aged about 14, was accidentally shot in his Back by another Lad, at the Distance of two Yards from him; so that the whole Load of Shot, not having Space to scatter, enter'd like a Ball, by the Edge of the Left Scapula, which it splinter'd; and, slanting upward, pass'd between the two superior Ribs, and fractur'd the Clavicle; the Resistance of which Bone hinder'd their Passage thro' the Skin; for some of them lay immediately on the fractur'd Part, cover'd only by the Cutis; which, with a Touch of the Incision-Knife, I took out, in Number about a Dozen: They were the small Mustard-seed Shot. After reducing the Fracture, I drew off ten Ounces of Blood (he having lost but very little by the Wound); and treated the Wound in his Back as usual in Gun-shot Wounds; and the Fever which attended it, as a common symptomatic Fever. In 8 or 9 Days time a plentiful Suppuration came on, and his Fever abated. Towards the Middle of January, the Discharge of fetid Pus was so great, not only through the Wound, but also by Expectoration, that I thought he could not long survive it: At each Time of Dressing (which was Morning and Evening, till the Quantity lessen'd) full six Ounces of Pus were discharg'd: The like Quantity he would generally cough up between the Dressings. When the Dressings were removed, I frequently made him force a Cough, and try if he could not throw out any Pus by his Mouth; but, instead of passing that Way, it flew out thro' the Wound, like Water from a Pump: If I blocked up the Wound with Tow, he could then freely discharge it by the Mouth. When the Matter had done flowing, the Air which was forc'd thro' the Wound by Coughing, would blow out a Candle, which I often experienced. experienced. The Matter was so prodigiously fetid, that, for some time after he was dress'd, the Stink in the Chamber was scarce tolerable; and it was near the Middle of March before the Discharge began to abate. In this Space of Time he cough'd up 25 Shot; had frequently hectic Heats, and Night-Sweats; a quick feverish Pulse return'd constantly towards Evening, with great Thirst; he had lost his Appetite, and was greatly emaciated; his chief Food was Milk, and Physick the Bark. In order to give a free Passage to the Matter thro' the Wound, and prevent the Stink from killing him (as the poor Boy expressed it), by coming through the Mouth, I had for some time kept a Cannula in the Wound; but, in less than a Fortnight, I found myself obliged to leave it quite out; for tho' it answer'd the End of giving the Matter a free Passage that Way, and prevented its coming by the Mouth, yet the Quantity thro' the Wound increased daily, and his hectic Heats became more violent. Seeing no Prospect of any End to be put to the Discharge of Matter, it keeping up to its usual Quantity for a Month or 6 Weeks longer, and the poor Boy reduced to a meer Skeleton, I was determined, if possible to heal the Wound, and commit the Event to Nature; there not being one favourable Symptom to give the least Hope of his Recovery. About the Middle of June the Wound was quite cicatriz'd, 2 or 3 Exfoliations being first cast off from the Scapula. His Cough still continued with a Discharge of the same fetid Pus, but in three Weeks it began to abate; and, towards the latter End of July, he had gain'd Flesh, and his Cough had left him; he walked walked abroad, and was, to Appearance, quite recover'd. But this fair Prospect did not last long; for, towards the latter End of August, I was called to him in the Night, and found him supported in the Bed, with a Half-pint Basin in his Hand, almost full of the same Sort of stinking putrid Matter, which he used to cough up: It had been emptied but a Quarter of an Hour before, so that, in less than half an Hour, he had expectorated a full Pint. This Cough continued upon him 16 Hours longer; when, the Load of Matter being pump'd up, he grew much better. Two or three Days before this severe Attack, he had complained of being faint, feverish, and strait at the Breast, for which he was bled, &c. In this Fit of Coughing, he brought up with the Pus 14 Shot. He had three of these violent Returns before the Summer was quite over, which reduced him nearly to his former weak State, but discharged no Shot. In November following, I laid on a Caustic to the Cicatrix of the Wound in his Back; and kept it open with a large Bean, to try if a Discharge, by way of Issue, might divert the Matter from coming by the Mouth: He had no such violent Seizures afterward, but still a hectic Cough upon him, which expectorated a small Quantity of the same fetid Pus: The Discharge from the Issue was pretty considerable, and he weather'd out the Winter tolerable well. In March 1739, he grew feverish, and complain'd of a great Load and Pain just above the Diaphragm, on the Left Side: I applied a warm Plaister, and drew off ten Ounces of Blood, which I found was pretty much inflamed. A few Days afterwards an Abscess formed between the Ribs, where he had before complained. plained of the Pain; which I opened, and discharged about four Ounces of the same fetid Matter, and 18 Shot. Here was a true Empyema, and I had now great Hopes of a Cure, Nature having pointed out such a depending Part, for a Discharge of what Matter might be lodged in the Thorax. I then healed up the Issue in his Back, and kept this new Wound open with a Cannula; but, within ten Days, the Matter had ceased flowing, his feverish Symptoms again increas'd, and his Cough return'd with a Discharge of the same putrid Matter. I threw aside the Cannula, and healed the Wound between the Ribs, it answering no End to keep it open longer. The remaining Part of the Year 1739, he had several Returns of his Cough, with pretty large Expectorations, but they were not of long Continuance; frequent Bleedings, a Milk-Diet, and vulnerary Medicines, were made use of. In the Years 1740, 41, 42, towards Spring and Autumn, he generally was seized with a Difficulty of Breathing, and Pain of the Side: Bleeding would relieve him for the present, but it seldom ended without a Discharge of the same Sort of Pus by Coughing, and with it, sometimes, one or two Shot. At the latter End of the Summer 1741, he had an Abscess formed in the left Side, between the true and spurious Ribs: I open'd it, and with the Matter discharged 9 Shot. Between these grand Fits of Coughing (if I may so call them), which happen'd three or four Times in the Year, he would gain Strength, grow fat, and work at his Trade of Glove-making. Towards the latter End of March 1743, his Cough return'd again with the same usual Violence, and the Discharge in One Night was a full Pint of fetid bloody Pus; half that Quantity was expectorated next Day. He had the same feverish Symptoms a few Days before this Cough, as usual, but rather more severe. It continued upon him 8 Days before it began to abate. No Shot were discharged at this time, as was expected; but he coughed up a broad Scale of a Bone, ragged at the Edges, and of an irregular Shape, which, I imagine, was a Part of the Scapula. A few Weeks after this he was taken into your Hospital. Thus far Mr. Peters. He had the Benefit of the Devon and Exeter Hospital, under my Care for 15 Months; during which Time he was hectic, had sometimes pleuritic Pains, for which he was often bled, and took soft Pectorals. He frequently spit Pus in great Quantities. I confin'd him to a Milk-Diet; order'd him Balsamics, particularly Bals. Locatelli in an Electuary. He is now healthy, strong, and fat; and frequently walks from Topsham to Exeter, which is near four Miles, and returns the same Day. I am &c. William Hallett.