Title: An Investigation into the Nature of Black Phthisis - or Ulceration Induced by Carbonaceous Accumulation in the - Lungs of Coal Miners
Author: Makellar, Archibald
Language: English
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AN INVESTIGATION

INTO THE NATURE OF

BLACK PHTHISIS;

OR

ULCERATION INDUCED BY CARBONACEOUS ACCUMULATION

IN

THE LUNGS OF COAL MINERS,

AND OTHER OPERATIVES.


BY

ARCHIBALD MAKELLAR, M.D., F.R.S.S.A.,

FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS OF EDINBURGH; MEMBER OF THE
MEDICO-CHIRURGICAL SOCIETY, OF THE HARVEIAN SOCIETY, OF THE OBSTETRICAL
SOCIETY, ETC. ETC., AND ONE OF THE PHYSICIANS TO THE NEW TOWN DISPENSARY
OF EDINBURGH.


REPRINTED FROM THE MONTHLY JOURNAL OF MEDICAL SCIENCE.


EDINBURGH:

SUTHERLAND & KNOX, 58 PRINCES STREET.

1846.



ANDREW JACK, PRINTER, EDINBURGH.



PREFACE.


An abstract of the investigations into the nature of carbonaceous
infiltration into the pulmonary tissues of coal miners, was read by Dr
Makellar at a meeting of the Medico-Chirurgical Society of Edinburgh,
Wednesday, 8th July, 1845, Dr Gairdner, President, in the Chair.

Reference was made, in particular, to the East Lothian coal-miners. The
carbonaceous disease described, was stated to be caused by the
inhalation of substances floating in the atmosphere of the coal-pit,
such as the products of the combustion of gunpowder, the smoke from the
miner's lamp, and the other foreign matters with which the air of the
mines is heavily charged, in consequence of their defective ventilation.
In the mines in which gunpowder is used, the disease is most severe in
its character, and most rapid in destroying the pulmonary tissue. The
carbon in some cases is expectorated in considerable quantity for some
time previous to death; in others, it is retained, and accumulates to a
great extent in the lungs.

As the disease advances, the action of the heart becomes feeble; and the
appearance of the blood indicates a carbonaceous admixture. The
carbonaceous deposit seems to supersede or supplant the formation of
other morbid bodies in the substance of the lungs--such as tubercle; for
in individuals belonging to families in which there exists an undoubted
phthisical diathesis, tubercle is never found on dissection.

The views expressed in this communication called forth the following
remarks.

PROFESSOR CHRISTISON called attention to the new and important fact, of
the carbonaceous matter being found in the circulating mass. He attached
great importance to Dr Makellar's researches.

PROFESSOR ALLEN THOMSON remarked, that the presence of this carbonaceous
matter in the blood, by no means proved, that it was formed in, or from
the blood.

DR HUGHES BENNETT said, that the antagonism of this carbonaceous disease
to tubercle, was a fact of great interest and importance, especially in
connection with two other recent observations; viz. 1st, That the
depositions of carbon in the lungs of old people, (which French
pathologists describe,) are not found associated with tubercle; and, 2d,
That under the supposed cicatrices of pulmonary tubercular cavities, a
layer of carbonaceous matter is commonly found.

Dr Makellar's paper called forth some interesting observations from the
President, Professor Simpson, and others.



BLACK PHTHISIS,

OR

ULCERATION INDUCED BY CARBONACEOUS ACCUMULATION IN THE LUNGS OF
COAL-MINERS


Among the many diseases incident to the coal-miner, none come oftener
under medical treatment, than affections of the respiratory and
circulating organs. While the collier is subject--during his short but
laborious life--to the other diseases which afflict the labouring
classes in this country, such as inflammations, fevers, acute
rheumatism, and the various eruptive diseases, he, at last, unavoidably,
falls a victim to lesions within the cavity of the chest, arising from
the nature of his employment. In the present communication, it is
proposed to lay before the profession a series of remarks, which I have
been enabled to put together, with a view to elucidate the cause and
progress of that very peculiar pulmonary disease, incident to
coal-miners, which I shall denominate BLACK PHTHISIS, or Ulceration
induced by Carbonaceous Accumulation in the Lungs.

The rise and progress of the malady may be thus sketched: A robust young
man, engaged as a miner, after being for a short time so occupied,
becomes affected with cough, inky expectoration, rapidly decreasing
pulse, and general exhaustion. In the course of a few years, he sinks
under the disease; and, on examination of the chest after death, the
lungs are found excavated, and several of the cavities filled with a
solid or fluid carbonaceous matter.

During the last ten years, my attention has been much directed, in the
course of my professional labours in the neighbourhood of the
coal-mining district of Haddingtonshire, to the above phenomena in the
pathology of the lungs, which have not hitherto been brought so fully
before the profession, as their importance demands. The subject presents
a very interesting field of investigation to the physiologist and
pathologist.

When we consider the difficulties which the medical man has to
encounter, in prosecuting his researches in morbid anatomy in a mining
district, it is sufficiently explained why the peculiarly diseased
structures in the body of the coal-miner should have been left so long
uninvestigated.

Not many years ago, the obstacles in the way of _post mortem_
examinations among colliers were insurmountable, and consequently, till
lately, few medical men could obtain permission to examine, after death,
the morbid appearances within the chest of a collier. With the rapid
advance in the general improvement which has been going on, the
collier's position in society has become greatly elevated; and his
deeply-rooted superstitious feelings have been, to a great extent,
dissipated. Let us hope that the school-master will find his way into
every collier's dwelling, enlightening his too long uncultivated mind;
and that the foolish prejudices shall cease, which have been hitherto
the barriers to _post-mortem_ examinations in his community.

The only medical writers, as far as I am aware, who have brought this
subject before the notice of the profession, are, Dr J. C. GREGORY, in
the report of a case of peculiar black infiltration of the whole lungs,
resembling "Melanosis," (_Edinburgh Medical and Surgical Journal_, No.
cix., October 1831); Dr CARSEWELL, in an article on "Spurious
Melanosis," (_Cyclopædia of Practical Medicine_, Vol. iii); Dr MARSHALL,
in a paper in _The Lancet_ for 1836, entitled "Cases of Spurious
Melanosis of the Lungs;" Dr WILLIAM THOMSON, now Professor of Medicine
in the University of Glasgow, in two able essays (_Medico-Chirurgical
Transactions of London_, Vols. xx. and xxi.), wherein he gives a number
of very interesting cases, collected from various coal districts of
Scotland, illustrating different forms of the disease; Dr PEARSON, in
the _Philosophical Trans._ for 1813, on the "Inhalation of Carbon into
the Pulmonary Air Cells;" and in a paper, by Dr GRAHAM, in vol. xlii. of
the _Edinburgh Medical and Surgical Journal_.

Recently, professional and other writers have directed attention to the
influence of various occupations in the production of diseases of the
chest. The pernicious employment of the needle-pointers, razor and
knife-grinders of Sheffield, and other manufacturing towns in
England,[1] have not only engaged the attention of the public at large,
but science has been at work to ascertain, with as much accuracy as
possible, the relative effects of the different avocations, on the
constitutions of those occupied in these destructive employments.
Researches of this nature tend much to the well-being of society, as
they make us acquainted with the maladies and sufferings peculiar to
certain classes of our fellow-men; and point out, also, the causes of
their early decay, and premature death. The coal-miners--those in whose
behalf I would now solicit the intervention of science--are most
valuable in their place, and their exhausting labours promote, in no
small degree, our domestic comforts.

Some of the diseases of colliers have in past time been very much
overlooked by the medical inquirer. There has been, within the last few
years, a very searching investigation as to the employment of women and
children in coal-mines; and by the laudable exertions of Lord Ashley--a
nobleman whose name shall ever be honoured among miners, and by all who
have the true interests of that community at heart--an Act of the
Legislature has been passed, declaring it unlawful for any owner of any
mine or colliery whatever, to allow any female to work therein; and also
enacting, that no boy under the age of ten years can be employed in
mines. It is to be regretted, however, that his Lordship did not embody
in his measure, provisions enforcing the free ventilation of mines under
government inspection; for nothing would tend more to improve the health
of those employed in them.

In the course of the inquiry, which formed the prelude and basis of Lord
Ashley's Act, much valuable information regarding the diseases of
colliers was elicited; and no one can peruse the voluminous
parliamentary report pertaining to these investigations, without being
struck with the very general prevalence of affections of the chest among
miners. It is to be hoped, that the interesting facts in regard to
disease, which this recent most necessary investigation has laid open,
will be the means of directing the attention of scientific men to the
subject, with a view to obviate, as far as human efforts can, the evils
which have been exposed. It may at first appear difficult, to point out
the means of removing effectually the causes of the pulmonary
carbonaceous disease of miners, but, be the difficulties what they may,
humanity encourages us to make the attempt.

In the _first place_, let us endeavour to ascertain the cause, and
_secondly_, to suggest means for the mitigation or prevention of this
scourge.

My present remarks do not refer to coal-miners in general, but to a
district in Scotland, in the Lothians, east of the river Forth, where
the labour is hard, and where its severity is in many cases increased by
a want of proper attention to the economy of mining operations. These
operations, as at present carried on, are extremely unwholesome, and
productive of diseases which have a manifest tendency to shorten life. I
draw the materials of my description from what I saw in a part of that
district referred to, where the various cases, hereafter to be adduced,
came under my medical treatment, and where I had the privilege of
examining the morbid appearances after death.

The locality[2] in which my observations were made, is that part of the
Lothians, extending from south to north, stretching from the foot of the
Lammermoors towards the sea-coast, including the coal-works of
Preston-Hall, Huntlaw, Pencaitland, Tranent, and Blindwells. In this
range of the coal-formation, the seam of coal is variable, but generally
exceedingly thin, varying in thickness from eighteen inches, to three or
four feet. It is with difficulty that mining operations can be
prosecuted, from the extremely limited space in which the men have to
move, and from the deficient ventilation. It appears, after thorough
investigation, that in the majority of the coal mines above mentioned,
ventilation is very much neglected, and that this neglect is partly
caused, by the immunity of these mines from carburetted hydrogen gas,
which exempts them from the danger of explosion. But though there be no
explosive gas, there is generated, to a certain extent, in the more
remote recesses of the pit, carbonic acid and other gases, producing the
most injurious effects--impairing the constitution by slow degrees, and
along with the more direct cause (the smoke from the lamp, candle, and
the product of the combustion of gunpowder,) making progressive inroads
on the health of the unfortunate miner. And how, I ask, can it be
otherwise, in such circumstances? So long as it is possible for him to
go on--so long as there is air enough to support the combustion of the
lamp or candle, the labourer must proceed with his toil. I say, from
there being no fire-damp, less attention is paid to ventilation, and it
is a common occurrence with colliers in these localities, to be obliged
to leave their work, from there not being a sufficiency of oxygen to
keep their lights burning, and support respiration; and this temporary
cessation of labour under such circumstances is regarded as a hardship
by some proprietors, while the bodily sufferings of the miner, shut up
and necessitated to labour in this situation, are little considered.

After labouring beyond a given time in those confined situations, there
is a much freer action of the respiratory apparatus, the oxygen is
considerably exhausted, and to make up for this deficiency, the volume
of air inspired, (impure though it be,) is much greater. Every now and
then, there is a disposition to draw a deep breath, followed by a
peculiar and gradual decrease of strength. Therefore, in these forcible
expansions of the chest, it is to be expected that a considerable
quantity of the floating carbon will be conveyed to the cellular tissue.

The atmosphere of the coal mine at length becomes so vitiated, by the
removal of the oxygen in breathing, and the substitution of carbonic
acid, that the respiration becomes gradually more difficult, and the
exhausted labourer has ultimately to retire from the pit, as there is no
other mode by which the noxious air can be removed--owing to the
underground apartments being so small--than by gradually allowing purer
air to accumulate. The miner is thus enabled to return to his
employment.

It is about thirty years since miners in this district adopted the use
of coarse linseed oil, instead of whale oil, to burn in their lamps; and
it is very generally known, that the smoke from the former is immensely
greater than that from the latter, and many old miners date the greater
prevalence of black spit to the introduction of the _linseed_ oil. This
change took place entirely on the score of economy. Any one can conceive
how hurtful to the delicate tissues of the respiratory organs, must be
an atmosphere thickened by such a sooty exhalation.

It is now known, that this disease originates in two principal causes,
viz., _First_, The inhalation of lamp smoke with the carbonic acid
gas[3] generated in the pit, and that expired from the lungs; _Second_,
Carbon, and the carburetted gases which float in the heated air after
the ever-recurring explosions of gunpowder, which the occurrence of trap
dykes renders necessary.

To those acquainted with mining operations, an explanation of the coal
and stone hewing process is unnecessary; but, for the sake of the
uninitiated, I may be allowed to state, in explanation, that, previous
to any coal hewing, it is needful to remove various strata of stone, to
open up road-ways, and break down obstructing dykes, by the aid of
gunpowder. All coal-miners are engaged exclusively with one or other
kind of labour; that is either in removing stone or coal: and the
peculiar disease to which each class is liable, varies considerably,
according to the employment. For instance, the disease is more severe
and more rapid in those who work in the stone, than in those engaged in
what is strictly coal-mining, while, at the same time, both ultimately
perish in consequence of it. The fact of the disease being more acute in
stone-miners, I am disposed to attribute to the carbon and other
products of the combustion of gunpowder, being more irritating and more
destructive to the lungs. A very striking instance of this occurred, a
few years ago, at the colliery of the Messrs Cadell of Tranent. A very
extensive coal level was carried through their coal field, where a great
number of young, vigorous men were employed at stone-mining, or
blasting, as it is called, every one of whom died before reaching the
age of thirty-five years. They used gunpowder in considerable
quantity:--and all expectorated carbon.

It was long a very general belief with medical writers, that the various
forms of discoloration in the pulmonary tissue was induced by some
peculiar change taking place in the economy or function of secretion,
independently of any direct influence from without. They were,
therefore, usually supposed to belong to the class of melanotic
formations, from presenting, as their distinguishing feature, a greater
or less degree of blackness. But, by recent investigations, it has been
proved, that the infiltrated carbon found in the bodies of coal miners
is not the result of any original disease, or change taking place within
the system,[4] but is carbon, which has been conveyed into the minute
pulmonary ramifications, in various forms, during respiration; and
which, while lodged in these tissues, produces irritation, terminating
in chronic ulcerative action of the parenchymatous substance. The very
minute bronchial ramifications first become impacted with carbon, and
consequently impervious to air; by gradual accumulation, this impacted
mass assumes a rather consistent form, mechanically compressing and
obliterating the air-cells, irritating the surrounding substance, and
promoting the progressive extension of the morbid action, till the whole
lobe is infiltrated with carbonaceous matter, which, sooner or later,
ends in ulceration and general disorganisation of the part. It is
evident, in tracing the disease through its various stages, up to that
of disorganisation, that wherever there is an impacted mass in any part
of the pulmonary structure, this is followed, sooner or later, by
softening, from its irritating effects upon the tissues by which it is
surrounded; and as this softening process advances, the innumerable sets
of vessels[5] composing the dense network of capillaries are broken
down, extending the cyst, so that, as the cysts enlarge, they gradually
approximate to each other, till all at last become merged in one great
cavity.

The majority of colliers, soon after they engage in their mining
operations, become afflicted with bronchial disease to a greater or less
extent.

Those who are hereditarily predisposed to pulmonary irritation, are, it
is my decided belief, more liable to "black phthisis" than others; but I
cannot suppose it possible, that any constitution, however robust and
sound, could resist the morbid effects resulting from carbon deposited
in the lungs. Tubercular phthisis is not at all prevalent in any collier
community with which I am acquainted, only occasional cases occurring,
and that amongst females. It is my impression, that a phthisical person,
engaged in the operations of a coal-pit, similar to those in
Haddingtonshire, would come under the influence of the carbonaceous
disease, instead of the true phthisis; for, in all the _post-mortem_
examinations which I have conducted, connected with this pulmonary
affection, I have never found tubercular deposit:--while other members
of the same family, having a like predisposition, and who never entered
a coal-pit, have died of phthisis. Can carbon inhaled destroy a
tubercular formation? I never knew or heard of a case of black spit in
a female collier, and this is accounted for by the circumstance, that
the women, when permitted to labour, previous to the late prohibitory
enactment, were only occupied as carriers; and from their movements
towards the pit shaft, in transporting the coals, were enabled to inhale
at intervals a purer atmosphere. The boys also, who were employed as
carriers to the pit shaft, continued to labour with like impunity, from
their occasional change of situation; but the miner, lying on his side
in a confined, smoky recess, under ground, gasping for breath,
proceeding with his exhausting labour, cannot fail, in his deep
inspirations, to draw in the deleterious vapour, to the most minute
ramifications of the pulmonary structure, and, as he daily repeats his
employment, so does he daily add to the accumulation of that foreign
matter which shall ultimately disorganize the respiratory apparatus. In
the first stage of the affection, there is an incessant dry cough,
particularly at night, and all the prominent symptoms of bronchitis are
present. Indeed, from the time a man becomes a coal-digger, and inhales
this noxious air,[6] there is ever after a manifest irritation in the
lining membrane of the respiratory passages, which is apparent before
carbon in any quantity can be supposed to be lodged in the lungs. The
mucous membrane of the air passages, by its continually pouring out a
viscid fluid, has the power of removing any foreign matter that may be
lodged in them. Now, should this membrane, owing to previous irritation,
lose to a certain degree this secretory power, then the foreign body
adheres to it, and is retained, and this, I think, constitutes the
preparatory stage of black deposit. In tracing the progress of the
disease, it is my belief, that immediately after the carbon is
established in the air-cells, the absorbents become actively engaged,
and the glandular structure soon partakes of the foreign substance. One
of the peculiar features, as we shall find, when we come to describe
cases, is, that the secretory function is ever after so changed in its
character, that the gland which formerly secreted mucus, to lubricate
the passages, now performs the same service with muco-carbon, and
continues to do so during the remainder of the patient's life--even, as
I have often seen, long after he has desisted from the occupation of a
coal-miner. In fact, it constitutes a striking peculiarity of this
disease, that when the carbon is once conveyed into the cellular tissue
of the lung, that organ commences the formation of carbon, thus
increasing the amount originally deposited, as was strikingly
exemplified in the case of Duncan and others, to be afterwards detailed.
Duncan had not for fifteen years been engaged in mining operations, nor
was there any possibility of his having inhaled more carbon: yet in him
it was found to have increased to the greatest possible extent, leaving
but a small portion of useful lung.

I have been long impressed with the belief, that the carbon is contained
in considerable quantity in the blood, particularly in the blood of
those far advanced in the disease. This impression arises, not only from
its dark and inky appearance, but from its sluggish flow, and
non-stimulating effects on the heart and general system; and when we
examine the morbid condition of the pulmonary structure,--ascertain the
presence of carbon in the glandular system and minute lymphatic vessels
of the lungs, and consider the relation existing between them and the
circulating fluid, we cannot suppose it possible, that such a mass of
foreign matter should be lodged in their parenchymatous substance
without imparting a portion to the blood. I was never more struck with
this, than in the case of Duncan, where the blood was more like thick
brownish ink than vital fluid.

No one who has witnessed the economy of these pits, can doubt the
inhalation, to a great degree, of lamp and gunpowder smoke into the
pulmonary tissue. What may be its chemical action there, is a question
for us to attend to as we proceed. If it be considered an established
fact, that carbon is inhaled, possessing all the chemical qualities of
that substance found floating in the air of the coal-mine, and either
expectorated from the lungs during life, or retained in those organs
till after death, we cannot but conclude, that the black matter is the
result of an external cause, and that that cause is the sooty matter.

Another question arises here, in connection with this phenomenon,
viz.--Does the carbon increase in the pulmonary tissues after the
collier has relinquished the occupation of a miner, and when there can
be no further inhalation, and if so, whence comes this increase? It must
be admitted, judging from several of the cases which follow, that it
does considerably augment. From this remarkable fact, does it not appear
probable, that when carbon is once lodged in the pulmonary structure by
inhalation, there is created by it a disposing affinity for the carbon
in the blood, by which there is caused an increase in the deposit of
carbon, without any more being inhaled.

_Appearances on Dissection._ In classifying the morbid appearances
observed in the pulmonary structure, I arrange them according to
divisions corresponding to three stages of the disease. _First_, Where
there exists extensive irritation of the mucous lining of the air
passages; and the carbon being inhaled, is absorbed into the
interlobular cellular substance, and minute glandular system, thereby
impeding the necessary change upon the blood. _Secondly_, Where the
irritative process, the result of this foreign matter in the lungs, has
proceeded so far, as to produce a variety of small cysts, containing
fluid and semi-fluid carbonaceous matter, following the course of the
bronchial ramifications. _Thirdly_, Where the ulcerative process has
advanced to such an extent, as to destroy the cellular texture, and
produce extensive excavation of one or more lobes.

_Stethoscopic Signs._--In the early stages, the sounds indicate a
swollen state of the air-passages, and vary in character according to
the part examined. The whistling and chirping sounds are loud and
distinct in the large and small bronchial ramifications, and both from
the absence of expectoration and the presence of the pulmonary bruit,
the highly irritated state of the mucous linings is apparent. The
affection ultimately assumes a chronic form, and continues present in
the respirable portions of the organ during life. As the carbonaceous
impaction advances, the sounds become exceedingly dull over the whole
thoracic region, and in many of the cases no sound whatever can be
distinguished. Where the lungs are cavernous, it is very easy to
discover pectoriloquy, from the contrast to the general dulness, and
when pleuritic and pericardial effusion advance much, it is difficult to
ascertain the cardiac action.

Such is a short account of the _Cause_, _Progress_, and _Morbid
Appearances_ of this deadly malady, as they came under my notice.

       *       *       *       *       *

From a variety of cases to which my attention was directed, I I have
selected _ten_, with the _post-mortem_ appearances in nine of them.
These cases extend over a period of eleven years, all of them
exhibiting, with some slight variation, the same character of disease,
and proceeding from the same cause--inhalation of carbonaceous matter.
Some of the cases occurred as far back as the years 1833-34, while the
last case came under my notice within these twelve months. Of the ten
patients, six were engaged at one period with stone-mining, and four
were entirely coal-miners; eight expectorated carbonaceous matter, and
two did not show any indication of black infiltration from the sputum;
six exhibited, on examination, most extensive excavations of the
pulmonary structure; and three only general impaction of these tissues,
with numerous small cysts containing black fluid; the body of the tenth,
I regret to say, was not examined, owing to neglect in communicating in
time the death of the patient, which took place a few weeks ago. These
morbid appearances exhibit three stages of the disease in regular
progression. The first is that where the carbon is confined to the
interlobular cellular tissue, and minute air-cells, producing cough,
dyspnoea, slight palpitation of the heart, and acceleration of pulse,
while, at the same time, the patient continues able to prosecute his
daily employment. The respiratory sounds, in this state of the chest,
are loud and distinct. Such a condition of the pulmonary structure is
often found on examination in the Carron _iron-moulder_, who has been
killed by accident, or has died from some other disease, having been
subjected in the course of his employment to the inhalation of
carbonaceous particles.

The second is that stage where the softening has commenced in the
several impacted pulmonary lobular-formed small cysts throughout the
substance of one or more lobes, the contents of which may either be
expectorated or remain encysted, giving rise to most harassing cough,
laborious breathing, and palpitations, dull resonance of chest, and
obscure respiratory murmur. The third and last stage, is that in which
the several cysts in one or more lobes have approximated each other,
forming extensive excavations, the prominent symptoms of the disease
becoming considerably aggravated, and the powers of the system sinking
to the lowest degree of exhaustion.

       *       *       *       *       *

CASE 1. George Davidson, collier from his youth. When I first saw him
professionally, in May 1834, he was aged thirty-two. From his earliest
years he was employed about the coal-works in Pencaitland parish, and
when very young, he went down the pit to assist in conveying coals to
the shaft, and ultimately became a coal-miner. For a considerable length
of time, he enjoyed good health, having neither cough, nor any other
affection. He was well-formed, and robust in constitution. A few months
previous to my seeing him, he had taken to the employment of
stone-mining in the pit at Huntlaw, where he was accustomed to labour,
and soon after being so engaged, he began to complain of uneasiness in
the chest, and troublesome short cough, quick pulse, especially at night
and in the morning, for which he sought medical advice, and was treated
for bronchial affection. He continued to prosecute the employment of
stone-mining in this coal-pit so long as his strength would permit,
which was a little more than two years, when (August 1836) he was
entirely disabled, from general exhaustion. By this time his cough had
much increased, and there was considerable dyspnoea, accompanied with
sharp pain in the thoracic region, both in walking quickly, and when
lying down. Pulse 80. He expectorated bloody tough mucus without any
tinge of black matter. All remedial means were adopted with a view to
the removal of the irritation of the chest, without producing any very
decided effect. The thoracic pain was occasionally subdued, but the
cough became incessant; loss of appetite, rapid emaciation, and cold
nocturnal sweats, with slow weak pulse, supervened. After a severe fit
of coughing, during one of his bad nights, the black expectoration made
its appearance, in considerable quantity, by which his sufferings were
for a few days alleviated, when the cough returned in the same degree of
severity, and was again mitigated by the black sputa, which was
expectorated without difficulty, and from this time (October 1836) there
was no interruption to a free carbonaceous expectoration.

In the early part of this man's illness, the stomach, the alimentary
canal, biliary and urinary secretions, continued unimpaired; but as the
cough advanced, gastric irritation, which was followed by vomiting
during the paroxysms, annoyed him; and for the last eight months of his
life, he suffered occasionally from severe attacks of gastrodynia,
which, when present, had the effect of considerably modifying the
thoracic irritation, and allaying the cough. There was nothing very
remarkable in the character of the urine; the quantity voided was small,
and very high coloured, with occasionally a lithic deposit. The fæces
were natural, and smeared with dark blue mucus. On examining the chest
with the stethoscope, the crepitant ronchus was heard in the upper part
of each lung. There was general dulness throughout the lower part of
both, with the exception of a small space at the inferior angle of the
left scapula, where pectoriloquy was distinctly heard, from which was
concluded the cavernous state of a portion of that lung. The heart's
action was languid, and often intermitting, producing vertigo and
occasional syncope. The pulse was gradually becoming slower; and at this
time, (Nov. 1836,) it was _forty-three_ in the minute. I was informed by
this man, that his chest affection first became manifest, after being
engaged with a difficult job in a newly formed coal-pit at Huntlaw,
where he had very little room to conduct his mining operations, which
were carried on with the help of gunpowder, and where he experienced a
sensation of suffocation from the confined nature of the pit,[7] which
did not permit of the exit of the evolved carbon, and ever after, his
cough and difficulty of breathing had been increasing rapidly. During
the greater part of the period he was under my charge, he continued to
expectorate black matter, of the consistency of treacle, mixed with
mucus in considerable quantity, and I would suppose, taking the average
of each week, that he expectorated from ten to twelve ounces daily of
thick treacle-like matter. I had the curiosity, during my attendance on
this patient, to separate the mucus from the carbon, by the simple
process of diluting the sputa with water, and thereafter separating and
drying the precipitated carbon. I was enabled by this means to procure
about one and a-half drachms of a beautiful black powder daily, and in
the course of a week, I had collected near to two ounces of the
substance. This process I continued for some weeks, till such time as I
had procured a sufficient stock of this remarkable product of the
pulmonary structure, and I am certain that the same quantity, if not
more, could have been obtained till his death, in Dec. 1836. It is
undoubtedly a striking phenomenon, connected with the pathology of the
chest, that the human lung can be converted into a manufactory of lamp
black!

Towards the close of this poor man's existence, the countenance and
surface of the body assumed a leaden hue, from the very general venous
congestion, and as his system became more exhausted, and he was about to
sink in death, the gastric irritation and nocturnal cold sweats which
had been long present with him considerably increased, along with a
cough so severe as actually to produce vomiting of the black sputa. His
tongue and fauces became so coated with the expectoration, that a
stranger viewing the patient would have said that he was vomiting black
paint.[8]

This case resembled in many of its features, one of tubercular phthisis,
more than is generally found in the disease before us, there being cough
and expectoration, dyspnoea, sharp pain in the thoracic region,
colliquative sweats,[9] and great emaciation, while at the same time,
the pulse was slow and weak, not exceeding thirty-six in the minute for
a week before death. No hectic heat of skin, but an extraordinary
depression of the arterial action, arising evidently from the redundancy
of carbon deposited in the pulmonary tissue, preventing the proper
oxygenation of the blood circulating in the organs, and thereby
producing a morbid effect on the whole system, which sufficiently
explains the cachectic condition of the body.

_Post-mortem examination, twenty-four hours after death._--In removing
the anterior part of the thorax, the lungs appeared full and dilated,
and of a very dark colour. Both lungs were strongly attached to the
pleura costalis, and a very considerable effusion of straw-coloured
fluid was found in both cavities of the chest. A few irregularly
situated dark glandular bodies were observed on the surface of the
costal pleura at each side of the sternum, and on the mediastinum. The
lungs were removed with difficulty on account of the strongly adhesive
bands attaching them to the ribs, and in handling them they conveyed the
impression of partial solidity:--several projecting, irregular firm
bodies, were felt immediately beneath the surface of the pleura, and
there was also present emphysematous inflation of the margins of the
upper lobes. In transecting the upper lobe of the left lung, it was
found considerably hollowed out, (to the degree of holding a large
orange,) and containing a small quantity of semi-fluid carbon,
resembling thick blacking, with the superior divisions of the left
bronchus opening abruptly into it. Many large blood-vessels crossed from
one side of the cavity to the other, to which shreds of parenchymatous
substance were attached. The inferior lobe was fully saturated with the
thick black fluid, and it felt solid under the knife, and several small
cysts containing the carbon in a more fluid state were dispersed
throughout its substance, in which minute bronchial branches terminated,
and by which this fluid was conveyed to the upper lobe, and thence to
the trachea. In examining the right lung, the upper, and part of the
middle lobe were pervious to air, and carried on, though defectively,
the function of respiration, while the interlobular cellular tissue
contained the infiltrated carbon. The inferior portion of the middle and
almost the whole of the under lobe were densely impacted, so that on a
small portion being detached, it sank in water. Both lungs represented,
in fact, a mass of moist soot, and how almost any blood could be brought
under the influence of the oxygen, and the vital principle be so long
maintained in a state of such disorganization, is a question of
difficult solution.

In tracing the various divisions of the bronchi, particularly in the
inferior lobes, some of the considerable branches were found completely
plugged up with solid carbon; and in prosecuting the investigation still
farther, with the aid of a powerful magnifier, the smaller twigs, with
the more minute structure of cells, were ascertained to contain the same
substance, forming the most perfect _racemes_, some of them extending to
the surface of the lung, and to be felt through the pleura. The lining
membrane of the permeable bronchial ramifications, when washed and freed
from the black matter, exposed an irritated and softened mucous surface,
which was easily torn from the cartilaginous laminæ. The interior of the
trachea and its divisions gave evidence of chronic inflammatory action
of long standing which extended from about midway between the thyroid
cartilage and bifurcation to the root of the lungs. A considerable
number of lymphatic glands, filled with--to all appearance--the carbon,
were situated along the sides, and particularly at the back part of the
trachea; which, from their size, must have interfered by pressure both
with respiration and expectoration. The mucous membrane of the left
bronchus in particular was much swollen and partially ulcerated towards
the root of the lung. In examining the heart after its removal from the
body, it was found peculiarly large and flabby, its cavities
considerably distended, especially the right auricle and ventricle,
while the valvular structure seemed natural. The pericardium contained
about 10 ounces of straw-coloured fluid. After examining the organ
particularly, I could discover nothing abnormal, but the enlarged and
softened state alluded to. The liver was large and highly congested with
dark thick blood, but otherwise it was healthy. The gall-bladder was
empty, and the spleen large and congested. The stomach was smallish and
empty. The mucous membrane was smeared with a blackish, tenacious fluid,
which, upon removal, appeared to be a portion of the expectoration. The
structure, as far as could be ascertained, was healthy. The small and
great intestines contained fluid carbon (evidently swallowed), while no
disease was manifest. The mesenteric glands were small and rather firm,
but they contained no black matter; the mesentery was much congested
with dark venous blood. The kidneys were apparently healthy, though
soft. The bladder was small and contracted. The head was not examined,
as I expected nothing but general congestion of the vessels.

This case comes under the third division of the disease, where the lungs
were cavernous, and where there was free expectoration of carbon.

CASE 2. The following case is one of unsuspected carbonaceous
accumulation in the lungs, the history of which proves the fact, that
the disease, when once established in the pulmonary structure, continues
to advance till it effects the destruction of the organs, although the
patient has not been engaged in any mining operations for many years
previous to his death.

Robert Reid, aged forty-six at his death, had been a collier since his
boyhood. He was a short, stout-made man, of very healthy constitution,
and never knew what it was to have a cough. He spent the early part of
his life at a coal-mine, near Glasgow (Airdrie), where he all along
enjoyed good health. In 1829, he removed from Airdrie to the coal-work
at Preston-Hall, Mid-Lothian, where he engaged in mining operations;
and, from the time he made this change, he dated the affection of which
he died, at the end of 1836. Two months after he removed to Preston-Hall
colliery, he was seized with bronchial affection, giving rise to a
tickling cough in the morning and when going to bed, accompanied by
dyspnoea, with a quick pulse (90), and palpitation of the heart. In
the first stage of the affection, he had no expectoration of
consequence; but soon after, a little tough mucus was coughed up, and
when it was difficult to expectorate, the sputum was occasionally tinged
with blood. At this period, the appetite continued to be good, and the
strength little impaired. During the day, he felt in his usual health;
and, therefore, he continued in full employment. At the end of the four
months (Jan. 1830), his cough had increased much, his palpitation of
heart, dyspnoea, and bronchial irritation had become very oppressive,
and general exhaustion had manifested itself. Recourse was had at this
period of the affection to bleeding, blisters, and expectorants, which
relieved him only temporarily, and while under this treatment,
he--having a large family dependent on his exertions for their
support--continued to struggle on at his daily vocation so long as he
was able to handle the pick-axe. At the close of 1832, which completed
three years of labour in this coal-mine, he was obliged to discontinue
all work, and take refuge in medical treatment, with a severe cough,
palpitation, annoying dyspnoea, small intermitting pulse, and
sleepless nights. On inquiring as to his general habits and mode of
life, I found that he had been all along a sober, regular-living man,
that he never complained of ill health till he engaged in this coal-mine
at Preston-Hall, where the work was difficult and the pit confined, he
having only twenty-four inches of coal seam which obliged him to labour
lying on his side or back.[10] He was also at this time occasionally
engaged as a stone-miner, and was consequently subjected not only to the
inhalation of the smoke of linseed oil, but to that of gunpowder. For
his chest complaint at this stage, he underwent a variety of medical
treatment, which produced mere palliation in his symptoms, and though
breathing a pure atmosphere in a country situation, he experienced a
most painful sensation of want of air, or, as he himself expressed it,
"a feeling as if he did not get enough down." By this time the
countenance had become livid, the lips and eyelids dark and congested.
After undergoing medical treatment in the country, without much relief,
he was removed to the Edinburgh Infirmary, in July 1833, in the hope of
deriving benefit; but after being a patient in that hospital for some
weeks, he returned home much worse. In addition to the aggravation of
his other symptoms, there were present oedematous swelling of the
extremities, which were generally cold and benumbed, gnawing pain in the
right hypochondriac region, and almost total loss of appetite. On
examining the right hypochondrium, which he described as swollen, there
was evident indication of an enlarged liver, and he complained much of
shooting pain in that region during a paroxysm of cough. Hitherto the
functions of the stomach and bowels had remained unimpaired; but at this
period, (September 1833,) the former became irritated, and the latter
obstructed. Tonics and gentle purgatives were administered, and
continued for a considerable time. The urinary secretion was all along
scanty and high coloured; but, as the disease advanced, the quantity
became exceedingly small, (almost none was voided for days together,)
for which he was taking diuretics; and on examining it with the
application of heat, I repeatedly found it coagulable. General anasarca
was now rapidly increasing; and as the cellular effusion advanced, the
breathing became more laborious. I understand, that at the commencement
of this person's affection, the pulse was frequent, with some heat of
skin at night, but from the time he became my patient, there was a
tendency to languor in the circulation, and the _beat_ at the wrist, for
some months previous to his death, was almost imperceptible. With a view
to remove the enlargement of the liver, a slight mercurial course was
proposed; but owing to debility, indicated at its commencement, it was
discontinued, and no effect produced on the organ. All medical treatment
having been given up, except mere palliatives, such as blisters and
expectorants, this poor man lingered out a most miserable existence from
his pectoral symptoms, and particularly from palpitation of heart.
Expectoration continued the same, of tough, ropy mucus, small in
quantity, and got up with difficulty from the air-passages. In repeated
examinations with the stethoscope, there was considerable dulness over
the whole thoracic region, no bruit whatever could be discovered in the
left side of the chest, no cavernous indication, although that side of
the thorax was fully developed. The mucous râle was heard very strong in
the upper lobe of the right lung, and some little crepitation at the
inferior angle of the scapula on the same side. The action of the heart
under the stethoscope gave rather an uncertain indication as to the
state of that organ, for though the sound was evidently communicated to
the ear, as being transmitted through a fluid, and not the heart
striking the ribs, still, from the very general dulness in the left side
of the chest, it was exceedingly difficult to decide whether this
obscurity arose from effusion into the pericardium, or from effusion
into the cavity of the chest. There was one remarkable symptom
manifested in this case,--that though the heart's action was to the
observer feeble, the patient's sensations were as if the pulsation was
very strong, and painfully difficult to bear, and this peculiar feeling
to a great extent prevented him from sleeping. I cannot record this case
without the painful recollection of this poor man's sufferings. For six
months previous to his death, the dyspnoea and palpitation attendant
upon his disease were of such a severe character, as to prevent him at
any time lying down; and his sensations would not even permit his
maintaining the sitting position, for he found it necessary to get upon
his hands and knees, as the only posture affording any alleviation to
his uneasiness. This peculiarity in the cardiac action was such, that,
as he expressed it, "he lived in continual dread of death," and this
being ever present to his mind, he was for weeks known almost never to
close his eyes. He died exhausted, in November 1836; and there being
doubts entertained regarding some of the symptoms of his disease, he
requested that his body should be examined, which was done twenty-six
hours after his death.

_Post-mortem Examination._--The general anasarca gave the body a bulky
appearance. On raising the sternum, the ribs seemed very firm and
unyielding. The lungs were of a dark blue colour, and seemed at first
appearance to fill completely both sides of the chest. Towards the
sternal end of the ribs, on the left side, three or four of the
substernal or mammary glands were found enlarged and filled with black
fluid. The pleura pulmonalis had (where there wore no adhesions)
interspersed over it patches of false exudation, _of a dark brown
colour_. The lungs adhered extensively to the pleura costalis, and from
the character of the adhesions, they were evidently of some years'
standing. In both sides of the chest there was effusion to a
considerable extent of a dark-coloured fluid, resembling porter in
appearance. On removing the left lung, which was difficult, from the
strong adhesive bands, it seemed, from its weight and softness, to
contain a fluid; and on making a longitudinal section of both lobes, a
large quantity of thick, black matter, similar to black paint, gushed
from the opening, exposing an almost excavated interior of both lobes.
The carbonaceous matter contained was in quantity about an English pint,
and the lung, when emptied, became quite flaccid, and very light. The
air-cells of this lung were entirely destroyed, or nearly so, and one of
the divisions of the left bronchus opened abruptly into the cavity at
the upper part. Both lobes were so completely adherent to each other,
from inflammatory action, as to form a continuous sac, containing the
above fluid. On examining the internal structure of the cavity, the
parenchymatous substance which formed its walls presented a rugged and
irregular appearance, resembling a sponge hollowed out, and infiltrated
with black paint.

At different points, the large pulmonary blood-vessels crossed the
cavity in the form of cords, with portions of structure attached, and
though these fragments had a black appearance, they exhibited, to a
considerable extent, their original cellular structure when washed in
water. The process of carbonaceous ulceration had proceeded so far in
this lung, that at some points the pleura pulmonalis, which was much
thickened, was left the sole medium between the contents of the sac and
the cavity of the chest; while in other parts it was thick and spongy.
On examining more minutely with the magnifier, open-mouthed bronchial
twigs, and very small blood-vessels, were seen plugged up with solid and
fluid carbon, and, from the appearance of the morbid structure, it was
manifest, that the ulcerative process had effected a complete
disorganization of the _bronchial_ tubes of every calibre, while the
smaller _arterial_ vessels had alone suffered, leaving the larger ones
entire.[11] Along the margin of the inferior lobe, indurated
accumulations were felt through the pleura, and, on being laid open,
they were ascertained to be impacted lobules, which resisted the knife.
Previous to the division, both lungs weighed about six pounds.

On examining the right lung, which seemed much similar in weight to the
left, and on making a section throughout its three lobes, the morbid
appearances varied in each. The upper lobe was infiltrated with carbon
into the interlobular cellular tissue, leaving the bronchial
ramifications respirable, and lubricated with frothy mucus. The middle
lobe presented a solid appearance, and contained a mass of indurated
black matter, of the size of a largish apple, and consistency of
consolidated blacking. The surrounding parenchymatous substance was
disorganized, and undergoing the process of softening. In dividing the
indurated substance, its internal structure exhibited a variety of
greyish lines, forming parallel and transverse ramifications, which
resembled small check in appearance, and which, when more accurately
examined, was ascertained to be the disorganised walls of the minute
air-cells and cellular tissue. The inferior lobe presented a state of
complete infiltration, with the air-cells generally entire, and on
putting a piece of it into water, it showed its density by sinking.

When we examine the morbid appearances in this case, and compare them
with the symptoms--when we consider that nearly all the respiration
carried on in this man's chest, was performed in the upper lobe of the
right lung, we are not surprised at his sufferings, nor is there much
difficulty in explaining the very painful dyspnoea, on his attempting
the recumbent position; and as death was instantaneous, it was evident
that the immediate cause was the bursting of the left pulmonary cyst
into the corresponding bronchus; the fluid carbon thus finding its way
to the trachea, produced suffocation.

The liver was exceedingly large, projecting outwards and downwards from
under the ribs, and pushing up the diaphragm. Its substance was soft,
engorged with dark blood, and easily torn. There was no carbonaceous
deposit throughout its structure, and its weight was upwards of twelve
pounds. There was a considerable quantity of very dark bile in the
gall-bladder. The heart was large, soft, and pale. There was
considerable attenuation of the walls of both auricles and ventricles.
The coronary veins were much distended with dark blood. The columnæ
carneæ of the right ventricle were exceedingly slender and bloodless;
the tricuspid valve was much thickened, and studded on both sides with
small cartilaginous granules; the other cavities of this organ were
apparently healthy, though thin in substance. The pericardium, which was
rough, and much distended, exhibited a variety of false membrane on its
internal surface, of a dark brown colour, and contained about eight
ounces of dark fluid, similar to that found in the cavity of the pleura.
In tracing the bronchi from the lungs to the bifurcation, the mucous
membrane, which was smeared with fluid carbon, appeared much irritated,
and considerably thickened, diminishing the diameter of these passages;
and there were found externally at the root of the lungs, and around the
bronchi, several large glands, containing a fluid to all appearance
carbonaceous. The trachea showed a similar irritated condition with that
of the bronchi. A little above the bifurcation, and at the back part of
the trachea, a cluster of lymphatic glands were found, some of them the
size of a horse bean, filled with carbon.

_The spleen_ was very large, and much darker than usual, highly
congested with venous blood, easily torn with the fingers, and weighed
about three pounds. Kidneys small, pale, and soft; bladder small, and
corrugated; large accumulation of light brown fluid into the cavity of
the abdomen, to the extent of two Scotch pints. The viscera were much
compressed from effusion. There was a rough brown exudation upon the
surface of the peritoneum and intestines. The stomach was contracted to
a small size. The mucous membrane was soft, pultaceous, and easily
removed, tinged with dark green bile. The lymphatic glands along both
curvatures were small and flaccid, and contained no black matter. The
intestines appeared empty and contracted. The duodenum showed the same
softened state of its mucous membrane as was exhibited by the stomach.
The mesenteric glands were free from any disease. The head, on removing
skull-cap, dura mater found natural; serous effusion to small extent
under the arachnoid; very general congestion of the pia mater, giving
both hemispheres of the brain a blackish appearance. The superior
longitudinal sinus was filled with dark, inky-looking blood. In removing
the pia mater, the convolutions of the brain were firm, and appeared
natural. There was a light brown effusion into both lateral ventricles
to the extent of about an ounce. Reid, when he first came to
Preston-Hall, had inhaled the evolved smoke of the coal-mine, thereby
laying a foundation of this infiltrated mass. It must be manifest to
every one who follows out the history of this case, and attends to the
morbid appearances found within the chest, that there was a progressive
accumulation of carbonaceous matter going on in the substance of the
lungs from the time the patient engaged in working this difficult seam
of coal till his death.

       *       *       *       *       *

CASE 3. D. S. was aged 39 years at his death, in August 1838. He had
been engaged as a coal-miner so soon as he was able to undertake work.
He was a tall, muscular man, and for a long time enjoyed excellent
health. He first began mining operations at one of the Pencaitland
collieries, and continued to labour there for many years. About six
years before his death, he was induced by an increase of wages, to
undertake stone-mining in the same pit; and soon after engaging in this
employment, he began to be troubled with a slight cough, accompanied by
dyspnoea, palpitation, and oppressive headach, which symptoms rapidly
increased in severity. He declared that his cough and general ailments
first showed themselves after labouring for a considerable time at
stone-work, with the aid of gunpowder, in a situation where the air
became so impure, both from defective ventilation and carbonaceous
particles floating in it, as materially to affect the breathing.
Although he repeatedly changed his place of labour from one coal-work to
another more healthy in the same parish, he experienced no mitigation of
his annoying cough. When I first saw this man for medical advice in July
1834, he had then been about two years engaged as a stone-miner, the
bronchial irritation was very general throughout the chest, he had
severe cough, hurried breathing, little or no expectoration, and on
applying the ear to the thorax, the sibilant and sonorous bronchi were
distinctly heard, which indicated a swollen and irritated condition of
the mucous linings of the air-passages, and this irritation was also
manifest in the mucous membrane of the nostrils, which was much swollen,
acutely tender, and impeding considerably the passage of the air. The
pulse was rather frequent, about 85 in the minute. There was present
much heat of skin during the night, which subsided towards the morning.

The remedial measures were blisters and expectorants, which relieved him
considerably. The cough recurred in paroxysms, accompanied by severe
headachs, with little frothy mucous expectoration, and there was
occasionally observed a slight tinge of blood in the sputum. At this
period, his appetite was good, and with the exception of his cough and
difficulty of breathing at night and morning, he seemed usually very
well. Though labouring under his disease, he continued at his employment
of stone-mining, and would not be convinced of its injurious effects.

_July 1835._ There was considerable increase of the palpitation when he
attempted the recumbent position, or moved hurriedly. The remedies
ultimately seemed to produce little effect. His general exhaustion
advanced rapidly, and obliged him to relinquish all mining occupation.
At the end of the summer of 1836, when I saw him more regularly, and was
enabled to watch his symptoms with more attention, these having
materially changed for the worse, percussion elicited dulness over the
chest, with the exception of the upper part of both lungs, where the
mucous râle was heard louder than usual. The heart's action was strong
and irregular, particularly so for some time after a fit of coughing,
when he suffered excessively from headach, succeeded by a tendency to
drowsiness. The pulse was slow and languid, not exceeding 50 in the
minute. His countenance had assumed a greyish inanimate aspect, his eyes
became sunk, his robust frame bent and so emaciated from this peculiar
disease, that though his age did not exceed 38 years, a stranger looking
at him, supposed him to have attained the age of 70. No treatment seemed
to have any effect in allaying the cough, nor was he permitted to lie
down. From his feeling of dyspnoea and thoracic oppression, his nights
were almost sleepless, his extremities oedematous, usually cold and
bloodless.

During the greater part of the time he was confined to the house, the
bowels were constipated, requiring daily purgatives. The urinary
secretion was small in quantity and high coloured, but in neither
discharge was there any thing very unnatural. In this almost inanimate
condition he lingered on, when about six months before his death, during
a paroxysm of cough, he expectorated a mouthful of thick black matter,
and continued so to do periodically, at intervals of about three weeks,
seeming to experience relief after voiding the carbonaceous sputum.

There was little change in the symptoms of this man till death. He took
little or no food, from his appetite being almost entirely gone, and
from gastric irritation being constantly present. His cough and
dyspnoea continued severe, with drowsy headachs and difficulty in
keeping the body warm. The arterial action was exceedingly low. The
pulse was 40 in the minute, and difficult to discern. The strongest
stimulant produced no increase of action, the sitting position was the
only one in which he was at all easy, and in which he remained day and
night till he ceased to live.

_Post-mortem examination, twenty-four hours after death._--The body was
much emaciated. The chest large, and integuments tightly drawn over it,
the ribs unyielding. In removing the anterior part of the chest, the
lungs adhered strongly to the ribs, and were covered very generally with
patches of dark-red false membrane, corrugating the pleura. Each side of
the thorax contained fully a pint of light-brown fluid. In removing the
left lung, it felt firm and developed, and in dividing it throughout its
lobes, a variety of small cavities and indurated masses of carbon were
found to pervade its substance, exhibiting a sooty appearance, extending
throughout the whole structure. The indurated nuclei were ascertained to
be impacted lobules, and the small cavities were these disorganized and
softened, and communicating with the bronchial tubes. Part of the upper,
and the whole of the inferior lobe, were soaked with carbon, and felt
indurated. The right lung was similarly disorganized with the left. The
greater part of the superior lobe was permeable to air, and the
interlobular tissue contained carbon, in small, hard granules. The
middle and inferior lobes contained several hard, indurated bodies,
progressing to a state of softening, and in separating a portion of the
latter lobe, it was found to sink in water. There was emphysema of the
margin of the inferior lobes. There appeared considerable irritation and
softening of the mucous membrane of both bronchi, extending from the
root of the lungs to beyond the bifurcation of the trachea. There were
several enlarged bronchial glands at the apex of the lungs, containing
black fluid.

The pericardium contained about eight ounces of straw-coloured fluid.
There was a light-brown exudation, extending over serous lamina of the
pericardium and the surface of the heart. The heart was flaccid, the
right auricle and ventricle were enlarged and attenuated, and both vena
cava at their junction with the heart were much dilated, the valvular
structure natural. The liver was large, soft, and easily torn. The
abdominal viscera in general appeared healthy; slight effusion into the
cavity of the peritoneum. In this case head not examined, but which no
doubt would have shown marks of extensive congestion, as in other
cases.

The above case comes under the second division of this disease, where
the irritative process resulting from the foreign body pervading the
lungs, had advanced so far as to produce a variety of small cysts, and
circumscribed, indurated masses, the former containing _fluid_, and the
latter _solid_ carbon, and it is evident in tracing its progress, that
there must have been a very rapid increase within the system in the
carbon originally deposited in the pulmonary structure by inhalation.
There was very limited black expectoration shortly before death, and
this merely the contents of a few small cavities communicating with the
bronchial ramifications, while both lungs were extensively infiltrated
with that matter which, had the patient lived, would have produced
general softening, and more extensive excavations by the coalition of
the various indurated tubulæ.

       *       *       *       *       *

CASE IV. J. T., aged 45 when he died, May 1837. He became a collier in
early life, in the neighbourhood of Glasgow, and came, at the age of 22
years, to East Lothian, to engage in collier labour at Blind Wells, near
Tranent. From his own account, he was rather of a delicate constitution,
and ill-fitted for the work of a coal-pit, consequently, after labouring
a few years, he was, at the age of 26,--owing to cough and difficulty of
breathing,--obliged to relinquish the employment of a miner. He left
East Lothian, and retired to the west of Scotland, where he became a
country merchant, and continued so occupied for upwards of fifteen
years. During that time, he was occasionally troubled, particularly in
the morning, with his cough and hurried breathing, which was increasing
in severity, but at no period had he expectorated black matter, nor was
there any indication that his sufferings arose from carbonaceous
disease. On account of becoming reduced in circumstances, he was under
the necessity, though labouring under chest affection, of returning to
his former employment of coal-mining at Blind Wells, at the age of 41,
August 1834. He had not been long engaged as a miner, after his return
to East Lothian, when his cough increased considerably, with laborious
breathing, palpitations, and overpowering headach. Both now and
formerly, he wrought solely as a coal-miner, and at no time of his life
did he work as a _stone-miner_. Having a family to provide for, he
struggled on laboriously under much suffering from his chest affection,
till general exhaustion compelled him to leave off work, and seek
regular medical advice, July 1836. From his statement regarding the
cause of the disease, I was led to understand that his cough, which
never left him from the time he was first seized, was induced, at an
early period, by bad air generated in the coal-pit at Black Wells, from
the work being ill ventilated, and from the general use of coarse
linseed oil for the lamps.

When I first saw this man professionally, he was labouring under general
weakness; his pulse was not above 40 in the minute, small and thready.
He suffered from drowsy headach, anorexia, cold and slightly
oedematous limbs. He had incessant cough, with tough mucous
expectoration. During a severe paroxysm, he vomited a mouthful of black
paint-like fluid, followed by considerable relief, and ever after till
his death, he continued to expectorate the same substance in great
quantity, often to the extent of 15 oz. daily. In examining the chest
with the ear, the sound, from the distinct pectoriloquy, indicated a
cavernous state of both lungs; otherwise the bruit was obscure.

The remedies were merely of a palliative character, knowing the patient
to be rapidly sinking. In this exhausted state he remained for some
months; his appetite was almost entirely gone; the oedema of limbs
increasing. There was also a leaden hue over the surface of the body,
which was constantly cold. At this stage, the quantity of urine voided
was small and dark in colour. Bowels obstinate; occasional vomiting. The
pulse ranged from 38 to 40. The lips and ears were livid, and his
drowsiness became more overpowering as death approached.

_Post-mortem examination._--The body was much emaciated; the ribs were
prominent and unyielding. On removing the anterior part of the thorax,
the lungs were found firmly adhering to the pleura costalis, and of a
dark blue colour. There was an effusion to the extent of about sixteen
ounces of light-brown fluid, found in the cavities of the pleura. The
greater part of the effusion was into the left side. The lining membrane
of the chest was almost wholly covered with false membrane of a dark
brown colour. The right lung filled almost completely the right cavity
of the thorax, while the left lung appeared much contracted,
particularly towards the apex. The pleura of both lungs was much
puckered, and interspersed with dark red patches around the adhesions.
Three or four of the substernal glands were found considerably enlarged,
and filled with black fluid, and a cluster of the anterior mediastinal
and lymphatic glands contained fluid having the same appearance. The
right lung appeared solid to the feel, when removed from the body. It
was rough and irregular over its surface, from a variety of indurated
substances projecting from beneath the pleura. In making a section of
the whole lung, each lobe was almost completely saturated with thick
inky fluid, and was observed to be here and there hard and granular,
particularly in the course of the larger bronchi. Portions of this lung
were pervious to air and emphysematous, but the greater part was
disorganized, and contained carbonaceous matter in a solid and fluid
state. The left lung was light and flaccid, when compared to the right.
The upper lobe was extensively excavated. The parenchymatous substance
was found ragged and unrespirable, and many large blood-vessels crossing
from either side of the cavity, pervious to blood. With the aid of the
magnifier, a variety of open-mouthed bronchial twigs and minute
blood-vessels were visible, communicating with the cavity. The upper
part of the inferior lobe was partially excavated, and containing about
four ounces of fluid carbon. The lower margin of this lobe was firmly
impacted.

The mucous membrane of the trachea and bronchial divisions appeared,
when washed and freed from the black matter, red and softened. The
lining membrane of larynx was partially ulcerated, and the rima
glottidis slightly oedematous. There were various small lymphatic
glands on the back part of the trachea, which contained black fluid.

The pericardium considerably distended, and contained nearly twelve
ounces of light-brown fluid. Evident marks of inflammatory action were
observed externally. On its internal surface it was thickly coated with
false membrane of a brown colour. The heart was pale, soft, and
attenuated. The right auricle was much dilated, and its walls
exceedingly thin. There were no further morbid appearances.
Head,--External congestion of an inky colour was found on the surface of
the brain, which was to all appearance otherwise healthy. There was an
effusion into both lateral ventricles. The abdominal viscera were
natural. The liver was much larger than usual, soft, and highly
congested with inky-coloured blood.[12]

It is evident, from the symptoms and history of the above case, that the
patient had contracted the disease of which he died at an early period
of his life, and that during the fifteen years he refrained from mining
operations, the pulmonary structure retained the carbon inhaled while
labouring in the coal-pit, and this is one of the many cases which can
be produced as examples of the fact that the foreign matter once
deposited in that structure originates a process of accumulative
impaction and ultimate softening of the organ, which is gradually
carried on till it is entirely disorganized. This case comes under the
third division of the morbid action, viz. where extensive excavation of
the structure is produced.

       *       *       *       *       *

CASE V. A. G., aged 52 at his death. He was a collier from his boyhood,
and wrought during the greater part of his life at Penston colliery in
the parish of Gladsmuir. He was a short-set robust man, and while
labouring at Penston, he enjoyed usually good health, free from cough or
any affection of the chest. When he had attained the age of 48 years,
(1833), he removed from the Penston to the Pencaitland coal-work, and
about six months after making this change, he began to experience a
slight difficulty of breathing, accompanied by a troublesome cough and
feverish nights. The pulse was 84. Various soothing remedies were
administered, which relieved for a little the pectoral symptoms; and as
he felt no decided physical debility, he continued as usual at
underground work. In 1835 I saw him often, and found that his pulmonary
symptoms were becoming more marked; his cough was excessively annoying
in the morning and when going to bed; his expectoration was frothy
mucus, with dyspepsia, palpitation, and occasional headach. The
resonance of the chest on percussion was very slightly impaired, and the
respiratory murmur was variable, being occasionally louder at one time
than another, and often much obscured, from the mucous secretion.

Labouring under this chest affection he still continued his daily
employment till the spring of 1836, when he was entirely laid aside,
being unable to go below ground, or to take the slightest fatigue, for
the smallest exertion produced a fit of coughing; and during a paroxysm
of this kind, he expectorated a few black sputa, which in a few days
disappeared, and gave place to the usual frothy mucous expectoration.
This bronchial discharge was accompanied by considerable relief to the
cough and dyspnoea. By this time, (June 1836), on applying the ear to
the chest, the resonance is dull, and respiratory murmur obscure. The
action of the heart was slow when compared to its former state. The
pulse not beyond 45 in the minute. By the end of this year he appeared
in a half dead state,--but a mere shadow in regard to flesh. He was
expectorating at intervals of some weeks, when the cough became more
severe, a few carbonaceous sputa, and suffering severely from gastric
irritation.[13] During the last week of his life, he expectorated
considerable quantities of black fluid, and died exhausted, January
1837.

_Post-mortem examination_, which was conducted hurriedly, exhibited
extensive effusion into both sides of the chest. The adhesions of the
pleura were strong, and evidently of long standing. There was very
general carbonaceous infiltration throughout the lungs, without
excavations to any extent. Various empty cysts, which could contain a
hazel-nut, were found in the superior and middle lobe of the right, and
throughout the whole of the left lung; in which bronchial twigs
terminated. The pericardium was distended, with limpid effusion. The
right side of the heart was dilated, and filled with dark
treacly-looking blood; and when washed, it appeared pale and bloodless.
Its walls were thin, various patches of brown exudation extending over
both pleuræ. There were several enlarged lymphatic glands, found at the
root of both lungs, filled with black fluid.

In examining the head, the pia mater was found much congested; but there
was no effusion discovered into any of the ventricles of the brain, nor
any other indication of disease.

In tracing the history of this patient, connected with the disease, it
will be observed, that until he came to Pencaitland colliery, he had no
symptom whatever of chest affection. Penston coal-work is exceedingly
well ventilated, and the miners who labour there seldom, if ever, suffer
from the black expectoration, owing to the evolved smoke of every kind
being freely carried off from its underground works, while it is quite
the contrary at Pencaitland, where many colliers, on leaving Penston,
are seized with the disease. This case comes under the second division
of the disease, where the irritative process, the result of the foreign
matter in the lungs, has proceeded so far as to produce a variety of
small cysts, containing fluid, or semi-fluid carbon, following the
course of the bronchial ramifications.

       *       *       *       *       *

CASE 6. D. L., aged twenty-six years at his death, in August 1837. He
was the son of a collier, at Pencaitland, and engaged at an early age in
putting the coals to his father; and when he was fit for full
collier-work, in 1831, he was employed at the same coal-work. He was a
tall, well-formed, robust young man, and not at all liable to chest
affection. For some time he wrought, as a coal-hewer, but latterly was
induced, (1834), for higher wages, to become a stone-miner in the same
coal-pit, where gunpowder was used extensively in the operations. About
six months after he commenced stone-mining, he became affected with a
short tickling cough, expectoration of pearly tenacious phlegm, hurried
breathing, tightness across the chest, frequent pulse (95), heat of skin
during the night, and occasional throbbing in the head. Being young, and
fearless of any danger from the occupation, although warned of the
consequences, he continued to prosecute it, and twelve months (May 1835)
after he first began, the cough had increased much in severity. The
expectoration was diminished, and had become more difficult to void from
the bronchi, and the breathing was more oppressive, accompanied by a
painful tightness across the chest in the morning. The body was
considerably reduced in bulk to what it previously had been. The pulse
ranged from 80 to 90; the appetite was impaired, and there was in the
morning a tendency to retching. The nocturnal heat of skin continued,
without any moisture, though his body was drenched with a clammy sweat
during the hours of labour. The respiratory murmur was harsh and
extensive at the upper part of both lungs, while the sibilant ronchus
was heard occasionally in the lower lobes. The heart's action was
regular, but impulse strong, on applying the hand to the cardiac region.
The remedies resorted to were blisters, bleeding (at an early stage),
expectorants, and tonics, which, to a certain degree, relieved the more
urgent symptoms.

In October 1835, the disease having made rapid progress, all the
symptoms had become more marked. The cough, from its frequency and
severity, was extremely exhausting, and the expectoration had become
more copious, and of a semi-black colour. The mucous râle was evident in
the upper part of both lungs, while the inferior lobes were dull to the
ear, and on percussion. The heart's action, at this stage, was less
strong, but no peculiarity in its function could be discovered. The
cardiac region exhibited every indication of effusion into the
pericardium. His body was now considerably emaciated, and the anterior
part of his chest was so much contracted, as to oblige him to stoop to a
great degree. Under this load of disease, he continued his employment of
a stone-miner, gradually losing flesh, with a rapidly increasing black
expectoration; and having several dependant on his exertions, he
resolved to work, while he could keep on foot, which he did till
September of the following year, (1836) when his once powerful body was
so reduced, from disease, and his cough so incessant, that he was unable
to move or speak without great fatigue. He preferred the sitting
position, as giving him most freedom in breathing. The pulse was rather
slow and small; the heart's action languid, and there was an evident
increase of dulness upon percussion over cardiac region. At this, the
closing period of the disease, (November 1836) he first complained of
drowsiness, accompanied by headach. The countenance was pallid; the eyes
sunk and inanimate, and the body tending to be cold; the urinary
secretion of a dark brown colour, and precipitates a dark deposit. The
bowels were exceedingly obstinate, with little change in any of the
symptoms; he lingered till January 1837.

_Post-mortem examination._--The body was much emaciated. The thorax was
large, and well arched. On removing the anterior part of the chest, the
lungs appeared to be fully developed, and of a dark blue colour. There
were several very slight adhesions between the pleuræ, and the effusion
into both cavities was small in quantity. The pleura costalis was almost
free from any exudation, but there were a variety of small patches of
false membrane throughout the pleura pulmonalis. The left lung exhibited
general carbonaceous infiltration. The upper lobe was partially
excavated. The pulmonary structure, internally, was ragged and easily
torn, and these cavities communicated with the bronchial divisions, the
walls of which formed various septa. The inferior lobe was almost
impervious to air. The minute bronchial ramifications and corresponding
lobules were impacted with dense carbon. There were several clusters of
small cysts throughout this lobe, containing carbon in a fluid state. A
portion of this lobe sank in water from its density, and when squeezed
with the hand, thick fluid carbon, containing hardened particles, could
be expressed from it. The right lung was similar in external appearance
to the left. The upper lobe was crepitant, though infiltrated with
carbon into the interlobular cellular tissue. The air-cells were gorged
with tenacious mucus. The middle lobe was partially excavated. The
cellular tissue was considerably disorganized, and similar in diseased
structure to the upper lobe of the left lung, with the exception of a
portion affected by vascular emphysema. The inferior lobe was much
condensed, and loaded with carbon of a very bright black. The mucous
membrane of the bronchial tubes was thickened, and slightly ulcerated.
Various lymphatic glands were found at the root of both lungs,
containing black fluid. The pericardium was considerably distended from
effusion of a straw-coloured fluid. The internal surface of the
pericardium was rough, and both laminæ appeared thickened from
inflammatory action. Effusion into cavity of chest to the extent of
twelve ounces. The heart was natural in appearance, but thin in
substance. The tricuspid and mitral valves were thickened, and
exhibiting minute granulations on their surface. The right auricle and
ventricle were dilated considerably. Aorta, and other vessels proceeding
from heart, were natural. The stomach was small, and exceedingly spongy
in its mucous lining. The intestines were healthy. The kidneys were
small, and peculiarly yellow in the internal structure. The liver was
large, and engorged with dark thick blood; several small carbonaceous
cysts throughout its substance. The spleen was large, soft, and much
congested. The mesenteric glands free from black matter.

_Head._--The arachnoid thickened and opaque; there was very general
congestion of pia mater with dark black blood, and when removed,
convolutions studded over with innumerable dark points. The surface of
the brain was apparently healthy, with an effusion of a light pink-like
fluid into the lateral ventricles. The internal substance of the brain
natural.

This case is interesting, as showing the very rapid course, in some
instances, of the disease to a fatal termination, and also how soon the
strongest man can be brought under its destructive influence. This is
the only case in which carbon was discovered in any of the other organs,
as exhibited in the liver. The above case comes under the third
division, showing extensive excavation of the pulmonary structure.

CASE VII. James R. aged 54 at his death, 1836. He was a large muscular
man, and wrought as a coal-miner in early life at Pencaitland, and, as
far as could be ascertained, he had never been engaged at stone-mining.
At the age of thirty he was obliged to desist work, on account of a
difficulty in his breathing, which he considered to be asthma, and he
was occupied above ground, as the engine-man, during the latter part of
his life. The slightest exertion produced exhaustion and palpitation of
the heart; his bowels were obstinate, and his urinary secretion small in
quantity. His cough was particularly troublesome in the morning, and was
relieved by a free expectoration of frothy mucus. In this condition he
continued, with the cough gradually increasing, for nearly twenty
years, as I understand, when he began to void black sputa, which daily
augmented in quantity till his decease, August 1836.

For some weeks previous to his death, his pulse had become slow and
thready, 36 in the minute. The oedema of the upper and lower
extremities was extensive; the dyspnoea increased considerably; the
countenance was livid; and the body remarkably cold. Stimulants in
considerable quantity were administered without the smallest effect.
Drowsiness supervened; and he was for some days previous to dissolution
in a torpid condition, while at the same time he was quite collected
when roused.

_Post-mortem examination._--On examining the body, the chest was large
and well formed. The effusion into the cellular substance was very
general. The cartilages of ribs were ossified, and both lungs were
adhering strongly to the pleura costalis. There was large effusion into
both cavities of the chest, to the extent of three English pints in
whole. The pleura pulmonalis was much thickened and rough, with false
membrane, and many patches of puckering. Several lymphatic glands in the
anterior part of the mediastinum contained black fluid. The left lung
was carbonaceous throughout its substance. The upper lobe partially
excavated and ragged; the inferior lobe infiltrated and emphysematous.
The right lung was of corresponding black appearance. The lower lobe had
a firm and condensed feel, and when divided, exhibited a mass resembling
indurated blacking. The middle lobe was in part permeable to air; and
there were several small cysts containing liquid carbon, connected with
minute bronchial ramifications. Various indurated knotty bodies were
extended throughout its substance. In the upper lobe, the carbon was
confined principally to the interlobular cellular tissue, and when
pressed in the hand, gave out thick, black, frothy serum. The mucous
membrane of bronchial divisions, when freed from the black matter, was
swollen and eroded as far up as the bifurcation of the trachea. At
several parts these passages were considerably contracted.

The heart was enlarged, and dilated in all its cavities. The valves of
the right and left ventricles wore thickened, from congestion of very
minute veins, and were granular to the feel. The substance of the heart
was soft. There were eight ounces of effusion into the pericardium,
resembling that formed in the cavities of the thorax. The liver and the
spleen were large; the former peculiarly yellow and oily. Several very
large veins, containing inky-looking blood, were seen ramifying its
substance. The spleen was very friable. The kidneys were small, and
apparently healthy.

Brain not examined.

This case comes under the third division of the disease. R.'s case is
peculiarly striking, from the length of time (twenty years or more) that
the carbon was concealed within the pulmonary tissue, and also because
he had never been engaged, as far as known, as a stone-miner; so that
this case, along with others, illustrates the fact, that where the
morbid action is the result of lamp smoke, from the combustion of coarse
oil, and not gunpowder smoke, the disease is much slower in its
progress, but ultimately fatal.

       *       *       *       *       *

CASE VIII. R. D., aged 37, at his death, 1839. He was the brother of
George Davidson, subject of the first case in this Essay. He began to
labour as a miner, with his brother, in early life, at Pencaitland
coal-work. He first began as a coal-miner, and after being so engaged
for five or six years, he removed to Penston coal-work, which adjoins.
He continued healthy for a considerable length of time, and at his
brother's death, December 1836, he was free to all appearance from any
affection of the chest. He returned, 1836, to Pencaitland coal-work,
where he engaged as a stone-miner, knowing that such employment was
destructive to life; and from that change he dated the commencement of
his disease. Cough, palpitation, dyspnoea, headach, quick pulse (90 in
the minute), made their appearance, soon after he began trap labour, and
these symptoms gradually increased, till he was laid aside in the course
of two years, (1838,) when he first expectorated black sputum.[14] As
his exhaustion advanced, the carbonaceous expectoration became more
copious, and he discharged from the lungs at an average twelve ounces of
fluid, resembling liquid blacking, daily; and he died in a manner
similar to his brother, Case No. 1. Some weeks previous to his death,
his pulse rapidly sank to about 45 or 50, and became exceedingly
feeble;--cold extremities, oedema of the legs and arms, lividity of
lips, eyelids, and ears, preceding dissolution.

_Post-mortem examination._--The chest was contracted; the ribs
unyielding, with extensive adhesions of the pleuræ. Both lungs were of a
dark-blue colour, much puckered from patches of false exudation. There
was extensive effusion into both cavities of the chest; and the right
lung showed carbonaceous infiltration throughout its whole extent. The
superior lobe was excavated, so as to contain a small orange; and about
six ounces of thick, black matter were found in it. The middle lobe was
crepitant, though soaked with black fluid; several impacted lobules were
scattered throughout its substance. The inferior lobe was indurated,
resembling a piece of moist peat. The left lung was cavernous in both
lobes, and the cysts were empty, the contents having been expectorated.
A small portion of the upper lobe was pervious to air. There were
several enlarged bronchial glands at the root of both lungs; and the
tracheal glands contained black fluid. The liver was large, and its
substance soft.

_Head._--There was extensive congestion of the blood-vessels of the
brain, with effusion into the lateral ventricles. The viscera of the
abdomen were extensively congested, with slight effusion into the
peritoneal cavity.

It will be observed in referring to the history of this case, that till
the time this man became a stone-miner, and carried on his operations
with the aid of gunpowder, he had no symptom of the disease of which he
died, and it is evident that the disease, if commenced at all, had made
little or no progress till after his return from Penston colliery to
Pencaitland, and after he had inhaled the residuum of gunpowder
combustion, therefore the disorganization of the pulmonary structure was
to all appearance effected between the summer of 1836 and December 1838,
showing decidedly the very irritating character of gunpowder smoke upon
the delicate tissue of the air-passages.

CASE 9. J. D., aged 37, at his death, April 1844. He was a well formed
man, with a fully developed chest. At so early an age as seven years, he
engaged in the labour of the coal-pit at Preston-Hall, Mid-Lothian, and
he continued to prosecute that employment for a period of 15 years, when
he was obliged to relinquish the work on account of an affection of the
chest, being, as he termed it, "touched in the breath." During the
subsequent 15 years of his life, he had never once entered a coal-pit,
nor had he any connexion with coal-works, but earned his bread by the
trade of a travelling merchant. He had suffered much in his wanderings,
from his breathing,[15] for more than two years continuously, while loss
of appetite, and thoracic irritation, had rendered his physical frame as
weak as that of a child.

When I first saw this man, which was about a month before his death, he
laboured under rending cough, with a scanty tough mucous
expectoration--oppressive dyspnoea, ascites, general anasarca,
occasional giddiness, and throbbing headach on motion, or on assuming
the standing position. His countenance was of a light blue or slate
colour, and his upper and lower extremities had much the same
appearance. His lips, eyelids, ears, and nose, were swollen and livid,
and his eye-balls effused, and apparently projecting from the sockets.
His sight was impaired and hazy. There was continued feeling of cold,
with occasional rigors, and difficulty in keeping the extremities warm.
There was considerable exhaustion upon the slightest exertion. The half
reclining posture was the only one in which he was comfortable. The
pulse was exceedingly slow, not above 36 in the minute, it was small,
and often imperceptible at the wrist. There was considerable weight and
feeling of oppressive fulness in the region of the heart, which was dull
on percussion. On applying the ear to the chest, little or no râle
whatever was discernible, and the action of the heart was almost
inaudible. He had a sensation as of great weight in the head, and
difficulty in raising it. Ho suffered from restless nights, short
hurried breathing, with a feeling and dread of suffocation, evident
fulness and enlargement in the region of liver, and inability to turn to
the right side. The urine was small in quantity, of a bluish colour, and
coagulable, irritability of stomach, and the bowels were obstinate and
difficult to move, even with drastic purgatives. The treatment was
merely palliative, no stimulant seemed to have any effect in exciting
the system. Ascites and general anasarca were considerable, giving the
body a large appearance. For some days previous to his dissolution,
there was increased lividity of countenance, and little or no action of
heart. He had at no time expectorated carbon, even during many severe
paroxysms of cough. Upon inquiry, I found that this man had been a
companion in labour to R. R. (whose case No. 2, is fully reported,) at
Preston-Hall colliery, and from the morbid appearances found in R.'s
chest, and from the character of the coal-work in which both were
engaged, I was induced to believe Duncan's to be a similar case. In
ascertaining his early history, I found him to be a robust powerful man,
though troubled with a cough and hurried breathing from his first
becoming a collier, circumstances very usual with those who engage in
difficult mining operations, and which they erroneously attribute to
want of air, nothing more.

_Post-mortem examination, twenty-four hours after death._--The body was
much swollen from effusion. On removing the anterior part of the chest,
both lungs were much compressed from an immense effusion of a light
brown fluid into the cavities of the chest to the extent of a gallon.
The lungs were of a deep black colour, and irregularly spotted with dark
brown patches of exudation. There were considerable adhesions of the
pleuræ, and marks of very general chronic inflammation and false
membrane over the greater part of the pleura costalis. There were
adhesions of the left lung to the pericardium, which was much thickened,
and contained about 14 ounces of a turbid fluid. On removing the left
lung, it seemed large, and felt partially consolidated, and on dividing
it throughout both lobes, it contained a mass of semi-fluid carbon, of a
bright black colour, similar to paint. In this lung, the air-cells were
almost entirely disorganized, unfitting it for the function of
respiration. The upper lobe was divided into a variety of cysts, filled
with carbonaceous matter in a fluid state, into which many of the
smaller bronchi opened, and through which various blood-vessels passed
uninjured. The inferior lobe, when emptied of its contents, was so much
excavated that the parenchymatous substance felt light and flaccid. On
dividing the right lung[16] it exhibited a pure black mass, but not so
fully disorganized as the left. Portions of each lobe were permeable to
air, while other parts formed cysts, containing fluid and solid carbon,
the inferior lobe showed an almost solid mass. The mucous membrane of
the respiratory passages was inflamed and spongy throughout the
divisions, the small ramifications were irritated and choked up with
tough, frothy phlegm. There were several large bronchial glands at the
root of the left lung. In tracing the divisions of the bronchi more
minutely, from the root of the lungs into their substance, clusters of
glands were observed filled with inky fluid, and narrowing considerably
the air-passages, and in washing carefully a portion of the upper lobe
of the right lung, and removing as far as possible the carbonaceous
matter, several lymphatic glands were seen with the aid of the
magnifier, imbedded in the interlobular cellular tissue, resembling
small black beads. The tracheal glands when examined, contained black
fluid, similar in appearance to what was found in the bronchial glands.
The mucous membrane of the trachea was soft and irritated, smeared with
tough bloody mucus, the lining membrane of the rima glottidis was
thickened and slightly granular.

The heart was much enlarged, and soft, with spots indicating chronic
inflammatory action on and about the right auricle. Both auricle and
ventricle on the left side of the heart contained a deep-dark blood.
There were several large lymphatic glands imbedded around the great
vessels proceeding from the base of the heart, containing black fluid,
the other cavities appeared healthy, though attenuated in substance. The
coronary veins were congested. None of the cervical glands contained
black fluid, though several of them were enlarged. The cavity of the
abdomen much distended from ascites; the contained fluid was to the
extent of about six Scotch pints of a straw colour; the viscera much
compressed, and matted together, with light brown exudation. The
peritoneum was rough, and coated with the same exudation. The stomach
and all the intestines correspondingly contracted; the mesentery
appeared healthy; the liver was much enlarged, and darker than usual;
the inferior lobe extending downwards, near to crest of ileum; the whole
organ loaded with inky-coloured blood; the substance easily torn. The
kidneys presented a natural appearance; the adipose substance in which
they were imbedded was oedematous; the medullary substance of each
presented a yellowish colour.

_Head._--The integuments were oedematous. On exposing membranes,
considerable effusion under arachnoid; very general venous congestion,
extending over the convolutions, and to the base of the brain. Effusion
into the lateral ventricles of a light yellow; the choroid plexuses
thickened, and of a dark venous appearance; substance of brain firm and
apparently healthy.

From the history of this case, it will be found that D. had at no time
shown any indication that carbon was infiltrated into the lungs. At an
early age he came under the influence of the smoke of coarse linseed
oil, and of gunpowder, while labouring in an unhealthy and
ill-ventilated pit, which produced a cough common amongst colliers, who
may be placed in similar circumstances; and it is evident, that during
the last fifteen years of his life, the carbon--having previously taken
up a lodgment in the pulmonary tissue--was gradually accumulating, and
thereby producing painful dyspnoea, and the other formidable symptoms
connected with the circulating organs, which followed as results, till
it had almost entirely saturated the cellular structure, and rendered
the lungs unfit for the functions of respiration, consequently impeding
the necessary change, through the medium of that function upon the
blood.

There was a marked similarity in the morbid appearances between this
case and that of Reid, (No. 2). They both wrought in the same pit at
Preston-Hall, and were affected in a similar manner. Both had enlarged
liver, and the left lung principally disorganised. Both had extensive
anasarcous and other effusions, and both had coagulable urine. Neither
expectorated black matter, and both died from the bursting of a
carbonaceous cyst into the bronchi, producing suffocation. Duncan lived
longer under the infiltration than Reid did; and this was no doubt owing
to his being younger, and also his healthy occupation latterly.

I have preserved a quantity of the contents of a cyst in the left lung
of this patient, for chemical analysis; also a portion of the blood from
the vena cava, and a little of the black fluid from the bronchial
glands.[17]


CASE 10. (The subject of the following case is still alive, 1845.) J.
S., aged thirty-six. He was born of collier parents, in the parish of
Pencaitland, and at as early an age as eight years, went under ground to
assist his parents in the transmission of the coal, and when fit for
work became a coal-hewer. From his infancy he was rather of a delicate
constitution, with flat and contracted chest. When I first saw him,
which was about eight years ago, (1837), he was in full employment as a
coal-hewer, complaining of shooting pains through his chest, tickling
cough in the morning, with scanty tough expectoration, and frequent
palpitations. He was repeatedly under treatment for bronchial affection,
which was usually relieved by expectorants, blisters, and _continued_
counter-irritants. Each attack of bronchitis was the result, as he
expressed it, of "breathing bad air in the pit," in which he was obliged
to relinquish labouring, as the lamp would not burn, from the state of
the atmosphere. He never wrought at the stone-mining nor blasting. In
examining the chest with the ear, at this stage of the affection, the
mucous râle was distinctly heard, and exceedingly loud throughout the
greater part of the chest. The heart's action was strong, but natural;
pulse 70, full and bounding. About four years ago, he removed from
Huntlaw to Blindwell, a coal-work towards the sea-coast, an extension of
the same coal formation. At this time, 1841, he had very troublesome
cough, particularly in bed, scanty frothy expectoration, annoying
dyspnoea, preventing him taking sufficient nourishment, headach,
obstinate bowels. He continued under all these ailments to labour with
much difficulty, till the summer of 1843.[18]

In reviewing the morbid appearances in the cases now detailed, it will
be observed, that in the majority of them, the left lung exhibited the
greater amount of diseased structure. This fact is particularly
interesting, as in _tubercular_ phthisis, a similar predominance of
disease is found on the left side.

In almost all the cases, there was found very extensive effusion into
the serous cavities, and particularly into those of the pleura and
pericardium. Both pleuræ were much thickened, and all the marks of a
long standing pleuritic and pericardial inflammatory action were seen.
The substance of the heart, in all the cases, was soft and attenuated;
the right auricle and ventricle were dilated; and there was thickening
of several of the valves. The liver and spleen were usually large and
congested. In all the cases, as the disease advanced, the pulse came
down to a very unfrequent and thready beat. From the great extent of the
venous congestion, the disease often assumed the aspect of asphyxia; and
in some instances the colour of the patients resembled that of persons
labouring under cyanosis.

The lividity of countenance, and the other concomitant symptoms, which
presented themselves, gave decided indications of the morbid effects of
this extraneous body. It requires little explanation to show how such a
diseased state of the pulmonary organs, as has been described, should
produce such results, by impeding the necessary chemical change of the
blood. Imperfect oxygenation of the blood, consequent on the altered
pulmonary structure, must cause a general depression of all the vital
organs. The excess of excrementitious matter in the circulation, must
produce effusion of serum into the various cavities, and also into the
cellular structure; and the appearances exhibited on the surface of the
brain and its membranes, afford a full explanation of the sluggish
inanimate condition of all the sufferers towards the close of their
existence.

From the cases above reported, it must be evident, that black phthisis
is the result of foreign matter inhaled and retained within the
pulmonary structure.

It is a melancholy fact connected with mining occupations in the
locality described, that few or none who engage in it, escape this
remarkable disease. I have never known one collier in many hundreds,
who, even in his usual health, was not, as he expressed it, more or less
"touched in his breathing;" and after much experience in auscultation in
such pulmonary affections, I am the more convinced that the dyspnoea
from which they suffer, arises from impaction of the minute bronchial
ramifications induced during their labour below ground, surrounded by an
impure atmosphere. The East Lothian colliers, of all miners throughout
the kingdom, are certainly most subject to this disease; and those at
Pencaitland are so to a fearful extent. In the late inquiry for the
Parliamentary report, such has been manifestly brought out, and I am
quite able to corroborate the conclusions at which the commissioners
have arrived. It has been supposed by many that this carbonaceous
affection was caused by inhalation of coal-dust. Now, when it can be
proved, that there is as much coal-dust at one coal-work as at another,
the question comes to be, why should colliers, labouring at one
coal-work, be subject to the disease; while those engaged at another,
escape? For instance, there is as much coal-dust at Penston and Huntlaw,
where there has never been black spit, as there is at Pencaitland,
Preston-Hall, and Blindwells. I conclude, therefore, that this cannot be
the cause, otherwise they should all be liable to the disease. Again,
those who labour as coal-bankers at the mouth of the shaft, are obliged
to inhale much coal-dust in shovelling and arranging the coal received
from the pit, and have the sputum tinged to a certain extent by
it--which resumes its natural appearance when the collier leaves the
labour producing it. They are not subject to the miners' cough, nor is
there carbonaceous infiltration found in the lungs of such labourers
after death. The females and boys, when, as formerly, both were allowed
to labour, could not fail to inhale much of the coal-dust in which they
were generally enveloped in their daily occupation; but no carbonaceous
deposit has ever been found in the pulmonary tissue of either the one or
the other. There are very interesting facts connected with the history
of this disease, showing the length of time which the carbon can be
retained, brought out by two cases on record, the one published as
formerly mentioned by Dr James Gregory, in the _Edinburgh Med. and Surg.
Journal_ for 1831, denominated, "Spurious Melanosis;" the other, a case
published by Dr William Thomson, (_Medico-Chirurgical Transactions of
London_ for 1837), and which was reported to him by Dr Simpson, now
Professor of Midwifery in Edinburgh.

Dr Gregory's case is that of John Hogg, who had been in the army for
more than twenty years, had seen much service as a soldier in America
and the West Indies, and had served in Spain during the Peninsular war.
On his return to his native country, he was engaged for a short time
before his death as a collier at Dalkeith. I understand, upon inquiry,
from those who were connected with Hogg, that he wrought in early life
as a miner at Pencaitland coal-work, and was obliged, though a young
man, to relinquish such employment on account of a chest affection, and
exchange the pick for the musket. From the history of this case, and
from the character of his occupation in early life, I apprehend that the
carbonaceous deposit took place when he was first labouring as a miner
at Pencaitland; and that he carried the foreign body in his lungs,
throughout his campaigns.

The case reported to Dr Thomson by Dr Simpson is that of a George Hogg,
who lived at Collinshiel, near Bathgate. In early life, this man
laboured at Pencaitland coal-work, where the greater number of the cases
now under consideration occurred; and it is stated as a certainty, that
he contracted the black phthisis while occupied in that district; for I
find from those who knew him at an early period, that his breathing was
much affected while at Pencaitland, and he was long supposed by his
fellow-miners to have imbibed the disease,--indeed he removed from
Pencaitland on account of it. The two Hoggs were relatives, and natives
of East Lothian.

It is evident, from several of the cases, that it is no uncommon feature
of this affection for the carbon to remain concealed in the pulmonary
tissue for very many years; and as both the Hoggs were miners at
Pencaitland, I have not the smallest doubt that it was then and there
that the disease had its origin; for I have never known a collier who
was a stone-miner who did not ultimately die of the carbonaceous
infiltration.

Apart from colliers and coal-mines, as a proof that carbonaceous
particles floating in the atmosphere are inhaled and lodged in the
bronchial ramifications, I may state the following circumstance, which
came under my own observation several years ago. After a gale of wind,
which had continued for more than a week, off the coast of America, in
the July of 1832, I was applied to for advice by several of the seamen,
on account of a tickling cough, followed by a peculiarly dark blue
expectoration, which I was told was almost general amongst the crew. I
was certainly at a loss, and put to my shifts, to render a reason; but,
upon investigating the matter further, I found that, during the gale,
the chimney of the cook's apartment in the _'tween-decks_ was rendered
inefficient, whereby the sleeping-berths were constantly filled with
smoke. I found almost all the seamen, to the number of nearly a hundred,
suffering considerably from cough, and expectorating an inky-coloured
phlegm, which continued more or less for about a fortnight. I ordered
soothing expectorants, and the dark sputa were profusely voided, and
ultimately disappeared; but whether any of the carbon had made a
permanent lodgment in the pulmonary tissue, is what I have never been
able to ascertain. I am now convinced, in recalling this occurrence,
that whatever be the situation, should carbon be floating in the air, it
can be conveyed into the air-cells; and had these seamen been longer
subjected to this foul atmosphere, a permanent lodgment of the carbon
would undoubtedly have been the consequence, and the disease now under
our consideration to a certainty produced. I further remember seeing,
several years ago, a case of partially carbonized lungs in a person who
had lived for a length of time in a smoky and confined room in Glasgow.
The patient died of dropsy, consequent, no doubt, on the pulmonary
affection; and on examining the chest, the upper lobe of both lungs, and
the bronchial glands contained black matter, similar in appearance to
that found in the colliers.

While engaged in committing these remarks to paper, I have been led in
my investigations to compare the various kinds of labour carried on in
coal-pits with the underground operations of many of the railways now in
progress throughout the kingdom; and being convinced of the very
injurious effects produced upon miners while prosecuting these
operations in confined situations where gunpowder is used, I shall be
much surprised if the same results do not follow the hazardous
undertakings connected with railway tunnelling, where gunpowder is had
recourse to, and in the course of years find in our public hospitals
cases of carbonaceous lung arising from this cause.[19]

It is no uncommon occurrence, in examining the pulmonary structure of
those who have resided in large and smoky towns, to find both the
substance of the lungs and bronchial glands containing black matter; and
this is the case especially with persons who, in such situations, have
passed the prime of life. But few, though not living in crowded towns,
have not, at some period of their life, come in contact with smoke, and
been obliged to breathe it, minutely combined with the air. It is not,
therefore, to be supposed improbable, that a portion of the infinitely
small particles, thus suspended in the atmosphere, should effect a
settlement in the more minute air-cells, and in course of time, be
conveyed to the interlobular cellular tissue by the process of
absorption, and thence to the bronchial glands. There are several cases
on record, from amongst iron-moulders,[20] where the pulmonary structure
has been found heavily charged with carbonaceous matter, from the
inhalation of the charcoal used in their processes, and where, during
life, there was a free black expectoration.[21]

There is, then, little doubt that the bronchial glands, from their
appearance in miners, moulders, and others, are the recipients of a
portion of impurities which have been carried into the pulmonary
structure by inhalation, and also those left after the process of
oxygenation of the blood; and when it is fully ascertained, from the
character of the atmosphere in the coal mine, that deleterious matter in
this form must be conveyed to the air-cells during respiration, there is
little difficulty in coming to the conclusion, that the black fluid
found to such an extent in these glands in the collier and moulder, is
similar to, and a part of, that discovered infiltrated into the
substance of the lungs. If we trace the black matter in the lymphatic
vessels, (which has been done), from the pulmonary organs to the
bronchial, mediastinal, and thoracic glands, and from thence to the
thoracic duct, we cannot but admit, that it does find its way into the
venous system, and thereby contaminates the vital current.[22]

Dr Pearson of London, in his very valuable paper, published in the
Philosophical Transactions of 1813, on the coaly matter in the bronchial
glands, was convinced beyond a doubt, that it was of foreign origin, and
possessed the properties of carbon conveyed into the lungs from without.
He, at that period, was not in possession of such facts as have been
recently elicited on the subject of deleterious inhalation; but the very
interesting materials which he brought to bear on his argument, have, I
think, most satisfactorily proved the assertion which he makes, that
"the lymphatics of the lungs absorb a variety of substances, especially
this coaly matter, which they convey to the bronchial glands, and thus
render them of a black or dark-blue colour." "The texture and proportion
of the tinging matter of the glands was," he says, "different in
different subjects, whether the lungs to which they belonged were in a
healthy or diseased condition. In persons, from about 18 to 20 years of
age, some of the bronchial glands contained no tinging black matter at
all, but were of a reddish colour; others were streaked or partially
black." Again, he says, "I think the charcoal in the pulmonary organs is
introduced with the air in breathing. In the air it is suspended in
invisible small particles, derived from the burning of coal, wood, and
other inflammable materials in common life. It is admitted that the
oxygen of atmospherical air passes through the pulmonary air-vesicles or
cells into the system of blood-vessels, and it is not improbable, that
through the same channel various matters contained in the air may be
introduced. But it is highly reasonable to suppose, that the particles
of charcoal should be retained in the minutest ramifications of the
air-tubes, or even in the air-vesicles under various circumstances, to
produce the coloured appearances on the surface, and in the substance of
the lungs, as above described."

"When I compare the black lines and black net-like figures, many of them
pentagonal, on the surface of the lungs, with the plates of the
lymphatic vessels by Cruikshank, Mascagni, and Fyffe, I found an exact
resemblance."

Dr Pearson, after various chemical experiments upon the bronchial glands
with caustic potash, muriatic and nitric acid, says, "I conceive I am
entitled to declare the black matter obtained from the bronchial glands,
and from the lungs, to be animal-charcoal in the uncombined state, _i.e._
not existing as a constituent ingredient of organized animal solids
or fluids." Dr Graham of London, in his paper on this subject, recorded
in the 42d vol. of the _Edinburgh Medical and Surgical Journal_, gives
the following opinion, as the result of a series of investigations, with
the view of determining the nature of the disease in question. He says,
I have had several opportunities of substantiating the carbonaceous
matter in a state of extraordinary accumulation in black lungs supplied
by my medical friends. The black powder, as derived from the lungs,
(after an analysis,) is unquestionably charcoal, and the gaseous
products from heated air, result from a little water and nitric acid
being retained persistently by the charcoal, notwithstanding the
repeated washing, but which re-acting on the charcoal at a high
temperature, coming off in a state of decomposition. In regard to
another analysis of a lung, he says, "The carbonaceous matter of the
lung cannot therefore be supposed to be coal, altered by the different
chemical processes to which it has been submitted in separating it from
the animal matter. The carbonaceous matter of this lung, appears rather
to be lamp black."

From the whole results, I am disposed to draw the following
conclusions:--

_1st_, The black matter found in the lungs is not a secretion, but
comes from without. The _pigmentum nigrum_ of the ox I find to lose its
colour entirely, and to leave only a quantity of white flocks, when
rubbed in a mortar with chlorine water. Sepia, which is a preparation of
the dark-coloured liquor of the cuttle fish, was also bleached by
chlorine, but the black matter of the lungs was not destroyed or
bleached in the slightest degree by chlorine, it even survived
unimpaired the destruction of the lungs by putrefaction in air.

_2d_, This foreign matter probably varies in composition in different
lungs, but in the cases actually examined, it seems to be little else
than lamp black or soot.

It does not appear, as far as I can ascertain, that any of the
Continental physiologists are familiar with the disease now under our
consideration. Several of them, both ancient and modern, discovered
black matter in the pulmonary tissues, but not connected with nor
exhibiting the black phthisis. It is therefore unnecessary to refer to
them in general.

The following foreign authors entertain various opinions in regard to
the dark appearances in the pulmonary tissue:--

Bichat supposes the black matter in the lungs "to be owing to small
bronchial glands extending along the surface of the pleura." Breschet
believes that it is formed by the blood exhaled into the cellular
tissue, stating that its chemical composition leads him to that
conclusion. Trousseau says that it is produced by a misdirection of the
natural pigments of the body, resulting from age, climate, or disease.
Andral says, that the black appearances are the result of secretion, and
that it is more manifest as the individual advances in life. Heasinger's
opinion is, that it is analogous to pigment, and therefore he agrees
with Trousseau. Lænnec was doubtful as to the real origin of black
pulmonary matter. He makes a distinction between melanotic and pulmonary
matter. He found that the melanotic matter was composed almost entirely
of albumen, while the black pulmonary matter found in the bronchial
glands contains a great quantity of carbon and hydrogen, and also that
these colouring matters have other distinguishing characters. The
melanotic matter is easily effaced by washing, while the other is
removed with difficulty. Lænnec further says, that he suspected that
this pulmonary matter might arise, at least in part, from the smoke of
lamps, and other combustible bodies which are used for heat and light;
for some old men are to be met with whose lungs contain very little
black matter, and whose bronchial glands are but partially tinged with
this colour; and it has struck him that he observed this amongst
villagers who had never been accustomed to watch.[23]

Mons. Guillot, physician to the hospital for the aged at Paris, has
undertaken a series of researches in regard to the black matter found in
the lungs of old men of very considerable age. These investigations are
published in the January, February, and March numbers of the _Archives
Générales de Médecine_.[24] It is his belief that death in such cases is
owing, in all appearance, more or less to a suppression of the
circulation of air and blood by the black substance. His impression is,
"that the carbon is not procured from without, but naturally deposited,
as life advances, in the substance of the respiratory organs; and that
this deposit of carbon causes death, by rendering the lungs
irrespirable, while, at the same time, it has much influence in
modifying the progress of _tubercular_ disease; so that, if the
tubercular affection was not cured, its progress was so far checked,
that life has been very long preserved." The black matter envelopes
completely both the pulmonary tubercles which have undergone a
transformation, and the caverns which no longer contain tuberculous
matter. He, while regarding these as the results of black matter in the
lungs, throws no light on the cause of the deposit of the particles of
carbon within the lungs.

Dr William Craig of Glasgow, in a letter to Mr Graham of London,
published in the 42d vol. of the _Medical and Surgical Journal of
Edinburgh_, states most interesting facts connected with this subject,
particularly in regard to black matter found in the pulmonary structure
of old people, which deserve considerable attention. He says--"I found
that a black discoloration of the lungs was by no means a rare
occurrence amongst those old people; and that it was impossible in many
instances to decide, whether the black colour was owing to an increase
of what is called the healthy black matter,--to a morbid secretion, or
to a foreign substance being imbedded with the atmospheric air. After
examining a considerable number of lungs, and finding that the division
of the black matter into three kinds was not founded upon observation,
and that the descriptions of them given by the best authorities were
insufficient to enable us to distinguish them from one another, I begin
to think, that in every instance in which black matter is found in the
lungs, it ought to be considered morbid. If we examine the lungs at
different stages of life, we find as a general rule that the quantity of
black matter increases with age. In young children we find no traces of
it, the lungs being of a reddish colour. At the age of ten years the
black matter makes its appearance in the outer surface of the lungs, and
in the interlobular spaces. At the age of thirty or forty, the lung
presents a greyish or mottled appearance, and the bronchial glands
contain more or less black matter. Between the age of seventy and a
hundred, the lungs are generally infiltrated with fluid black matter,
which can be expressed from the cut surfaces, and stain the hands
black."

"There are many circumstances which favour the accumulation of this
black matter in the lungs; for instance, long-continued living in a
smoky atmosphere, like that of this city, the inhalation of coal-dust,
as in the case of colliers, or of charcoal-powder, as in the case of
iron-founders. There can be no doubt that we inhale foreign substances
along with the atmospheric air.

"We find the mucus which has remained in the nostrils for some time to
be of a dark colour, and if we examine it with a microscope, we find,
that this is owing to the presence of small particles of dust or other
foreign substances, which the air may have accidentally contained. The
mucus first coughed up from the lungs in the morning, is of a dark
colour from the same cause, and the facts now maintained prove, that
foreign substances suspended in minute particles in the atmosphere, may
be inhaled into the lungs. I believe in all the extreme cases which have
occurred in colliers and moulders, that there must have existed some
previous disease of the lungs which prevented the foreign matter from
being thrown off." "According to the views which we have taken of the
subject, there are only two ways by which black matters may be deposited
in the lungs; first, by a morbid secretion; second, by a foreign
substance inhaled with the atmosphere. The former is a rare disease,
while the latter is very common. I am inclined to think that the true
melanosis generally occurs in the form of rounded tumours, which, when
cut in two, present a uniform black colour without any trace of
air-cells, while in the spurious melanosis the deposition is general,
and black matter flows freely out when the cut surfaces are pressed. At
first the lung is crepitous, and swims in water; but as the black matter
increases, it becomes solid, and, as in the case of colliers who die of
this disease, resembles a piece of wet peat in point of consistence. It
is only in the cases of colliers, moulders, or others who inhale great
quantities of black matter, that the lungs are rendered perfectly
solid."

There is an exceedingly interesting and valuable paper, written by Dr
Brockmann of Clausthal, upon the pulmonary diseases of a certain class
of German miners,--supposed to be in the Hartz mountains,--in
_Neumeister's Repertorium_ for December 1844, an abridged translation of
which is to be found in the September number of the _Monthly Journal of
Medical Science_.

It is very evident that the disease there considered is produced by
carbonaceous inhalation, and resembles in all its features the black
phthisis so general amongst the colliers in Haddingtonshire. The morbid
appearances described by Dr Brockmann are very similar to the first and
second division of that disease, presenting a very general carbonaceous
infiltration of the pulmonary tissues; but in none of the stages are
there to be found the extensive excavations discovered in the lungs of
the coal-miner. Dr Brockmann makes three divisions of the morbid
appearances, "The essential (wesentliche), accidental (zufällige), and
secondary. The first shows an entirely black (pechschwärze) colour of
the lungs through its whole substance, enclosing not only the air,
blood, and lymph vessels, but also the connecting cellular tissue, the
nervous substance, pleuræ pulmonalis, and bronchial glands." In such a
state, it is usual for the lung to remain perfectly normal, and to
exhibit the greatest varieties.

The accidental (zufällige) is evidently the disease in a more advanced
form, corresponding in a great measure with the second stage of the
morbid action, found in the pulmonary organ of the collier. It is to be
regretted that no accurate description is given either of the character
of the mine, or the nature of the employment in which the miners are
engaged, whether they be coal, silver, or lead mines, and if they are in
the habit of burning coarse lint-seed oil.

There is a very striking similarity between what Dr Brockmann calls the
secondary anatomical changes, and many of those exhibited in the
collier; first, membranes; second, collections of fluid into the pleuræ
and pericardium; third, the softened heart, and very general emaciation;
fourth, the extensive venous congestion, with thick black blood.

The liver is described by Dr Brockmann as being small:--in the collier
it is usually puffy, and much congested.

The symptoms do almost in all points accord with those presented in the
collier, as will appear from the following quotation, from the paper.
"In the first stage, there is no local, functional, or general feature
by which we can ascertain that the disease has commenced; probability is
all we can reach. In the second stage, the disease is more obvious. And,
first, there is a change in the expression of countenance; to a fine
blooming appearance, which perhaps the patient previously had, there has
succeeded a dark yellowish cast,--a change which gradually spreads over
the whole body. For some time the patient may have remarked a gradual
loss of strength, and now he complains of want of appetite and
disordered digestion, and more particularly of shooting pains in the
back and muscles of the chest. Cough likewise supervenes, which may
either be quite dry, or at most accompanied with a little pure mucus.
There is also a greater or less degree of oppression, accompanied with
palpitation of heart, not only after a severe fit of coughing, but after
every exertion of the lungs. As yet no local deviation from the normal
condition is seen on examination of the chest by percussion or
auscultation." "The disease meanwhile passes into the third stage. The
features of the patient now become more and more changed and
deteriorated, and betray a deep melancholy. The colour of the face,
which had been hitherto of an earthly hue, becomes blackish, as also the
cornea, whereby the eye loses its lustre. The appearance of the patient
becomes still more frightful from the great loss of flesh, and the dark
skin hanging loose on his bones. The fat not only seems to have
disappeared, but the muscular substance also--the whole frame being
shrivelled. The patient complains of increasing weakness, diminished
appetite, flying pains often concentrated at the pit of the stomach; and
coughs much. The expectoration is for the most part difficult, and
consists of masses of mucus, either greyish, or tending to a black
colour. A black streak is frequently observed running through the
whitish mucus; one half of it may be white, the other black, or
occasional black points may be observed throughout the mass, and
sometimes, though rarely, blood. Dyspnoea is usually connected with
the cough. It now begins to tell upon the patient, and is so
characteristic, that the disease has been named asthma metallicum. The
disturbance of the digestive organs increases the disease,--the appetite
is entirely lost,--the tongue is covered with a white fur--there is an
oppression at the stomach after a full meal--frequent eructations, and a
tendency to constipation. The distress of the patient becomes increased
in consequence of the shooting pains in the muscular system." "In the
fourth and last stage, all the external appearances indicate the near
approach of dissolution,--the face and members become bloated, and the
feet greatly swollen." "The dyspnoea meanwhile, from effusion into the
chest and pericardium, becomes so severe, that the patient cannot
maintain the horizontal position, the expectoration becomes copious,
consisting of a black inky (dintenschwarze), or ash-coloured fluid,
sometimes of mere masses of mucus streaked with black." "The disease is
never accompanied with colliquative sweats or diarrhoea."

I am sorry to find that there is no allusion whatever to the state of
the pulse. Dr Brockmann, in his remarks on the essential nature of this
pulmonary disease of miners, brought under his notice, seems to
entertain the impression that along with the inhaled carbon, resulting
from the combustion of gunpowder, there is also an organic
pigment-deposit present in the pulmonary tissue, which he supposes must
have been formed in the lungs.

I have long entertained the belief, which I have stated in another part
of this essay, that if the carbon is once conveyed into, and established
in the parenchyma of the lungs, that organ commences the formation of
carbon; thus increasing the amount originally deposited. Dr Brockmann
sets forth, as grounds for this view, that "if the parenchyma of the
lungs were filled with carbonaceous dust, their specific gravity ought
to be increased; but this is not the case. A completely melanosed lung
swims in water, both as a whole and when cut into parts." It is very
evident from these remarks, that the author has not seen the disease as
it is exhibited in the third division of morbid action in the collier,
otherwise he would have both observed the lungs considerably augmented
in weight, and also so densely impacted from the accumulation of carbon,
as wholly to sink in water. See for instance case No. 2, where the lungs
weighed about six pounds, and parts of the cellular tissue were so
indurated, as to be cut with difficulty. In this case, the patient did
not expectorate.

Dr Brockmann, as he advances, puts a question here, which more fully
shows that the disease under his consideration was of a mild character
compared with that under our notice. "If," says he, "pulmonary melanosis
arise entirely from inhalation of carbonaceous dust, why is it not
observed in other workmen, who are as much, and even more, exposed to
its influence, as for instance, smelters, or moulders, and colliers?" He
says, further, "were the carbon inhaled in quantity sufficient to
explain the black colour of the lungs, it ought also, from its
mechanical irritation, to produce inflammation in the delicate mucous
membrane of the organ, but there are no symptoms of this during life,
nor any traces of it after death." An answer to these remarks will be
most satisfactorily given by a reference to the published cases, where
the disease is principally found amongst colliers and moulders, and
where the pulmonary organs, particularly in the former, are found to
undergo most fearful disorganization from the presence of carbon. It is
very remarkable, that the author of these exceedingly interesting
observations should never have found excavations of the parenchyma, when
it is so general as the result of the same disease in this country,
particularly in the locality to which I refer. Not knowing the
character of the mine, it is impossible to judge; but I am disposed to
conclude that there cannot be the same quantity of carbon floating in
the atmosphere breathed by the German miner,--the disease resembles very
much that milder form found in the iron moulder.

With regard to the carbonaceous state of the blood, I am sorry that I
have not yet completed my investigations on that subject. It is still my
belief that the carbon being once inhaled, there is an affinity found
for that in the circulating fluid, and from its not being consumed,
owing to a deficiency of oxygen, there is a progressive increase going
on. I am very much gratified to find that Dr Brockmann entertains a
somewhat similar opinion in respect to the state of the blood.

The effects of such a morbid structure upon the collier population in
general is very marked. Previous to the late legislative act, the tender
youth of both sexes were at an early age consigned to the coal pit, and
obliged to labour beyond their feeble strength, in circumstances ill
adapted to their years. Such early bodily exhaustion soon produced in
them a pallid countenance, soft and relaxed muscular fibre, and
predisposed much to disease as they advanced in life. The miner on this
account was generally from his youth, thin; in fact, you never see a fat
and healthy-looking collier, and, according to the advance of pulmonary
disease, with them, so is the progress of emaciation. Such a state of
body may well be looked for in miners, labouring as they do, from ten to
twelve hours in the twenty-four under ground, breathing a heated and
impure atmosphere, which with difficulty sustains life, and which is
demonstrably calculated, from its deleterious qualities, to induce
serious disease. The effects manifest in the parent descend, and visible
in the youngest children; they are squalid and wretched-looking,--and
how can such offspring be otherwise? They are exceedingly subject to all
children's diseases, and peculiarly predisposed to pulmonary irritation
of one kind or other.

With regard to medical treatment, little can be done after the disease
has passed its first stage. Early removal from the occupation, and
proper attention to nutrition, alone seem to hold out the hope of
prolonging the life of the patient; but if there be carbon lodged in the
pulmonary tissues, there is a certainty of its sooner or later proving
fatal. Attention to the state of the digestive organs, and using every
means to remove the dyspeptic symptoms, which are prominently present
throughout the various stages of this disease, are indispensably
requisite; and, as to nutrition, the nature of the diet should be as
generous as possible. Anodynes and expectorants are the only remedies
which seem at all efficacious in allaying irritation.

With a view to remove urgent symptoms, venesection has repeatedly been
had recourse to, but in almost all instances I would say, with
decidedly bad effects. Blood-letting does harm, producing general
debility and rapid sinking.[25]

With regard to the prevention of this disease, ventilation, as has been
stated, is very much neglected in the pits now under consideration,
where the various cases have occurred; and to that neglect I ascribe the
prevalence of the malady. In those pits referred to, the workable
apartments are so confined, and become after a time so destitute of
oxygen, as, along with the smoke from lamps and gunpowder, to render the
air unfit for healthy respiration. The only effectual remedy is a free
admission of pure air, so applied as to remove the confined smoke. This
remark both applies to coal and stone-mining. The introduction of some
other mode of lighting such pits than by oil is required. I know several
coal-pits where there is no carbonaceous disease, nor was it ever known;
and on examination I find that there is and ever has been in them a free
circulation of air. For example, the Penston coal-work, which joins
Pencaitland, has ever been free from this disease; but many of the
Penston colliers, on coming to work at Pencaitland, have been seized
with, and died shortly after, of the black spit: for instance, G. case
No. 5, and D. case No. 8, are such.

How this is to be accomplished, is for the scientific man to say. With
all due deference, I may be allowed to suggest various modes which might
be adopted to free the underground atmosphere of the noxious
ingredients. Could fresh air not be forced down by the power of the
steam-engine, which is at every coal-pit? Could extensive fanners not be
erected and propelled by the same machinery?[26] I am much surprised
that no attempt has been made to light these pits with portable gas in
some way or other. As far as I can understand, such an application of it
would not be difficult. A small gasometer could be erected, and the
necessary apparatus procured at little expense, and by such means, I
would suppose, it could be carried to any part of the mines, which are
not extensive.

Many proprietors may grudge the expense involved in such improvements,
and thus prove a barrier to these necessary alterations; but I would ask
any candid and generous mind, what is expense when the object in view is
the removal of a disease to which many human beings fall a
sacrifice?[27]

It must appear to every one that these collier diseases are crying
evils, the preventive of which is based, as will be seen, on thorough
ventilation; and in order to protect the miner, there should be a
vigilant attention paid to the economy of underground works. No one need
be surprised at the result of such a noxious atmosphere; and it becomes
a duty with the government to protect these poor people by laws, and to
adopt those measures which are best calculated to preserve their health;
and should there arise difficulties of an insurmountable character in
the ventilation of these pits, why continue the mining operation in such
situations at such a sacrifice of human life?[28]

       *       *       *       *       *

In the course of my investigations in regard to pulmonary carbonaceous
infiltration, I was led to consider the circumstances of those engaged
in other occupations than coal-mining. Any one who has carefully
examined the structure of the human bronchial glands, at different
epochs of life, must have been struck with their appearance in those
who, from their vocation, are compelled to breathe a sooty atmosphere,
or who have lived in ill ventilated dwellings.

I am further convinced, from the results of my recent investigations,
that the bronchial glands in such persons invariably contain
carbonaceous matter which has been inhaled at some period of life.
Having long entertained the belief that the lungs of chimney sweeps, for
example, would, in all probability, be found to contain carbon, within
the last few months two cases, of an exceedingly interesting character,
connected with the present inquiry, have presented themselves,--the one
of pulmonary disease, evidently resulting from the bronchial and
lymphatic glands being impacted with inhaled carbon derived from
soot,--the other a case of melanosis occurring in a young person. Though
the two diseases differ materially, they have often been confounded with
each other and assigned to the same cause. My object in here reporting a
case of stratiform melanosis, in connection with a disease having an
external origin, is to afford an illustration of the fact, that all
black deposits found in the system are not carbon. There exists a marked
chemical distinction between the melanotic and the carbonaceous matter;
and the anatomical situation of the two is also different.

CASE.--A chimney sweep, aged 50, of the name of Campbell, residing at
Stockbridge. The short history of his case I procured from his friends,
as I did not see him during his illness. He had been a soldier in early
life, and had seen much foreign service. After he relinquished the army,
he became a chimney sweep, in which capacity he was constantly engaged
for nearly twenty years. He had had, for a considerable time, a
troublesome cough with tough expectoration. He experienced a difficulty
of breathing in making any exertion, and he had considerable oedema of
the limbs. From these symptoms he believed that he was subject to
_asthma_. He had only been confined to bed for two days previous to his
death.

_Post-mortem Appearances._--The body exhibited extensive anasarca; the
thorax was well arched; the cartilages of the ribs were ossified. On
removing the anterior part of the chest, the pleuræ were found to adhere
strongly, and appeared rough and puckered from extensive exudation of a
brown colour, which extended very generally over the serous membranes.
Both cavities contained nearly three gallons of light brown fluid. The
pericardium was considerably distended with a straw-coloured fluid, and
several flakes of lymph floated throughout the effusion. Both auricles
of the heart were enlarged, and distended with exceedingly dark blood.
The walls of both ventricles were much thickened. The valvular structure
of the auricles was congested and granular. The lungs were removed from
the chest with difficulty, owing to the very general pleuritic
adhesions. Both exhibited extensive emphysema. In dividing the lungs,
and tracing the bronchial ramifications, each lobe was found to contain
clusters of enlarged and indurated bronchial glands, impacted with thick
black matter; and prosecuting the investigations, the minute lymphatic
glands were observed clustered in a similar manner, and containing black
fluid. In the substance of the upper lobe of both lungs, the bronchial
glands were of a bright black colour; they were particularly large, and
so numerous as to press considerably upon and obstruct several of the
bronchial tubes. In fact the upper lobe of both lungs exhibited the
plum-pudding structure. At the bifurcation and back part of the trachea,
the bronchial glands were numerous, and of a deep black colour. A
considerable mass of the glandular structure was removed for chemical
and microscopic examination.

The second case was that of a boy aged six years, who was under
treatment for an affection of the heart and kidneys, and who died
apparently from disease of these organs. He was, during his whole life,
of a relaxed and weakly constitution, exceedingly sallow in the
complexion, with a very deep blue tint of the sclerotic coat of the eye.
In the course of the post-mortem examination, there was discovered, in
the lower and lateral part of the right pleura, a cyst containing about
an ounce of semi-fluid melanotic matter; and also the morbid secretion
presented the stratified appearance described by Dr Carswell in his
article upon Melanosis, extending over the inferior half of the costal
pleura and the corresponding part of the diaphragm. It formed a distinct
layer on the surface of the serous membrane, resembling ink or blacking,
and could with difficulty be removed. The black deposit resembled much
in appearance the foreign matter found in the pulmonary organs of the
coal-miner, and therefore was submitted, as well as the bronchial
glands in the other case, to chemical analysis, with the view of
ascertaining if there existed any analogy in the component parts of
each.

Dr Douglas Maclagan submitted both these substances to the action of
concentrated nitric acid, and the results were, that the glandular
structure of the chimney sweep contained a very large proportion of
carbon, while of the contents of the melanotic cyst, the same process
did not leave a vestige of colouring matter,--evidently proving the
distinction which exists between those two dark deposits, and making it
sufficiently obvious, that melanotic matter is composed of the
constituent elements of the blood, and has its origin within the body.
There cannot remain a doubt as to the nature of the chimney sweeper's
case; for, from the knowledge which we have of his occupation, and from
the chemical properties manifest after investigation, I think I am
entitled to declare the black matter obtained from the bronchial glands
to be carbon inhaled with the air during his labour, and not existing as
a constituent ingredient of organized solids or fluids.

The microscopic examination showed the carbon most distinctly in a
molecular form.

It is my intention to return to this subject at a future time.

  NORTHUMBERLAND STREET, EDINBURGH,
  January 1846.


       *       *       *       *       *


FOOTNOTES:

[1] Vide an admirable series of papers on this subject in the volume of
this Journal for 1843, by Dr Calvert Holland.

[2] About ten miles east from Edinburgh.

[3] Generated from the decay of vegetable and other substances in the
_formerly wrought_ pits, which communicate with those at present in use.

[4] It is proved, from the difference in the chemical character
possessed by the melanotic matter, as compared with the matter found in
the lungs of miners.

[5] It will be observed, that, though the small blood vessels are
destroyed, no hemorrhage takes place, owing to the formation of a
carbonaceous plug.

[6] The air of the coal-pit is so charged with carbon as to prevent the
collier from distinguishing his neighbour when at work.

[7] Note from the evidence of a collier examined before the Government
Commissioners in 1842, No. 147 of Report. "Colliers in this part of the
country are subject to many oppressions; first, Black spit, which
attacks the men as soon as they get the length of 30 years of age;"
second, Note 150, "The want of proper ventilation in the pit is the
chief cause, and no part requires more looking after than East Lothian,"
the men die off like rotten sheep. Note, 153, the witness, 32 years old,
says, "I am unable to labour much now, as I am fashed with bad
breathing--the air below is very bad, and till lately no ventilation
existed."

[8] The black sputum retains its colour after being submitted for some
days to the action of nitric acid.

[9] This is the only case in which I at any time observed colliquative
sweats as a symptom of this disease.

[10] To convey an impression of the nature of the labour in which the
man was engaged I shall simply extract a few remarks from the evidence
of the miners at this coal-work, taken by Mr Franks for the Government's
Commissioners, Note 105. "At all times the air is foul, and the lamps
never burn bright. The seam of coal is 24 inches, and the road only
three feet high." Note 108--"Experienced colliers do not like the work,
and many are touched in the breath." And in such a situation man is
doomed to labour! Note 114--"Most of the men here are _fashed_ with
_that trouble_; Foster, Miller, Blyth, and Aitken are all clean gone in
the breath together. Colliers here drop down very soon."

[11] It is evident in this disease that the bronchial ramifications are
destroyed, while the arteries, with the exception of the minute twigs,
are preserved.

[12] One of the lungs (the left one) now described, I sent to Dr John
Thomson, late Professor of Pathology, and will probably be found in his
collection, which I understand is in the College of Surgeons.

[13] After a free expectoration of black matter, there was an evident
mitigation of all the pectoral symptoms, and as the carbon again
accumulated in the lungs, the sufferings of the patient were very
considerably increased.

[14] This sputum was subjected to the action of nitric acid, which
produced no effect upon its colour.

[15] When pulmonary disorganization has proceeded far, from the presence
of carbon, there is a languor in the vital action from defective
oxygenation of the blood, which produces a gradual reduction in the
temperature of the body, requiring double clothing, and even that
addition is, with the aid of stimulants, not sufficient to keep the
patient warm.

[16] This lung is in the possession of Sir James Clark, of London.

[17] The above substances were submitted separately to the action of
nitric acid and caustic potash, and the result was that a large
proportion of carbon was precipitated.

[18] Since writing the above the patient has died; and I regret that,
owing to neglect in communicating with me, I have been prevented
examining the morbid appearances.

[19] Several of the Pencaitland colliers are at present engaged in the
tunnelling operations near to Edinburgh, connected with the North
British Railway.

[20] Dr Hamilton's of Falkirk paper in the Edin. Med. and Surgical
Journal, Vol. xlii.

[21] I have very lately, through the kindness of Mr Girdwood, surgeon at
Falkirk, had an opportunity of examining two or three iron-moulders in
that district. Both from the nature of the employment in those iron
works, and the character which the pulmonary affection exhibits, the
fact of inhalation is fully established. The moulder is at a certain
stage of his labour enveloped in a cloud of finely-ground charcoal, a
portion of which cannot fail to find its way to the lungs in breathing.
He is subject to tickling cough, and as the disease advances, the
respiratory sounds, which indicate considerable bronchial irritation,
present themselves, and ultimately become dull, and in some parts
obscure.

Of the several cases which I saw with Mr Girdwood, one, who has not been
labouring for some years as a moulder, occasionally expectorated black
matter, and in the other two, there was general dullness of both lungs;
and, I doubt not, impaction.

[22] It has not been in my power hitherto to procure so satisfactory a
chemical analysis of the blood as I would wish, but through the kind
assistance of Dr Douglas Maclagan, who has undertaken to conduct the
process, I expect very soon to be able to lay it before the profession.

[23] I found little or no black matter in the lungs of farm servants,
who are much in the open air.

[24] _Vide_ MONTHLY JOURNAL for 1845, p. 702.

[25] At any time when these colliers required venesection, particularly
towards the last stage of the disease, the blood appeared peculiarly
dark and treacle-like.

[26] Could oxygen not be prepared and forced down?

[27] I am happy to find that the attention of the noble proprietor of
the Newbattle coal works is now directed to this subject.

[28] I cannot pass from this subject without an observation on the
beneficial results which have been the consequence of Lord Ashley's
valuable colliery Act. The female Labourers, and particularly the
unmarried, have improved not only in their appearance, but also in
general physical development, since they have abandoned the unhealthy
labour of the coal-mine. They are no longer the squalid, filthy, and
ill-favoured race they formerly were. There is now exhibited on the face
of the collier girl the bloom of health and cheerfulness; and when we
descend to their domestic economy, there is observed a comfort in the
management of their households, which formerly did not exist. Their
children are now particularly cared for, both in health and when
suffering from disease; and we must regard this early watching as an
important step to the removal of that predisposition to pulmonary
irritation, so general in the collier community.





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