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 THEMEDICO-CHIRURGICAL SOCIETY, OF THE HARVEIAN SOCIETY, OF THE OBSTETRICALSOCIETY, ETC. ETC. , AND ONE OF THE PHYSICIANS TO THE NEW TOWN DISPENSARYOF 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 carbonaceousinfiltration into the pulmonary tissues of coal miners, was read by DrMakellar 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. Thecarbonaceous disease described, was stated to be caused by theinhalation of substances floating in the atmosphere of the coal-pit, such as the products of the combustion of gunpowder, the smoke from theminer's lamp, and the other foreign matters with which the air of themines is heavily charged, in consequence of their defective ventilation. In the mines in which gunpowder is used, the disease is most severe inits character, and most rapid in destroying the pulmonary tissue. Thecarbon in some cases is expectorated in considerable quantity for sometime previous to death; in others, it is retained, and accumulates to agreat extent in the lungs. 

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

The views expressed in this communication called forth the followingremarks. 

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

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

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

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

BLACK PHTHISIS, OR

ULCERATION INDUCED BY CARBONACEOUS ACCUMULATION IN THE LUNGS OFCOAL-MINERS

Among the many diseases incident to the coal-miner, none come oftenerunder medical treatment, than affections of the respiratory andcirculating organs. While the collier is subject--during his short butlaborious life--to the other diseases which afflict the labouringclasses in this country, such as inflammations, fevers, acuterheumatism, and the various eruptive diseases, he, at last, unavoidably, falls a victim to lesions within the cavity of the chest, arising fromthe nature of his employment. In the present communication, it isproposed to lay before the profession a series of remarks, which I havebeen enabled to put together, with a view to elucidate the cause andprogress of that very peculiar pulmonary disease, incident tocoal-miners, which I shall denominate BLACK PHTHISIS, or Ulcerationinduced by Carbonaceous Accumulation in the Lungs. 

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

During the last ten years, my attention has been much directed, in thecourse of my professional labours in the neighbourhood of thecoal-mining district of Haddingtonshire, to the above phenomena in thepathology of the lungs, which have not hitherto been brought so fullybefore the profession, as their importance demands. The subject presentsa very interesting field of investigation to the physiologist andpathologist. 

When we consider the difficulties which the medical man has toencounter, in prosecuting his researches in morbid anatomy in a miningdistrict, it is sufficiently explained why the peculiarly diseasedstructures in the body of the coal-miner should have been left so longuninvestigated. 

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

The only medical writers, as far as I am aware, who have brought thissubject before the notice of the profession, are, Dr J. C. GREGORY, inthe 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 "SpuriousMelanosis, " (_Cyclopædia of Practical Medicine_, Vol. Iii); Dr MARSHALL, in a paper in _The Lancet_ for 1836, entitled "Cases of SpuriousMelanosis of the Lungs;" Dr WILLIAM THOMSON, now Professor of Medicinein the University of Glasgow, in two able essays (_Medico-ChirurgicalTransactions of London_, Vols. Xx. And xxi. ), wherein he gives a numberof very interesting cases, collected from various coal districts ofScotland, illustrating different forms of the disease; Dr PEARSON, inthe _Philosophical Trans. _ for 1813, on the "Inhalation of Carbon intothe Pulmonary Air Cells;" and in a paper, by Dr GRAHAM, in vol. Xlii. Ofthe _Edinburgh Medical and Surgical Journal_. 

Recently, professional and other writers have directed attention to theinfluence of various occupations in the production of diseases of thechest. The pernicious employment of the needle-pointers, razor andknife-grinders of Sheffield, and other manufacturing towns inEngland, [1] have not only engaged the attention of the public at large, but science has been at work to ascertain, with as much accuracy aspossible, the relative effects of the different avocations, on theconstitutions of those occupied in these destructive employments. Researches of this nature tend much to the well-being of society, asthey make us acquainted with the maladies and sufferings peculiar tocertain classes of our fellow-men; and point out, also, the causes oftheir early decay, and premature death. The coal-miners--those in whosebehalf I would now solicit the intervention of science--are mostvaluable in their place, and their exhausting labours promote, in nosmall degree, our domestic comforts. 

Some of the diseases of colliers have in past time been very muchoverlooked by the medical inquirer. There has been, within the last fewyears, a very searching investigation as to the employment of women andchildren in coal-mines; and by the laudable exertions of Lord Ashley--anobleman whose name shall ever be honoured among miners, and by all whohave the true interests of that community at heart--an Act of theLegislature has been passed, declaring it unlawful for any owner of anymine or colliery whatever, to allow any female to work therein; and alsoenacting, that no boy under the age of ten years can be employed inmines. It is to be regretted, however, that his Lordship did not embodyin his measure, provisions enforcing the free ventilation of mines undergovernment inspection; for nothing would tend more to improve the healthof those employed in them. 

In the course of the inquiry, which formed the prelude and basis of LordAshley's Act, much valuable information regarding the diseases ofcolliers was elicited; and no one can peruse the voluminousparliamentary report pertaining to these investigations, without beingstruck with the very general prevalence of affections of the chest amongminers. It is to be hoped, that the interesting facts in regard todisease, which this recent most necessary investigation has laid open, will be the means of directing the attention of scientific men to thesubject, with a view to obviate, as far as human efforts can, the evilswhich have been exposed. It may at first appear difficult, to point outthe means of removing effectually the causes of the pulmonarycarbonaceous 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 thisscourge. 

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

The locality[2] in which my observations were made, is that part of theLothians, extending from south to north, stretching from the foot of theLammermoors towards the sea-coast, including the coal-works ofPreston-Hall, Huntlaw, Pencaitland, Tranent, and Blindwells. In thisrange of the coal-formation, the seam of coal is variable, but generallyexceedingly thin, varying in thickness from eighteen inches, to three orfour feet. It is with difficulty that mining operations can beprosecuted, from the extremely limited space in which the men have tomove, and from the deficient ventilation. It appears, after thoroughinvestigation, that in the majority of the coal mines above mentioned, ventilation is very much neglected, and that this neglect is partlycaused, by the immunity of these mines from carburetted hydrogen gas, which exempts them from the danger of explosion. But though there be noexplosive gas, there is generated, to a certain extent, in the moreremote recesses of the pit, carbonic acid and other gases, producing themost injurious effects--impairing the constitution by slow degrees, andalong with the more direct cause (the smoke from the lamp, candle, andthe product of the combustion of gunpowder, ) making progressive inroadson the health of the unfortunate miner. And how, I ask, can it beotherwise, in such circumstances? So long as it is possible for him togo on--so long as there is air enough to support the combustion of thelamp or candle, the labourer must proceed with his toil. I say, fromthere being no fire-damp, less attention is paid to ventilation, and itis a common occurrence with colliers in these localities, to be obligedto leave their work, from there not being a sufficiency of oxygen tokeep their lights burning, and support respiration; and this temporarycessation of labour under such circumstances is regarded as a hardshipby some proprietors, while the bodily sufferings of the miner, shut upand necessitated to labour in this situation, are little considered. 

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

The atmosphere of the coal mine at length becomes so vitiated, by theremoval of the oxygen in breathing, and the substitution of carbonicacid, that the respiration becomes gradually more difficult, and theexhausted labourer has ultimately to retire from the pit, as there is noother mode by which the noxious air can be removed--owing to theunderground apartments being so small--than by gradually allowing purerair to accumulate. The miner is thus enabled to return to hisemployment. 

It is about thirty years since miners in this district adopted the useof coarse linseed oil, instead of whale oil, to burn in their lamps; andit is very generally known, that the smoke from the former is immenselygreater than that from the latter, and many old miners date the greaterprevalence of black spit to the introduction of the _linseed_ oil. Thischange took place entirely on the score of economy. Any one can conceivehow hurtful to the delicate tissues of the respiratory organs, must bean 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 acidgas[3] generated in the pit, and that expired from the lungs; _Second_, Carbon, and the carburetted gases which float in the heated air afterthe ever-recurring explosions of gunpowder, which the occurrence of trapdykes renders necessary. 

To those acquainted with mining operations, an explanation of the coaland stone hewing process is unnecessary; but, for the sake of theuninitiated, I may be allowed to state, in explanation, that, previousto any coal hewing, it is needful to remove various strata of stone, toopen up road-ways, and break down obstructing dykes, by the aid ofgunpowder. All coal-miners are engaged exclusively with one or otherkind of labour; that is either in removing stone or coal: and thepeculiar disease to which each class is liable, varies considerably, according to the employment. For instance, the disease is more severeand more rapid in those who work in the stone, than in those engaged inwhat is strictly coal-mining, while, at the same time, both ultimatelyperish in consequence of it. The fact of the disease being more acute instone-miners, I am disposed to attribute to the carbon and otherproducts of the combustion of gunpowder, being more irritating and moredestructive to the lungs. A very striking instance of this occurred, afew years ago, at the colliery of the Messrs Cadell of Tranent. A veryextensive coal level was carried through their coal field, where a greatnumber of young, vigorous men were employed at stone-mining, orblasting, as it is called, every one of whom died before reaching theage of thirty-five years. They used gunpowder in considerablequantity:--and all expectorated carbon. 

It was long a very general belief with medical writers, that the variousforms of discoloration in the pulmonary tissue was induced by somepeculiar 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 melanoticformations, from presenting, as their distinguishing feature, a greateror less degree of blackness. But, by recent investigations, it has beenproved, that the infiltrated carbon found in the bodies of coal minersis not the result of any original disease, or change taking place withinthe system, [4] but is carbon, which has been conveyed into the minutepulmonary ramifications, in various forms, during respiration; andwhich, while lodged in these tissues, produces irritation, terminatingin chronic ulcerative action of the parenchymatous substance. The veryminute bronchial ramifications first become impacted with carbon, andconsequently impervious to air; by gradual accumulation, this impactedmass assumes a rather consistent form, mechanically compressing andobliterating the air-cells, irritating the surrounding substance, andpromoting the progressive extension of the morbid action, till the wholelobe is infiltrated with carbonaceous matter, which, sooner or later, ends in ulceration and general disorganisation of the part. It isevident, in tracing the disease through its various stages, up to thatof disorganisation, that wherever there is an impacted mass in any partof the pulmonary structure, this is followed, sooner or later, bysoftening, from its irritating effects upon the tissues by which it issurrounded; and as this softening process advances, the innumerable setsof vessels[5] composing the dense network of capillaries are brokendown, extending the cyst, so that, as the cysts enlarge, they graduallyapproximate to each other, till all at last become merged in one greatcavity. 

The majority of colliers, soon after they engage in their miningoperations, become afflicted with bronchial disease to a greater or lessextent. 

Those who are hereditarily predisposed to pulmonary irritation, are, itis my decided belief, more liable to "black phthisis" than others; but Icannot suppose it possible, that any constitution, however robust andsound, could resist the morbid effects resulting from carbon depositedin the lungs. Tubercular phthisis is not at all prevalent in any colliercommunity 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 inHaddingtonshire, would come under the influence of the carbonaceousdisease, instead of the true phthisis; for, in all the _post-mortem_examinations which I have conducted, connected with this pulmonaryaffection, I have never found tubercular deposit:--while other membersof the same family, having a like predisposition, and who never entereda coal-pit, have died of phthisis. Can carbon inhaled destroy atubercular formation? I never knew or heard of a case of black spit ina female collier, and this is accounted for by the circumstance, thatthe women, when permitted to labour, previous to the late prohibitoryenactment, were only occupied as carriers; and from their movementstowards the pit shaft, in transporting the coals, were enabled to inhaleat intervals a purer atmosphere. The boys also, who were employed ascarriers to the pit shaft, continued to labour with like impunity, fromtheir occasional change of situation; but the miner, lying on his sidein a confined, smoky recess, under ground, gasping for breath, proceeding with his exhausting labour, cannot fail, in his deepinspirations, to draw in the deleterious vapour, to the most minuteramifications of the pulmonary structure, and, as he daily repeats hisemployment, so does he daily add to the accumulation of that foreignmatter which shall ultimately disorganize the respiratory apparatus. Inthe first stage of the affection, there is an incessant dry cough, particularly at night, and all the prominent symptoms of bronchitis arepresent. Indeed, from the time a man becomes a coal-digger, and inhalesthis noxious air, [6] there is ever after a manifest irritation in thelining membrane of the respiratory passages, which is apparent beforecarbon in any quantity can be supposed to be lodged in the lungs. Themucous membrane of the air passages, by its continually pouring out aviscid fluid, has the power of removing any foreign matter that may belodged in them. Now, should this membrane, owing to previous irritation, lose to a certain degree this secretory power, then the foreign bodyadheres to it, and is retained, and this, I think, constitutes thepreparatory stage of black deposit. In tracing the progress of thedisease, it is my belief, that immediately after the carbon isestablished in the air-cells, the absorbents become actively engaged, and the glandular structure soon partakes of the foreign substance. Oneof the peculiar features, as we shall find, when we come to describecases, is, that the secretory function is ever after so changed in itscharacter, that the gland which formerly secreted mucus, to lubricatethe passages, now performs the same service with muco-carbon, andcontinues to do so during the remainder of the patient's life--even, asI have often seen, long after he has desisted from the occupation of acoal-miner. In fact, it constitutes a striking peculiarity of thisdisease, that when the carbon is once conveyed into the cellular tissueof the lung, that organ commences the formation of carbon, thusincreasing the amount originally deposited, as was strikinglyexemplified in the case of Duncan and others, to be afterwards detailed. Duncan had not for fifteen years been engaged in mining operations, norwas there any possibility of his having inhaled more carbon: yet in himit was found to have increased to the greatest possible extent, leavingbut a small portion of useful lung. 

I have been long impressed with the belief, that the carbon is containedin considerable quantity in the blood, particularly in the blood ofthose far advanced in the disease. This impression arises, not only fromits dark and inky appearance, but from its sluggish flow, andnon-stimulating effects on the heart and general system; and when weexamine the morbid condition of the pulmonary structure, --ascertain thepresence of carbon in the glandular system and minute lymphatic vesselsof the lungs, and consider the relation existing between them and thecirculating fluid, we cannot suppose it possible, that such a mass offoreign matter should be lodged in their parenchymatous substancewithout imparting a portion to the blood. I was never more struck withthis, than in the case of Duncan, where the blood was more like thickbrownish ink than vital fluid. 

No one who has witnessed the economy of these pits, can doubt theinhalation, to a great degree, of lamp and gunpowder smoke into thepulmonary tissue. What may be its chemical action there, is a questionfor us to attend to as we proceed. If it be considered an establishedfact, that carbon is inhaled, possessing all the chemical qualities ofthat substance found floating in the air of the coal-mine, and eitherexpectorated from the lungs during life, or retained in those organstill after death, we cannot but conclude, that the black matter is theresult 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 thecollier has relinquished the occupation of a miner, and when there canbe no further inhalation, and if so, whence comes this increase? It mustbe admitted, judging from several of the cases which follow, that itdoes considerably augment. From this remarkable fact, does it not appearprobable, that when carbon is once lodged in the pulmonary structure byinhalation, there is created by it a disposing affinity for the carbonin the blood, by which there is caused an increase in the deposit ofcarbon, without any more being inhaled. 

_Appearances on Dissection. _ In classifying the morbid appearancesobserved in the pulmonary structure, I arrange them according todivisions corresponding to three stages of the disease. _First_, Wherethere exists extensive irritation of the mucous lining of the airpassages; and the carbon being inhaled, is absorbed into theinterlobular cellular substance, and minute glandular system, therebyimpeding the necessary change upon the blood. _Secondly_, Where theirritative process, the result of this foreign matter in the lungs, hasproceeded so far, as to produce a variety of small cysts, containingfluid and semi-fluid carbonaceous matter, following the course of thebronchial ramifications. _Thirdly_, Where the ulcerative process hasadvanced to such an extent, as to destroy the cellular texture, andproduce extensive excavation of one or more lobes. 

_Stethoscopic Signs. _--In the early stages, the sounds indicate aswollen state of the air-passages, and vary in character according tothe part examined. The whistling and chirping sounds are loud anddistinct in the large and small bronchial ramifications, and both fromthe absence of expectoration and the presence of the pulmonary bruit, the highly irritated state of the mucous linings is apparent. Theaffection ultimately assumes a chronic form, and continues present inthe respirable portions of the organ during life. As the carbonaceousimpaction advances, the sounds become exceedingly dull over the wholethoracic region, and in many of the cases no sound whatever can bedistinguished. Where the lungs are cavernous, it is very easy todiscover pectoriloquy, from the contrast to the general dulness, andwhen pleuritic and pericardial effusion advance much, it is difficult toascertain the cardiac action. 

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

 * * * * *

From a variety of cases to which my attention was directed, I I haveselected _ten_, with the _post-mortem_ appearances in nine of them. These cases extend over a period of eleven years, all of themexhibiting, 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 thelast case came under my notice within these twelve months. Of the tenpatients, six were engaged at one period with stone-mining, and fourwere entirely coal-miners; eight expectorated carbonaceous matter, andtwo did not show any indication of black infiltration from the sputum;six exhibited, on examination, most extensive excavations of thepulmonary 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 intime the death of the patient, which took place a few weeks ago. Thesemorbid appearances exhibit three stages of the disease in regularprogression. The first is that where the carbon is confined to theinterlobular 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 hisdaily employment. The respiratory sounds, in this state of the chest, are loud and distinct. Such a condition of the pulmonary structure isoften found on examination in the Carron _iron-moulder_, who has beenkilled by accident, or has died from some other disease, having beensubjected in the course of his employment to the inhalation ofcarbonaceous particles. 

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

 * * * * *

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

In the early part of this man's illness, the stomach, the alimentarycanal, biliary and urinary secretions, continued unimpaired; but as thecough advanced, gastric irritation, which was followed by vomitingduring the paroxysms, annoyed him; and for the last eight months of hislife, he suffered occasionally from severe attacks of gastrodynia, which, when present, had the effect of considerably modifying thethoracic irritation, and allaying the cough. There was nothing veryremarkable in the character of the urine; the quantity voided was small, and very high coloured, with occasionally a lithic deposit. The fæceswere natural, and smeared with dark blue mucus. On examining the chestwith the stethoscope, the crepitant ronchus was heard in the upper partof each lung. There was general dulness throughout the lower part ofboth, with the exception of a small space at the inferior angle of theleft scapula, where pectoriloquy was distinctly heard, from which wasconcluded the cavernous state of a portion of that lung. The heart'saction was languid, and often intermitting, producing vertigo andoccasional syncope. The pulse was gradually becoming slower; and at thistime, (Nov. 1836, ) it was _forty-three_ in the minute. I was informed bythis man, that his chest affection first became manifest, after beingengaged with a difficult job in a newly formed coal-pit at Huntlaw, where he had very little room to conduct his mining operations, whichwere carried on with the help of gunpowder, and where he experienced asensation of suffocation from the confined nature of the pit, [7] whichdid not permit of the exit of the evolved carbon, and ever after, hiscough and difficulty of breathing had been increasing rapidly. Duringthe greater part of the period he was under my charge, he continued toexpectorate black matter, of the consistency of treacle, mixed withmucus in considerable quantity, and I would suppose, taking the averageof each week, that he expectorated from ten to twelve ounces daily ofthick treacle-like matter. I had the curiosity, during my attendance onthis patient, to separate the mucus from the carbon, by the simpleprocess of diluting the sputa with water, and thereafter separating anddrying the precipitated carbon. I was enabled by this means to procureabout one and a-half drachms of a beautiful black powder daily, and inthe course of a week, I had collected near to two ounces of thesubstance. This process I continued for some weeks, till such time as Ihad procured a sufficient stock of this remarkable product of thepulmonary structure, and I am certain that the same quantity, if notmore, could have been obtained till his death, in Dec. 1836. It isundoubtedly a striking phenomenon, connected with the pathology of thechest, that the human lung can be converted into a manufactory of lampblack!

Towards the close of this poor man's existence, the countenance andsurface of the body assumed a leaden hue, from the very general venouscongestion, and as his system became more exhausted, and he was about tosink in death, the gastric irritation and nocturnal cold sweats whichhad been long present with him considerably increased, along with acough so severe as actually to produce vomiting of the black sputa. Histongue and fauces became so coated with the expectoration, that astranger viewing the patient would have said that he was vomiting blackpaint. [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 coughand 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 fora week before death. No hectic heat of skin, but an extraordinarydepression of the arterial action, arising evidently from the redundancyof carbon deposited in the pulmonary tissue, preventing the properoxygenation of the blood circulating in the organs, and therebyproducing a morbid effect on the whole system, which sufficientlyexplains the cachectic condition of the body. 

_Post-mortem examination, twenty-four hours after death. _--In removingthe anterior part of the thorax, the lungs appeared full and dilated, and of a very dark colour. Both lungs were strongly attached to thepleura costalis, and a very considerable effusion of straw-colouredfluid was found in both cavities of the chest. A few irregularlysituated dark glandular bodies were observed on the surface of thecostal pleura at each side of the sternum, and on the mediastinum. Thelungs were removed with difficulty on account of the strongly adhesivebands attaching them to the ribs, and in handling them they conveyed theimpression of partial solidity:--several projecting, irregular firmbodies, were felt immediately beneath the surface of the pleura, andthere was also present emphysematous inflation of the margins of theupper lobes. In transecting the upper lobe of the left lung, it wasfound considerably hollowed out, (to the degree of holding a largeorange, ) and containing a small quantity of semi-fluid carbon, resembling thick blacking, with the superior divisions of the leftbronchus opening abruptly into it. Many large blood-vessels crossed fromone side of the cavity to the other, to which shreds of parenchymatoussubstance were attached. The inferior lobe was fully saturated with thethick black fluid, and it felt solid under the knife, and several smallcysts containing the carbon in a more fluid state were dispersedthroughout its substance, in which minute bronchial branches terminated, and by which this fluid was conveyed to the upper lobe, and thence tothe trachea. In examining the right lung, the upper, and part of themiddle lobe were pervious to air, and carried on, though defectively, the function of respiration, while the interlobular cellular tissuecontained the infiltrated carbon. The inferior portion of the middle andalmost the whole of the under lobe were densely impacted, so that on asmall portion being detached, it sank in water. Both lungs represented, in fact, a mass of moist soot, and how almost any blood could be broughtunder the influence of the oxygen, and the vital principle be so longmaintained in a state of such disorganization, is a question ofdifficult solution. 

In tracing the various divisions of the bronchi, particularly in theinferior lobes, some of the considerable branches were found completelyplugged up with solid carbon; and in prosecuting the investigation stillfarther, with the aid of a powerful magnifier, the smaller twigs, withthe more minute structure of cells, were ascertained to contain the samesubstance, forming the most perfect _racemes_, some of them extending tothe surface of the lung, and to be felt through the pleura. The liningmembrane of the permeable bronchial ramifications, when washed and freedfrom the black matter, exposed an irritated and softened mucous surface, which was easily torn from the cartilaginous laminæ. The interior of thetrachea and its divisions gave evidence of chronic inflammatory actionof long standing which extended from about midway between the thyroidcartilage and bifurcation to the root of the lungs. A considerablenumber of lymphatic glands, filled with--to all appearance--the carbon, were situated along the sides, and particularly at the back part of thetrachea; which, from their size, must have interfered by pressure bothwith respiration and expectoration. The mucous membrane of the leftbronchus in particular was much swollen and partially ulcerated towardsthe root of the lung. In examining the heart after its removal from thebody, it was found peculiarly large and flabby, its cavitiesconsiderably distended, especially the right auricle and ventricle, while the valvular structure seemed natural. The pericardium containedabout 10 ounces of straw-coloured fluid. After examining the organparticularly, I could discover nothing abnormal, but the enlarged andsoftened state alluded to. The liver was large and highly congested withdark thick blood, but otherwise it was healthy. The gall-bladder wasempty, and the spleen large and congested. The stomach was smallish andempty. The mucous membrane was smeared with a blackish, tenacious fluid, which, upon removal, appeared to be a portion of the expectoration. Thestructure, as far as could be ascertained, was healthy. The small andgreat intestines contained fluid carbon (evidently swallowed), while nodisease was manifest. The mesenteric glands were small and rather firm, but they contained no black matter; the mesentery was much congestedwith dark venous blood. The kidneys were apparently healthy, thoughsoft. 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 lungswere cavernous, and where there was free expectoration of carbon. 

CASE 2. The following case is one of unsuspected carbonaceousaccumulation in the lungs, the history of which proves the fact, thatthe disease, when once established in the pulmonary structure, continuesto advance till it effects the destruction of the organs, although thepatient has not been engaged in any mining operations for many yearsprevious to his death. 

Robert Reid, aged forty-six at his death, had been a collier since hisboyhood. 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 ofhis life at a coal-mine, near Glasgow (Airdrie), where he all alongenjoyed good health. In 1829, he removed from Airdrie to the coal-workat Preston-Hall, Mid-Lothian, where he engaged in mining operations;and, from the time he made this change, he dated the affection of whichhe died, at the end of 1836. Two months after he removed to Preston-Hallcolliery, he was seized with bronchial affection, giving rise to atickling cough in the morning and when going to bed, accompanied bydyspnoea, with a quick pulse (90), and palpitation of the heart. Inthe first stage of the affection, he had no expectoration ofconsequence; but soon after, a little tough mucus was coughed up, andwhen it was difficult to expectorate, the sputum was occasionally tingedwith blood. At this period, the appetite continued to be good, and thestrength little impaired. During the day, he felt in his usual health;and, therefore, he continued in full employment. At the end of the fourmonths (Jan. 1830), his cough had increased much, his palpitation ofheart, dyspnoea, and bronchial irritation had become very oppressive, and general exhaustion had manifested itself. Recourse was had at thisperiod of the affection to bleeding, blisters, and expectorants, whichrelieved him only temporarily, and while under this treatment, he--having a large family dependent on his exertions for theirsupport--continued to struggle on at his daily vocation so long as hewas able to handle the pick-axe. At the close of 1832, which completedthree years of labour in this coal-mine, he was obliged to discontinueall work, and take refuge in medical treatment, with a severe cough, palpitation, annoying dyspnoea, small intermitting pulse, andsleepless nights. On inquiring as to his general habits and mode oflife, 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-mineat Preston-Hall, where the work was difficult and the pit confined, hehaving only twenty-four inches of coal seam which obliged him to labourlying on his side or back. [10] He was also at this time occasionallyengaged as a stone-miner, and was consequently subjected not only to theinhalation of the smoke of linseed oil, but to that of gunpowder. Forhis chest complaint at this stage, he underwent a variety of medicaltreatment, which produced mere palliation in his symptoms, and thoughbreathing a pure atmosphere in a country situation, he experienced amost 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 thecountenance 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 ofderiving benefit; but after being a patient in that hospital for someweeks, he returned home much worse. In addition to the aggravation ofhis other symptoms, there were present oedematous swelling of theextremities, which were generally cold and benumbed, gnawing pain in theright hypochondriac region, and almost total loss of appetite. Onexamining the right hypochondrium, which he described as swollen, therewas evident indication of an enlarged liver, and he complained much ofshooting pain in that region during a paroxysm of cough. Hitherto thefunctions of the stomach and bowels had remained unimpaired; but at thisperiod, (September 1833, ) the former became irritated, and the latterobstructed. Tonics and gentle purgatives were administered, andcontinued for a considerable time. The urinary secretion was all alongscanty and high coloured; but, as the disease advanced, the quantitybecame exceedingly small, (almost none was voided for days together, )for which he was taking diuretics; and on examining it with theapplication of heat, I repeatedly found it coagulable. General anasarcawas now rapidly increasing; and as the cellular effusion advanced, thebreathing became more laborious. I understand, that at the commencementof this person's affection, the pulse was frequent, with some heat ofskin at night, but from the time he became my patient, there was atendency to languor in the circulation, and the _beat_ at the wrist, forsome months previous to his death, was almost imperceptible. With a viewto remove the enlargement of the liver, a slight mercurial course wasproposed; but owing to debility, indicated at its commencement, it wasdiscontinued, and no effect produced on the organ. All medical treatmenthaving been given up, except mere palliatives, such as blisters andexpectorants, this poor man lingered out a most miserable existence fromhis pectoral symptoms, and particularly from palpitation of heart. Expectoration continued the same, of tough, ropy mucus, small inquantity, and got up with difficulty from the air-passages. In repeatedexaminations with the stethoscope, there was considerable dulness overthe whole thoracic region, no bruit whatever could be discovered in theleft side of the chest, no cavernous indication, although that side ofthe thorax was fully developed. The mucous râle was heard very strong inthe upper lobe of the right lung, and some little crepitation at theinferior angle of the scapula on the same side. The action of the heartunder the stethoscope gave rather an uncertain indication as to thestate of that organ, for though the sound was evidently communicated tothe ear, as being transmitted through a fluid, and not the heartstriking the ribs, still, from the very general dulness in the left sideof the chest, it was exceedingly difficult to decide whether thisobscurity arose from effusion into the pericardium, or from effusioninto the cavity of the chest. There was one remarkable symptommanifested in this case, --that though the heart's action was to theobserver feeble, the patient's sensations were as if the pulsation wasvery strong, and painfully difficult to bear, and this peculiar feelingto a great extent prevented him from sleeping. I cannot record this casewithout the painful recollection of this poor man's sufferings. For sixmonths previous to his death, the dyspnoea and palpitation attendantupon his disease were of such a severe character, as to prevent him atany time lying down; and his sensations would not even permit hismaintaining the sitting position, for he found it necessary to get uponhis hands and knees, as the only posture affording any alleviation tohis uneasiness. This peculiarity in the cardiac action was such, that, as he expressed it, "he lived in continual dread of death, " and thisbeing ever present to his mind, he was for weeks known almost never toclose his eyes. He died exhausted, in November 1836; and there beingdoubts entertained regarding some of the symptoms of his disease, herequested that his body should be examined, which was done twenty-sixhours after his death. 

_Post-mortem Examination. _--The general anasarca gave the body a bulkyappearance. On raising the sternum, the ribs seemed very firm andunyielding. The lungs were of a dark blue colour, and seemed at firstappearance to fill completely both sides of the chest. Towards thesternal end of the ribs, on the left side, three or four of thesubsternal or mammary glands were found enlarged and filled with blackfluid. The pleura pulmonalis had (where there wore no adhesions)interspersed over it patches of false exudation, _of a dark browncolour_. The lungs adhered extensively to the pleura costalis, and fromthe character of the adhesions, they were evidently of some years'standing. In both sides of the chest there was effusion to aconsiderable extent of a dark-coloured fluid, resembling porter inappearance. On removing the left lung, which was difficult, from thestrong adhesive bands, it seemed, from its weight and softness, tocontain a fluid; and on making a longitudinal section of both lobes, alarge quantity of thick, black matter, similar to black paint, gushedfrom 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. Theair-cells of this lung were entirely destroyed, or nearly so, and one ofthe divisions of the left bronchus opened abruptly into the cavity atthe upper part. Both lobes were so completely adherent to each other, from inflammatory action, as to form a continuous sac, containing theabove fluid. On examining the internal structure of the cavity, theparenchymatous substance which formed its walls presented a rugged andirregular appearance, resembling a sponge hollowed out, and infiltratedwith black paint. 

At different points, the large pulmonary blood-vessels crossed thecavity in the form of cords, with portions of structure attached, andthough these fragments had a black appearance, they exhibited, to aconsiderable extent, their original cellular structure when washed inwater. The process of carbonaceous ulceration had proceeded so far inthis lung, that at some points the pleura pulmonalis, which was muchthickened, was left the sole medium between the contents of the sac andthe cavity of the chest; while in other parts it was thick and spongy. On examining more minutely with the magnifier, open-mouthed bronchialtwigs, and very small blood-vessels, were seen plugged up with solid andfluid carbon, and, from the appearance of the morbid structure, it wasmanifest, that the ulcerative process had effected a completedisorganization of the _bronchial_ tubes of every calibre, while thesmaller _arterial_ vessels had alone suffered, leaving the larger onesentire. [11] Along the margin of the inferior lobe, induratedaccumulations 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 theleft, and on making a section throughout its three lobes, the morbidappearances varied in each. The upper lobe was infiltrated with carboninto the interlobular cellular tissue, leaving the bronchialramifications respirable, and lubricated with frothy mucus. The middlelobe presented a solid appearance, and contained a mass of induratedblack matter, of the size of a largish apple, and consistency ofconsolidated blacking. The surrounding parenchymatous substance wasdisorganized, and undergoing the process of softening. In dividing theindurated substance, its internal structure exhibited a variety ofgreyish lines, forming parallel and transverse ramifications, whichresembled small check in appearance, and which, when more accuratelyexamined, was ascertained to be the disorganised walls of the minuteair-cells and cellular tissue. The inferior lobe presented a state ofcomplete infiltration, with the air-cells generally entire, and onputting a piece of it into water, it showed its density by sinking. 

When we examine the morbid appearances in this case, and compare themwith the symptoms--when we consider that nearly all the respirationcarried on in this man's chest, was performed in the upper lobe of theright lung, we are not surprised at his sufferings, nor is there muchdifficulty in explaining the very painful dyspnoea, on his attemptingthe recumbent position; and as death was instantaneous, it was evidentthat the immediate cause was the bursting of the left pulmonary cystinto the corresponding bronchus; the fluid carbon thus finding its wayto the trachea, produced suffocation. 

The liver was exceedingly large, projecting outwards and downwards fromunder the ribs, and pushing up the diaphragm. Its substance was soft, engorged with dark blood, and easily torn. There was no carbonaceousdeposit throughout its structure, and its weight was upwards of twelvepounds. There was a considerable quantity of very dark bile in thegall-bladder. The heart was large, soft, and pale. There wasconsiderable attenuation of the walls of both auricles and ventricles. The coronary veins were much distended with dark blood. The columnæcarneæ of the right ventricle were exceedingly slender and bloodless;the tricuspid valve was much thickened, and studded on both sides withsmall cartilaginous granules; the other cavities of this organ wereapparently healthy, though thin in substance. The pericardium, which wasrough, and much distended, exhibited a variety of false membrane on itsinternal surface, of a dark brown colour, and contained about eightounces of dark fluid, similar to that found in the cavity of the pleura. In tracing the bronchi from the lungs to the bifurcation, the mucousmembrane, 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 thebronchi, several large glands, containing a fluid to all appearancecarbonaceous. The trachea showed a similar irritated condition with thatof the bronchi. A little above the bifurcation, and at the back part ofthe trachea, a cluster of lymphatic glands were found, some of them thesize of a horse bean, filled with carbon. 

_The spleen_ was very large, and much darker than usual, highlycongested with venous blood, easily torn with the fingers, and weighedabout three pounds. Kidneys small, pale, and soft; bladder small, andcorrugated; large accumulation of light brown fluid into the cavity ofthe abdomen, to the extent of two Scotch pints. The viscera were muchcompressed from effusion. There was a rough brown exudation upon thesurface of the peritoneum and intestines. The stomach was contracted toa small size. The mucous membrane was soft, pultaceous, and easilyremoved, tinged with dark green bile. The lymphatic glands along bothcurvatures were small and flaccid, and contained no black matter. Theintestines appeared empty and contracted. The duodenum showed the samesoftened state of its mucous membrane as was exhibited by the stomach. The mesenteric glands were free from any disease. The head, on removingskull-cap, dura mater found natural; serous effusion to small extentunder the arachnoid; very general congestion of the pia mater, givingboth hemispheres of the brain a blackish appearance. The superiorlongitudinal sinus was filled with dark, inky-looking blood. In removingthe pia mater, the convolutions of the brain were firm, and appearednatural. There was a light brown effusion into both lateral ventriclesto the extent of about an ounce. Reid, when he first came toPreston-Hall, had inhaled the evolved smoke of the coal-mine, therebylaying a foundation of this infiltrated mass. It must be manifest toevery one who follows out the history of this case, and attends to themorbid appearances found within the chest, that there was a progressiveaccumulation of carbonaceous matter going on in the substance of thelungs from the time the patient engaged in working this difficult seamof coal till his death. 

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CASE 3. D. S. Was aged 39 years at his death, in August 1838. He hadbeen 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 excellenthealth. He first began mining operations at one of the Pencaitlandcollieries, and continued to labour there for many years. About sixyears before his death, he was induced by an increase of wages, toundertake stone-mining in the same pit; and soon after engaging in thisemployment, he began to be troubled with a slight cough, accompanied bydyspnoea, palpitation, and oppressive headach, which symptoms rapidlyincreased in severity. He declared that his cough and general ailmentsfirst showed themselves after labouring for a considerable time atstone-work, with the aid of gunpowder, in a situation where the airbecame so impure, both from defective ventilation and carbonaceousparticles floating in it, as materially to affect the breathing. Although he repeatedly changed his place of labour from one coal-work toanother more healthy in the same parish, he experienced no mitigation ofhis annoying cough. When I first saw this man for medical advice in July1834, he had then been about two years engaged as a stone-miner, thebronchial irritation was very general throughout the chest, he hadsevere cough, hurried breathing, little or no expectoration, and onapplying the ear to the thorax, the sibilant and sonorous bronchi weredistinctly heard, which indicated a swollen and irritated condition ofthe mucous linings of the air-passages, and this irritation was alsomanifest in the mucous membrane of the nostrils, which was much swollen, acutely tender, and impeding considerably the passage of the air. Thepulse was rather frequent, about 85 in the minute. There was presentmuch heat of skin during the night, which subsided towards the morning. 

The remedial measures were blisters and expectorants, which relieved himconsiderably. The cough recurred in paroxysms, accompanied by severeheadachs, with little frothy mucous expectoration, and there wasoccasionally observed a slight tinge of blood in the sputum. At thisperiod, his appetite was good, and with the exception of his cough anddifficulty of breathing at night and morning, he seemed usually verywell. Though labouring under his disease, he continued at his employmentof stone-mining, and would not be convinced of its injurious effects. 

_July 1835. _ There was considerable increase of the palpitation when heattempted the recumbent position, or moved hurriedly. The remediesultimately seemed to produce little effect. His general exhaustionadvanced rapidly, and obliged him to relinquish all mining occupation. At the end of the summer of 1836, when I saw him more regularly, and wasenabled to watch his symptoms with more attention, these havingmaterially changed for the worse, percussion elicited dulness over thechest, with the exception of the upper part of both lungs, where themucous râle was heard louder than usual. The heart's action was strongand irregular, particularly so for some time after a fit of coughing, when he suffered excessively from headach, succeeded by a tendency todrowsiness. The pulse was slow and languid, not exceeding 50 in theminute. His countenance had assumed a greyish inanimate aspect, his eyesbecame sunk, his robust frame bent and so emaciated from this peculiardisease, that though his age did not exceed 38 years, a stranger lookingat him, supposed him to have attained the age of 70. No treatment seemedto have any effect in allaying the cough, nor was he permitted to liedown. From his feeling of dyspnoea and thoracic oppression, his nightswere almost sleepless, his extremities oedematous, usually cold andbloodless. 

During the greater part of the time he was confined to the house, thebowels were constipated, requiring daily purgatives. The urinarysecretion was small in quantity and high coloured, but in neitherdischarge was there any thing very unnatural. In this almost inanimatecondition he lingered on, when about six months before his death, duringa 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 tooklittle or no food, from his appetite being almost entirely gone, andfrom gastric irritation being constantly present. His cough anddyspnoea continued severe, with drowsy headachs and difficulty inkeeping the body warm. The arterial action was exceedingly low. Thepulse was 40 in the minute, and difficult to discern. The strongeststimulant produced no increase of action, the sitting position was theonly one in which he was at all easy, and in which he remained day andnight till he ceased to live. 

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

The pericardium contained about eight ounces of straw-coloured fluid. There was a light-brown exudation, extending over serous lamina of thepericardium and the surface of the heart. The heart was flaccid, theright auricle and ventricle were enlarged and attenuated, and both venacava at their junction with the heart were much dilated, the valvularstructure natural. The liver was large, soft, and easily torn. Theabdominal viscera in general appeared healthy; slight effusion into thecavity of the peritoneum. In this case head not examined, but which nodoubt would have shown marks of extensive congestion, as in othercases. 

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

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CASE IV. J. T. , aged 45 when he died, May 1837. He became a collier inearly life, in the neighbourhood of Glasgow, and came, at the age of 22years, to East Lothian, to engage in collier labour at Blind Wells, nearTranent. From his own account, he was rather of a delicate constitution, and ill-fitted for the work of a coal-pit, consequently, after labouringa few years, he was, at the age of 26, --owing to cough and difficulty ofbreathing, --obliged to relinquish the employment of a miner. He leftEast Lothian, and retired to the west of Scotland, where he became acountry merchant, and continued so occupied for upwards of fifteenyears. During that time, he was occasionally troubled, particularly inthe morning, with his cough and hurried breathing, which was increasingin severity, but at no period had he expectorated black matter, nor wasthere any indication that his sufferings arose from carbonaceousdisease. On account of becoming reduced in circumstances, he was underthe necessity, though labouring under chest affection, of returning tohis 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 returnto East Lothian, when his cough increased considerably, with laboriousbreathing, palpitations, and overpowering headach. Both now andformerly, he wrought solely as a coal-miner, and at no time of his lifedid he work as a _stone-miner_. Having a family to provide for, hestruggled on laboriously under much suffering from his chest affection, till general exhaustion compelled him to leave off work, and seekregular medical advice, July 1836. From his statement regarding thecause of the disease, I was led to understand that his cough, whichnever left him from the time he was first seized, was induced, at anearly period, by bad air generated in the coal-pit at Black Wells, fromthe work being ill ventilated, and from the general use of coarselinseed oil for the lamps. 

When I first saw this man professionally, he was labouring under generalweakness; his pulse was not above 40 in the minute, small and thready. He suffered from drowsy headach, anorexia, cold and slightlyoedematous limbs. He had incessant cough, with tough mucousexpectoration. During a severe paroxysm, he vomited a mouthful of blackpaint-like fluid, followed by considerable relief, and ever after tillhis death, he continued to expectorate the same substance in greatquantity, often to the extent of 15 oz. Daily. In examining the chestwith the ear, the sound, from the distinct pectoriloquy, indicated acavernous state of both lungs; otherwise the bruit was obscure. 

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

_Post-mortem examination. _--The body was much emaciated; the ribs wereprominent and unyielding. On removing the anterior part of the thorax, the lungs were found firmly adhering to the pleura costalis, and of adark blue colour. There was an effusion to the extent of about sixteenounces of light-brown fluid, found in the cavities of the pleura. Thegreater part of the effusion was into the left side. The lining membraneof the chest was almost wholly covered with false membrane of a darkbrown colour. The right lung filled almost completely the right cavityof the thorax, while the left lung appeared much contracted, particularly towards the apex. The pleura of both lungs was muchpuckered, 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 mediastinaland lymphatic glands contained fluid having the same appearance. Theright lung appeared solid to the feel, when removed from the body. Itwas rough and irregular over its surface, from a variety of induratedsubstances projecting from beneath the pleura. In making a section ofthe whole lung, each lobe was almost completely saturated with thickinky fluid, and was observed to be here and there hard and granular, particularly in the course of the larger bronchi. Portions of this lungwere pervious to air and emphysematous, but the greater part wasdisorganized, and contained carbonaceous matter in a solid and fluidstate. The left lung was light and flaccid, when compared to the right. The upper lobe was extensively excavated. The parenchymatous substancewas found ragged and unrespirable, and many large blood-vessels crossingfrom either side of the cavity, pervious to blood. With the aid of themagnifier, a variety of open-mouthed bronchial twigs and minuteblood-vessels were visible, communicating with the cavity. The upperpart of the inferior lobe was partially excavated, and containing aboutfour ounces of fluid carbon. The lower margin of this lobe was firmlyimpacted. 

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

The pericardium considerably distended, and contained nearly twelveounces of light-brown fluid. Evident marks of inflammatory action wereobserved externally. On its internal surface it was thickly coated withfalse membrane of a brown colour. The heart was pale, soft, andattenuated. The right auricle was much dilated, and its wallsexceedingly thin. There were no further morbid appearances. Head, --External congestion of an inky colour was found on the surface ofthe brain, which was to all appearance otherwise healthy. There was aneffusion into both lateral ventricles. The abdominal viscera werenatural. The liver was much larger than usual, soft, and highlycongested with inky-coloured blood. [12]

It is evident, from the symptoms and history of the above case, that thepatient had contracted the disease of which he died at an early periodof his life, and that during the fifteen years he refrained from miningoperations, the pulmonary structure retained the carbon inhaled whilelabouring in the coal-pit, and this is one of the many cases which canbe produced as examples of the fact that the foreign matter oncedeposited in that structure originates a process of accumulativeimpaction and ultimate softening of the organ, which is graduallycarried on till it is entirely disorganized. This case comes under thethird division of the morbid action, viz. Where extensive excavation ofthe structure is produced. 

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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 inthe parish of Gladsmuir. He was a short-set robust man, and whilelabouring at Penston, he enjoyed usually good health, free from cough orany affection of the chest. When he had attained the age of 48 years, (1833), he removed from the Penston to the Pencaitland coal-work, andabout six months after making this change, he began to experience aslight difficulty of breathing, accompanied by a troublesome cough andfeverish nights. The pulse was 84. Various soothing remedies wereadministered, which relieved for a little the pectoral symptoms; and ashe felt no decided physical debility, he continued as usual atunderground work. In 1835 I saw him often, and found that his pulmonarysymptoms were becoming more marked; his cough was excessively annoyingin the morning and when going to bed; his expectoration was frothymucus, with dyspepsia, palpitation, and occasional headach. Theresonance of the chest on percussion was very slightly impaired, and therespiratory murmur was variable, being occasionally louder at one timethan another, and often much obscured, from the mucous secretion. 

Labouring under this chest affection he still continued his dailyemployment till the spring of 1836, when he was entirely laid aside, being unable to go below ground, or to take the slightest fatigue, forthe smallest exertion produced a fit of coughing; and during a paroxysmof this kind, he expectorated a few black sputa, which in a few daysdisappeared, and gave place to the usual frothy mucous expectoration. This bronchial discharge was accompanied by considerable relief to thecough and dyspnoea. By this time, (June 1836), on applying the ear tothe chest, the resonance is dull, and respiratory murmur obscure. Theaction of the heart was slow when compared to its former state. Thepulse not beyond 45 in the minute. By the end of this year he appearedin a half dead state, --but a mere shadow in regard to flesh. He wasexpectorating at intervals of some weeks, when the cough became moresevere, a few carbonaceous sputa, and suffering severely from gastricirritation. [13] During the last week of his life, he expectoratedconsiderable quantities of black fluid, and died exhausted, January1837. 

_Post-mortem examination_, which was conducted hurriedly, exhibitedextensive effusion into both sides of the chest. The adhesions of thepleura were strong, and evidently of long standing. There was verygeneral carbonaceous infiltration throughout the lungs, withoutexcavations to any extent. Various empty cysts, which could contain ahazel-nut, were found in the superior and middle lobe of the right, andthroughout the whole of the left lung; in which bronchial twigsterminated. The pericardium was distended, with limpid effusion. Theright side of the heart was dilated, and filled with darktreacly-looking blood; and when washed, it appeared pale and bloodless. Its walls were thin, various patches of brown exudation extending overboth pleuræ. There were several enlarged lymphatic glands, found at theroot of both lungs, filled with black fluid. 

In examining the head, the pia mater was found much congested; but therewas no effusion discovered into any of the ventricles of the brain, norany other indication of disease. 

In tracing the history of this patient, connected with the disease, itwill be observed, that until he came to Pencaitland colliery, he had nosymptom whatever of chest affection. Penston coal-work is exceedinglywell ventilated, and the miners who labour there seldom, if ever, sufferfrom the black expectoration, owing to the evolved smoke of every kindbeing freely carried off from its underground works, while it is quitethe contrary at Pencaitland, where many colliers, on leaving Penston, are seized with the disease. This case comes under the second divisionof the disease, where the irritative process, the result of the foreignmatter in the lungs, has proceeded so far as to produce a variety ofsmall cysts, containing fluid, or semi-fluid carbon, following thecourse of the bronchial ramifications. 

 * * * * *

CASE 6. D. L. , aged twenty-six years at his death, in August 1837. Hewas the son of a collier, at Pencaitland, and engaged at an early age inputting the coals to his father; and when he was fit for fullcollier-work, in 1831, he was employed at the same coal-work. He was atall, well-formed, robust young man, and not at all liable to chestaffection. For some time he wrought, as a coal-hewer, but latterly wasinduced, (1834), for higher wages, to become a stone-miner in the samecoal-pit, where gunpowder was used extensively in the operations. Aboutsix months after he commenced stone-mining, he became affected with ashort tickling cough, expectoration of pearly tenacious phlegm, hurriedbreathing, tightness across the chest, frequent pulse (95), heat of skinduring the night, and occasional throbbing in the head. Being young, andfearless of any danger from the occupation, although warned of theconsequences, he continued to prosecute it, and twelve months (May 1835)after he first began, the cough had increased much in severity. Theexpectoration was diminished, and had become more difficult to void fromthe bronchi, and the breathing was more oppressive, accompanied by apainful tightness across the chest in the morning. The body wasconsiderably reduced in bulk to what it previously had been. The pulseranged from 80 to 90; the appetite was impaired, and there was in themorning a tendency to retching. The nocturnal heat of skin continued, without any moisture, though his body was drenched with a clammy sweatduring the hours of labour. The respiratory murmur was harsh andextensive at the upper part of both lungs, while the sibilant ronchuswas heard occasionally in the lower lobes. The heart's action wasregular, 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 moreurgent symptoms. 

In October 1835, the disease having made rapid progress, all thesymptoms had become more marked. The cough, from its frequency andseverity, was extremely exhausting, and the expectoration had becomemore copious, and of a semi-black colour. The mucous râle was evident inthe upper part of both lungs, while the inferior lobes were dull to theear, and on percussion. The heart's action, at this stage, was lessstrong, but no peculiarity in its function could be discovered. Thecardiac region exhibited every indication of effusion into thepericardium. His body was now considerably emaciated, and the anteriorpart of his chest was so much contracted, as to oblige him to stoop to agreat degree. Under this load of disease, he continued his employment ofa stone-miner, gradually losing flesh, with a rapidly increasing blackexpectoration; and having several dependant on his exertions, heresolved to work, while he could keep on foot, which he did tillSeptember of the following year, (1836) when his once powerful body wasso reduced, from disease, and his cough so incessant, that he was unableto move or speak without great fatigue. He preferred the sittingposition, as giving him most freedom in breathing. The pulse was ratherslow and small; the heart's action languid, and there was an evidentincrease of dulness upon percussion over cardiac region. At this, theclosing period of the disease, (November 1836) he first complained ofdrowsiness, accompanied by headach. The countenance was pallid; the eyessunk and inanimate, and the body tending to be cold; the urinarysecretion of a dark brown colour, and precipitates a dark deposit. Thebowels were exceedingly obstinate, with little change in any of thesymptoms; he lingered till January 1837. 

_Post-mortem examination. _--The body was much emaciated. The thorax waslarge, and well arched. On removing the anterior part of the chest, thelungs appeared to be fully developed, and of a dark blue colour. Therewere several very slight adhesions between the pleuræ, and the effusioninto both cavities was small in quantity. The pleura costalis was almostfree from any exudation, but there were a variety of small patches offalse membrane throughout the pleura pulmonalis. The left lung exhibitedgeneral carbonaceous infiltration. The upper lobe was partiallyexcavated. The pulmonary structure, internally, was ragged and easilytorn, and these cavities communicated with the bronchial divisions, thewalls of which formed various septa. The inferior lobe was almostimpervious to air. The minute bronchial ramifications and correspondinglobules were impacted with dense carbon. There were several clusters ofsmall cysts throughout this lobe, containing carbon in a fluid state. Aportion of this lobe sank in water from its density, and when squeezedwith the hand, thick fluid carbon, containing hardened particles, couldbe expressed from it. The right lung was similar in external appearanceto the left. The upper lobe was crepitant, though infiltrated withcarbon into the interlobular cellular tissue. The air-cells were gorgedwith tenacious mucus. The middle lobe was partially excavated. Thecellular tissue was considerably disorganized, and similar in diseasedstructure to the upper lobe of the left lung, with the exception of aportion affected by vascular emphysema. The inferior lobe was muchcondensed, and loaded with carbon of a very bright black. The mucousmembrane 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 fromeffusion of a straw-coloured fluid. The internal surface of thepericardium was rough, and both laminæ appeared thickened frominflammatory action. Effusion into cavity of chest to the extent oftwelve ounces. The heart was natural in appearance, but thin insubstance. The tricuspid and mitral valves were thickened, andexhibiting minute granulations on their surface. The right auricle andventricle were dilated considerably. Aorta, and other vessels proceedingfrom heart, were natural. The stomach was small, and exceedingly spongyin its mucous lining. The intestines were healthy. The kidneys weresmall, and peculiarly yellow in the internal structure. The liver waslarge, and engorged with dark thick blood; several small carbonaceouscysts throughout its substance. The spleen was large, soft, and muchcongested. The mesenteric glands free from black matter. 

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

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

CASE VII. James R. Aged 54 at his death, 1836. He was a large muscularman, and wrought as a coal-miner in early life at Pencaitland, and, asfar 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 adifficulty in his breathing, which he considered to be asthma, and hewas occupied above ground, as the engine-man, during the latter part ofhis life. The slightest exertion produced exhaustion and palpitation ofthe heart; his bowels were obstinate, and his urinary secretion small inquantity. His cough was particularly troublesome in the morning, and wasrelieved by a free expectoration of frothy mucus. In this condition hecontinued, with the cough gradually increasing, for nearly twentyyears, as I understand, when he began to void black sputa, which dailyaugmented in quantity till his decease, August 1836. 

For some weeks previous to his death, his pulse had become slow andthready, 36 in the minute. The oedema of the upper and lowerextremities was extensive; the dyspnoea increased considerably; thecountenance was livid; and the body remarkably cold. Stimulants inconsiderable quantity were administered without the smallest effect. Drowsiness supervened; and he was for some days previous to dissolutionin a torpid condition, while at the same time he was quite collectedwhen roused. 

_Post-mortem examination. _--On examining the body, the chest was largeand well formed. The effusion into the cellular substance was verygeneral. The cartilages of ribs were ossified, and both lungs wereadhering strongly to the pleura costalis. There was large effusion intoboth cavities of the chest, to the extent of three English pints inwhole. The pleura pulmonalis was much thickened and rough, with falsemembrane, and many patches of puckering. Several lymphatic glands in theanterior part of the mediastinum contained black fluid. The left lungwas carbonaceous throughout its substance. The upper lobe partiallyexcavated and ragged; the inferior lobe infiltrated and emphysematous. The right lung was of corresponding black appearance. The lower lobe hada firm and condensed feel, and when divided, exhibited a mass resemblingindurated blacking. The middle lobe was in part permeable to air; andthere were several small cysts containing liquid carbon, connected withminute bronchial ramifications. Various indurated knotty bodies wereextended throughout its substance. In the upper lobe, the carbon wasconfined principally to the interlobular cellular tissue, and whenpressed in the hand, gave out thick, black, frothy serum. The mucousmembrane of bronchial divisions, when freed from the black matter, wasswollen and eroded as far up as the bifurcation of the trachea. Atseveral parts these passages were considerably contracted. 

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

Brain not examined. 

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

 * * * * *

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

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

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

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

CASE 9. J. D. , aged 37, at his death, April 1844. He was a well formedman, with a fully developed chest. At so early an age as seven years, heengaged in the labour of the coal-pit at Preston-Hall, Mid-Lothian, andhe continued to prosecute that employment for a period of 15 years, whenhe was obliged to relinquish the work on account of an affection of thechest, being, as he termed it, "touched in the breath. " During thesubsequent 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 thetrade of a travelling merchant. He had suffered much in his wanderings, from his breathing, [15] for more than two years continuously, while lossof appetite, and thoracic irritation, had rendered his physical frame asweak as that of a child. 

When I first saw this man, which was about a month before his death, helaboured under rending cough, with a scanty tough mucousexpectoration--oppressive dyspnoea, ascites, general anasarca, occasional giddiness, and throbbing headach on motion, or on assumingthe standing position. His countenance was of a light blue or slatecolour, and his upper and lower extremities had much the sameappearance. 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 halfreclining posture was the only one in which he was comfortable. Thepulse was exceedingly slow, not above 36 in the minute, it was small, and often imperceptible at the wrist. There was considerable weight andfeeling of oppressive fulness in the region of the heart, which was dullon percussion. On applying the ear to the chest, little or no râlewhatever was discernible, and the action of the heart was almostinaudible. He had a sensation as of great weight in the head, anddifficulty in raising it. Ho suffered from restless nights, shorthurried breathing, with a feeling and dread of suffocation, evidentfulness and enlargement in the region of liver, and inability to turn tothe right side. The urine was small in quantity, of a bluish colour, andcoagulable, irritability of stomach, and the bowels were obstinate anddifficult to move, even with drastic purgatives. The treatment wasmerely palliative, no stimulant seemed to have any effect in excitingthe system. Ascites and general anasarca were considerable, giving thebody a large appearance. For some days previous to his dissolution, there was increased lividity of countenance, and little or no action ofheart. He had at no time expectorated carbon, even during many severeparoxysms of cough. Upon inquiry, I found that this man had been acompanion in labour to R. R. (whose case No. 2, is fully reported, ) atPreston-Hall colliery, and from the morbid appearances found in R. 'schest, and from the character of the coal-work in which both wereengaged, I was induced to believe Duncan's to be a similar case. Inascertaining his early history, I found him to be a robust powerful man, though troubled with a cough and hurried breathing from his firstbecoming a collier, circumstances very usual with those who engage indifficult mining operations, and which they erroneously attribute towant of air, nothing more. 

_Post-mortem examination, twenty-four hours after death. _--The body wasmuch swollen from effusion. On removing the anterior part of the chest, both lungs were much compressed from an immense effusion of a lightbrown 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 darkbrown patches of exudation. There were considerable adhesions of thepleuræ, and marks of very general chronic inflammation and falsemembrane over the greater part of the pleura costalis. There wereadhesions of the left lung to the pericardium, which was much thickened, and contained about 14 ounces of a turbid fluid. On removing the leftlung, it seemed large, and felt partially consolidated, and on dividingit throughout both lobes, it contained a mass of semi-fluid carbon, of abright black colour, similar to paint. In this lung, the air-cells werealmost entirely disorganized, unfitting it for the function ofrespiration. The upper lobe was divided into a variety of cysts, filledwith carbonaceous matter in a fluid state, into which many of thesmaller bronchi opened, and through which various blood-vessels passeduninjured. The inferior lobe, when emptied of its contents, was so muchexcavated that the parenchymatous substance felt light and flaccid. Ondividing the right lung[16] it exhibited a pure black mass, but not sofully disorganized as the left. Portions of each lobe were permeable toair, while other parts formed cysts, containing fluid and solid carbon, the inferior lobe showed an almost solid mass. The mucous membrane ofthe respiratory passages was inflamed and spongy throughout thedivisions, the small ramifications were irritated and choked up withtough, frothy phlegm. There were several large bronchial glands at theroot of the left lung. In tracing the divisions of the bronchi moreminutely, from the root of the lungs into their substance, clusters ofglands were observed filled with inky fluid, and narrowing considerablythe air-passages, and in washing carefully a portion of the upper lobeof the right lung, and removing as far as possible the carbonaceousmatter, several lymphatic glands were seen with the aid of themagnifier, imbedded in the interlobular cellular tissue, resemblingsmall black beads. The tracheal glands when examined, contained blackfluid, similar in appearance to what was found in the bronchial glands. The mucous membrane of the trachea was soft and irritated, smeared withtough bloody mucus, the lining membrane of the rima glottidis wasthickened and slightly granular. 

The heart was much enlarged, and soft, with spots indicating chronicinflammatory action on and about the right auricle. Both auricle andventricle on the left side of the heart contained a deep-dark blood. There were several large lymphatic glands imbedded around the greatvessels proceeding from the base of the heart, containing black fluid, the other cavities appeared healthy, though attenuated in substance. Thecoronary veins were congested. None of the cervical glands containedblack fluid, though several of them were enlarged. The cavity of theabdomen much distended from ascites; the contained fluid was to theextent of about six Scotch pints of a straw colour; the viscera muchcompressed, and matted together, with light brown exudation. Theperitoneum was rough, and coated with the same exudation. The stomachand all the intestines correspondingly contracted; the mesenteryappeared healthy; the liver was much enlarged, and darker than usual;the inferior lobe extending downwards, near to crest of ileum; the wholeorgan loaded with inky-coloured blood; the substance easily torn. Thekidneys presented a natural appearance; the adipose substance in whichthey were imbedded was oedematous; the medullary substance of eachpresented 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. Effusioninto the lateral ventricles of a light yellow; the choroid plexusesthickened, and of a dark venous appearance; substance of brain firm andapparently healthy. 

From the history of this case, it will be found that D. Had at no timeshown any indication that carbon was infiltrated into the lungs. At anearly age he came under the influence of the smoke of coarse linseedoil, and of gunpowder, while labouring in an unhealthy andill-ventilated pit, which produced a cough common amongst colliers, whomay be placed in similar circumstances; and it is evident, that duringthe last fifteen years of his life, the carbon--having previously takenup a lodgment in the pulmonary tissue--was gradually accumulating, andthereby producing painful dyspnoea, and the other formidable symptomsconnected with the circulating organs, which followed as results, tillit had almost entirely saturated the cellular structure, and renderedthe lungs unfit for the functions of respiration, consequently impedingthe necessary change, through the medium of that function upon theblood. 

There was a marked similarity in the morbid appearances between thiscase and that of Reid, (No. 2). They both wrought in the same pit atPreston-Hall, and were affected in a similar manner. Both had enlargedliver, and the left lung principally disorganised. Both had extensiveanasarcous and other effusions, and both had coagulable urine. Neitherexpectorated black matter, and both died from the bursting of acarbonaceous cyst into the bronchi, producing suffocation. Duncan livedlonger under the infiltration than Reid did; and this was no doubt owingto his being younger, and also his healthy occupation latterly. 

I have preserved a quantity of the contents of a cyst in the left lungof this patient, for chemical analysis; also a portion of the blood fromthe vena cava, and a little of the black fluid from the bronchialglands. [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 ofPencaitland, and at as early an age as eight years, went under ground toassist his parents in the transmission of the coal, and when fit forwork became a coal-hewer. From his infancy he was rather of a delicateconstitution, with flat and contracted chest. When I first saw him, which was about eight years ago, (1837), he was in full employment as acoal-hewer, complaining of shooting pains through his chest, ticklingcough in the morning, with scanty tough expectoration, and frequentpalpitations. 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 heexpressed it, of "breathing bad air in the pit, " in which he was obligedto relinquish labouring, as the lamp would not burn, from the state ofthe atmosphere. He never wrought at the stone-mining nor blasting. Inexamining the chest with the ear, at this stage of the affection, themucous râle was distinctly heard, and exceedingly loud throughout thegreater part of the chest. The heart's action was strong, but natural;pulse 70, full and bounding. About four years ago, he removed fromHuntlaw to Blindwell, a coal-work towards the sea-coast, an extension ofthe same coal formation. At this time, 1841, he had very troublesomecough, particularly in bed, scanty frothy expectoration, annoyingdyspnoea, preventing him taking sufficient nourishment, headach, obstinate bowels. He continued under all these ailments to labour withmuch difficulty, till the summer of 1843. [18]

In reviewing the morbid appearances in the cases now detailed, it willbe observed, that in the majority of them, the left lung exhibited thegreater amount of diseased structure. This fact is particularlyinteresting, as in _tubercular_ phthisis, a similar predominance ofdisease is found on the left side. 

In almost all the cases, there was found very extensive effusion intothe serous cavities, and particularly into those of the pleura andpericardium. Both pleuræ were much thickened, and all the marks of along 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 thickeningof several of the valves. The liver and spleen were usually large andcongested. In all the cases, as the disease advanced, the pulse camedown to a very unfrequent and thready beat. From the great extent of thevenous congestion, the disease often assumed the aspect of asphyxia; andin some instances the colour of the patients resembled that of personslabouring under cyanosis. 

The lividity of countenance, and the other concomitant symptoms, whichpresented themselves, gave decided indications of the morbid effects ofthis extraneous body. It requires little explanation to show how such adiseased state of the pulmonary organs, as has been described, shouldproduce such results, by impeding the necessary chemical change of theblood. Imperfect oxygenation of the blood, consequent on the alteredpulmonary structure, must cause a general depression of all the vitalorgans. The excess of excrementitious matter in the circulation, mustproduce effusion of serum into the various cavities, and also into thecellular structure; and the appearances exhibited on the surface of thebrain and its membranes, afford a full explanation of the sluggishinanimate condition of all the sufferers towards the close of theirexistence. 

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

It is a melancholy fact connected with mining occupations in thelocality described, that few or none who engage in it, escape thisremarkable 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 insuch pulmonary affections, I am the more convinced that the dyspnoeafrom which they suffer, arises from impaction of the minute bronchialramifications induced during their labour below ground, surrounded by animpure atmosphere. The East Lothian colliers, of all miners throughoutthe kingdom, are certainly most subject to this disease; and those atPencaitland are so to a fearful extent. In the late inquiry for theParliamentary report, such has been manifestly brought out, and I amquite able to corroborate the conclusions at which the commissionershave arrived. It has been supposed by many that this carbonaceousaffection was caused by inhalation of coal-dust. Now, when it can beproved, that there is as much coal-dust at one coal-work as at another, the question comes to be, why should colliers, labouring at onecoal-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 bethe cause, otherwise they should all be liable to the disease. Again, those who labour as coal-bankers at the mouth of the shaft, are obligedto inhale much coal-dust in shovelling and arranging the coal receivedfrom the pit, and have the sputum tinged to a certain extent byit--which resumes its natural appearance when the collier leaves thelabour producing it. They are not subject to the miners' cough, nor isthere carbonaceous infiltration found in the lungs of such labourersafter death. The females and boys, when, as formerly, both were allowedto labour, could not fail to inhale much of the coal-dust in which theywere generally enveloped in their daily occupation; but no carbonaceousdeposit has ever been found in the pulmonary tissue of either the one orthe other. There are very interesting facts connected with the historyof this disease, showing the length of time which the carbon can beretained, brought out by two cases on record, the one published asformerly mentioned by Dr James Gregory, in the _Edinburgh Med. And Surg. Journal_ for 1831, denominated, "Spurious Melanosis;" the other, a casepublished by Dr William Thomson, (_Medico-Chirurgical Transactions ofLondon_ for 1837), and which was reported to him by Dr Simpson, nowProfessor of Midwifery in Edinburgh. 

Dr Gregory's case is that of John Hogg, who had been in the army formore than twenty years, had seen much service as a soldier in Americaand 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 timebefore his death as a collier at Dalkeith. I understand, upon inquiry, from those who were connected with Hogg, that he wrought in early lifeas a miner at Pencaitland coal-work, and was obliged, though a youngman, to relinquish such employment on account of a chest affection, andexchange the pick for the musket. From the history of this case, andfrom the character of his occupation in early life, I apprehend that thecarbonaceous deposit took place when he was first labouring as a minerat 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 manlaboured at Pencaitland coal-work, where the greater number of the casesnow under consideration occurred; and it is stated as a certainty, thathe contracted the black phthisis while occupied in that district; for Ifind from those who knew him at an early period, that his breathing wasmuch affected while at Pencaitland, and he was long supposed by hisfellow-miners to have imbibed the disease, --indeed he removed fromPencaitland on account of it. The two Hoggs were relatives, and nativesof East Lothian. 

It is evident, from several of the cases, that it is no uncommon featureof this affection for the carbon to remain concealed in the pulmonarytissue for very many years; and as both the Hoggs were miners atPencaitland, I have not the smallest doubt that it was then and therethat the disease had its origin; for I have never known a collier whowas a stone-miner who did not ultimately die of the carbonaceousinfiltration. 

Apart from colliers and coal-mines, as a proof that carbonaceousparticles floating in the atmosphere are inhaled and lodged in thebronchial ramifications, I may state the following circumstance, whichcame 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, inthe 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 blueexpectoration, which I was told was almost general amongst the crew. Iwas 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 renderedinefficient, whereby the sleeping-berths were constantly filled withsmoke. I found almost all the seamen, to the number of nearly a hundred, suffering considerably from cough, and expectorating an inky-colouredphlegm, which continued more or less for about a fortnight. I orderedsoothing expectorants, and the dark sputa were profusely voided, andultimately disappeared; but whether any of the carbon had made apermanent lodgment in the pulmonary tissue, is what I have never beenable to ascertain. I am now convinced, in recalling this occurrence, that whatever be the situation, should carbon be floating in the air, itcan be conveyed into the air-cells; and had these seamen been longersubjected to this foul atmosphere, a permanent lodgment of the carbonwould undoubtedly have been the consequence, and the disease now underour consideration to a certainty produced. I further remember seeing, several years ago, a case of partially carbonized lungs in a person whohad lived for a length of time in a smoky and confined room in Glasgow. The patient died of dropsy, consequent, no doubt, on the pulmonaryaffection; and on examining the chest, the upper lobe of both lungs, andthe bronchial glands contained black matter, similar in appearance tothat found in the colliers. 

While engaged in committing these remarks to paper, I have been led inmy investigations to compare the various kinds of labour carried on incoal-pits with the underground operations of many of the railways now inprogress throughout the kingdom; and being convinced of the veryinjurious effects produced upon miners while prosecuting theseoperations in confined situations where gunpowder is used, I shall bemuch surprised if the same results do not follow the hazardousundertakings connected with railway tunnelling, where gunpowder is hadrecourse to, and in the course of years find in our public hospitalscases of carbonaceous lung arising from this cause. [19]

It is no uncommon occurrence, in examining the pulmonary structure ofthose who have resided in large and smoky towns, to find both thesubstance of the lungs and bronchial glands containing black matter; andthis is the case especially with persons who, in such situations, havepassed 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, andbeen obliged to breathe it, minutely combined with the air. It is not, therefore, to be supposed improbable, that a portion of the infinitelysmall particles, thus suspended in the atmosphere, should effect asettlement in the more minute air-cells, and in course of time, beconveyed to the interlobular cellular tissue by the process ofabsorption, and thence to the bronchial glands. There are several caseson record, from amongst iron-moulders, [20] where the pulmonary structurehas been found heavily charged with carbonaceous matter, from theinhalation of the charcoal used in their processes, and where, duringlife, there was a free black expectoration. [21]

There is, then, little doubt that the bronchial glands, from theirappearance in miners, moulders, and others, are the recipients of aportion of impurities which have been carried into the pulmonarystructure by inhalation, and also those left after the process ofoxygenation of the blood; and when it is fully ascertained, from thecharacter of the atmosphere in the coal mine, that deleterious matter inthis form must be conveyed to the air-cells during respiration, there islittle difficulty in coming to the conclusion, that the black fluidfound to such an extent in these glands in the collier and moulder, issimilar to, and a part of, that discovered infiltrated into thesubstance of the lungs. If we trace the black matter in the lymphaticvessels, (which has been done), from the pulmonary organs to thebronchial, mediastinal, and thoracic glands, and from thence to thethoracic duct, we cannot but admit, that it does find its way into thevenous system, and thereby contaminates the vital current. [22]

Dr Pearson of London, in his very valuable paper, published in thePhilosophical Transactions of 1813, on the coaly matter in the bronchialglands, was convinced beyond a doubt, that it was of foreign origin, andpossessed the properties of carbon conveyed into the lungs from without. He, at that period, was not in possession of such facts as have beenrecently elicited on the subject of deleterious inhalation; but the veryinteresting materials which he brought to bear on his argument, have, Ithink, most satisfactorily proved the assertion which he makes, that"the lymphatics of the lungs absorb a variety of substances, especiallythis coaly matter, which they convey to the bronchial glands, and thusrender them of a black or dark-blue colour. " "The texture and proportionof the tinging matter of the glands was, " he says, "different indifferent subjects, whether the lungs to which they belonged were in ahealthy or diseased condition. In persons, from about 18 to 20 years ofage, some of the bronchial glands contained no tinging black matter atall, but were of a reddish colour; others were streaked or partiallyblack. " Again, he says, "I think the charcoal in the pulmonary organs isintroduced with the air in breathing. In the air it is suspended ininvisible small particles, derived from the burning of coal, wood, andother inflammable materials in common life. It is admitted that theoxygen of atmospherical air passes through the pulmonary air-vesicles orcells into the system of blood-vessels, and it is not improbable, thatthrough the same channel various matters contained in the air may beintroduced. But it is highly reasonable to suppose, that the particlesof charcoal should be retained in the minutest ramifications of theair-tubes, or even in the air-vesicles under various circumstances, toproduce the coloured appearances on the surface, and in the substance ofthe lungs, as above described. "

"When I compare the black lines and black net-like figures, many of thempentagonal, on the surface of the lungs, with the plates of thelymphatic vessels by Cruikshank, Mascagni, and Fyffe, I found an exactresemblance. "

Dr Pearson, after various chemical experiments upon the bronchial glandswith caustic potash, muriatic and nitric acid, says, "I conceive I amentitled 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 solidsor fluids. " Dr Graham of London, in his paper on this subject, recordedin the 42d vol. Of the _Edinburgh Medical and Surgical Journal_, givesthe following opinion, as the result of a series of investigations, withthe view of determining the nature of the disease in question. He says, I have had several opportunities of substantiating the carbonaceousmatter in a state of extraordinary accumulation in black lungs suppliedby my medical friends. The black powder, as derived from the lungs, (after an analysis, ) is unquestionably charcoal, and the gaseousproducts from heated air, result from a little water and nitric acidbeing retained persistently by the charcoal, notwithstanding therepeated washing, but which re-acting on the charcoal at a hightemperature, coming off in a state of decomposition. In regard toanother analysis of a lung, he says, "The carbonaceous matter of thelung cannot therefore be supposed to be coal, altered by the differentchemical processes to which it has been submitted in separating it fromthe animal matter. The carbonaceous matter of this lung, appears ratherto be lamp black. "

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

_1st_, The black matter found in the lungs is not a secretion, butcomes from without. The _pigmentum nigrum_ of the ox I find to lose itscolour entirely, and to leave only a quantity of white flocks, whenrubbed in a mortar with chlorine water. Sepia, which is a preparation ofthe dark-coloured liquor of the cuttle fish, was also bleached bychlorine, but the black matter of the lungs was not destroyed orbleached in the slightest degree by chlorine, it even survivedunimpaired the destruction of the lungs by putrefaction in air. 

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

It does not appear, as far as I can ascertain, that any of theContinental physiologists are familiar with the disease now under ourconsideration. Several of them, both ancient and modern, discoveredblack matter in the pulmonary tissues, but not connected with norexhibiting the black phthisis. It is therefore unnecessary to refer tothem in general. 

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

Bichat supposes the black matter in the lungs "to be owing to smallbronchial glands extending along the surface of the pleura. " Breschetbelieves that it is formed by the blood exhaled into the cellulartissue, stating that its chemical composition leads him to thatconclusion. Trousseau says that it is produced by a misdirection of thenatural pigments of the body, resulting from age, climate, or disease. Andral says, that the black appearances are the result of secretion, andthat it is more manifest as the individual advances in life. Heasinger'sopinion is, that it is analogous to pigment, and therefore he agreeswith Trousseau. Lænnec was doubtful as to the real origin of blackpulmonary matter. He makes a distinction between melanotic and pulmonarymatter. He found that the melanotic matter was composed almost entirelyof albumen, while the black pulmonary matter found in the bronchialglands contains a great quantity of carbon and hydrogen, and also thatthese colouring matters have other distinguishing characters. Themelanotic matter is easily effaced by washing, while the other isremoved with difficulty. Lænnec further says, that he suspected thatthis pulmonary matter might arise, at least in part, from the smoke oflamps, and other combustible bodies which are used for heat and light;for some old men are to be met with whose lungs contain very littleblack matter, and whose bronchial glands are but partially tinged withthis colour; and it has struck him that he observed this amongstvillagers who had never been accustomed to watch. [23]

Mons. Guillot, physician to the hospital for the aged at Paris, hasundertaken a series of researches in regard to the black matter found inthe lungs of old men of very considerable age. These investigations arepublished in the January, February, and March numbers of the _ArchivesGénérales de Médecine_. [24] It is his belief that death in such cases isowing, in all appearance, more or less to a suppression of thecirculation 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 thatthis deposit of carbon causes death, by rendering the lungsirrespirable, while, at the same time, it has much influence inmodifying the progress of _tubercular_ disease; so that, if thetubercular affection was not cured, its progress was so far checked, that life has been very long preserved. " The black matter envelopescompletely both the pulmonary tubercles which have undergone atransformation, and the caverns which no longer contain tuberculousmatter. He, while regarding these as the results of black matter in thelungs, throws no light on the cause of the deposit of the particles ofcarbon 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 ofEdinburgh_, states most interesting facts connected with this subject, particularly in regard to black matter found in the pulmonary structureof old people, which deserve considerable attention. He says--"I foundthat a black discoloration of the lungs was by no means a rareoccurrence amongst those old people; and that it was impossible in manyinstances to decide, whether the black colour was owing to an increaseof what is called the healthy black matter, --to a morbid secretion, orto a foreign substance being imbedded with the atmospheric air. Afterexamining a considerable number of lungs, and finding that the divisionof the black matter into three kinds was not founded upon observation, and that the descriptions of them given by the best authorities wereinsufficient to enable us to distinguish them from one another, I beginto think, that in every instance in which black matter is found in thelungs, it ought to be considered morbid. If we examine the lungs atdifferent stages of life, we find as a general rule that the quantity ofblack matter increases with age. In young children we find no traces ofit, the lungs being of a reddish colour. At the age of ten years theblack matter makes its appearance in the outer surface of the lungs, andin the interlobular spaces. At the age of thirty or forty, the lungpresents a greyish or mottled appearance, and the bronchial glandscontain more or less black matter. Between the age of seventy and ahundred, the lungs are generally infiltrated with fluid black matter, which can be expressed from the cut surfaces, and stain the handsblack. "

"There are many circumstances which favour the accumulation of thisblack matter in the lungs; for instance, long-continued living in asmoky 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 ofiron-founders. There can be no doubt that we inhale foreign substancesalong with the atmospheric air. 

"We find the mucus which has remained in the nostrils for some time tobe 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 otherforeign substances, which the air may have accidentally contained. Themucus first coughed up from the lungs in the morning, is of a darkcolour from the same cause, and the facts now maintained prove, thatforeign substances suspended in minute particles in the atmosphere, maybe inhaled into the lungs. I believe in all the extreme cases which haveoccurred in colliers and moulders, that there must have existed someprevious disease of the lungs which prevented the foreign matter frombeing thrown off. " "According to the views which we have taken of thesubject, there are only two ways by which black matters may be depositedin the lungs; first, by a morbid secretion; second, by a foreignsubstance inhaled with the atmosphere. The former is a rare disease, while the latter is very common. I am inclined to think that the truemelanosis generally occurs in the form of rounded tumours, which, whencut in two, present a uniform black colour without any trace ofair-cells, while in the spurious melanosis the deposition is general, and black matter flows freely out when the cut surfaces are pressed. Atfirst the lung is crepitous, and swims in water; but as the black matterincreases, it becomes solid, and, as in the case of colliers who die ofthis disease, resembles a piece of wet peat in point of consistence. Itis only in the cases of colliers, moulders, or others who inhale greatquantities of black matter, that the lungs are rendered perfectlysolid. "

There is an exceedingly interesting and valuable paper, written by DrBrockmann of Clausthal, upon the pulmonary diseases of a certain classof German miners, --supposed to be in the Hartz mountains, --in_Neumeister's Repertorium_ for December 1844, an abridged translation ofwhich is to be found in the September number of the _Monthly Journal ofMedical Science_. 

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

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

There is a very striking similarity between what Dr Brockmann calls thesecondary anatomical changes, and many of those exhibited in thecollier; first, membranes; second, collections of fluid into the pleuræand 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 collierit is usually puffy, and much congested. 

The symptoms do almost in all points accord with those presented in thecollier, as will appear from the following quotation, from the paper. "In the first stage, there is no local, functional, or general featureby which we can ascertain that the disease has commenced; probability isall 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 fineblooming appearance, which perhaps the patient previously had, there hassucceeded a dark yellowish cast, --a change which gradually spreads overthe whole body. For some time the patient may have remarked a gradualloss of strength, and now he complains of want of appetite anddisordered digestion, and more particularly of shooting pains in theback and muscles of the chest. Cough likewise supervenes, which mayeither be quite dry, or at most accompanied with a little pure mucus. There is also a greater or less degree of oppression, accompanied withpalpitation of heart, not only after a severe fit of coughing, but afterevery exertion of the lungs. As yet no local deviation from the normalcondition is seen on examination of the chest by percussion orauscultation. " "The disease meanwhile passes into the third stage. Thefeatures of the patient now become more and more changed anddeteriorated, and betray a deep melancholy. The colour of the face, which had been hitherto of an earthly hue, becomes blackish, as also thecornea, whereby the eye loses its lustre. The appearance of the patientbecomes still more frightful from the great loss of flesh, and the darkskin hanging loose on his bones. The fat not only seems to havedisappeared, but the muscular substance also--the whole frame beingshrivelled. The patient complains of increasing weakness, diminishedappetite, flying pains often concentrated at the pit of the stomach; andcoughs much. The expectoration is for the most part difficult, andconsists of masses of mucus, either greyish, or tending to a blackcolour. A black streak is frequently observed running through thewhitish mucus; one half of it may be white, the other black, oroccasional black points may be observed throughout the mass, andsometimes, though rarely, blood. Dyspnoea is usually connected withthe cough. It now begins to tell upon the patient, and is socharacteristic, that the disease has been named asthma metallicum. Thedisturbance of the digestive organs increases the disease, --the appetiteis entirely lost, --the tongue is covered with a white fur--there is anoppression at the stomach after a full meal--frequent eructations, and atendency to constipation. The distress of the patient becomes increasedin consequence of the shooting pains in the muscular system. " "In thefourth and last stage, all the external appearances indicate the nearapproach of dissolution, --the face and members become bloated, and thefeet greatly swollen. " "The dyspnoea meanwhile, from effusion into thechest and pericardium, becomes so severe, that the patient cannotmaintain 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 isnever accompanied with colliquative sweats or diarrhoea. "

I am sorry to find that there is no allusion whatever to the state ofthe pulse. Dr Brockmann, in his remarks on the essential nature of thispulmonary disease of miners, brought under his notice, seems toentertain the impression that along with the inhaled carbon, resultingfrom the combustion of gunpowder, there is also an organicpigment-deposit present in the pulmonary tissue, which he supposes musthave been formed in the lungs. 

I have long entertained the belief, which I have stated in another partof this essay, that if the carbon is once conveyed into, and establishedin the parenchyma of the lungs, that organ commences the formation ofcarbon; thus increasing the amount originally deposited. Dr Brockmannsets forth, as grounds for this view, that "if the parenchyma of thelungs were filled with carbonaceous dust, their specific gravity oughtto be increased; but this is not the case. A completely melanosed lungswims in water, both as a whole and when cut into parts. " It is veryevident from these remarks, that the author has not seen the disease asit is exhibited in the third division of morbid action in the collier, otherwise he would have both observed the lungs considerably augmentedin 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 lungsweighed about six pounds, and parts of the cellular tissue were soindurated, as to be cut with difficulty. In this case, the patient didnot expectorate. 

Dr Brockmann, as he advances, puts a question here, which more fullyshows that the disease under his consideration was of a mild charactercompared with that under our notice. "If, " says he, "pulmonary melanosisarise entirely from inhalation of carbonaceous dust, why is it notobserved in other workmen, who are as much, and even more, exposed toits influence, as for instance, smelters, or moulders, and colliers?" Hesays, further, "were the carbon inhaled in quantity sufficient toexplain the black colour of the lungs, it ought also, from itsmechanical irritation, to produce inflammation in the delicate mucousmembrane 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 bemost satisfactorily given by a reference to the published cases, wherethe disease is principally found amongst colliers and moulders, andwhere the pulmonary organs, particularly in the former, are found toundergo most fearful disorganization from the presence of carbon. It isvery remarkable, that the author of these exceedingly interestingobservations should never have found excavations of the parenchyma, whenit is so general as the result of the same disease in this country, particularly in the locality to which I refer. Not knowing thecharacter of the mine, it is impossible to judge; but I am disposed toconclude that there cannot be the same quantity of carbon floating inthe atmosphere breathed by the German miner, --the disease resembles verymuch that milder form found in the iron moulder. 

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

The effects of such a morbid structure upon the collier population ingeneral is very marked. Previous to the late legislative act, the tenderyouth of both sexes were at an early age consigned to the coal pit, andobliged to labour beyond their feeble strength, in circumstances illadapted to their years. Such early bodily exhaustion soon produced inthem a pallid countenance, soft and relaxed muscular fibre, andpredisposed much to disease as they advanced in life. The miner on thisaccount was generally from his youth, thin; in fact, you never see a fatand healthy-looking collier, and, according to the advance of pulmonarydisease, with them, so is the progress of emaciation. Such a state ofbody may well be looked for in miners, labouring as they do, from ten totwelve hours in the twenty-four under ground, breathing a heated andimpure atmosphere, which with difficulty sustains life, and which isdemonstrably calculated, from its deleterious qualities, to induceserious disease. The effects manifest in the parent descend, and visiblein the youngest children; they are squalid and wretched-looking, --andhow can such offspring be otherwise? They are exceedingly subject to allchildren's diseases, and peculiarly predisposed to pulmonary irritationof one kind or other. 

With regard to medical treatment, little can be done after the diseasehas passed its first stage. Early removal from the occupation, andproper attention to nutrition, alone seem to hold out the hope ofprolonging the life of the patient; but if there be carbon lodged in thepulmonary tissues, there is a certainty of its sooner or later provingfatal. Attention to the state of the digestive organs, and using everymeans to remove the dyspeptic symptoms, which are prominently presentthroughout the various stages of this disease, are indispensablyrequisite; and, as to nutrition, the nature of the diet should be asgenerous as possible. Anodynes and expectorants are the only remedieswhich seem at all efficacious in allaying irritation. 

With a view to remove urgent symptoms, venesection has repeatedly beenhad recourse to, but in almost all instances I would say, withdecidedly bad effects. Blood-letting does harm, producing generaldebility and rapid sinking. [25]

With regard to the prevention of this disease, ventilation, as has beenstated, is very much neglected in the pits now under consideration, where the various cases have occurred; and to that neglect I ascribe theprevalence of the malady. In those pits referred to, the workableapartments are so confined, and become after a time so destitute ofoxygen, as, along with the smoke from lamps and gunpowder, to render theair unfit for healthy respiration. The only effectual remedy is a freeadmission of pure air, so applied as to remove the confined smoke. Thisremark both applies to coal and stone-mining. The introduction of someother mode of lighting such pits than by oil is required. I know severalcoal-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 freecirculation of air. For example, the Penston coal-work, which joinsPencaitland, has ever been free from this disease; but many of thePenston colliers, on coming to work at Pencaitland, have been seizedwith, and died shortly after, of the black spit: for instance, G. CaseNo. 5, and D. Case No. 8, are such. 

How this is to be accomplished, is for the scientific man to say. Withall due deference, I may be allowed to suggest various modes which mightbe adopted to free the underground atmosphere of the noxiousingredients. Could fresh air not be forced down by the power of thesteam-engine, which is at every coal-pit? Could extensive fanners not beerected and propelled by the same machinery?[26] I am much surprisedthat no attempt has been made to light these pits with portable gas insome way or other. As far as I can understand, such an application of itwould not be difficult. A small gasometer could be erected, and thenecessary apparatus procured at little expense, and by such means, Iwould suppose, it could be carried to any part of the mines, which arenot extensive. 

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

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

 * * * * *

In the course of my investigations in regard to pulmonary carbonaceousinfiltration, I was led to consider the circumstances of those engagedin other occupations than coal-mining. Any one who has carefullyexamined the structure of the human bronchial glands, at differentepochs of life, must have been struck with their appearance in thosewho, 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 containcarbonaceous matter which has been inhaled at some period of life. Having long entertained the belief that the lungs of chimney sweeps, forexample, would, in all probability, be found to contain carbon, withinthe last few months two cases, of an exceedingly interesting character, connected with the present inquiry, have presented themselves, --the oneof pulmonary disease, evidently resulting from the bronchial andlymphatic glands being impacted with inhaled carbon derived fromsoot, --the other a case of melanosis occurring in a young person. Thoughthe two diseases differ materially, they have often been confounded witheach other and assigned to the same cause. My object in here reporting acase of stratiform melanosis, in connection with a disease having anexternal origin, is to afford an illustration of the fact, that allblack deposits found in the system are not carbon. There exists a markedchemical 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 atStockbridge. 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 earlylife, and had seen much foreign service. After he relinquished the army, he became a chimney sweep, in which capacity he was constantly engagedfor nearly twenty years. He had had, for a considerable time, atroublesome cough with tough expectoration. He experienced a difficultyof breathing in making any exertion, and he had considerable oedema ofthe limbs. From these symptoms he believed that he was subject to_asthma_. He had only been confined to bed for two days previous to hisdeath. 

_Post-mortem Appearances. _--The body exhibited extensive anasarca; thethorax was well arched; the cartilages of the ribs were ossified. Onremoving the anterior part of the chest, the pleuræ were found to adherestrongly, and appeared rough and puckered from extensive exudation of abrown colour, which extended very generally over the serous membranes. Both cavities contained nearly three gallons of light brown fluid. Thepericardium was considerably distended with a straw-coloured fluid, andseveral flakes of lymph floated throughout the effusion. Both auriclesof the heart were enlarged, and distended with exceedingly dark blood. The walls of both ventricles were much thickened. The valvular structureof the auricles was congested and granular. The lungs were removed fromthe chest with difficulty, owing to the very general pleuriticadhesions. Both exhibited extensive emphysema. In dividing the lungs, and tracing the bronchial ramifications, each lobe was found to containclusters of enlarged and indurated bronchial glands, impacted with thickblack matter; and prosecuting the investigations, the minute lymphaticglands were observed clustered in a similar manner, and containing blackfluid. In the substance of the upper lobe of both lungs, the bronchialglands were of a bright black colour; they were particularly large, andso numerous as to press considerably upon and obstruct several of thebronchial tubes. In fact the upper lobe of both lungs exhibited theplum-pudding structure. At the bifurcation and back part of the trachea, the bronchial glands were numerous, and of a deep black colour. Aconsiderable mass of the glandular structure was removed for chemicaland microscopic examination. 

The second case was that of a boy aged six years, who was undertreatment for an affection of the heart and kidneys, and who diedapparently from disease of these organs. He was, during his whole life, of a relaxed and weakly constitution, exceedingly sallow in thecomplexion, with a very deep blue tint of the sclerotic coat of the eye. In the course of the post-mortem examination, there was discovered, inthe lower and lateral part of the right pleura, a cyst containing aboutan ounce of semi-fluid melanotic matter; and also the morbid secretionpresented the stratified appearance described by Dr Carswell in hisarticle upon Melanosis, extending over the inferior half of the costalpleura and the corresponding part of the diaphragm. It formed a distinctlayer on the surface of the serous membrane, resembling ink or blacking, and could with difficulty be removed. The black deposit resembled muchin appearance the foreign matter found in the pulmonary organs of thecoal-miner, and therefore was submitted, as well as the bronchialglands in the other case, to chemical analysis, with the view ofascertaining if there existed any analogy in the component parts ofeach. 

Dr Douglas Maclagan submitted both these substances to the action ofconcentrated nitric acid, and the results were, that the glandularstructure of the chimney sweep contained a very large proportion ofcarbon, while of the contents of the melanotic cyst, the same processdid not leave a vestige of colouring matter, --evidently proving thedistinction which exists between those two dark deposits, and making itsufficiently obvious, that melanotic matter is composed of theconstituent elements of the blood, and has its origin within the body. There cannot remain a doubt as to the nature of the chimney sweeper'scase; for, from the knowledge which we have of his occupation, and fromthe chemical properties manifest after investigation, I think I amentitled to declare the black matter obtained from the bronchial glandsto be carbon inhaled with the air during his labour, and not existing asa constituent ingredient of organized solids or fluids. 

The microscopic examination showed the carbon most distinctly in amolecular form. 

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

 NORTHUMBERLAND STREET, EDINBURGH, January 1846. 

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FOOTNOTES:

[1] Vide an admirable series of papers on this subject in the volume ofthis 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 characterpossessed by the melanotic matter, as compared with the matter found inthe lungs of miners. 

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

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

[7] Note from the evidence of a collier examined before the GovernmentCommissioners in 1842, No. 147 of Report. "Colliers in this part of thecountry are subject to many oppressions; first, Black spit, whichattacks 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 thechief 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 badbreathing--the air below is very bad, and till lately no ventilationexisted. "

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

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

[10] To convey an impression of the nature of the labour in which theman was engaged I shall simply extract a few remarks from the evidenceof the miners at this coal-work, taken by Mr Franks for the Government'sCommissioners, Note 105. "At all times the air is foul, and the lampsnever burn bright. The seam of coal is 24 inches, and the road onlythree feet high. " Note 108--"Experienced colliers do not like the work, and many are touched in the breath. " And in such a situation man isdoomed to labour! Note 114--"Most of the men here are _fashed_ with_that trouble_; Foster, Miller, Blyth, and Aitken are all clean gone inthe breath together. Colliers here drop down very soon. "

[11] It is evident in this disease that the bronchial ramifications aredestroyed, 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 JohnThomson, late Professor of Pathology, and will probably be found in hiscollection, which I understand is in the College of Surgeons. 

[13] After a free expectoration of black matter, there was an evidentmitigation of all the pectoral symptoms, and as the carbon againaccumulated in the lungs, the sufferings of the patient were veryconsiderably increased. 

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

[15] When pulmonary disorganization has proceeded far, from the presenceof carbon, there is a languor in the vital action from defectiveoxygenation of the blood, which produces a gradual reduction in thetemperature of the body, requiring double clothing, and even thataddition is, with the aid of stimulants, not sufficient to keep thepatient warm. 

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

[17] The above substances were submitted separately to the action ofnitric acid and caustic potash, and the result was that a largeproportion 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 preventedexamining the morbid appearances. 

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

[20] Dr Hamilton's of Falkirk paper in the Edin. Med. And SurgicalJournal, Vol. Xlii. 

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

Of the several cases which I saw with Mr Girdwood, one, who has not beenlabouring for some years as a moulder, occasionally expectorated blackmatter, 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 achemical analysis of the blood as I would wish, but through the kindassistance of Dr Douglas Maclagan, who has undertaken to conduct theprocess, 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, particularlytowards the last stage of the disease, the blood appeared peculiarlydark 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 ofthe Newbattle coal works is now directed to this subject. 

[28] I cannot pass from this subject without an observation on thebeneficial results which have been the consequence of Lord Ashley'svaluable colliery Act. The female Labourers, and particularly theunmarried, have improved not only in their appearance, but also ingeneral physical development, since they have abandoned the unhealthylabour of the coal-mine. They are no longer the squalid, filthy, andill-favoured race they formerly were. There is now exhibited on the faceof the collier girl the bloom of health and cheerfulness; and when wedescend to their domestic economy, there is observed a comfort in themanagement of their households, which formerly did not exist. Theirchildren are now particularly cared for, both in health and whensuffering from disease; and we must regard this early watching as animportant step to the removal of that predisposition to pulmonaryirritation, so general in the collier community.