An Investigation into the Nature of Black Phthisis Part 2

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

_Post-mortem examination._--The body was much emaciated. The thorax was large, and well arched. On removing the anterior part of the chest, the lungs appeared to be fully developed, and of a dark blue colour. There were several very slight adhesions between the pleurae, and the effusion into both cavities was small in quant.i.ty. The pleura costalis was almost free from any exudation, but there were a variety of small patches of false membrane throughout the pleura pulmonalis. The left lung exhibited general carbonaceous infiltration. The upper lobe was partially excavated. The pulmonary structure, internally, was ragged and easily torn, and these cavities communicated with the bronchial divisions, the walls of which formed various septa. The inferior lobe was almost impervious to air. The minute bronchial ramifications and corresponding lobules were impacted with dense carbon. There were several cl.u.s.ters of small cysts throughout this lobe, containing carbon in a fluid state. A portion of this lobe sank in water from its density, and when squeezed with the hand, thick fluid carbon, containing hardened particles, could be expressed from it. The right lung was similar in external appearance to the left. The upper lobe was crepitant, though infiltrated with carbon into the interlobular cellular tissue. The air-cells were gorged with tenacious mucus. The middle lobe was partially excavated. The cellular tissue was considerably disorganized, and similar in diseased structure to the upper lobe of the left lung, with the exception of a portion affected by vascular emphysema. The inferior lobe was much condensed, and loaded with carbon of a very bright black. The mucous membrane of the bronchial tubes was thickened, and slightly ulcerated.

Various lymphatic glands were found at the root of both lungs, containing black fluid. The pericardium was considerably distended from effusion of a straw-coloured fluid. The internal surface of the pericardium was rough, and both laminae appeared thickened from inflammatory action. Effusion into cavity of chest to the extent of twelve ounces. The heart was natural in appearance, but thin in substance. The tricuspid and mitral valves were thickened, and exhibiting minute granulations on their surface. The right auricle and ventricle were dilated considerably. Aorta, and other vessels proceeding from heart, were natural. The stomach was small, and exceedingly spongy in its mucous lining. The intestines were healthy. The kidneys were small, and peculiarly yellow in the internal structure. The liver was large, and engorged with dark thick blood; several small carbonaceous cysts throughout its substance. The spleen was large, soft, and much congested. The mesenteric glands free from black matter.

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

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

CASE VII. James R. aged 54 at his death, 1836. He was a large muscular man, and wrought as a coal-miner in early life at Pencaitland, and, as far as could be ascertained, he had never been engaged at stone-mining.

At the age of thirty he was obliged to desist work, on account of a difficulty in his breathing, which he considered to be asthma, and he was occupied above ground, as the engine-man, during the latter part of his life. The slightest exertion produced exhaustion and palpitation of the heart; his bowels were obstinate, and his urinary secretion small in quant.i.ty. His cough was particularly troublesome in the morning, and was relieved by a free expectoration of frothy mucus. In this condition he continued, with the cough gradually increasing, for nearly twenty years, as I understand, when he began to void black sputa, which daily augmented in quant.i.ty till his decease, August 1836.

For some weeks previous to his death, his pulse had become slow and thready, 36 in the minute. The oedema of the upper and lower extremities was extensive; the dyspnoea increased considerably; the countenance was livid; and the body remarkably cold. Stimulants in considerable quant.i.ty were administered without the smallest effect.

Drowsiness supervened; and he was for some days previous to dissolution in a torpid condition, while at the same time he was quite collected when roused.

_Post-mortem examination._--On examining the body, the chest was large and well formed. The effusion into the cellular substance was very general. The cartilages of ribs were ossified, and both lungs were adhering strongly to the pleura costalis. There was large effusion into both cavities of the chest, to the extent of three English pints in whole. The pleura pulmonalis was much thickened and rough, with false membrane, and many patches of puckering. Several lymphatic glands in the anterior part of the mediastinum contained black fluid. The left lung was carbonaceous throughout its substance. The upper lobe partially excavated and ragged; the inferior lobe infiltrated and emphysematous.

The right lung was of corresponding black appearance. The lower lobe had a firm and condensed feel, and when divided, exhibited a ma.s.s resembling indurated blacking. The middle lobe was in part permeable to air; and there were several small cysts containing liquid carbon, connected with minute bronchial ramifications. Various indurated knotty bodies were extended throughout its substance. In the upper lobe, the carbon was confined princ.i.p.ally to the interlobular cellular tissue, and when pressed in the hand, gave out thick, black, frothy serum. The mucous membrane of bronchial divisions, when freed from the black matter, was swollen and eroded as far up as the bifurcation of the trachea. At several parts these pa.s.sages were considerably contracted.

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

Brain not examined.

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

CASE VIII. R. D., aged 37, at his death, 1839. He was the brother of George Davidson, subject of the first case in this Essay. He began to labour as a miner, with his brother, in early life, at Pencaitland coal-work. He first began as a coal-miner, and after being so engaged for five or six years, he removed to Penston coal-work, which adjoins.

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

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

A small portion of the upper lobe was pervious to air. There were several enlarged bronchial glands at the root of both lungs; and the tracheal glands contained black fluid. The liver was large, and its substance soft.

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

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

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

When I first saw this man, which was about a month before his death, he laboured under rending cough, with a scanty tough mucous expectoration--oppressive dyspnoea, ascites, general anasarca, occasional giddiness, and throbbing headach on motion, or on a.s.suming the standing position. His countenance was of a light blue or slate colour, and his upper and lower extremities had much the same appearance. His lips, eyelids, ears, and nose, were swollen and livid, and his eye-b.a.l.l.s effused, and apparently projecting from the sockets.

His sight was impaired and hazy. There was continued feeling of cold, with occasional rigors, and difficulty in keeping the extremities warm.

There was considerable exhaustion upon the slightest exertion. The half reclining posture was the only one in which he was comfortable. The pulse was exceedingly slow, not above 36 in the minute, it was small, and often imperceptible at the wrist. There was considerable weight and feeling of oppressive fulness in the region of the heart, which was dull on percussion. On applying the ear to the chest, little or no rale whatever was discernible, and the action of the heart was almost inaudible. He had a sensation as of great weight in the head, and difficulty in raising it. Ho suffered from restless nights, short hurried breathing, with a feeling and dread of suffocation, evident fulness and enlargement in the region of liver, and inability to turn to the right side. The urine was small in quant.i.ty, of a bluish colour, and coagulable, irritability of stomach, and the bowels were obstinate and difficult to move, even with drastic purgatives. The treatment was merely palliative, no stimulant seemed to have any effect in exciting the system. Ascites and general anasarca were considerable, giving the body a large appearance. For some days previous to his dissolution, there was increased lividity of countenance, and little or no action of heart. He had at no time expectorated carbon, even during many severe paroxysms of cough. Upon inquiry, I found that this man had been a companion in labour to R. R. (whose case No. 2, is fully reported,) at Preston-Hall colliery, and from the morbid appearances found in R.'s chest, and from the character of the coal-work in which both were engaged, I was induced to believe Duncan's to be a similar case. In ascertaining his early history, I found him to be a robust powerful man, though troubled with a cough and hurried breathing from his first becoming a collier, circ.u.mstances very usual with those who engage in difficult mining operations, and which they erroneously attribute to want of air, nothing more.

_Post-mortem examination, twenty-four hours after death._--The body was much swollen from effusion. On removing the anterior part of the chest, both lungs were much compressed from an immense effusion of a light brown fluid into the cavities of the chest to the extent of a gallon.

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

The mucous membrane of the trachea was soft and irritated, smeared with tough b.l.o.o.d.y mucus, the lining membrane of the rima glottidis was thickened and slightly granular.

The heart was much enlarged, and soft, with spots indicating chronic inflammatory action on and about the right auricle. Both auricle and ventricle on the left side of the heart contained a deep-dark blood.

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

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

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

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

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

CASE 10. (The subject of the following case is still alive, 1845.) J.

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

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

In almost all the cases, there was found very extensive effusion into the serous cavities, and particularly into those of the pleura and pericardium. Both pleurae were much thickened, and all the marks of a long standing pleuritic and pericardial inflammatory action were seen.

The substance of the heart, in all the cases, was soft and attenuated; the right auricle and ventricle were dilated; and there was thickening of several of the valves. The liver and spleen were usually large and congested. In all the cases, as the disease advanced, the pulse came down to a very unfrequent and thready beat. From the great extent of the venous congestion, the disease often a.s.sumed the aspect of asphyxia; and in some instances the colour of the patients resembled that of persons labouring under cyanosis.

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

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

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

Journal_ for 1831, denominated, "Spurious Melanosis;" the other, a case published by Dr William Thomson, (_Medico-Chirurgical Transactions of London_ for 1837), and which was reported to him by Dr Simpson, now Professor of Midwifery in Edinburgh.

Dr Gregory's case is that of John Hogg, who had been in the army for more than twenty years, had seen much service as a soldier in America and the West Indies, and had served in Spain during the Peninsular war.

On his return to his native country, he was engaged for a short time before his death as a collier at Dalkeith. I understand, upon inquiry, from those who were connected with Hogg, that he wrought in early life as a miner at Pencaitland coal-work, and was obliged, though a young man, to relinquish such employment on account of a chest affection, and exchange the pick for the musket. From the history of this case, and from the character of his occupation in early life, I apprehend that the carbonaceous deposit took place when he was first labouring as a miner at Pencaitland; and that he carried the foreign body in his lungs, throughout his campaigns.

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

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

Apart from colliers and coal-mines, as a proof that carbonaceous particles floating in the atmosphere are inhaled and lodged in the bronchial ramifications, I may state the following circ.u.mstance, which came under my own observation several years ago. After a gale of wind, which had continued for more than a week, off the coast of America, in the July of 1832, I was applied to for advice by several of the seamen, on account of a tickling cough, followed by a peculiarly dark blue expectoration, which I was told was almost general amongst the crew. I was certainly at a loss, and put to my shifts, to render a reason; but, upon investigating the matter further, I found that, during the gale, the chimney of the cook's apartment in the _'tween-decks_ was rendered inefficient, whereby the sleeping-berths were constantly filled with smoke. I found almost all the seamen, to the number of nearly a hundred, suffering considerably from cough, and expectorating an inky-coloured phlegm, which continued more or less for about a fortnight. I ordered soothing expectorants, and the dark sputa were profusely voided, and ultimately disappeared; but whether any of the carbon had made a permanent lodgment in the pulmonary tissue, is what I have never been able to ascertain. I am now convinced, in recalling this occurrence, that whatever be the situation, should carbon be floating in the air, it can be conveyed into the air-cells; and had these seamen been longer subjected to this foul atmosphere, a permanent lodgment of the carbon would undoubtedly have been the consequence, and the disease now under our consideration to a certainty produced. I further remember seeing, several years ago, a case of partially carbonized lungs in a person who had lived for a length of time in a smoky and confined room in Glasgow.

The patient died of dropsy, consequent, no doubt, on the pulmonary affection; and on examining the chest, the upper lobe of both lungs, and the bronchial glands contained black matter, similar in appearance to that found in the colliers.

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

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

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

Dr Pearson of London, in his very valuable paper, published in the Philosophical Transactions of 1813, on the coaly matter in the bronchial glands, was convinced beyond a doubt, that it was of foreign origin, and possessed the properties of carbon conveyed into the lungs from without.

He, at that period, was not in possession of such facts as have been recently elicited on the subject of deleterious inhalation; but the very interesting materials which he brought to bear on his argument, have, I think, most satisfactorily proved the a.s.sertion which he makes, that "the lymphatics of the lungs absorb a variety of substances, especially this coaly matter, which they convey to the bronchial glands, and thus render them of a black or dark-blue colour." "The texture and proportion of the tinging matter of the glands was," he says, "different in different subjects, whether the lungs to which they belonged were in a healthy or diseased condition. In persons, from about 18 to 20 years of age, some of the bronchial glands contained no tinging black matter at all, but were of a reddish colour; others were streaked or partially black." Again, he says, "I think the charcoal in the pulmonary organs is introduced with the air in breathing. In the air it is suspended in invisible small particles, derived from the burning of coal, wood, and other inflammable materials in common life. It is admitted that the oxygen of atmospherical air pa.s.ses through the pulmonary air-vesicles or cells into the system of blood-vessels, and it is not improbable, that through the same channel various matters contained in the air may be introduced. But it is highly reasonable to suppose, that the particles of charcoal should be retained in the minutest ramifications of the air-tubes, or even in the air-vesicles under various circ.u.mstances, to produce the coloured appearances on the surface, and in the substance of the lungs, as above described."

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

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

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

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