and wrought during the greater part of his life at Penston colliery in
the parish of Gladsmuir. He was a short-set robust man, and while
labouring at Penston, he enjoyed usually good health, free from cough or
any affection of the chest. When he had attained the age of 48 years,
(1833), he removed from the Penston to the Pencaitland coal-work, and
about six months after making this change, he began to experience a
slight difficulty of breathing, accompanied by a troublesome cough and
feverish nights. The pulse was 84. Various soothing remedies were
administered, which relieved for a little the pectoral symptoms; and as
he felt no decided physical debility, he continued as usual at
underground work. In 1835 I saw him often, and found that his pulmonary
symptoms were becoming more marked; his cough was excessively annoying
in the morning and when going to bed; his expectoration was frothy
mucus, with dyspepsia, palpitation, and occasional headach. The
resonance of the chest on percussion was very slightly impaired, and the
respiratory murmur was variable, being occasionally louder at one time
than another, and often much obscured, from the mucous secretion.
Labouring under this chest affection he still continued his daily
employment till the spring of 1836, when he was entirely laid aside,
being unable to go below ground, or to take the slightest fatigue, for
the smallest exertion produced a fit of coughing; and during a paroxysm
of this kind, he expectorated a few black sputa, which in a few days
disappeared, and gave place to the usual frothy mucous expectoration.
This bronchial discharge was accompanied by considerable relief to the
cough and dyspnoea. By this time, (June 1836), on applying the ear to
the chest, the resonance is dull, and respiratory murmur obscure. The
action of the heart was slow when compared to its former state. The
pulse not beyond 45 in the minute. By the end of this year he appeared
in a half dead state,--but a mere shadow in regard to flesh. He was
expectorating at intervals of some weeks, when the cough became more
severe, a few carbonaceous sputa, and suffering severely from gastric
irritation.[13] During the last week of his life, he expectorated
considerable quantities of black fluid, and died exhausted, January
1837.
_Post-mortem examination_, which was conducted hurriedly, exhibited
extensive effusion into both sides of the chest. The adhesions of the
pleura were strong, and evidently of long standing. There was very
general carbonaceous infiltration throughout the lungs, without
excavations to any extent. Various empty cysts, which could contain a
hazel-nut, were found in the superior and middle lobe of the right, and
throughout the whole of the left lung; in which bronchial twigs
terminated. The pericardium was distended, with limpid effusion. The
right side of the heart was dilated, and filled with dark
treacly-looking blood; and when washed, it appeared pale and bloodless.
Its walls were thin, various patches of brown exudation extending over
both pleuræ. There were several enlarged lymphatic glands, found at the
root of both lungs, filled with black fluid.
In examining the head, the pia mater was found much congested; but there
was no effusion discovered into any of the ventricles of the brain, nor
any other indication of disease.
In tracing the history of this patient, connected with the disease, it
will be observed, that until he came to Pencaitland colliery, he had no
symptom whatever of chest affection. Penston coal-work is exceedingly
well ventilated, and the miners who labour there seldom, if ever, suffer
from the black expectoration, owing to the evolved smoke of every kind
being freely carried off from its underground works, while it is quite
the contrary at Pencaitland, where many colliers, on leaving Penston,
are seized with the disease. This case comes under the second division
of the disease, where the irritative process, the result of the foreign
matter in the lungs, has proceeded so far as to produce a variety of
small cysts, containing fluid, or semi-fluid carbon, following the
course of the bronchial ramifications.
* * * * *
CASE 6. D. L., aged twenty-six years at his death, in August 1837. He
was the son of a collier, at Pencaitland, and engaged at an early age in
putting the coals to his father; and when he was fit for full
collier-work, in 1831, he was employed at the same coal-work. He was a
tall, well-formed, robust young man, and not at all liable to chest
affection. For some time he wrought, as a coal-hewer, but latterly was
induced, (1834), for higher wages, to become a stone-miner in the same
coal-pit, where gunpowder was used extensively in the operations. About
six months after he commenced stone-mining, he became affected with a
short tickling cough, expectoration of pearly tenacious phlegm, hurried
breathing, tightness across the chest, frequent pulse (95), heat of skin
during the night, and occasional throbbing in the head. Being young, and
fearless of any danger from the occupation, although warned of the
consequences, he continued to prosecute it, and twelve months (May 1835)
after he first began, the cough had increased much in severity. The
expectoration was diminished, and had become more difficult to void from
the bronchi, and the breathing was more oppressive, accompanied by a
painful tightness across the chest in the morning. The body was
considerably reduced in bulk to what it previously had been. The pulse
ranged from 80 to 90; the appetite was impaired, and there was in the
morning a tendency to retching. The nocturnal heat of skin continued,
without any moisture, though his body was drenched with a clammy sweat
during the hours of labour. The respiratory murmur was harsh and
extensive at the upper part of both lungs, while the sibilant ronchus
was heard occasionally in the lower lobes. The heart's action was
regular, but impulse strong, on applying the hand to the cardiac region.
The remedies resorted to were blisters, bleeding (at an early stage),
expectorants, and tonics, which, to a certain degree, relieved the more
urgent symptoms.
In October 1835, the disease having made rapid progress, all the
symptoms had become more marked. The cough, from its frequency and
severity, was extremely exhausting, and the expectoration had become
more copious, and of a semi-black colour. The mucous râle was evident in
the upper part of both lungs, while the inferior lobes were dull to the
ear, and on percussion. The heart's action, at this stage, was less
strong, but no peculiarity in its function could be discovered. The
cardiac region exhibited every indication of effusion into the
pericardium. His body was now considerably emaciated, and the anterior
part of his chest was so much contracted, as to oblige him to stoop to a
great degree. Under this load of disease, he continued his employment of
a stone-miner, gradually losing flesh, with a rapidly increasing black
expectoration; and having several dependant on his exertions, he
resolved to work, while he could keep on foot, which he did till
September of the following year, (1836) when his once powerful body was
so reduced, from disease, and his cough so incessant, that he was unable
to move or speak without great fatigue. He preferred the sitting
position, as giving him most freedom in breathing. The pulse was rather
slow and small; the heart's action languid, and there was an evident
increase of dulness upon percussion over cardiac region. At this, the
closing period of the disease, (November 1836) he first complained of
drowsiness, accompanied by headach. The countenance was pallid; the eyes
sunk and inanimate, and the body tending to be cold; the urinary
secretion of a dark brown colour, and precipitates a dark deposit. The
bowels were exceedingly obstinate, with little change in any of the
symptoms; he lingered till January 1837.
_Post-mortem examination._--The body was much emaciated. The thorax was
large, and well arched. On removing the anterior part of the chest, the
lungs appeared to be fully developed, and of a dark blue colour. There
were several very slight adhesions between the pleuræ, and the effusion
into both cavities was small in quantity. The pleura costalis was almost
free from any exudation, but there were a variety of small patches of
false membrane throughout the pleura pulmonalis. The left lung exhibited
general carbonaceous infiltration. The upper lobe was partially
excavated. The pulmonary structure, internally, was ragged and easily
torn, and these cavities communicated with the bronchial divisions, the
walls of which formed various septa. The inferior lobe was almost
impervious to air. The minute bronchial ramifications and corresponding
lobules were impacted with dense carbon. There were several clusters of
small cysts throughout this lobe, containing carbon in a fluid state. A
portion of this lobe sank in water from its density, and when squeezed
with the hand, thick fluid carbon, containing hardened particles, could
be expressed from it. The right lung was similar in external appearance
to the left. The upper lobe was crepitant, though infiltrated with
carbon into the interlobular cellular tissue. The air-cells were gorged
with tenacious mucus. The middle lobe was partially excavated. The
cellular tissue was considerably disorganized, and similar in diseased
structure to the upper lobe of the left lung, with the exception of a
portion affected by vascular emphysema. The inferior lobe was much
condensed, and loaded with carbon of a very bright black. The mucous
membrane of the bronchial tubes was thickened, and slightly ulcerated.
Various lymphatic glands were found at the root of both lungs,
containing black fluid. The pericardium was considerably distended from
effusion of a straw-coloured fluid. The internal surface of the
pericardium was rough, and both laminæ appeared thickened from
inflammatory action. Effusion into cavity of chest to the extent of
twelve ounces. The heart was natural in appearance, but thin in
substance. The tricuspid and mitral valves were thickened, and
exhibiting minute granulations on their surface. The right auricle and
ventricle were dilated considerably. Aorta, and other vessels proceeding
from heart, were natural. The stomach was small, and exceedingly spongy
in its mucous lining. The intestines were healthy. The kidneys were
small, and peculiarly yellow in the internal structure. The liver was
large, and engorged with dark thick blood; several small carbonaceous
cysts throughout its substance. The spleen was large, soft, and much
congested. The mesenteric glands free from black matter.
_Head._--The arachnoid thickened and opaque; there was very general
congestion of pia mater with dark black blood, and when removed,
convolutions studded over with innumerable dark points. The surface of
the brain was apparently healthy, with an effusion of a light pink-like
fluid into the lateral ventricles. The internal substance of the brain
natural.
This case is interesting, as showing the very rapid course, in some
instances, of the disease to a fatal termination, and also how soon the
strongest man can be brought under its destructive influence. This is
the only case in which carbon was discovered in any of the other organs,
as exhibited in the liver. The above case comes under the third
division, showing extensive excavation of the pulmonary structure.
CASE VII. James R. aged 54 at his death, 1836. He was a large muscular
man, and wrought as a coal-miner in early life at Pencaitland, and, as
far as could be ascertained, he had never been engaged at stone-mining.
At the age of thirty he was obliged to desist work, on account of a
difficulty in his breathing, which he considered to be asthma, and he
was occupied above ground, as the engine-man, during the latter part of
his life. The slightest exertion produced exhaustion and palpitation of
the heart; his bowels were obstinate, and his urinary secretion small in
quantity. His cough was particularly troublesome in the morning, and was
relieved by a free expectoration of frothy mucus. In this condition he
continued, with the cough gradually increasing, for nearly twenty
years, as I understand, when he began to void black sputa, which daily
augmented in quantity till his decease, August 1836.
For some weeks previous to his death, his pulse had become slow and
thready, 36 in the minute. The oedema of the upper and lower
extremities was extensive; the dyspnoea increased considerably; the
countenance was livid; and the body remarkably cold. Stimulants in
considerable quantity were administered without the smallest effect.
Drowsiness supervened; and he was for some days previous to dissolution
in a torpid condition, while at the same time he was quite collected
when roused.
_Post-mortem examination._--On examining the body, the chest was large
and well formed. The effusion into the cellular substance was very
general. The cartilages of ribs were ossified, and both lungs were
adhering strongly to the pleura costalis. There was large effusion into
both cavities of the chest, to the extent of three English pints in
whole. The pleura pulmonalis was much thickened and rough, with false
membrane, and many patches of puckering. Several lymphatic glands in the
anterior part of the mediastinum contained black fluid. The left lung
was carbonaceous throughout its substance. The upper lobe partially
excavated and ragged; the inferior lobe infiltrated and emphysematous.
The right lung was of corresponding black appearance. The lower lobe had
a firm and condensed feel, and when divided, exhibited a mass resembling
indurated blacking. The middle lobe was in part permeable to air; and
there were several small cysts containing liquid carbon, connected with
minute bronchial ramifications. Various indurated knotty bodies were
extended throughout its substance. In the upper lobe, the carbon was
confined principally to the interlobular cellular tissue, and when
pressed in the hand, gave out thick, black, frothy serum. The mucous
membrane of bronchial divisions, when freed from the black matter, was
swollen and eroded as far up as the bifurcation of the trachea. At
several parts these passages were considerably contracted.
The heart was enlarged, and dilated in all its cavities. The valves of
the right and left ventricles wore thickened, from congestion of very
minute veins, and were granular to the feel. The substance of the heart
was soft. There were eight ounces of effusion into the pericardium,
resembling that formed in the cavities of the thorax. The liver and the
spleen were large; the former peculiarly yellow and oily. Several very
large veins, containing inky-looking blood, were seen ramifying its
substance. The spleen was very friable. The kidneys were small, and
apparently healthy.
Brain not examined.
This case comes under the third division of the disease. R.'s case is
peculiarly striking, from the length of time (twenty years or more) that
the carbon was concealed within the pulmonary tissue, and also because
he had never been engaged, as far as known, as a stone-miner; so that
this case, along with others, illustrates the fact, that where the
morbid action is the result of lamp smoke, from the combustion of coarse
oil, and not gunpowder smoke, the disease is much slower in its
progress, but ultimately fatal.
* * * * *
CASE VIII. R. D., aged 37, at his death, 1839. He was the brother of
George Davidson, subject of the first case in this Essay. He began to
labour as a miner, with his brother, in early life, at Pencaitland
coal-work. He first began as a coal-miner, and after being so engaged
for five or six years, he removed to Penston coal-work, which adjoins.
He continued healthy for a considerable length of time, and at his
brother's death, December 1836, he was free to all appearance from any
affection of the chest. He returned, 1836, to Pencaitland coal-work,
where he engaged as a stone-miner, knowing that such employment was
destructive to life; and from that change he dated the commencement of
his disease. Cough, palpitation, dyspnoea, headach, quick pulse (90 in
the minute), made their appearance, soon after he began trap labour, and
these symptoms gradually increased, till he was laid aside in the course
of two years, (1838,) when he first expectorated black sputum.[14] As
his exhaustion advanced, the carbonaceous expectoration became more
copious, and he discharged from the lungs at an average twelve ounces of
fluid, resembling liquid blacking, daily; and he died in a manner
similar to his brother, Case No. 1. Some weeks previous to his death,
his pulse rapidly sank to about 45 or 50, and became exceedingly
feeble;--cold extremities, oedema of the legs and arms, lividity of
lips, eyelids, and ears, preceding dissolution.
_Post-mortem examination._--The chest was contracted; the ribs
unyielding, with extensive adhesions of the pleuræ. Both lungs were of a
dark-blue colour, much puckered from patches of false exudation. There
was extensive effusion into both cavities of the chest; and the right
lung showed carbonaceous infiltration throughout its whole extent. The
superior lobe was excavated, so as to contain a small orange; and about
six ounces of thick, black matter were found in it. The middle lobe was
crepitant, though soaked with black fluid; several impacted lobules were
scattered throughout its substance. The inferior lobe was indurated,
resembling a piece of moist peat. The left lung was cavernous in both
lobes, and the cysts were empty, the contents having been expectorated.
A small portion of the upper lobe was pervious to air. There were
several enlarged bronchial glands at the root of both lungs; and the
tracheal glands contained black fluid. The liver was large, and its
substance soft.
_Head._--There was extensive congestion of the blood-vessels of the
brain, with effusion into the lateral ventricles. The viscera of the
abdomen were extensively congested, with slight effusion into the
peritoneal cavity.
It will be observed in referring to the history of this case, that till
the time this man became a stone-miner, and carried on his operations
with the aid of gunpowder, he had no symptom of the disease of which he
died, and it is evident that the disease, if commenced at all, had made
little or no progress till after his return from Penston colliery to
Pencaitland, and after he had inhaled the residuum of gunpowder
combustion, therefore the disorganization of the pulmonary structure was
to all appearance effected between the summer of 1836 and December 1838,
showing decidedly the very irritating character of gunpowder smoke upon
the delicate tissue of the air-passages.
CASE 9. J. D., aged 37, at his death, April 1844. He was a well formed
man, with a fully developed chest. At so early an age as seven years, he
engaged in the labour of the coal-pit at Preston-Hall, Mid-Lothian, and
he continued to prosecute that employment for a period of 15 years, when
he was obliged to relinquish the work on account of an affection of the
chest, being, as he termed it, "touched in the breath." During the
subsequent 15 years of his life, he had never once entered a coal-pit,
nor had he any connexion with coal-works, but earned his bread by the
trade of a travelling merchant. He had suffered much in his wanderings,
from his breathing,[15] for more than two years continuously, while loss
of appetite, and thoracic irritation, had rendered his physical frame as
weak as that of a child.
When I first saw this man, which was about a month before his death, he
laboured under rending cough, with a scanty tough mucous
expectoration--oppressive dyspnoea, ascites, general anasarca,
occasional giddiness, and throbbing headach on motion, or on assuming
the standing position. His countenance was of a light blue or slate
colour, and his upper and lower extremities had much the same
appearance. His lips, eyelids, ears, and nose, were swollen and livid,
and his eye-balls effused, and apparently projecting from the sockets.
His sight was impaired and hazy. There was continued feeling of cold,
with occasional rigors, and difficulty in keeping the extremities warm.
There was considerable exhaustion upon the slightest exertion. The half
reclining posture was the only one in which he was comfortable. The
pulse was exceedingly slow, not above 36 in the minute, it was small,
and often imperceptible at the wrist. There was considerable weight and
feeling of oppressive fulness in the region of the heart, which was dull
on percussion. On applying the ear to the chest, little or no râle
whatever was discernible, and the action of the heart was almost
inaudible. He had a sensation as of great weight in the head, and
difficulty in raising it. Ho suffered from restless nights, short
hurried breathing, with a feeling and dread of suffocation, evident
fulness and enlargement in the region of liver, and inability to turn to
the right side. The urine was small in quantity, of a bluish colour, and
coagulable, irritability of stomach, and the bowels were obstinate and
difficult to move, even with drastic purgatives. The treatment was
merely palliative, no stimulant seemed to have any effect in exciting
the system. Ascites and general anasarca were considerable, giving the
body a large appearance. For some days previous to his dissolution,
there was increased lividity of countenance, and little or no action of
heart. He had at no time expectorated carbon, even during many severe
paroxysms of cough. Upon inquiry, I found that this man had been a
companion in labour to R. R. (whose case No. 2, is fully reported,) at
Preston-Hall colliery, and from the morbid appearances found in R.'s
chest, and from the character of the coal-work in which both were
engaged, I was induced to believe Duncan's to be a similar case. In
ascertaining his early history, I found him to be a robust powerful man,
though troubled with a cough and hurried breathing from his first
becoming a collier, circumstances very usual with those who engage in
difficult mining operations, and which they erroneously attribute to
want of air, nothing more.