much swollen from effusion. On removing the anterior part of the chest,
both lungs were much compressed from an immense effusion of a light
brown fluid into the cavities of the chest to the extent of a gallon.
The lungs were of a deep black colour, and irregularly spotted with dark
brown patches of exudation. There were considerable adhesions of the
pleuræ, and marks of very general chronic inflammation and false
membrane over the greater part of the pleura costalis. There were
adhesions of the left lung to the pericardium, which was much thickened,
and contained about 14 ounces of a turbid fluid. On removing the left
lung, it seemed large, and felt partially consolidated, and on dividing
it throughout both lobes, it contained a mass of semi-fluid carbon, of a
bright black colour, similar to paint. In this lung, the air-cells were
almost entirely disorganized, unfitting it for the function of
respiration. The upper lobe was divided into a variety of cysts, filled
with carbonaceous matter in a fluid state, into which many of the
smaller bronchi opened, and through which various blood-vessels passed
uninjured. The inferior lobe, when emptied of its contents, was so much
excavated that the parenchymatous substance felt light and flaccid. On
dividing the right lung[16] it exhibited a pure black mass, but not so
fully disorganized as the left. Portions of each lobe were permeable to
air, while other parts formed cysts, containing fluid and solid carbon,
the inferior lobe showed an almost solid mass. The mucous membrane of
the respiratory passages was inflamed and spongy throughout the
divisions, the small ramifications were irritated and choked up with
tough, frothy phlegm. There were several large bronchial glands at the
root of the left lung. In tracing the divisions of the bronchi more
minutely, from the root of the lungs into their substance, clusters of
glands were observed filled with inky fluid, and narrowing considerably
the air-passages, and in washing carefully a portion of the upper lobe
of the right lung, and removing as far as possible the carbonaceous
matter, several lymphatic glands were seen with the aid of the
magnifier, imbedded in the interlobular cellular tissue, resembling
small black beads. The tracheal glands when examined, contained black
fluid, similar in appearance to what was found in the bronchial glands.
The mucous membrane of the trachea was soft and irritated, smeared with
tough bloody mucus, the lining membrane of the rima glottidis was
thickened and slightly granular.
The heart was much enlarged, and soft, with spots indicating chronic
inflammatory action on and about the right auricle. Both auricle and
ventricle on the left side of the heart contained a deep-dark blood.
There were several large lymphatic glands imbedded around the great
vessels proceeding from the base of the heart, containing black fluid,
the other cavities appeared healthy, though attenuated in substance. The
coronary veins were congested. None of the cervical glands contained
black fluid, though several of them were enlarged. The cavity of the
abdomen much distended from ascites; the contained fluid was to the
extent of about six Scotch pints of a straw colour; the viscera much
compressed, and matted together, with light brown exudation. The
peritoneum was rough, and coated with the same exudation. The stomach
and all the intestines correspondingly contracted; the mesentery
appeared healthy; the liver was much enlarged, and darker than usual;
the inferior lobe extending downwards, near to crest of ileum; the whole
organ loaded with inky-coloured blood; the substance easily torn. The
kidneys presented a natural appearance; the adipose substance in which
they were imbedded was oedematous; the medullary substance of each
presented a yellowish colour.
_Head._--The integuments were oedematous. On exposing membranes,
considerable effusion under arachnoid; very general venous congestion,
extending over the convolutions, and to the base of the brain. Effusion
into the lateral ventricles of a light yellow; the choroid plexuses
thickened, and of a dark venous appearance; substance of brain firm and
apparently healthy.
From the history of this case, it will be found that D. had at no time
shown any indication that carbon was infiltrated into the lungs. At an
early age he came under the influence of the smoke of coarse linseed
oil, and of gunpowder, while labouring in an unhealthy and
ill-ventilated pit, which produced a cough common amongst colliers, who
may be placed in similar circumstances; and it is evident, that during
the last fifteen years of his life, the carbon--having previously taken
up a lodgment in the pulmonary tissue--was gradually accumulating, and
thereby producing painful dyspnoea, and the other formidable symptoms
connected with the circulating organs, which followed as results, till
it had almost entirely saturated the cellular structure, and rendered
the lungs unfit for the functions of respiration, consequently impeding
the necessary change, through the medium of that function upon the
blood.
There was a marked similarity in the morbid appearances between this
case and that of Reid, (No. 2). They both wrought in the same pit at
Preston-Hall, and were affected in a similar manner. Both had enlarged
liver, and the left lung principally disorganised. Both had extensive
anasarcous and other effusions, and both had coagulable urine. Neither
expectorated black matter, and both died from the bursting of a
carbonaceous cyst into the bronchi, producing suffocation. Duncan lived
longer under the infiltration than Reid did; and this was no doubt owing
to his being younger, and also his healthy occupation latterly.
I have preserved a quantity of the contents of a cyst in the left lung
of this patient, for chemical analysis; also a portion of the blood from
the vena cava, and a little of the black fluid from the bronchial
glands.[17]
CASE 10. (The subject of the following case is still alive, 1845.) J.
S., aged thirty-six. He was born of collier parents, in the parish of
Pencaitland, and at as early an age as eight years, went under ground to
assist his parents in the transmission of the coal, and when fit for
work became a coal-hewer. From his infancy he was rather of a delicate
constitution, with flat and contracted chest. When I first saw him,
which was about eight years ago, (1837), he was in full employment as a
coal-hewer, complaining of shooting pains through his chest, tickling
cough in the morning, with scanty tough expectoration, and frequent
palpitations. He was repeatedly under treatment for bronchial affection,
which was usually relieved by expectorants, blisters, and _continued_
counter-irritants. Each attack of bronchitis was the result, as he
expressed it, of "breathing bad air in the pit," in which he was obliged
to relinquish labouring, as the lamp would not burn, from the state of
the atmosphere. He never wrought at the stone-mining nor blasting. In
examining the chest with the ear, at this stage of the affection, the
mucous râle was distinctly heard, and exceedingly loud throughout the
greater part of the chest. The heart's action was strong, but natural;
pulse 70, full and bounding. About four years ago, he removed from
Huntlaw to Blindwell, a coal-work towards the sea-coast, an extension of
the same coal formation. At this time, 1841, he had very troublesome
cough, particularly in bed, scanty frothy expectoration, annoying
dyspnoea, preventing him taking sufficient nourishment, headach,
obstinate bowels. He continued under all these ailments to labour with
much difficulty, till the summer of 1843.[18]
In reviewing the morbid appearances in the cases now detailed, it will
be observed, that in the majority of them, the left lung exhibited the
greater amount of diseased structure. This fact is particularly
interesting, as in _tubercular_ phthisis, a similar predominance of
disease is found on the left side.
In almost all the cases, there was found very extensive effusion into
the serous cavities, and particularly into those of the pleura and
pericardium. Both pleuræ were much thickened, and all the marks of a
long standing pleuritic and pericardial inflammatory action were seen.
The substance of the heart, in all the cases, was soft and attenuated;
the right auricle and ventricle were dilated; and there was thickening
of several of the valves. The liver and spleen were usually large and
congested. In all the cases, as the disease advanced, the pulse came
down to a very unfrequent and thready beat. From the great extent of the
venous congestion, the disease often assumed the aspect of asphyxia; and
in some instances the colour of the patients resembled that of persons
labouring under cyanosis.
The lividity of countenance, and the other concomitant symptoms, which
presented themselves, gave decided indications of the morbid effects of
this extraneous body. It requires little explanation to show how such a
diseased state of the pulmonary organs, as has been described, should
produce such results, by impeding the necessary chemical change of the
blood. Imperfect oxygenation of the blood, consequent on the altered
pulmonary structure, must cause a general depression of all the vital
organs. The excess of excrementitious matter in the circulation, must
produce effusion of serum into the various cavities, and also into the
cellular structure; and the appearances exhibited on the surface of the
brain and its membranes, afford a full explanation of the sluggish
inanimate condition of all the sufferers towards the close of their
existence.
From the cases above reported, it must be evident, that black phthisis
is the result of foreign matter inhaled and retained within the
pulmonary structure.
It is a melancholy fact connected with mining occupations in the
locality described, that few or none who engage in it, escape this
remarkable disease. I have never known one collier in many hundreds,
who, even in his usual health, was not, as he expressed it, more or less
"touched in his breathing;" and after much experience in auscultation in
such pulmonary affections, I am the more convinced that the dyspnoea
from which they suffer, arises from impaction of the minute bronchial
ramifications induced during their labour below ground, surrounded by an
impure atmosphere. The East Lothian colliers, of all miners throughout
the kingdom, are certainly most subject to this disease; and those at
Pencaitland are so to a fearful extent. In the late inquiry for the
Parliamentary report, such has been manifestly brought out, and I am
quite able to corroborate the conclusions at which the commissioners
have arrived. It has been supposed by many that this carbonaceous
affection was caused by inhalation of coal-dust. Now, when it can be
proved, that there is as much coal-dust at one coal-work as at another,
the question comes to be, why should colliers, labouring at one
coal-work, be subject to the disease; while those engaged at another,
escape? For instance, there is as much coal-dust at Penston and Huntlaw,
where there has never been black spit, as there is at Pencaitland,
Preston-Hall, and Blindwells. I conclude, therefore, that this cannot be
the cause, otherwise they should all be liable to the disease. Again,
those who labour as coal-bankers at the mouth of the shaft, are obliged
to inhale much coal-dust in shovelling and arranging the coal received
from the pit, and have the sputum tinged to a certain extent by
it--which resumes its natural appearance when the collier leaves the
labour producing it. They are not subject to the miners' cough, nor is
there carbonaceous infiltration found in the lungs of such labourers
after death. The females and boys, when, as formerly, both were allowed
to labour, could not fail to inhale much of the coal-dust in which they
were generally enveloped in their daily occupation; but no carbonaceous
deposit has ever been found in the pulmonary tissue of either the one or
the other. There are very interesting facts connected with the history
of this disease, showing the length of time which the carbon can be
retained, brought out by two cases on record, the one published as
formerly mentioned by Dr James Gregory, in the _Edinburgh Med. and Surg.
Journal_ for 1831, denominated, "Spurious Melanosis;" the other, a case
published by Dr William Thomson, (_Medico-Chirurgical Transactions of
London_ for 1837), and which was reported to him by Dr Simpson, now
Professor of Midwifery in Edinburgh.
Dr Gregory's case is that of John Hogg, who had been in the army for
more than twenty years, had seen much service as a soldier in America
and the West Indies, and had served in Spain during the Peninsular war.
On his return to his native country, he was engaged for a short time
before his death as a collier at Dalkeith. I understand, upon inquiry,
from those who were connected with Hogg, that he wrought in early life
as a miner at Pencaitland coal-work, and was obliged, though a young
man, to relinquish such employment on account of a chest affection, and
exchange the pick for the musket. From the history of this case, and
from the character of his occupation in early life, I apprehend that the
carbonaceous deposit took place when he was first labouring as a miner
at Pencaitland; and that he carried the foreign body in his lungs,
throughout his campaigns.
The case reported to Dr Thomson by Dr Simpson is that of a George Hogg,
who lived at Collinshiel, near Bathgate. In early life, this man
laboured at Pencaitland coal-work, where the greater number of the cases
now under consideration occurred; and it is stated as a certainty, that
he contracted the black phthisis while occupied in that district; for I
find from those who knew him at an early period, that his breathing was
much affected while at Pencaitland, and he was long supposed by his
fellow-miners to have imbibed the disease,--indeed he removed from
Pencaitland on account of it. The two Hoggs were relatives, and natives
of East Lothian.
It is evident, from several of the cases, that it is no uncommon feature
of this affection for the carbon to remain concealed in the pulmonary
tissue for very many years; and as both the Hoggs were miners at
Pencaitland, I have not the smallest doubt that it was then and there
that the disease had its origin; for I have never known a collier who
was a stone-miner who did not ultimately die of the carbonaceous
infiltration.
Apart from colliers and coal-mines, as a proof that carbonaceous
particles floating in the atmosphere are inhaled and lodged in the
bronchial ramifications, I may state the following circumstance, which
came under my own observation several years ago. After a gale of wind,
which had continued for more than a week, off the coast of America, in
the July of 1832, I was applied to for advice by several of the seamen,
on account of a tickling cough, followed by a peculiarly dark blue
expectoration, which I was told was almost general amongst the crew. I
was certainly at a loss, and put to my shifts, to render a reason; but,
upon investigating the matter further, I found that, during the gale,
the chimney of the cook's apartment in the _'tween-decks_ was rendered
inefficient, whereby the sleeping-berths were constantly filled with
smoke. I found almost all the seamen, to the number of nearly a hundred,
suffering considerably from cough, and expectorating an inky-coloured
phlegm, which continued more or less for about a fortnight. I ordered
soothing expectorants, and the dark sputa were profusely voided, and
ultimately disappeared; but whether any of the carbon had made a
permanent lodgment in the pulmonary tissue, is what I have never been
able to ascertain. I am now convinced, in recalling this occurrence,
that whatever be the situation, should carbon be floating in the air, it
can be conveyed into the air-cells; and had these seamen been longer
subjected to this foul atmosphere, a permanent lodgment of the carbon
would undoubtedly have been the consequence, and the disease now under
our consideration to a certainty produced. I further remember seeing,
several years ago, a case of partially carbonized lungs in a person who
had lived for a length of time in a smoky and confined room in Glasgow.
The patient died of dropsy, consequent, no doubt, on the pulmonary
affection; and on examining the chest, the upper lobe of both lungs, and
the bronchial glands contained black matter, similar in appearance to
that found in the colliers.
While engaged in committing these remarks to paper, I have been led in
my investigations to compare the various kinds of labour carried on in
coal-pits with the underground operations of many of the railways now in
progress throughout the kingdom; and being convinced of the very
injurious effects produced upon miners while prosecuting these
operations in confined situations where gunpowder is used, I shall be
much surprised if the same results do not follow the hazardous
undertakings connected with railway tunnelling, where gunpowder is had
recourse to, and in the course of years find in our public hospitals
cases of carbonaceous lung arising from this cause.[19]
It is no uncommon occurrence, in examining the pulmonary structure of
those who have resided in large and smoky towns, to find both the
substance of the lungs and bronchial glands containing black matter; and
this is the case especially with persons who, in such situations, have
passed the prime of life. But few, though not living in crowded towns,
have not, at some period of their life, come in contact with smoke, and
been obliged to breathe it, minutely combined with the air. It is not,
therefore, to be supposed improbable, that a portion of the infinitely
small particles, thus suspended in the atmosphere, should effect a
settlement in the more minute air-cells, and in course of time, be
conveyed to the interlobular cellular tissue by the process of
absorption, and thence to the bronchial glands. There are several cases
on record, from amongst iron-moulders,[20] where the pulmonary structure
has been found heavily charged with carbonaceous matter, from the
inhalation of the charcoal used in their processes, and where, during
life, there was a free black expectoration.[21]
There is, then, little doubt that the bronchial glands, from their
appearance in miners, moulders, and others, are the recipients of a
portion of impurities which have been carried into the pulmonary
structure by inhalation, and also those left after the process of
oxygenation of the blood; and when it is fully ascertained, from the
character of the atmosphere in the coal mine, that deleterious matter in
this form must be conveyed to the air-cells during respiration, there is
little difficulty in coming to the conclusion, that the black fluid
found to such an extent in these glands in the collier and moulder, is
similar to, and a part of, that discovered infiltrated into the
substance of the lungs. If we trace the black matter in the lymphatic
vessels, (which has been done), from the pulmonary organs to the
bronchial, mediastinal, and thoracic glands, and from thence to the
thoracic duct, we cannot but admit, that it does find its way into the
venous system, and thereby contaminates the vital current.[22]
Dr Pearson of London, in his very valuable paper, published in the
Philosophical Transactions of 1813, on the coaly matter in the bronchial
glands, was convinced beyond a doubt, that it was of foreign origin, and
possessed the properties of carbon conveyed into the lungs from without.
He, at that period, was not in possession of such facts as have been
recently elicited on the subject of deleterious inhalation; but the very
interesting materials which he brought to bear on his argument, have, I
think, most satisfactorily proved the assertion which he makes, that
"the lymphatics of the lungs absorb a variety of substances, especially
this coaly matter, which they convey to the bronchial glands, and thus
render them of a black or dark-blue colour." "The texture and proportion
of the tinging matter of the glands was," he says, "different in
different subjects, whether the lungs to which they belonged were in a
healthy or diseased condition. In persons, from about 18 to 20 years of
age, some of the bronchial glands contained no tinging black matter at
all, but were of a reddish colour; others were streaked or partially
black." Again, he says, "I think the charcoal in the pulmonary organs is
introduced with the air in breathing. In the air it is suspended in
invisible small particles, derived from the burning of coal, wood, and
other inflammable materials in common life. It is admitted that the
oxygen of atmospherical air passes through the pulmonary air-vesicles or
cells into the system of blood-vessels, and it is not improbable, that
through the same channel various matters contained in the air may be
introduced. But it is highly reasonable to suppose, that the particles
of charcoal should be retained in the minutest ramifications of the
air-tubes, or even in the air-vesicles under various circumstances, to
produce the coloured appearances on the surface, and in the substance of
the lungs, as above described."
"When I compare the black lines and black net-like figures, many of them
pentagonal, on the surface of the lungs, with the plates of the
lymphatic vessels by Cruikshank, Mascagni, and Fyffe, I found an exact
resemblance."
Dr Pearson, after various chemical experiments upon the bronchial glands
with caustic potash, muriatic and nitric acid, says, "I conceive I am
entitled to declare the black matter obtained from the bronchial glands,
and from the lungs, to be animal-charcoal in the uncombined state, _i.e._
not existing as a constituent ingredient of organized animal solids
or fluids." Dr Graham of London, in his paper on this subject, recorded
in the 42d vol. of the _Edinburgh Medical and Surgical Journal_, gives
the following opinion, as the result of a series of investigations, with
the view of determining the nature of the disease in question. He says,
I have had several opportunities of substantiating the carbonaceous
matter in a state of extraordinary accumulation in black lungs supplied
by my medical friends. The black powder, as derived from the lungs,
(after an analysis,) is unquestionably charcoal, and the gaseous
products from heated air, result from a little water and nitric acid
being retained persistently by the charcoal, notwithstanding the
repeated washing, but which re-acting on the charcoal at a high
temperature, coming off in a state of decomposition. In regard to
another analysis of a lung, he says, "The carbonaceous matter of the
lung cannot therefore be supposed to be coal, altered by the different
chemical processes to which it has been submitted in separating it from
the animal matter. The carbonaceous matter of this lung, appears rather
to be lamp black."
From the whole results, I am disposed to draw the following
conclusions:--
_1st_, The black matter found in the lungs is not a secretion, but
comes from without. The _pigmentum nigrum_ of the ox I find to lose its
colour entirely, and to leave only a quantity of white flocks, when
rubbed in a mortar with chlorine water. Sepia, which is a preparation of
the dark-coloured liquor of the cuttle fish, was also bleached by
chlorine, but the black matter of the lungs was not destroyed or
bleached in the slightest degree by chlorine, it even survived
unimpaired the destruction of the lungs by putrefaction in air.
_2d_, This foreign matter probably varies in composition in different
lungs, but in the cases actually examined, it seems to be little else
than lamp black or soot.
It does not appear, as far as I can ascertain, that any of the
Continental physiologists are familiar with the disease now under our
consideration. Several of them, both ancient and modern, discovered
black matter in the pulmonary tissues, but not connected with nor
exhibiting the black phthisis. It is therefore unnecessary to refer to
them in general.
The following foreign authors entertain various opinions in regard to
the dark appearances in the pulmonary tissue:--
Bichat supposes the black matter in the lungs "to be owing to small
bronchial glands extending along the surface of the pleura." Breschet
believes that it is formed by the blood exhaled into the cellular
tissue, stating that its chemical composition leads him to that
conclusion. Trousseau says that it is produced by a misdirection of the
natural pigments of the body, resulting from age, climate, or disease.
Andral says, that the black appearances are the result of secretion, and
that it is more manifest as the individual advances in life. Heasinger's
opinion is, that it is analogous to pigment, and therefore he agrees
with Trousseau. Lænnec was doubtful as to the real origin of black
pulmonary matter. He makes a distinction between melanotic and pulmonary
matter. He found that the melanotic matter was composed almost entirely
of albumen, while the black pulmonary matter found in the bronchial
glands contains a great quantity of carbon and hydrogen, and also that
these colouring matters have other distinguishing characters. The
melanotic matter is easily effaced by washing, while the other is
removed with difficulty. Lænnec further says, that he suspected that
this pulmonary matter might arise, at least in part, from the smoke of
lamps, and other combustible bodies which are used for heat and light;
for some old men are to be met with whose lungs contain very little
black matter, and whose bronchial glands are but partially tinged with
this colour; and it has struck him that he observed this amongst
villagers who had never been accustomed to watch.[23]