undertaken a series of researches in regard to the black matter found in
the lungs of old men of very considerable age. These investigations are
published in the January, February, and March numbers of the _Archives
Générales de Médecine_.[24] It is his belief that death in such cases is
owing, in all appearance, more or less to a suppression of the
circulation of air and blood by the black substance. His impression is,
"that the carbon is not procured from without, but naturally deposited,
as life advances, in the substance of the respiratory organs; and that
this deposit of carbon causes death, by rendering the lungs
irrespirable, while, at the same time, it has much influence in
modifying the progress of _tubercular_ disease; so that, if the
tubercular affection was not cured, its progress was so far checked,
that life has been very long preserved." The black matter envelopes
completely both the pulmonary tubercles which have undergone a
transformation, and the caverns which no longer contain tuberculous
matter. He, while regarding these as the results of black matter in the
lungs, throws no light on the cause of the deposit of the particles of
carbon within the lungs.
Dr William Craig of Glasgow, in a letter to Mr Graham of London,
published in the 42d vol. of the _Medical and Surgical Journal of
Edinburgh_, states most interesting facts connected with this subject,
particularly in regard to black matter found in the pulmonary structure
of old people, which deserve considerable attention. He says--"I found
that a black discoloration of the lungs was by no means a rare
occurrence amongst those old people; and that it was impossible in many
instances to decide, whether the black colour was owing to an increase
of what is called the healthy black matter,--to a morbid secretion, or
to a foreign substance being imbedded with the atmospheric air. After
examining a considerable number of lungs, and finding that the division
of the black matter into three kinds was not founded upon observation,
and that the descriptions of them given by the best authorities were
insufficient to enable us to distinguish them from one another, I begin
to think, that in every instance in which black matter is found in the
lungs, it ought to be considered morbid. If we examine the lungs at
different stages of life, we find as a general rule that the quantity of
black matter increases with age. In young children we find no traces of
it, the lungs being of a reddish colour. At the age of ten years the
black matter makes its appearance in the outer surface of the lungs, and
in the interlobular spaces. At the age of thirty or forty, the lung
presents a greyish or mottled appearance, and the bronchial glands
contain more or less black matter. Between the age of seventy and a
hundred, the lungs are generally infiltrated with fluid black matter,
which can be expressed from the cut surfaces, and stain the hands
black."
"There are many circumstances which favour the accumulation of this
black matter in the lungs; for instance, long-continued living in a
smoky atmosphere, like that of this city, the inhalation of coal-dust,
as in the case of colliers, or of charcoal-powder, as in the case of
iron-founders. There can be no doubt that we inhale foreign substances
along with the atmospheric air.
"We find the mucus which has remained in the nostrils for some time to
be of a dark colour, and if we examine it with a microscope, we find,
that this is owing to the presence of small particles of dust or other
foreign substances, which the air may have accidentally contained. The
mucus first coughed up from the lungs in the morning, is of a dark
colour from the same cause, and the facts now maintained prove, that
foreign substances suspended in minute particles in the atmosphere, may
be inhaled into the lungs. I believe in all the extreme cases which have
occurred in colliers and moulders, that there must have existed some
previous disease of the lungs which prevented the foreign matter from
being thrown off." "According to the views which we have taken of the
subject, there are only two ways by which black matters may be deposited
in the lungs; first, by a morbid secretion; second, by a foreign
substance inhaled with the atmosphere. The former is a rare disease,
while the latter is very common. I am inclined to think that the true
melanosis generally occurs in the form of rounded tumours, which, when
cut in two, present a uniform black colour without any trace of
air-cells, while in the spurious melanosis the deposition is general,
and black matter flows freely out when the cut surfaces are pressed. At
first the lung is crepitous, and swims in water; but as the black matter
increases, it becomes solid, and, as in the case of colliers who die of
this disease, resembles a piece of wet peat in point of consistence. It
is only in the cases of colliers, moulders, or others who inhale great
quantities of black matter, that the lungs are rendered perfectly
solid."
There is an exceedingly interesting and valuable paper, written by Dr
Brockmann of Clausthal, upon the pulmonary diseases of a certain class
of German miners,--supposed to be in the Hartz mountains,--in
_Neumeister's Repertorium_ for December 1844, an abridged translation of
which is to be found in the September number of the _Monthly Journal of
Medical Science_.
It is very evident that the disease there considered is produced by
carbonaceous inhalation, and resembles in all its features the black
phthisis so general amongst the colliers in Haddingtonshire. The morbid
appearances described by Dr Brockmann are very similar to the first and
second division of that disease, presenting a very general carbonaceous
infiltration of the pulmonary tissues; but in none of the stages are
there to be found the extensive excavations discovered in the lungs of
the coal-miner. Dr Brockmann makes three divisions of the morbid
appearances, "The essential (wesentliche), accidental (zufällige), and
secondary. The first shows an entirely black (pechschwärze) colour of
the lungs through its whole substance, enclosing not only the air,
blood, and lymph vessels, but also the connecting cellular tissue, the
nervous substance, pleuræ pulmonalis, and bronchial glands." In such a
state, it is usual for the lung to remain perfectly normal, and to
exhibit the greatest varieties.
The accidental (zufällige) is evidently the disease in a more advanced
form, corresponding in a great measure with the second stage of the
morbid action, found in the pulmonary organ of the collier. It is to be
regretted that no accurate description is given either of the character
of the mine, or the nature of the employment in which the miners are
engaged, whether they be coal, silver, or lead mines, and if they are in
the habit of burning coarse lint-seed oil.
There is a very striking similarity between what Dr Brockmann calls the
secondary anatomical changes, and many of those exhibited in the
collier; first, membranes; second, collections of fluid into the pleuræ
and pericardium; third, the softened heart, and very general emaciation;
fourth, the extensive venous congestion, with thick black blood.
The liver is described by Dr Brockmann as being small:--in the collier
it is usually puffy, and much congested.
The symptoms do almost in all points accord with those presented in the
collier, as will appear from the following quotation, from the paper.
"In the first stage, there is no local, functional, or general feature
by which we can ascertain that the disease has commenced; probability is
all we can reach. In the second stage, the disease is more obvious. And,
first, there is a change in the expression of countenance; to a fine
blooming appearance, which perhaps the patient previously had, there has
succeeded a dark yellowish cast,--a change which gradually spreads over
the whole body. For some time the patient may have remarked a gradual
loss of strength, and now he complains of want of appetite and
disordered digestion, and more particularly of shooting pains in the
back and muscles of the chest. Cough likewise supervenes, which may
either be quite dry, or at most accompanied with a little pure mucus.
There is also a greater or less degree of oppression, accompanied with
palpitation of heart, not only after a severe fit of coughing, but after
every exertion of the lungs. As yet no local deviation from the normal
condition is seen on examination of the chest by percussion or
auscultation." "The disease meanwhile passes into the third stage. The
features of the patient now become more and more changed and
deteriorated, and betray a deep melancholy. The colour of the face,
which had been hitherto of an earthly hue, becomes blackish, as also the
cornea, whereby the eye loses its lustre. The appearance of the patient
becomes still more frightful from the great loss of flesh, and the dark
skin hanging loose on his bones. The fat not only seems to have
disappeared, but the muscular substance also--the whole frame being
shrivelled. The patient complains of increasing weakness, diminished
appetite, flying pains often concentrated at the pit of the stomach; and
coughs much. The expectoration is for the most part difficult, and
consists of masses of mucus, either greyish, or tending to a black
colour. A black streak is frequently observed running through the
whitish mucus; one half of it may be white, the other black, or
occasional black points may be observed throughout the mass, and
sometimes, though rarely, blood. Dyspnoea is usually connected with
the cough. It now begins to tell upon the patient, and is so
characteristic, that the disease has been named asthma metallicum. The
disturbance of the digestive organs increases the disease,--the appetite
is entirely lost,--the tongue is covered with a white fur--there is an
oppression at the stomach after a full meal--frequent eructations, and a
tendency to constipation. The distress of the patient becomes increased
in consequence of the shooting pains in the muscular system." "In the
fourth and last stage, all the external appearances indicate the near
approach of dissolution,--the face and members become bloated, and the
feet greatly swollen." "The dyspnoea meanwhile, from effusion into the
chest and pericardium, becomes so severe, that the patient cannot
maintain the horizontal position, the expectoration becomes copious,
consisting of a black inky (dintenschwarze), or ash-coloured fluid,
sometimes of mere masses of mucus streaked with black." "The disease is
never accompanied with colliquative sweats or diarrhoea."
I am sorry to find that there is no allusion whatever to the state of
the pulse. Dr Brockmann, in his remarks on the essential nature of this
pulmonary disease of miners, brought under his notice, seems to
entertain the impression that along with the inhaled carbon, resulting
from the combustion of gunpowder, there is also an organic
pigment-deposit present in the pulmonary tissue, which he supposes must
have been formed in the lungs.
I have long entertained the belief, which I have stated in another part
of this essay, that if the carbon is once conveyed into, and established
in the parenchyma of the lungs, that organ commences the formation of
carbon; thus increasing the amount originally deposited. Dr Brockmann
sets forth, as grounds for this view, that "if the parenchyma of the
lungs were filled with carbonaceous dust, their specific gravity ought
to be increased; but this is not the case. A completely melanosed lung
swims in water, both as a whole and when cut into parts." It is very
evident from these remarks, that the author has not seen the disease as
it is exhibited in the third division of morbid action in the collier,
otherwise he would have both observed the lungs considerably augmented
in weight, and also so densely impacted from the accumulation of carbon,
as wholly to sink in water. See for instance case No. 2, where the lungs
weighed about six pounds, and parts of the cellular tissue were so
indurated, as to be cut with difficulty. In this case, the patient did
not expectorate.
Dr Brockmann, as he advances, puts a question here, which more fully
shows that the disease under his consideration was of a mild character
compared with that under our notice. "If," says he, "pulmonary melanosis
arise entirely from inhalation of carbonaceous dust, why is it not
observed in other workmen, who are as much, and even more, exposed to
its influence, as for instance, smelters, or moulders, and colliers?" He
says, further, "were the carbon inhaled in quantity sufficient to
explain the black colour of the lungs, it ought also, from its
mechanical irritation, to produce inflammation in the delicate mucous
membrane of the organ, but there are no symptoms of this during life,
nor any traces of it after death." An answer to these remarks will be
most satisfactorily given by a reference to the published cases, where
the disease is principally found amongst colliers and moulders, and
where the pulmonary organs, particularly in the former, are found to
undergo most fearful disorganization from the presence of carbon. It is
very remarkable, that the author of these exceedingly interesting
observations should never have found excavations of the parenchyma, when
it is so general as the result of the same disease in this country,
particularly in the locality to which I refer. Not knowing the
character of the mine, it is impossible to judge; but I am disposed to
conclude that there cannot be the same quantity of carbon floating in
the atmosphere breathed by the German miner,--the disease resembles very
much that milder form found in the iron moulder.
With regard to the carbonaceous state of the blood, I am sorry that I
have not yet completed my investigations on that subject. It is still my
belief that the carbon being once inhaled, there is an affinity found
for that in the circulating fluid, and from its not being consumed,
owing to a deficiency of oxygen, there is a progressive increase going
on. I am very much gratified to find that Dr Brockmann entertains a
somewhat similar opinion in respect to the state of the blood.
The effects of such a morbid structure upon the collier population in
general is very marked. Previous to the late legislative act, the tender
youth of both sexes were at an early age consigned to the coal pit, and
obliged to labour beyond their feeble strength, in circumstances ill
adapted to their years. Such early bodily exhaustion soon produced in
them a pallid countenance, soft and relaxed muscular fibre, and
predisposed much to disease as they advanced in life. The miner on this
account was generally from his youth, thin; in fact, you never see a fat
and healthy-looking collier, and, according to the advance of pulmonary
disease, with them, so is the progress of emaciation. Such a state of
body may well be looked for in miners, labouring as they do, from ten to
twelve hours in the twenty-four under ground, breathing a heated and
impure atmosphere, which with difficulty sustains life, and which is
demonstrably calculated, from its deleterious qualities, to induce
serious disease. The effects manifest in the parent descend, and visible
in the youngest children; they are squalid and wretched-looking,--and
how can such offspring be otherwise? They are exceedingly subject to all
children's diseases, and peculiarly predisposed to pulmonary irritation
of one kind or other.
With regard to medical treatment, little can be done after the disease
has passed its first stage. Early removal from the occupation, and
proper attention to nutrition, alone seem to hold out the hope of
prolonging the life of the patient; but if there be carbon lodged in the
pulmonary tissues, there is a certainty of its sooner or later proving
fatal. Attention to the state of the digestive organs, and using every
means to remove the dyspeptic symptoms, which are prominently present
throughout the various stages of this disease, are indispensably
requisite; and, as to nutrition, the nature of the diet should be as
generous as possible. Anodynes and expectorants are the only remedies
which seem at all efficacious in allaying irritation.
With a view to remove urgent symptoms, venesection has repeatedly been
had recourse to, but in almost all instances I would say, with
decidedly bad effects. Blood-letting does harm, producing general
debility and rapid sinking.[25]
With regard to the prevention of this disease, ventilation, as has been
stated, is very much neglected in the pits now under consideration,
where the various cases have occurred; and to that neglect I ascribe the
prevalence of the malady. In those pits referred to, the workable
apartments are so confined, and become after a time so destitute of
oxygen, as, along with the smoke from lamps and gunpowder, to render the
air unfit for healthy respiration. The only effectual remedy is a free
admission of pure air, so applied as to remove the confined smoke. This
remark both applies to coal and stone-mining. The introduction of some
other mode of lighting such pits than by oil is required. I know several
coal-pits where there is no carbonaceous disease, nor was it ever known;
and on examination I find that there is and ever has been in them a free
circulation of air. For example, the Penston coal-work, which joins
Pencaitland, has ever been free from this disease; but many of the
Penston colliers, on coming to work at Pencaitland, have been seized
with, and died shortly after, of the black spit: for instance, G. case
No. 5, and D. case No. 8, are such.
How this is to be accomplished, is for the scientific man to say. With
all due deference, I may be allowed to suggest various modes which might
be adopted to free the underground atmosphere of the noxious
ingredients. Could fresh air not be forced down by the power of the
steam-engine, which is at every coal-pit? Could extensive fanners not be
erected and propelled by the same machinery?[26] I am much surprised
that no attempt has been made to light these pits with portable gas in
some way or other. As far as I can understand, such an application of it
would not be difficult. A small gasometer could be erected, and the
necessary apparatus procured at little expense, and by such means, I
would suppose, it could be carried to any part of the mines, which are
not extensive.
Many proprietors may grudge the expense involved in such improvements,
and thus prove a barrier to these necessary alterations; but I would ask
any candid and generous mind, what is expense when the object in view is
the removal of a disease to which many human beings fall a
sacrifice?[27]
It must appear to every one that these collier diseases are crying
evils, the preventive of which is based, as will be seen, on thorough
ventilation; and in order to protect the miner, there should be a
vigilant attention paid to the economy of underground works. No one need
be surprised at the result of such a noxious atmosphere; and it becomes
a duty with the government to protect these poor people by laws, and to
adopt those measures which are best calculated to preserve their health;
and should there arise difficulties of an insurmountable character in
the ventilation of these pits, why continue the mining operation in such
situations at such a sacrifice of human life?[28]
* * * * *
In the course of my investigations in regard to pulmonary carbonaceous
infiltration, I was led to consider the circumstances of those engaged
in other occupations than coal-mining. Any one who has carefully
examined the structure of the human bronchial glands, at different
epochs of life, must have been struck with their appearance in those
who, from their vocation, are compelled to breathe a sooty atmosphere,
or who have lived in ill ventilated dwellings.
I am further convinced, from the results of my recent investigations,
that the bronchial glands in such persons invariably contain
carbonaceous matter which has been inhaled at some period of life.
Having long entertained the belief that the lungs of chimney sweeps, for
example, would, in all probability, be found to contain carbon, within
the last few months two cases, of an exceedingly interesting character,
connected with the present inquiry, have presented themselves,--the one
of pulmonary disease, evidently resulting from the bronchial and
lymphatic glands being impacted with inhaled carbon derived from
soot,--the other a case of melanosis occurring in a young person. Though
the two diseases differ materially, they have often been confounded with
each other and assigned to the same cause. My object in here reporting a
case of stratiform melanosis, in connection with a disease having an
external origin, is to afford an illustration of the fact, that all
black deposits found in the system are not carbon. There exists a marked
chemical distinction between the melanotic and the carbonaceous matter;
and the anatomical situation of the two is also different.
CASE.--A chimney sweep, aged 50, of the name of Campbell, residing at
Stockbridge. The short history of his case I procured from his friends,
as I did not see him during his illness. He had been a soldier in early
life, and had seen much foreign service. After he relinquished the army,
he became a chimney sweep, in which capacity he was constantly engaged
for nearly twenty years. He had had, for a considerable time, a
troublesome cough with tough expectoration. He experienced a difficulty
of breathing in making any exertion, and he had considerable oedema of
the limbs. From these symptoms he believed that he was subject to
_asthma_. He had only been confined to bed for two days previous to his
death.
_Post-mortem Appearances._--The body exhibited extensive anasarca; the
thorax was well arched; the cartilages of the ribs were ossified. On
removing the anterior part of the chest, the pleuræ were found to adhere
strongly, and appeared rough and puckered from extensive exudation of a
brown colour, which extended very generally over the serous membranes.
Both cavities contained nearly three gallons of light brown fluid. The
pericardium was considerably distended with a straw-coloured fluid, and
several flakes of lymph floated throughout the effusion. Both auricles
of the heart were enlarged, and distended with exceedingly dark blood.
The walls of both ventricles were much thickened. The valvular structure
of the auricles was congested and granular. The lungs were removed from
the chest with difficulty, owing to the very general pleuritic
adhesions. Both exhibited extensive emphysema. In dividing the lungs,
and tracing the bronchial ramifications, each lobe was found to contain
clusters of enlarged and indurated bronchial glands, impacted with thick
black matter; and prosecuting the investigations, the minute lymphatic
glands were observed clustered in a similar manner, and containing black
fluid. In the substance of the upper lobe of both lungs, the bronchial
glands were of a bright black colour; they were particularly large, and
so numerous as to press considerably upon and obstruct several of the
bronchial tubes. In fact the upper lobe of both lungs exhibited the
plum-pudding structure. At the bifurcation and back part of the trachea,
the bronchial glands were numerous, and of a deep black colour. A
considerable mass of the glandular structure was removed for chemical
and microscopic examination.