BLACK PHTHISIS,
OR
ULCERATION INDUCED BY CARBONACEOUS ACCUMULATION IN THE LUNGS OF COAL-MINERS
Among the many diseases incident to the coal-miner, none come oftener under medical treatment, than affections of the respiratory and circulating organs. While the collier is subject—during his short but laborious life—to the other diseases which afflict the labouring classes in this country, such as inflammations, fevers, acute rheumatism, and the various eruptive diseases, he, at last, unavoidably, falls a victim to lesions within the cavity of the chest, arising from the nature of his employment. In the present communication, it is proposed to lay before the profession a series of remarks, which I have been enabled to put together, with a view to elucidate the cause and progress of that very peculiar pulmonary disease, incident to coal-miners, which I shall denominate Black Phthisis, or Ulceration induced by Carbonaceous Accumulation in the Lungs.
The rise and progress of the malady may be thus sketched: A robust young man, engaged as a miner, after being for a short time so occupied, becomes affected with cough, inky expectoration, rapidly decreasing pulse, and general exhaustion. In the course of a few years, he sinks under the disease; and, on examination of the chest after death, the lungs are found excavated, and several of the cavities filled with a solid or fluid carbonaceous matter.
During the last ten years, my attention has been much directed, in the course of my professional labours in the neighbourhood of the coal-mining district of Haddingtonshire, to the above phenomena in the pathology of the lungs, which have not hitherto been brought so fully before the profession, as their importance demands. The subject presents a very interesting field of investigation to the physiologist and pathologist.
When we consider the difficulties which the medical man has to encounter, in prosecuting his researches in morbid anatomy in a mining district, it is sufficiently explained why the peculiarly diseased structures in the body of the coal-miner should have been left so long uninvestigated.
Not many years ago, the obstacles in the way of post mortem examinations among colliers were insurmountable, and consequently, till lately, few medical men could obtain permission to examine, after death, the morbid appearances within the chest of a collier. With the rapid advance in the general improvement which has been going on, the collier's position in society has become greatly elevated; and his deeply-rooted superstitious feelings have been, to a great extent, dissipated. Let us hope that the school-master will find his way into every collier's dwelling, enlightening his too long uncultivated mind; and that the foolish prejudices shall cease, which have been hitherto the barriers to post-mortem examinations in his community.
The only medical writers, as far as I am aware, who have brought this subject before the notice of the profession, are, Dr J. C. Gregory, in the report of a case of peculiar black infiltration of the whole lungs, resembling "Melanosis," (Edinburgh Medical and Surgical Journal, No. cix., October 1831); Dr Carsewell, in an article on "Spurious Melanosis," (Cyclopædia of Practical Medicine, Vol. iii); Dr Marshall, in a paper in The Lancet for 1836, entitled "Cases of Spurious Melanosis of the Lungs;" Dr William Thomson, now Professor of Medicine in the University of Glasgow, in two able essays (Medico-Chirurgical Transactions of London, Vols. xx. and xxi.), wherein he gives a number of very interesting cases, collected from various coal districts of Scotland, illustrating different forms of the disease; Dr Pearson, in the Philosophical Trans. for 1813, on the "Inhalation of Carbon into the Pulmonary Air Cells;" and in a paper, by Dr Graham, in vol. xlii. of the Edinburgh Medical and Surgical Journal.