Case 3. D. S. was aged 39 years at his death, in August 1838. He had been engaged as a coal-miner so soon as he was able to undertake work. He was a tall, muscular man, and for a long time enjoyed excellent health. He first began mining operations at one of the Pencaitland collieries, and continued to labour there for many years. About six years before his death, he was induced by an increase of wages, to undertake stone-mining in the same pit; and soon after engaging in this employment, he began to be troubled with a slight cough, accompanied by dyspnœa, palpitation, and oppressive headach, which symptoms rapidly increased in severity. He declared that his cough and general ailments first showed themselves after labouring for a considerable time at stone-work, with the aid of gunpowder, in a situation where the air became so impure, both from defective ventilation and carbonaceous particles floating in it, as materially to affect the breathing. Although he repeatedly changed his place of labour from one coal-work to another more healthy in the same parish, he experienced no mitigation of his annoying cough. When I first saw this man for medical advice in July 1834, he had then been about two years engaged as a stone-miner, the bronchial irritation was very general throughout the chest, he had severe cough, hurried breathing, little or no expectoration, and on applying the ear to the thorax, the sibilant and sonorous bronchi were distinctly heard, which indicated a swollen and irritated condition of the mucous linings of the air-passages, and this irritation was also manifest in the mucous membrane of the nostrils, which was much swollen, acutely tender, and impeding considerably the passage of the air. The pulse was rather frequent, about 85 in the minute. There was present much heat of skin during the night, which subsided towards the morning.
The remedial measures were blisters and expectorants, which relieved him considerably. The cough recurred in paroxysms, accompanied by severe headachs, with little frothy mucous expectoration, and there was occasionally observed a slight tinge of blood in the sputum. At this period, his appetite was good, and with the exception of his cough and difficulty of breathing at night and morning, he seemed usually very well. Though labouring under his disease, he continued at his employment of stone-mining, and would not be convinced of its injurious effects.
July 1835. There was considerable increase of the palpitation when he attempted the recumbent position, or moved hurriedly. The remedies ultimately seemed to produce little effect. His general exhaustion advanced rapidly, and obliged him to relinquish all mining occupation. At the end of the summer of 1836, when I saw him more regularly, and was enabled to watch his symptoms with more attention, these having materially changed for the worse, percussion elicited dulness over the chest, with the exception of the upper part of both lungs, where the mucous râle was heard louder than usual. The heart's action was strong and irregular, particularly so for some time after a fit of coughing, when he suffered excessively from headach, succeeded by a tendency to drowsiness. The pulse was slow and languid, not exceeding 50 in the minute. His countenance had assumed a greyish inanimate aspect, his eyes became sunk, his robust frame bent and so emaciated from this peculiar disease, that though his age did not exceed 38 years, a stranger looking at him, supposed him to have attained the age of 70. No treatment seemed to have any effect in allaying the cough, nor was he permitted to lie down. From his feeling of dyspnœa and thoracic oppression, his nights were almost sleepless, his extremities œdematous, usually cold and bloodless.
During the greater part of the time he was confined to the house, the bowels were constipated, requiring daily purgatives. The urinary secretion was small in quantity and high coloured, but in neither discharge was there any thing very unnatural. In this almost inanimate condition he lingered on, when about six months before his death, during a paroxysm of cough, he expectorated a mouthful of thick black matter, and continued so to do periodically, at intervals of about three weeks, seeming to experience relief after voiding the carbonaceous sputum.
There was little change in the symptoms of this man till death. He took little or no food, from his appetite being almost entirely gone, and from gastric irritation being constantly present. His cough and dyspnœa continued severe, with drowsy headachs and difficulty in keeping the body warm. The arterial action was exceedingly low. The pulse was 40 in the minute, and difficult to discern. The strongest stimulant produced no increase of action, the sitting position was the only one in which he was at all easy, and in which he remained day and night till he ceased to live.
Post-mortem examination, twenty-four hours after death.—The body was much emaciated. The chest large, and integuments tightly drawn over it, the ribs unyielding. In removing the anterior part of the chest, the lungs adhered strongly to the ribs, and were covered very generally with patches of dark-red false membrane, corrugating the pleura. Each side of the thorax contained fully a pint of light-brown fluid. In removing the left lung, it felt firm and developed, and in dividing it throughout its lobes, a variety of small cavities and indurated masses of carbon were found to pervade its substance, exhibiting a sooty appearance, extending throughout the whole structure. The indurated nuclei were ascertained to be impacted lobules, and the small cavities were these disorganized and softened, and communicating with the bronchial tubes. Part of the upper, and the whole of the inferior lobe, were soaked with carbon, and felt indurated. The right lung was similarly disorganized with the left. The greater part of the superior lobe was permeable to air, and the interlobular tissue contained carbon, in small, hard granules. The middle and inferior lobes contained several hard, indurated bodies, progressing to a state of softening, and in separating a portion of the latter lobe, it was found to sink in water. There was emphysema of the margin of the inferior lobes. There appeared considerable irritation and softening of the mucous membrane of both bronchi, extending from the root of the lungs to beyond the bifurcation of the trachea. There were several enlarged bronchial glands at the apex of the lungs, containing black fluid.
The pericardium contained about eight ounces of straw-coloured fluid. There was a light-brown exudation, extending over serous lamina of the pericardium and the surface of the heart. The heart was flaccid, the right auricle and ventricle were enlarged and attenuated, and both vena cava at their junction with the heart were much dilated, the valvular structure natural. The liver was large, soft, and easily torn. The abdominal viscera in general appeared healthy; slight effusion into the cavity of the peritoneum. In this case head not examined, but which no doubt would have shown marks of extensive congestion, as in other cases.
The above case comes under the second division of this disease, where the irritative process resulting from the foreign body pervading the lungs, had advanced so far as to produce a variety of small cysts, and circumscribed, indurated masses, the former containing fluid, and the latter solid carbon, and it is evident in tracing its progress, that there must have been a very rapid increase within the system in the carbon originally deposited in the pulmonary structure by inhalation. There was very limited black expectoration shortly before death, and this merely the contents of a few small cavities communicating with the bronchial ramifications, while both lungs were extensively infiltrated with that matter which, had the patient lived, would have produced general softening, and more extensive excavations by the coalition of the various indurated tubulæ.
Case IV. J. T., aged 45 when he died, May 1837. He became a collier in early life, in the neighbourhood of Glasgow, and came, at the age of 22 years, to East Lothian, to engage in collier labour at Blind Wells, near Tranent. From his own account, he was rather of a delicate constitution, and ill-fitted for the work of a coal-pit, consequently, after labouring a few years, he was, at the age of 26,—owing to cough and difficulty of breathing,—obliged to relinquish the employment of a miner. He left East Lothian, and retired to the west of Scotland, where he became a country merchant, and continued so occupied for upwards of fifteen years. During that time, he was occasionally troubled, particularly in the morning, with his cough and hurried breathing, which was increasing in severity, but at no period had he expectorated black matter, nor was there any indication that his sufferings arose from carbonaceous disease. On account of becoming reduced in circumstances, he was under the necessity, though labouring under chest affection, of returning to his former employment of coal-mining at Blind Wells, at the age of 41, August 1834. He had not been long engaged as a miner, after his return to East Lothian, when his cough increased considerably, with laborious breathing, palpitations, and overpowering headach. Both now and formerly, he wrought solely as a coal-miner, and at no time of his life did he work as a stone-miner. Having a family to provide for, he struggled on laboriously under much suffering from his chest affection, till general exhaustion compelled him to leave off work, and seek regular medical advice, July 1836. From his statement regarding the cause of the disease, I was led to understand that his cough, which never left him from the time he was first seized, was induced, at an early period, by bad air generated in the coal-pit at Black Wells, from the work being ill ventilated, and from the general use of coarse linseed oil for the lamps.