Chapter 7

_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.

The second case was that of a boy aged six years, who was under treatment for an affection of the heart and kidneys, and who died apparently from disease of these organs. He was, during his whole life, of a relaxed and weakly constitution, exceedingly sallow in the complexion, with a very deep blue tint of the sclerotic coat of the eye. In the course of the post-mortem examination, there was discovered, in the lower and lateral part of the right pleura, a cyst containing about an ounce of semi-fluid melanotic matter; and also the morbid secretion presented the stratified appearance described by Dr Carswell in his article upon Melanosis, extending over the inferior half of the costal pleura and the corresponding part of the diaphragm. It formed a distinct layer on the surface of the serous membrane, resembling ink or blacking, and could with difficulty be removed. The black deposit resembled much in appearance the foreign matter found in the pulmonary organs of the coal-miner, and therefore was submitted, as well as the bronchial glands in the other case, to chemical analysis, with the view of ascertaining if there existed any analogy in the component parts of each.

Dr Douglas Maclagan submitted both these substances to the action of concentrated nitric acid, and the results were, that the glandular structure of the chimney sweep contained a very large proportion of carbon, while of the contents of the melanotic cyst, the same process did not leave a vestige of colouring matter,--evidently proving the distinction which exists between those two dark deposits, and making it sufficiently obvious, that melanotic matter is composed of the constituent elements of the blood, and has its origin within the body. There cannot remain a doubt as to the nature of the chimney sweeper's case; for, from the knowledge which we have of his occupation, and from the chemical properties manifest after investigation, I think I am entitled to declare the black matter obtained from the bronchial glands to be carbon inhaled with the air during his labour, and not existing as a constituent ingredient of organized solids or fluids.

The microscopic examination showed the carbon most distinctly in a molecular form.

It is my intention to return to this subject at a future time.

NORTHUMBERLAND STREET, EDINBURGH, January 1846.

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FOOTNOTES:

[1] Vide an admirable series of papers on this subject in the volume of this Journal for 1843, by Dr Calvert Holland.

[2] About ten miles east from Edinburgh.

[3] Generated from the decay of vegetable and other substances in the _formerly wrought_ pits, which communicate with those at present in use.

[4] It is proved, from the difference in the chemical character possessed by the melanotic matter, as compared with the matter found in the lungs of miners.

[5] It will be observed, that, though the small blood vessels are destroyed, no hemorrhage takes place, owing to the formation of a carbonaceous plug.

[6] The air of the coal-pit is so charged with carbon as to prevent the collier from distinguishing his neighbour when at work.

[7] Note from the evidence of a collier examined before the Government Commissioners in 1842, No. 147 of Report. "Colliers in this part of the country are subject to many oppressions; first, Black spit, which attacks the men as soon as they get the length of 30 years of age;" second, Note 150, "The want of proper ventilation in the pit is the chief cause, and no part requires more looking after than East Lothian," the men die off like rotten sheep. Note, 153, the witness, 32 years old, says, "I am unable to labour much now, as I am fashed with bad breathing--the air below is very bad, and till lately no ventilation existed."

[8] The black sputum retains its colour after being submitted for some days to the action of nitric acid.

[9] This is the only case in which I at any time observed colliquative sweats as a symptom of this disease.

[10] To convey an impression of the nature of the labour in which the man was engaged I shall simply extract a few remarks from the evidence of the miners at this coal-work, taken by Mr Franks for the Government's Commissioners, Note 105. "At all times the air is foul, and the lamps never burn bright. The seam of coal is 24 inches, and the road only three feet high." Note 108--"Experienced colliers do not like the work, and many are touched in the breath." And in such a situation man is doomed to labour! Note 114--"Most of the men here are _fashed_ with _that trouble_; Foster, Miller, Blyth, and Aitken are all clean gone in the breath together. Colliers here drop down very soon."

[11] It is evident in this disease that the bronchial ramifications are destroyed, while the arteries, with the exception of the minute twigs, are preserved.

[12] One of the lungs (the left one) now described, I sent to Dr John Thomson, late Professor of Pathology, and will probably be found in his collection, which I understand is in the College of Surgeons.

[13] After a free expectoration of black matter, there was an evident mitigation of all the pectoral symptoms, and as the carbon again accumulated in the lungs, the sufferings of the patient were very considerably increased.

[14] This sputum was subjected to the action of nitric acid, which produced no effect upon its colour.

[15] When pulmonary disorganization has proceeded far, from the presence of carbon, there is a languor in the vital action from defective oxygenation of the blood, which produces a gradual reduction in the temperature of the body, requiring double clothing, and even that addition is, with the aid of stimulants, not sufficient to keep the patient warm.

[16] This lung is in the possession of Sir James Clark, of London.

[17] The above substances were submitted separately to the action of nitric acid and caustic potash, and the result was that a large proportion of carbon was precipitated.

[18] Since writing the above the patient has died; and I regret that, owing to neglect in communicating with me, I have been prevented examining the morbid appearances.

[19] Several of the Pencaitland colliers are at present engaged in the tunnelling operations near to Edinburgh, connected with the North British Railway.

[20] Dr Hamilton's of Falkirk paper in the Edin. Med. and Surgical Journal, Vol. xlii.

[21] I have very lately, through the kindness of Mr Girdwood, surgeon at Falkirk, had an opportunity of examining two or three iron-moulders in that district. Both from the nature of the employment in those iron works, and the character which the pulmonary affection exhibits, the fact of inhalation is fully established. The moulder is at a certain stage of his labour enveloped in a cloud of finely-ground charcoal, a portion of which cannot fail to find its way to the lungs in breathing. He is subject to tickling cough, and as the disease advances, the respiratory sounds, which indicate considerable bronchial irritation, present themselves, and ultimately become dull, and in some parts obscure.

Of the several cases which I saw with Mr Girdwood, one, who has not been labouring for some years as a moulder, occasionally expectorated black matter, and in the other two, there was general dullness of both lungs; and, I doubt not, impaction.

[22] It has not been in my power hitherto to procure so satisfactory a chemical analysis of the blood as I would wish, but through the kind assistance of Dr Douglas Maclagan, who has undertaken to conduct the process, I expect very soon to be able to lay it before the profession.

[23] I found little or no black matter in the lungs of farm servants, who are much in the open air.

[24] _Vide_ MONTHLY JOURNAL for 1845, p. 702.

[25] At any time when these colliers required venesection, particularly towards the last stage of the disease, the blood appeared peculiarly dark and treacle-like.

[26] Could oxygen not be prepared and forced down?

[27] I am happy to find that the attention of the noble proprietor of the Newbattle coal works is now directed to this subject.

[28] I cannot pass from this subject without an observation on the beneficial results which have been the consequence of Lord Ashley's valuable colliery Act. The female Labourers, and particularly the unmarried, have improved not only in their appearance, but also in general physical development, since they have abandoned the unhealthy labour of the coal-mine. They are no longer the squalid, filthy, and ill-favoured race they formerly were. There is now exhibited on the face of the collier girl the bloom of health and cheerfulness; and when we descend to their domestic economy, there is observed a comfort in the management of their households, which formerly did not exist. Their children are now particularly cared for, both in health and when suffering from disease; and we must regard this early watching as an important step to the removal of that predisposition to pulmonary irritation, so general in the collier community.