Part 1 (1/2)
An Investigation into the Nature of Black Phthisis.
by Archibald Makellar.
PREFACE.
An abstract of the investigations into the nature of carbonaceous infiltration into the pulmonary tissues of coal miners, was read by Dr Makellar at a meeting of the Medico-Chirurgical Society of Edinburgh, Wednesday, 8th July, 1845, Dr Gairdner, President, in the Chair.
Reference was made, in particular, to the East Lothian coal-miners. The carbonaceous disease described, was stated to be caused by the inhalation of substances floating in the atmosphere of the coal-pit, such as the products of the combustion of gunpowder, the smoke from the miner's lamp, and the other foreign matters with which the air of the mines is heavily charged, in consequence of their defective ventilation.
In the mines in which gunpowder is used, the disease is most severe in its character, and most rapid in destroying the pulmonary tissue. The carbon in some cases is expectorated in considerable quant.i.ty for some time previous to death; in others, it is retained, and acc.u.mulates to a great extent in the lungs.
As the disease advances, the action of the heart becomes feeble; and the appearance of the blood indicates a carbonaceous admixture. The carbonaceous deposit seems to supersede or supplant the formation of other morbid bodies in the substance of the lungs--such as tubercle; for in individuals belonging to families in which there exists an undoubted phthisical diathesis, tubercle is never found on dissection.
The views expressed in this communication called forth the following remarks.
PROFESSOR CHRISTISON called attention to the new and important fact, of the carbonaceous matter being found in the circulating ma.s.s. He attached great importance to Dr Makellar's researches.
PROFESSOR ALLEN THOMSON remarked, that the presence of this carbonaceous matter in the blood, by no means proved, that it was formed in, or from the blood.
DR HUGHES BENNETT said, that the antagonism of this carbonaceous disease to tubercle, was a fact of great interest and importance, especially in connection with two other recent observations; viz. 1st, That the depositions of carbon in the lungs of old people, (which French pathologists describe,) are not found a.s.sociated with tubercle; and, 2d, That under the supposed cicatrices of pulmonary tubercular cavities, a layer of carbonaceous matter is commonly found.
Dr Makellar's paper called forth some interesting observations from the President, Professor Simpson, and others.
BLACK PHTHISIS,
OR
ULCERATION INDUCED BY CARBONACEOUS ACc.u.mULATION 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 cla.s.ses 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 Acc.u.mulation 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 Haddingtons.h.i.+re, 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 superst.i.tious 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 Ca.r.s.eWELL, in an article on ”Spurious Melanosis,” (_Cyclopaedia of Practical Medicine_, Vol. iii); Dr MARSHALL, in a paper in _The Lancet_ for 1836, ent.i.tled ”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, ill.u.s.trating 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_.
Recently, professional and other writers have directed attention to the influence of various occupations in the production of diseases of the chest. The pernicious employment of the needle-pointers, razor and knife-grinders of Sheffield, and other manufacturing towns in England,[1] have not only engaged the attention of the public at large, but science has been at work to ascertain, with as much accuracy as possible, the relative effects of the different avocations, on the const.i.tutions of those occupied in these destructive employments.
Researches of this nature tend much to the well-being of society, as they make us acquainted with the maladies and sufferings peculiar to certain cla.s.ses of our fellow-men; and point out, also, the causes of their early decay, and premature death. The coal-miners--those in whose behalf I would now solicit the intervention of science--are most valuable in their place, and their exhausting labours promote, in no small degree, our domestic comforts.
Some of the diseases of colliers have in past time been very much overlooked by the medical inquirer. There has been, within the last few years, a very searching investigation as to the employment of women and children in coal-mines; and by the laudable exertions of Lord Ashley--a n.o.bleman whose name shall ever be honoured among miners, and by all who have the true interests of that community at heart--an Act of the Legislature has been pa.s.sed, declaring it unlawful for any owner of any mine or colliery whatever, to allow any female to work therein; and also enacting, that no boy under the age of ten years can be employed in mines. It is to be regretted, however, that his Lords.h.i.+p did not embody in his measure, provisions enforcing the free ventilation of mines under government inspection; for nothing would tend more to improve the health of those employed in them.