An Investigation into the Nature of Black Phthisis | Page 7

especially at night and in the morning, for which he sought medical advice, and was treated for bronchial affection. He continued to prosecute the employment of stone-mining in this coal-pit so long as his strength would permit, which was a little more than two years, when (August 1836) he was entirely disabled, from general exhaustion. By this time his cough had much increased, and there was considerable dyspnoea, accompanied with sharp pain in the thoracic region, both in walking quickly, and when lying down. Pulse 80. He expectorated bloody tough mucus without any tinge of black matter. All remedial means were adopted with a view to the removal of the irritation of the chest, without producing any very decided effect. The thoracic pain was occasionally subdued, but the cough became incessant; loss of appetite, rapid emaciation, and cold nocturnal sweats, with slow weak pulse, supervened. After a severe fit of coughing, during one of his bad nights, the black expectoration made its appearance, in considerable quantity, by which his sufferings were for a few days alleviated, when the cough returned in the same degree of severity, and was again mitigated by the black sputa, which was expectorated without difficulty, and from this time (October 1836) there was no interruption to a free carbonaceous expectoration.
In the early part of this man's illness, the stomach, the alimentary canal, biliary and urinary secretions, continued unimpaired; but as the cough advanced, gastric irritation, which was followed by vomiting during the paroxysms, annoyed him; and for the last eight months of his life, he suffered occasionally from severe attacks of gastrodynia, which, when present, had the effect of considerably modifying the thoracic irritation, and allaying the cough. There was nothing very remarkable in the character of the urine; the quantity voided was small, and very high coloured, with occasionally a lithic deposit. The f?ces were natural, and smeared with dark blue mucus. On examining the chest with the stethoscope, the crepitant ronchus was heard in the upper part of each lung. There was general dulness throughout the lower part of both, with the exception of a small space at the inferior angle of the left scapula, where pectoriloquy was distinctly heard, from which was concluded the cavernous state of a portion of that lung. The heart's action was languid, and often intermitting, producing vertigo and occasional syncope. The pulse was gradually becoming slower; and at this time, (Nov. 1836,) it was forty-three in the minute. I was informed by this man, that his chest affection first became manifest, after being engaged with a difficult job in a newly formed coal-pit at Huntlaw, where he had very little room to conduct his mining operations, which were carried on with the help of gunpowder, and where he experienced a sensation of suffocation from the confined nature of the pit,[7] which did not permit of the exit of the evolved carbon, and ever after, his cough and difficulty of breathing had been increasing rapidly. During the greater part of the period he was under my charge, he continued to expectorate black matter, of the consistency of treacle, mixed with mucus in considerable quantity, and I would suppose, taking the average of each week, that he expectorated from ten to twelve ounces daily of thick treacle-like matter. I had the curiosity, during my attendance on this patient, to separate the mucus from the carbon, by the simple process of diluting the sputa with water, and thereafter separating and drying the precipitated carbon. I was enabled by this means to procure about one and a-half drachms of a beautiful black powder daily, and in the course of a week, I had collected near to two ounces of the substance. This process I continued for some weeks, till such time as I had procured a sufficient stock of this remarkable product of the pulmonary structure, and I am certain that the same quantity, if not more, could have been obtained till his death, in Dec. 1836. It is undoubtedly a striking phenomenon, connected with the pathology of the chest, that the human lung can be converted into a manufactory of lamp black!
Towards the close of this poor man's existence, the countenance and surface of the body assumed a leaden hue, from the very general venous congestion, and as his system became more exhausted, and he was about to sink in death, the gastric irritation and nocturnal cold sweats which had been long present with him considerably increased, along with a cough so severe as actually to produce vomiting of the black sputa. His tongue and fauces became so coated with the expectoration, that a stranger viewing the patient would have said that he was vomiting black paint.[8]
This case resembled in many of its features, one of tubercular phthisis, more than is