An Investigation into the Nature of Black Phthisis | Page 8

generally found in the disease before us, there being cough and expectoration, dyspnoea, sharp pain in the thoracic region, colliquative sweats,[9] and great emaciation, while at the same time, the pulse was slow and weak, not exceeding thirty-six in the minute for a week before death. No hectic heat of skin, but an extraordinary depression of the arterial action, arising evidently from the redundancy of carbon deposited in the pulmonary tissue, preventing the proper oxygenation of the blood circulating in the organs, and thereby producing a morbid effect on the whole system, which sufficiently explains the cachectic condition of the body.
Post-mortem examination, twenty-four hours after death.--In removing the anterior part of the thorax, the lungs appeared full and dilated, and of a very dark colour. Both lungs were strongly attached to the pleura costalis, and a very considerable effusion of straw-coloured fluid was found in both cavities of the chest. A few irregularly situated dark glandular bodies were observed on the surface of the costal pleura at each side of the sternum, and on the mediastinum. The lungs were removed with difficulty on account of the strongly adhesive bands attaching them to the ribs, and in handling them they conveyed the impression of partial solidity:--several projecting, irregular firm bodies, were felt immediately beneath the surface of the pleura, and there was also present emphysematous inflation of the margins of the upper lobes. In transecting the upper lobe of the left lung, it was found considerably hollowed out, (to the degree of holding a large orange,) and containing a small quantity of semi-fluid carbon, resembling thick blacking, with the superior divisions of the left bronchus opening abruptly into it. Many large blood-vessels crossed from one side of the cavity to the other, to which shreds of parenchymatous substance were attached. The inferior lobe was fully saturated with the thick black fluid, and it felt solid under the knife, and several small cysts containing the carbon in a more fluid state were dispersed throughout its substance, in which minute bronchial branches terminated, and by which this fluid was conveyed to the upper lobe, and thence to the trachea. In examining the right lung, the upper, and part of the middle lobe were pervious to air, and carried on, though defectively, the function of respiration, while the interlobular cellular tissue contained the infiltrated carbon. The inferior portion of the middle and almost the whole of the under lobe were densely impacted, so that on a small portion being detached, it sank in water. Both lungs represented, in fact, a mass of moist soot, and how almost any blood could be brought under the influence of the oxygen, and the vital principle be so long maintained in a state of such disorganization, is a question of difficult solution.
In tracing the various divisions of the bronchi, particularly in the inferior lobes, some of the considerable branches were found completely plugged up with solid carbon; and in prosecuting the investigation still farther, with the aid of a powerful magnifier, the smaller twigs, with the more minute structure of cells, were ascertained to contain the same substance, forming the most perfect racemes, some of them extending to the surface of the lung, and to be felt through the pleura. The lining membrane of the permeable bronchial ramifications, when washed and freed from the black matter, exposed an irritated and softened mucous surface, which was easily torn from the cartilaginous lamin?. The interior of the trachea and its divisions gave evidence of chronic inflammatory action of long standing which extended from about midway between the thyroid cartilage and bifurcation to the root of the lungs. A considerable number of lymphatic glands, filled with--to all appearance--the carbon, were situated along the sides, and particularly at the back part of the trachea; which, from their size, must have interfered by pressure both with respiration and expectoration. The mucous membrane of the left bronchus in particular was much swollen and partially ulcerated towards the root of the lung. In examining the heart after its removal from the body, it was found peculiarly large and flabby, its cavities considerably distended, especially the right auricle and ventricle, while the valvular structure seemed natural. The pericardium contained about 10 ounces of straw-coloured fluid. After examining the organ particularly, I could discover nothing abnormal, but the enlarged and softened state alluded to. The liver was large and highly congested with dark thick blood, but otherwise it was healthy. The gall-bladder was empty, and the spleen large and congested. The stomach was smallish and empty. The mucous membrane was smeared with a blackish, tenacious fluid, which, upon removal, appeared to be a portion of the expectoration. The structure, as far as could be ascertained, was healthy. The small and great intestines contained fluid carbon (evidently swallowed),