An Investigation into the Nature of Black Phthisis | Page 5

is accounted for by the
circumstance, that the women, when permitted to labour, previous to
the late prohibitory enactment, were only occupied as carriers; and
from their movements towards the pit shaft, in transporting the coals,
were enabled to inhale at intervals a purer atmosphere. The boys also,
who were employed as carriers to the pit shaft, continued to labour with
like impunity, from their occasional change of situation; but the miner,
lying on his side in a confined, smoky recess, under ground, gasping
for breath, proceeding with his exhausting labour, cannot fail, in his
deep inspirations, to draw in the deleterious vapour, to the most minute
ramifications of the pulmonary structure, and, as he daily repeats his
employment, so does he daily add to the accumulation of that foreign
matter which shall ultimately disorganize the respiratory apparatus. In
the first stage of the affection, there is an incessant dry cough,
particularly at night, and all the prominent symptoms of bronchitis are
present. Indeed, from the time a man becomes a coal-digger, and
inhales this noxious air,[6] there is ever after a manifest irritation in the
lining membrane of the respiratory passages, which is apparent before
carbon in any quantity can be supposed to be lodged in the lungs. The
mucous membrane of the air passages, by its continually pouring out a

viscid fluid, has the power of removing any foreign matter that may be
lodged in them. Now, should this membrane, owing to previous
irritation, lose to a certain degree this secretory power, then the foreign
body adheres to it, and is retained, and this, I think, constitutes the
preparatory stage of black deposit. In tracing the progress of the disease,
it is my belief, that immediately after the carbon is established in the
air-cells, the absorbents become actively engaged, and the glandular
structure soon partakes of the foreign substance. One of the peculiar
features, as we shall find, when we come to describe cases, is, that the
secretory function is ever after so changed in its character, that the
gland which formerly secreted mucus, to lubricate the passages, now
performs the same service with muco-carbon, and continues to do so
during the remainder of the patient's life--even, as I have often seen,
long after he has desisted from the occupation of a coal-miner. In fact,
it constitutes a striking peculiarity of this disease, that when the carbon
is once conveyed into the cellular tissue of the lung, that organ
commences the formation of carbon, thus increasing the amount
originally deposited, as was strikingly exemplified in the case of
Duncan and others, to be afterwards detailed. Duncan had not for
fifteen years been engaged in mining operations, nor was there any
possibility of his having inhaled more carbon: yet in him it was found
to have increased to the greatest possible extent, leaving but a small
portion of useful lung.
I have been long impressed with the belief, that the carbon is contained
in considerable quantity in the blood, particularly in the blood of those
far advanced in the disease. This impression arises, not only from its
dark and inky appearance, but from its sluggish flow, and
non-stimulating effects on the heart and general system; and when we
examine the morbid condition of the pulmonary structure,--ascertain
the presence of carbon in the glandular system and minute lymphatic
vessels of the lungs, and consider the relation existing between them
and the circulating fluid, we cannot suppose it possible, that such a
mass of foreign matter should be lodged in their parenchymatous
substance without imparting a portion to the blood. I was never more
struck with this, than in the case of Duncan, where the blood was more
like thick brownish ink than vital fluid.

No one who has witnessed the economy of these pits, can doubt the
inhalation, to a great degree, of lamp and gunpowder smoke into the
pulmonary tissue. What may be its chemical action there, is a question
for us to attend to as we proceed. If it be considered an established fact,
that carbon is inhaled, possessing all the chemical qualities of that
substance found floating in the air of the coal-mine, and either
expectorated from the lungs during life, or retained in those organs till
after death, we cannot but conclude, that the black matter is the result
of an external cause, and that that cause is the sooty matter.
Another question arises here, in connection with this phenomenon,
viz.--Does the carbon increase in the pulmonary tissues after the collier
has relinquished the occupation of a miner, and when there can be no
further inhalation, and if so, whence comes this increase? It must be
admitted, judging from several of the cases which follow, that it does
considerably augment. From this remarkable fact, does it not appear