An Investigation into the Nature of Black Phthisis | Page 6

probable, that when carbon is once lodged in the pulmonary structure
by inhalation, there is created by it a disposing affinity for the carbon in
the blood, by which there is caused an increase in the deposit of carbon,
without any more being inhaled.
Appearances on Dissection. In classifying the morbid appearances
observed in the pulmonary structure, I arrange them according to
divisions corresponding to three stages of the disease. First, Where
there exists extensive irritation of the mucous lining of the air passages;
and the carbon being inhaled, is absorbed into the interlobular cellular
substance, and minute glandular system, thereby impeding the
necessary change upon the blood. Secondly, Where the irritative
process, the result of this foreign matter in the lungs, has proceeded so
far, as to produce a variety of small cysts, containing fluid and
semi-fluid carbonaceous matter, following the course of the bronchial
ramifications. Thirdly, Where the ulcerative process has advanced to
such an extent, as to destroy the cellular texture, and produce extensive
excavation of one or more lobes.
Stethoscopic Signs.--In the early stages, the sounds indicate a swollen
state of the air-passages, and vary in character according to the part

examined. The whistling and chirping sounds are loud and distinct in
the large and small bronchial ramifications, and both from the absence
of expectoration and the presence of the pulmonary bruit, the highly
irritated state of the mucous linings is apparent. The affection
ultimately assumes a chronic form, and continues present in the
respirable portions of the organ during life. As the carbonaceous
impaction advances, the sounds become exceedingly dull over the
whole thoracic region, and in many of the cases no sound whatever can
be distinguished. Where the lungs are cavernous, it is very easy to
discover pectoriloquy, from the contrast to the general dulness, and
when pleuritic and pericardial effusion advance much, it is difficult to
ascertain the cardiac action.
Such is a short account of the Cause, Progress, and Morbid
Appearances of this deadly malady, as they came under my notice.
* * * * *
From a variety of cases to which my attention was directed, I I have
selected ten, with the post-mortem appearances in nine of them. These
cases extend over a period of eleven years, all of them exhibiting, with
some slight variation, the same character of disease, and proceeding
from the same cause--inhalation of carbonaceous matter. Some of the
cases occurred as far back as the years 1833-34, while the last case
came under my notice within these twelve months. Of the ten patients,
six were engaged at one period with stone-mining, and four were
entirely coal-miners; eight expectorated carbonaceous matter, and two
did not show any indication of black infiltration from the sputum; six
exhibited, on examination, most extensive excavations of the
pulmonary structure; and three only general impaction of these tissues,
with numerous small cysts containing black fluid; the body of the tenth,
I regret to say, was not examined, owing to neglect in communicating
in time the death of the patient, which took place a few weeks ago.
These morbid appearances exhibit three stages of the disease in regular
progression. The first is that where the carbon is confined to the
interlobular cellular tissue, and minute air-cells, producing cough,
dyspnoea, slight palpitation of the heart, and acceleration of pulse,

while, at the same time, the patient continues able to prosecute his daily
employment. The respiratory sounds, in this state of the chest, are loud
and distinct. Such a condition of the pulmonary structure is often found
on examination in the Carron iron-moulder, who has been killed by
accident, or has died from some other disease, having been subjected in
the course of his employment to the inhalation of carbonaceous
particles.
The second is that stage where the softening has commenced in the
several impacted pulmonary lobular-formed small cysts throughout the
substance of one or more lobes, the contents of which may either be
expectorated or remain encysted, giving rise to most harassing cough,
laborious breathing, and palpitations, dull resonance of chest, and
obscure respiratory murmur. The third and last stage, is that in which
the several cysts in one or more lobes have approximated each other,
forming extensive excavations, the prominent symptoms of the disease
becoming considerably aggravated, and the powers of the system
sinking to the lowest degree of exhaustion.
* * * * *
CASE 1. George Davidson, collier from his youth. When I first saw
him professionally, in May 1834, he was aged thirty-two. From his
earliest years he was employed about the coal-works in Pencaitland
parish, and when very young, he went down the pit to assist in
conveying coals to the shaft, and ultimately became a coal-miner. For a
considerable length of time, he enjoyed good health, having neither
cough, nor