An Investigation into the Nature of Black Phthisis | Page 8

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 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
laminæ. 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