On the Expectoration of Black matter from the Lungs
By George Steele, Esq., Surgeon, Musselburgh.
[The following is an extract from the paper to which we alluded in our notice of the volume of the Medico-Chirurgical Transactions lately published, and for which we have not till now been able to make room.—Ed. Gaz.]
note: Please be aware that the below article contains details of
post-mortems. For a summary of the miners named in this, and other
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The black matter expectorated by colliers is of two kinds. One is simply the coal dust inhaled while the individual is at work, and this is spit by every collier, the quantity varying according to the nature of the coal and the manner in which it is worked. Thus, if the air be confined, and if the coal be dry, and if it be worked in a manner which is technically called shearing, the quantity of dust inhaled is considerable; whereas, if the coal be wet, and if, as sometimes happens, there be a current of air blowing in a direction from the miner, and more particularly if the workings are conducted according to the long-wall method, the quantity is comparatively trifling. The dust thus inhaled is never considered by the workmen as at all dangerous, and is generally wholly expectorated in a few hours, or at most in a day or two after exposure. The miners are of opinion that eating largely of fresh butter facilitates its expectoration.
The other kind of black matter is of a very different nature, being generated in the lungs themselves. It does not, however, seem to be connected, either as cause or effect, with any seriously morbid condition of the pulmonary structure, as it may be perceived more or less impregnating the sputa of many miners who do not suffer from any pulmonary complaint. When its formation has once taken place, it appears never afterwards entirely to leave the lungs, but maintains its existence within the body during the remainder of life, and this, although the individual afflicted with it does not continue to work as a miner. When the disposition to produce it has been created, that disposition continues after the cause has been removed. D. Wilson, a miner, was not under ground for twenty-four weeks, and during the whole of that time had black spit. He is a stout healthy man about fifty, of florid complexion, and never had a pectoral complaint This man's wife has not been in a pit for fourteen years, and has a constant black spit without any pectoral complaint. T. Ross, after having been a number of years employed as a miner, was at sea for three years; and during the whole of that time his sputa were never perfectly free from a black impregnation. I could cite numberless cases similar to these.
There are no men at any of the coalworks which I attend who are employed in removing, with the aid of gunpowder, the free-stone which separates the different layers of coal, but a number of workmen are employed in removing a stratum of stone lying above the coal. This is done for the purpose of heightening the roads after the coal itself has been removed by the collier, and this is effected with picks and wedges. The work is all above head; a great quantity of stone-dust is inhaled by the men, but they do not complain of it as injurious. The men who do this work are, however, employed at it only two or three days in a week, and sometimes not so much.
I consider the pulmonary disease of coal miners to be excited chiefly by two causes, viz. running mines in stone, and working in impure air. In running stonemines the workmen use gunpowder; there is often little, and sometimes no ventilation ; and the air is loaded with stony particles, with gunpowder-smoke, lampsmoke, and sometimes, though not always, with choke-damp. This kind of work is a fertile source of evil, and if persisted in, sooner or later produces incurable disease in those who are engaged in it. The morbid affection thus induced is chronic bronchitis, and exhibits all the ordinary symptoms of that disease. It commences with a trifling cough, which is troublesome only in the mornings; and after the expectoration of a greater or smaller quantity of frothy mucus, it goes off, giving no further trouble until next morning, when the secretion of the preceding night excites a renewal of the cough for its expectoration. In this state matters continue, sometimes for several years; the man determines to give up stone-working, and does so for a time, but the inducement of a higher rate of wages again tempts him to his destruction. The complaint advances; the cough becomes more severe; the secretion from the bronchia more copious, and more difficult to be brought up: the individual complains also of tightness across the chest, shortness in the breathing, with a sense of fulness and occasional pulsation at the epigastrium : he feels himself getting unable for the same exertion as formerly ; and when interrogated about the cause of his complaints, invariably ascribes them to stone-work and bad air. This man never recovers. He lays himself off work, and perhaps gets considerably better; he also gives up stone-working, and returns to coal; but it is now too late; the evil is done; his bronchial membrane is in a state of chronic inflammation, and the coal dust, which formerly was all but innocuous, now aggravates the morbid condition. Again he must drop working; he has frequent head-ache, and an aching weariness in the back and loins; his cough becomes more constant and more severe; sometimes it is very troublesome during the night, but in by far the greater number of cases, after passing a few hours during the early part of the night in unrefreshing sleep, he is awoke with sometimes an intense feeling of suffocation; his lips and face become livid ; he throws his body forwards, and grasps his knees with his hands, that being the only attitude in which respiration can be carried on. After a short time a fit of coughing commences, which ends in the slow expectoration of a great quantity of tenacious glairy mucus, and leaves the patient in a state of complete exhaustion. The sputa are sometimes of a yellowish colour, often grey, and occasionally black ; they have also at times a puriform admixture, and are not (infrequently tinged with blood. If the individual thus attacked be under 40 years of age, and if he take care of himself, he may still be restored to the enjoyment, for a time at least, of tolerable health; but if towards fifty, there is no hope for him ; he gradually becomes emaciated; his countenance becomes wan and anxious, his skin shrivelled, the veins on the surface prominent, the shoulders high, and the body bent forwards. He drags on a wearisome and unenviable existence, sometimes for a number of years, and occasionally attempting some trifling employment for a day or two at a time; but his dyspnoea and cough increasing, he gradually declines, and dies from exhaustion.
In other cases, although the bronchial affection is the first of which complaint is made, still, when medical aid is applied for, disease of the heart is the more prominent symptom. This seems to be induced by the impeded circulation in the lungs, the consequence of the long continued inhalation of air impregnated with carbonic acid gas. The same circumstance also causes engorgement in the hepatic and mesenteric vessels, giving rise to abdominal pain, to haemorrhoids, the discharge of black stools, or of dark blood in an unmixed state from the anus. In other cases the determination is to the head, and relief is often obtained by the discharge of black blood from the nose. I consider coal miners to be peculiarly liable to disease of the heart, and to aortic aneurism.
2d. My experience does not enable me to say whether other miners are equally liable to this disease with coal-miners, as all those who are employed in stone-mines at the collieries here, work also, when not so employed, as colliers. But I should think that other miners must be equally liable to the bronchitic affection, and when this exists, the presence or absence of black spit seems of little consequence as regards either the progress or termination of the disease. I form this opinion from the fact, that those who restrict themselves to the working of coal are not peculiarly liable to pulmonary complaints, and they areas long lived and as healthy as any class of labourers whatever. The temperature of the place in which they work is almost always warm and equable; they sutler little from any inflammatory complaint excepting rheumatism, and tubercular phthisis is among them a rare disease. I am informed of several robust looking men, who wrought merely as sinkers of pits and not as miners, who fell victims to pulmonary disease, and some of whom had black spit; this, however, is not in my experience n common occurrence in the case of mere sinksmen. Some individuals are little injured by stonemining compared with others. Abram Bennett, aged 68, is a stout erect man, who has wrought a great many years (about fifteen) at stone-work. He has been a sinksman and has run many stone-mines, both in coal-fields and lime quarries, and at other times worked as a collier. He complains neither of cough nor dyspnoea. There are others also, with whom I am acquainted, who hare enjoyed a similar immunity from disease. Much depends upon the nature of the minerals through which the mine is carried; and in the Mid-Lothian coal-field the edge seams are considered to be in a much greater degree injurious than the flat. This is owing chiefly to three circumstances:—1st. In the edge seams the strata are not so much impregnated with moisture. 2d. The cutting process by the pick of the miner is carried on more upon a line with his own face, and hence more dust is emitted and inhaled. But the principal reason is, that the stone contains some poisonous matter which is probably of a metallic nature, as the workmen complain of its exciting a styptic and metallic taste in the month. A mine was carried across the strata in the Niddry estate, the finishing of which required a number of years. Six or eight of the miners employed in it died ; several were obliged to leave it, and only one of those who commanded it was able to work in it throughout and lived to see it completed. There was a particular stone in this mine, which was repeatedly met with, and to which the miners gave the name of arsenic, which was found highly pestiferous : its exact nature I am not acquainted with. In a stone-mine run some years ago in the Newbattle field, a great many men died, the average length of time each of the miners employed in it lived, being about two years. The mortality was ascribed to the nature of the stone.
3d. The period of life at which the disease occurs must vary according to the length of time the individual has been exposed to the exciting cause, and to natural difference of constitution ; and It must depend also on the nature of the minerals in which the mining operations are conducted. I have often seen it prove fatal about the age of from fifty to fifty-five.
4th. From the description above given may be gathered nearly all the information which I am able to give in regard to the course of the disease. It differs from ordinary tubercular consumption in being seldom attended with hectic fever, and never with the distinct and well-marked hectic of the latter. In the disease under consideration the dyspnoea is in general much more distressing than in any cases of phthisis which I have witnessed. The emaciation is not so extreme. There are seldom colliquative sweats or diarrhoea. The fulness and frequency of the pulse met with in tubercular phthisis are not concomitants of this affection. In a great majority of cases phthisis makes its attack, and proves fatal much earlier in life than this disease is ever met with; and in the latter there is a livid discolouration of the lips and hands, and sometimes of the face, and not unfrequently anasarca in a greater or less degree.
I regret that I have not kept notes of the post-mortem appearances in any of the bodies which I examined, with the exception of only one or two; and in these my attention was more particularly directed to the morbid condition of the heart than of the lungs. Indeed the state of the bronchia has been so uniformly the same, or nearly so, that of late I have not in every case minutely examined it. The mucous membrane is highly vascular, generally soft and swollen, and not unfrequently ulcerated. The lungs in several cases contained black, carbonaceous-looking matter, lying along the course of the bronchial tubes, and enclosed in bags of cellular membrane. I have seen it sometimes distributed through the lungs in little nodules; and in one case which I distinctly recollect, this black matter pervaded their whole substance, and the band of the dissector, on being withdrawn from the chest, after the substance of the lungs had been cut into, had the same appearance as if it had been dipped in a basin of thick charcoal and water.
It may not, perhaps, be unworthy of being mentioned, that while stone mining seems injurious, chiefly, if not solely, to the pulmonary structure, the deleterious effect produced byv the inhalation of chokedamp is exerted principally upon the heart. I have often thought that the production of the black pulmonary matter resulted rather from some condition of the system produced by the circulation through it of imperfectly-oxygenated blood, than from any direct effect produced merely on the lungs by the inhaled stone dust or impure air.
London medical gazette or Journal of practical medicine, Volume 20, 1837