90

On the Diseases, Condition, and Habits of theCollier Population of East Lothian. ByS. SCOTT ALISON, M.D., Hon. Sec. to theMedical Society of London.

(Continued from p. 858, vol. i., 1841-2.)

On the Diseases, Condition, and Habits of theCollier Population of East Lothian. ByS. ScoTT ALISON, M.D., Hon. Sec. to theMedical Society of London.

(Continued from p. 858, vol. i., 1841-2.)" Spurious melanosis, or the black spit’

of colliers, is a disease of pretty frequentoccurrence among the older colliers, andamong those men who have been employedin cutting and blasting stone dykes in thecollieries. The symptoms are emaciation ofthe whole body, constant shortness and quick-ness of breath, occasional stitches in thesides; quick pulse, usually upwards of onehundred in the minute; hacking cough dayand night, attended by a copious expectora-tion for the most part perfectly black, andvery much the same as thick blacking incolour and consistence, but occasionally yel-lowish and mucous, or white and frothy ;respiration is cavernous in some parts anddull in others; a wheezing noise is heard inthe bronchial passages, from the presence ofan inordinate quantity of fluid; the musclesof respiration become very prominent, theneck is shortened, the chest being drawn up,the nostrils are dilated, and the countenanceis of an anxious aspect. The strength gra-dually wasting, the collier who has hithertocontinued at his employment finds that he isunable to work six days in the week, andgoes under ground-perhaps only two or threedays in that time ; in the course of time hefinds an occasional half-day’s employment asmuch as he can manage, and when only afew weeks’ or months’ journey from thegrave ultimately takes a final leave of hislabour.

" This disease is never cured, and if theunhappy victim of an unwholesome occupa-tion is not hurried off by some more acutedisease, or by violence, it invariably ends inthe death of the sufferer. Several colliershave died of this disease under my care, butthe number is inconsiderable compared withthose who have fallen under the less alarm-

ing and less rapid strides of bronchitis, withits numerous complications. William Swan,aged forty-four years, died of this diseaseunder my charge in 1835. According to anote of the case which I preserved, I findthat he expectorated fluid having’ much theappearance of thick (black) ink, and havingnot the least particle of white mucus or ofpus apparent;’ pulse 120, body much ema-ciated, and urine high-coloured and scanty.This man had been engaged from boyhood asa collier, and had for eighteen years beenoccasionally employed in blasting stonedykes with gunpowder. At the time of myattendance on this poor man I was told thathe was the last surviving man of a com-pany’ of several men, amounting, if 1 recol-lect aright, to ten or twelve, who had beenemployed only a few years back in blastingstone dykes in a colliery, all or most of them

having died of the’ black spit,’ or spuriousmelanosis, at an early age, the identical dis.ease of which poor Swan was dying.

" When the lungs of persons who havedied of this disease are examined after death,they are found to be of a black colour, as ifdyed, and to be the seat of much morbidalteration. Cavities or caverns are disco.vered in these organs, chiefly at the superiorparts, containing more or less black fluid ofsome consistence, and communicating for themost part together. When lungs thus black,ened and diseased are pressed, black-coloured serum or fluid is obtained, fromwhich, and likewise from the fluid containedin the caverns, an extract may be obtainedwhich burns with a flame the same as coal,and which when subjected to heat evolvesgas similar to coal-gas, and which is combus.tible. The parts of the lungs adjacent to thecaverns are generally condensed and oede-matous.

" The causes of this singular disease arecoal-dust, the carbon evolved by the combus-tion of lamps, and by the firing of gunpow.der, and also the stone-dust disengagedduring the disentegration of the dykes’ incollieries. The blackened colour of thelungs, and the fluids contained within them,obviously depend on the presence of minutecoal-dust, and the disengaged carbon of thelamps, and of the gunpowder used in blast.ing. It appears to me that the changes

brought about by these black bodies are

chiefly the dying of the lungs where therealready exist caverns, and where thesecaverns do not exist a certain amount of irritation in the bronchial passages and air-cellsof the lungs, for the most part giving rise to

violent bronchitis only, attended by thicken-ing of the mucous membrane, and a copioussecretion of mucous or muco-purulent fluid,to which they impart the black dye. But Iam inclined to think that though these blackagents seldom induce the’ black spit,’ characterised by degeneration of the lungs andby caverns, that they may sometimes bringabout this disease, where they are present inlarge quantity, and are continued for a considerable length of time, and when moreoverthe pulmonary tissue on which they are operating proves to be more than usually delicate and prone to ulcerative action.

° My reasons for holding this opinion arethe following : First, persons out of numberinhale minute coal-dust and the disengagedcarbon of lamps and gunpowder for mam’years, and continue to spit during that timeblackish expectoration without having anyindication of more serious lesion than that ofbronchitis, with its usual complications, andcertainly without the usual symptoms ofcavernous lung. Secondly, minute coal-dustand disengaged carbon, the product of com-bustion, are neither of an acrid nature, norothat mechanical irregularity which wouldnecessarily irritate the pulmonary- tissue 0

91

stlch an extent as to produce inflammatory hood up to old age. The most common ofaction, and caverns in an organ defended by them were, inflammation of that organ, anda mucous coat, lubricated by fluid and pos- of its covering the pericardium, simple en-sessed of means to throw off foreign agents. largement or hypertrophy, contraction of theThat coal-dust is neither acrid in its chemi- auriculo-ventricular communications, and ofcal nature nor irritating in its physical cha- the commencement of the aorta. The symp-racter is sufficiently proved by the fact, of toms were well marked, attended for thethe truth of which any one may satisfy him- most part with increase of the heart’s action,self, that coal-dust remains for years under the force of its contractions being sensiblythe integuments of colliers without producing augmented, and in many cases, especiallythe slightest inconvenience, excepting the those of hypertrophy, much and preternatu-disfigurement attendant upon the presence of rally extended over the chest. The breathingblack spots. Many colliers may be seen was usually much affected; the pulse un-with black discoloration of the white mem- natural, sometimes irregular, intermittent,brane of the eye, from the presence of coal- small, forcible, and jerking ; at other timesdust, without suffering the slightest pain, slow, large, and feeble, according to themorbid action, or inconvenience of any kind nature of the affection. A considerablein consequence. number of those affected with the acute in-" The chief cause of the degeneration and dammatory affections recovered perfectly,

of the caverns of the lungs in colliers suffer- but many only recovered partially, and foring under ’ black spit,’ appears to me to be the remainder of life suffered much annoy-the stone-dust disengaged during the disin- ance and bad health from the consequencestegration of the dykes. Stone’dust is much of these affections. Some suffered simplemore calculated than coal-dust to produce enlargement, and experienced strong palpi-irritation, inflammation, and ulcerative ac- tations and difficulty of breathing. Whention, from its greater irregularity and hard- the orifices became contracted, as frequentlyness. Sand rubbed in upon the skin produces happened, dropsical symptoms supervened,irritation, and when introduced under the and carried off the patient.eyelids induces severe inflammatory action. " The causes of the affections of the heartStone-masons suffer much from ulcerative among colliers I regard to be the applicationaction in the lungs, and from the formation of of cold and wet to the body during and aftercaverns in these organs, in consequence of work, violent straining and protracted exer-inhaling the stone-dust which is diffused tions requiring deep inspirations, interruptionthrough the atmosphere by their chiselling to the flow of the blood from the heart, inoperations. consequence of extensive disease of the lungs" I have frequently been informed by in- and bronchial tubes and cells, and also of

telligent colliers likewise that the black-spit great deformity; and the excessive dissipa-is rarely if ever produced in mere coal- tion in which colliers too frequently indulge.hewers, and that it is chiefly or entirely con- These causes operated occasionally singly,fined to those individuals who have been but for the most they acted conjointly in theengaged in stone-work, production of the diseases of the heart." The gaseous fluids evolved during the 14 Aueurisms and ossific deposits of the

firing of gunpowder may likewise act an great arteries within the chest I found to beimportant part in the production of the morbid common among colliers, and even among thealteration of the lungs, which are remarked women. I attribute these morbid alterationsin those who die of black-spit. If this view to the violent efforts which colliers are con-of the case be taken, it will appear that the stantly in the habit of making, and to intoxi-spurious melanosis of colliers is simply the cation and tippling, which are well known tosame disease to which stone-masons, needle- be productive of deranged nutrition of thepointers, and others who inhale sharp, gritty, heart and great vessels.and irritating particles are subject, to which · When aneurisms proved mortal, deathan additional feature, namely, the black usually took place instantaneously.colour of the lungs and expectoration, has " Inflammatory affections of the stomachbeen superadded, and which has been de- and liver are also common diseases amongrived from the black colour of the coal-dust colliers, and in consequence of the inductionand disengaged carbon, the product of com- of morbid alterations of structure, lead tobustion. destruction of health, and finally to prema-

41 Inflammatory affections of the lungs, ture death through the various steps of dys-their coverings the pleurae, and of the pepsia, intractable vomiting (occasionally ofmuscles of the chest, are very common com- blood), diarrhoea (sometimes bloody), jaun-plaints among colliers, and sometimes prove dice, and dropsy of the legs and belly. Themortal. The chief causes are, sudden changes chief cause of these affections, both in theirfrom heat to cold, suppressed perspiration, acute and chronic forms, is the excessive usewet clothes, and exposure in going to and of whisky.

-

from the colliery. " Hernia, or rupture, does not appear to" I found the diseases of the heart very have been more common among colliers than

common among colliers at all ages from- boy- among other labouring people.

92

" The kidney is very frequently the seat of 11 The diseases of the nervous system are,disease among colliers ; inflammation of that on the whole or taken collectively, not veryorgan came occasionally under my care. common among colliers, certainly much lessMorbid alterations of urine were particularly frequent than among the pampered and luxu.common, and gravel was frequently depo- rious ; but some individual forms of nervoussited. Several colliers died under my care disease are frequently observed.with partial suppression of the secretion of "Palsy of the lower extremities, boththat organ, and their cases were characterised complete and partial, are more common

by general dropsy, by their urine becoming among colliers than among persons engagedthick, and presenting white flakes like the in agricultural operations, or in the variousboiled white of an egg upon the application handicrafts. I have known many colliers atof a boiling heat, and by a lethargic condition an early age to be martyrs to this affection,of the brain, indicated by torpor of the mind in its various shades, from debility and ain all its divisions. The causes of the more tottering condition of the limbs to downrightserious diseases of the kidney were, exposure insensibility and complete loss of voluntaryto cold while the body was perspiring freely, motion. Some colliers who suffered theworking for hours together amid water and milder forms of this disease merely werewith wet clothes, contusions on back and enabled to continue at work, while of thoseloins, and excess in whisky. who were affected to a more serious extent"The two first-mentioned causes were the greater part remained helpless; a few

found to be in operation in the greatest num- recovered so far as to permit of their work-ber of the cases of organic alteration; contu- ing a little in the collieries, or to follow somesions and falls were the occasional exciting more easy occupation, such as driving acauses, and were generally attended by horse and cart, a very common resource

bloody urine, while a large majority of the among the crippled, and a considerable num.merely functional derangements was referri- ber died in consequence of coexistent injuryble to dissipation. to other parts. The most common, nay the

" Diseases of the spinal column are very almost invariable cause of this disease amongcommon at all ages among individuals em- colliers, was the application of violence to

ployed in collieries. I have attended many the spine, received in their occupation as

persons labouring under the most serious of colliers. A few cases of partial loss of powerthe diseases which are incident to the spine. and sensibility arose from blows and injuriesFew middle-aged or old colliers are to be inflicted on the head. In 1837 a poor lad,seen without curvature of the spine more or about twenty years of age, named Rutber-less extensive, the result of the unnatural ford, was affected with this disease: he

position in which their bodies are retained received a most severe injury on the backfor hours together when at work. This and upon the lower extremities. His limbsaffection is indicated by general crookedness were cold, senseless, and motionless; theof the trunk, by stooping, and in general by bladder was paralysed. After sufferingone shoulder being higher than the other. dreadful agony for several days he died. OnThe health of the collier does not necessarily examination after death the lumbar portionsuffer from mere curvature of the spine, of the spine was found dislocated, the bodyalthough it is frequently found that curva- of one vertebrae being driven a considerableture is most complete in those of delicate space before the one above it.health. In 1836 a young collier, about thirtyCaries of the vertebrae of the back and years old, named Duncan, suffered a some-

loins very frequently come under my charge what similar injury of the spine, and wasin the persons of young and middle-aged considered for some time in a dying condi-colliers, and has almost invariably termi- tion ; the bladder was paralysed, and like-nated in the formation of lumbar and psoas wise the lower limbs. In addition to thisabscess. Of the many colliers who suffered there were serious injuries of other parts.under these abscesses not one individual This man recovered sufficiently to go about,recovered. The size to which the external and although unfit for laborious occupation,tumour sometimes attained was enormous, went below ground again, but finding it im-and the quantity of fluid which was wont to possible to continue at that employment,pour out daily, for weeks in succession, was sought a livelihood by hawking articles aboutvery great. I have known some of these the country with a pony and cart.colliers to go about and work after the " Convulsions take place occasionallytumour had obtained considerable size, in among colliers, and are produced chiefly byorder to maintain themselves. the excessive use of whisky.

" The causes of caries of the spine, and of " General paralysis, or palsy of one side,lumbar and psoas abscess, are, for the most occurs not unfrequently, but certainly muchpart, strumous habit of body, great external less seldom than among men of studious andviolence, inducing inflammatory and snbse- literary habits. The chief cause is the long-quent suppurative action, and moderate vio- continued practice of drinking whisky to

lence or exertion concurring with a strumous excess. I do not remember having met adisposition, case of this or any other cerebral disease

93

produced by mental exertion or by moralcauses." Hypochondriasis I never met with in a

collier community, and those who were thusaffected were, almost without exception,puerperal women, or young persons labour-ing under organic disease of the brain." Common hysterical convulsion fits were

not uncommon, but the singular and anoma-lous forms of hysteria, in its modern wide

acceptation, were rarely remarked amongcollier females. I found whisky to be thecommon exciting cause of these convulsionfits, and the subjects were generally strongand florid young women." The various forms of continued fever

were very prevalent among the colliers whocame under my observation. It was a com-mon thing for many families in the samevillage to be ill of fever at the same time, andfor the members of all these families to beaffected. I have seen on many occasions thetwo beds in a collier house filled with personslabouring under typhus fever, each contain-ing four and five at the same time. So com-mon is fever among the collier population,that comparatively few are to be found at thethirtieth year who have not suffered fromthis disease. Death is a common termina-tion of this disease at all periods of life. The

old very frequently fell under this malady ;the middle-aged died less often ; and the

young recovered in the greatest numbers." Many heads of families died of this dis-

ease under my care, and the privation anddestitution consequent on this event was fre-quently of a very aggravated character. Ido not think fever was much more prevalentamong colliers than among other labourers."The exciting causes of this disease are

chiefly referrible to the habits of the colliers,to the condition of their domiciles, and tothat of the atmosphere around their dwell-ings. The habits which are productive offever are dissipation, irregular dieting, andgeneral recklessness. The conditions of thedomiciles favourable to the invasion of feverare those of non-ventilation, darkness, acces-sibility to the wind and rain, general filth,the presence of impurities, and of the generalabsence of necessary furniture and utensils.The condition of the atmosphere around thedwellings which favours the invasion offever, proceeds from the presence of heaps ofcorrupting animal and vegetable materials,known as dunghills, and commonly presentbefore the houses of the collier population."

MEDICAL ETIQUETTE ATCARLISLE.

SUPERIORS AND MENIALS IN DISPENSARIES.

MR. WILLIAM Boyn, a member of theRoyal College of Surgeons in London, hasforwarded to us a letter for publication,

which contains the following statements,presented to the profession by Mr. Boyd " onthe ground of its relation to a subject whichdeeply concerns their general interests,namely, the terms of mutual intercoursewhich ought to regulate the conduct of itsmembers." Mr. Boyd adds, that it is not

without reluctance that he has taken this

step, being but a young member of the pro-fession, but he justly considers that he hasbeen subjected to treatment which it wouldhave been as mean and spiritless in him to

bear, as it was tyrannical and insolent on

the part of those who endeavoured to subjecthim to their authority. Mr. Boyd thus de.scribes this treatment and its history :-

" On the 21st of February last I waselected to the office of apothecary to theCarlisle Dispensary by the medical commit-tee of that institution; on Tuesday, the 1stinstant, I went to Carlisle in pursuance ofthe appointment; excepting with one gentle-man, to whom I had a short time previouslyhad a letter of introduction, I was an utterstranger in the place. My predecessor, Mr.William Reeves, who has just commencedpractising on his own account, had beenunable to attend to his duties at the dispen-sary in consequence of indisposition for aperiod of more than two months, and duringthat time those duties had been dischargedfor him gratuitously by Mr. Dacre, a gentle-man who, although educated to the profes-sion, is not at present in practice. On thesame day that I arrived in Carlisle, Mr.Reeves was appointed an honorary medicalofficer of the charity. With a consideratekindness which I shall ever remember, Mr.Dacre proposed to continue his services inthe institution until I should have becomefully acquainted with the town ; and it was

arranged that he should attend with me tothe patients at that time on the books, whilstI took charge of the new cases. With a listof seventy-seven house patients to be visited,and not fewer than a hundred and thirtyout-patients, the latter of whom I under-stand are usually treated by the honoraryoflicers, I could not but be sensible of Mr.Dacre’s generous proposal, and we wereproceeding upon the plan I have just men-tioned. On the 3rd instant we were calledto visit a patient labouring under peritonitis :his symptoms in the first instance, however,were somewhat obscure ; the seat of disease,as indicated by tenderness on pressure, beingextremely circumscribed, and so close to thegroin as to give rise to some ambiguity.Under these circumstances, and in conse-

quence of being unable to meet with Mr.Reeves at the time, we mentioned the caseto Dr. Barnes, who is physician-extraordi-nary to the institution, and since the retire-ment of the late acting honorary officers, who