Appendix B to the report of the Commissioners appointed to inquire into the condition of all mines in Great Britain to which the provisions of the Act 23 & 24 Vict. Cap. 151 do not apply, with reference to the health and safety of persons employed in such mines. / Presented to both houses of Parliament by command of Her Majesty.
- Great Britain. Royal Commission on Mines
- Date:
- 1864
Licence: Public Domain Mark
Credit: Appendix B to the report of the Commissioners appointed to inquire into the condition of all mines in Great Britain to which the provisions of the Act 23 & 24 Vict. Cap. 151 do not apply, with reference to the health and safety of persons employed in such mines. / Presented to both houses of Parliament by command of Her Majesty. Source: Wellcome Collection.
Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.
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![3 mode of coiuniencenient. In some cases it supervenes alter the occurrence of cold or a state of prolonged but slight indisposition, as dyspepsia or rheumatism. In others it occurs suddenly with a severe attack of inflamma- tion of the chest, occasioned by cold taken in the mine or at the surface. When the disease originates in the former mode, it appears to have a special tendency to run into chronic asthma, with increasing difficulty of breathing and impairment of general power. In the latter mode it more 10 frequently is attended by active febrile disturbance and terminates in consolidation of some portion of the lungs, from which the jjatient never entirely recovers, but is left continxially suffering more or less from cough and exjjecto- ration, with increasing debility. In the former class of cases, or as I should regard it, in uncomplicated miner's asthma, the physical signs are often ^'ery slight in the earlier stages and afford little explanation of the difficulty of breathing, prostration of strength and palpitation, under which the patient labours. On carefully examining 20 all parts of the chest, the only morbid conditions de- tectable are often the want of full and free expansion, general feebleness of the respiratory sounds, and extreme weakness of the sounds and action of the heart and pulse at the wrist. In the advanced stages, however, the symptoms of asthma and the signs of emphysema become very marked. The difficulty of breathing is extreme, and is aggravated by any slight exertion, as by ascending stairs or a slight elevation, and it is usually nuich increased by certain 30 states of atmosphere and when the patient takes cold. Notwithstanding the great effort which is made in breath- ing the movements of the chest are most imperfect, there is little change of capacity with the inspu-atory and expiratory acts, and the respiration is almost entirely ab- dominal. The patient speaks slowly and interruptedly, and often is not able to count aloud tolO or 12 without drawing a fresh breath. The shoulders are raised, the supra-clavi- cular spaces much depressed, and the chest covered by large and distended veins. The chest is full and rounded. 40 The resonance on percussion is abnormally clear, and the inspiratory sound is scarcely audible and the expiratory prolonged ; or the respiratory sounds, if there be more or less bronchitis, are masked by sibilant and sonorous rlionchi. The dulness on percussion in the region of the heart is altogether absent or considerably diminished in extent; and the heart's sounds are very inaudible, and the jjulsation feeble and visible over a large space in the left side of the epigastrium. The pulse at the wrist is also uniformly weak and often slow. 50 In the other or complicated form of the disease there are usually evidences of consolidation in some part of the chest, at the upper clavicular, dorsal or lateral regions ; indicated by the usual signs, deficiency of resonance on percussion and of the respiratory movements and unduly loud cough and vocal resonance and tubular breathing. Sometimes the whole chest is contracted being narrow across, the supra clavicular spaces are depressed, and the liver and stomach advance to a high level from below. In this condition the resonance on percussion may be only slightly 60 if at all impaired, but the movements of the chest are very imperfect, the vocal thrill is usually exaggerated, and the respiratory sounds are harsh. Large veins are also generally seen upon the surface of the chest. In both forms of the disease the patients' strength be- comes very much reduced, their complexion is very sallow, and they suffer from shortness and difficulty of breath- ing, much aggravated upon taking any active exercise or when suffering from cold. They have usually a hard cough, often with a husky or hoarse voice, and they 70 expectorate a considerable quantity of secretion, which is generally described as of a deep brown colour. Their appetite is impaired, their food does not agree well with them and their bowels are confined. They often ex- perience palpitation, and the sounds and action of the heart and the pulse at the wrist are very feeble. The form of the disease in which there is local consolida- tion in some portion of the lungs, bears a close general resemblance to true consumption, and especially where, as often happens, the voice is husky and the patient expecto- 80 rates blood. There are, hovi'ever, features by which it is sufficiently distinguished fi'om that disease. It usually occurs in persons who do not present any hereditary pre- disposition to phthisis—their parents and other relatives having often attained advanced ages and being quite healthy. It commences at a later period of life than phthisis, indeed in ])ersons who have reached ages at which con- sumption is by no means of frequent occurrence. It is also much slower and less active in its progress, so that in per- sons who have been ill for several years the signs often do 90 not indicate extensive or advanced disease. The quickness of pulse, the rapid and extreme emaciation, and the night perspirations so characteristic of true phthisis, are also generally aljsent or only slightly marked, and there is rarely diarrhoea, indeed the bowels are often obstinately confined. The course and result of the two forms of miners' disease differ. When the affection takes the asthmatic form, though the patient continues always a great sufferer and unfit for any active occupation, life may be prolonged for many years. I met with instances in which the men stated that they had been in this state for several years, 100 7, 11 or 12, 20, and 25 or 2fi years. Indeed tnis condition seems to be a kind of imperfect natural cure. Patients several times mentioned that many years before they had been very seriously ill so as to be compelled to give up work, and were stated by medical men to be running into rapid consumption. After having, however, completely laid by for some months, or a year or two, they rallied, and while suffering from symptoms of asthma, recovered a cer- tain amount of vigour, and had continued much in the same state since. 110 In the form of disease in which portions of the lung become consolidated, the disease seems generally to progress, though slowly, and ultimately to determine some form of disorganization of the lungs. The signs of cavities develop themselves, indicating either considerable dilatation of the bronchial tubes or the occurrence of ulceration in the lung tissues, and the patient's power more rapidly breaks down, so that the affection usually terminates fatally at the most in 7 or 8 years. The precise nature of these several forms of affection can 120 only be ascertained by a series of post-mortem examina- tions, and I have had the opportunity of examining after death but one case of miners' disease. In that instance the affection seemed to have originated in bronchitis and pneumonia, leading to collapse or consolidation of the lung, and no tubercle was found in any part of the body. The patient was a man 55 years of age, who had been a miner since he was 13 or 14 years old; he had been laid by ill for three years, though ailing for a greater length of time. The left lung was found slightly attached to the parietes 130 by old cellular adhesions. It was voluminous, somewhat emphysematous at the edges, of a deep blue or black colour, and sparingly crepitant. The bronchial tubes con- tained much secretion of a dark brown colour. The right lung was universally attached to the parietes by strong fibro-cartilaginous adhesions. One of the ribs was carious, and an abscess had formed in the situation, con- taining thick yellow pus, which involved the pleura but not the lung itself. The substance of the lung was of the same colour as the left, and entirely solid [except towards 140 the upjjer part, where there were several irregularly shaped cavities, which, together with the bronchial tubes, contained a similar brown material to that found in the tubes of the left lung. The bronchial glands were also very large, hard, and of a black colour. In the bronchus of the right lung, the terminal jjortion of that of the left, and the commence- ment of the trachea, the mucous membrane was deeply reddened and studded with small yellowish coloured deposits of lymph. The trachea and larynx were large, 150 but the mucous membrane on the epiglottis and cordse vocales, though thickened, was free from ulceration. It will be seen from the tables in the appendix that this form of disease occurred, generally speaking, in persons of midddle age; of 39 patients examined, the mean age at ' the time was 47 years, and the extremes of age 25 and 63. The average duration of the disease was then four years, but there was a great variety in the cases in this respect, the periods having ranged from 1 year to 25 or 26. The ages at which the patients stated that they had 160 first worked underground ranged from 7, 8, and 9, to 20 and 27 years, and their })eriod of work prior to the occur- rence of disease was, on an average of 36 cases, 27 years. From this calculation, however, three cases in which the patient had only worked one year, five years, and eight years, are excluded ; and without these cases the periods of work ranged from 11 to 51 years. Consumption.—Next in point of frequency among the diseases of the miners was tubercular consumption. Of this affection I met with 12 cases in which the disease was ad- 170 vanced, and three others in which it was only commencing. In five cases also classed under the head of miners' asthma, there were detected evidences of consolidation at the upper part of one or both lungs, which might have been tubercu- lous, but probably was the result of inflammatory action in impaired constitutions. As is usually the case, the instances of consumption which fell under my notice occxirrcd most generally in persons who displayed some hereditary predisposition to the disease, other members of the same family and often persons who had not worked 180 underground, having died of consumption. The cases of consumption in miners did not differ from the disease as ordinarily seen, except that in some instances the affection occurred at ages at which, xmdev favourable cir- 3](https://iiif.wellcomecollection.org/image/b23983292_0007.jp2/full/800%2C/0/default.jpg)
