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

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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cumstances, the liability is comparatively small; the disease also \\ as sometimes unusually prolonpjed. In other respects all the common characters of phthsis were observed—the quickness of pulse, tbe night perspirations, the tendency to diarrhoE-a, and the physical signs were those which are commonly detected. In one case the disease disjjlaycd a somewhat imusual complication, albuminuria and dropsy. The cases taljulated in the appendix illustrate the remarks here made. The mean age of the 12 patients was 35 years, iO and the ages ranged from 21 to 62. The duration of the disease averaged 9 to 10 months at the time the patients were examined, the extreme duration being four months and seven or eight years. The ages at which the patients had begun to work underground ranged from 9 or 10 to 21, and of 11 cases the period of work prior to the com- mencement of the symptoms was 20 years. The extreme periods of work were 14 and 41 years, exclusive of one case in which a person, always very delicate, had only worked five years. 20 There can be no doubt that the work in which the miners are engaged peculiarly predisposes them to suffer from alTections of the chest; but the special form which these affections assume would appear to depend to a considerable extent upon the original constitutional power of the men, and especially u]5on the existence or absence of any hereditary predisposition to phthisis. When the miner is of healthy constitution, he resists to a much later period the unfavour- able influences to which he is subjected, and the diseases 'vhich iiltimately occur are asthma connected with gradual 30 failure of the power of the heart and lungs, with or with- out chronic bronchitis; or iriflaramatory consolidation of some portion of the lungs, which may ultimately terminate in disorganization and ulceration of the tissue. When on the contrary the 2)atient is originally of feeble constitutional power, and especially if predisposed to phthisis, he becomes an invalid at an earlier period, and suffers from true tubercular phthisis. In some cases, how- ever, where the predisposition is only slight, the patient escapes the disease during the period of life in which the 40 tendency is usually manifested, and only sinks under it when under more fa-\'ourable circumstances he would pro- bably have escaped it altogether. A case of mesenteric disease, an affection also of tuber- culous nature, in a boy 17 years of age, who had gone to work underground at 14 and had worked about a year and a half before his health failed, is also included among the cases examined. 4. Diseases of the heart, SfC.—From the violent muscular exertion undergone by the miners, l)oth when working 50 underground and m ascending the ladders, I expected fre- quently to meet with affections of the heart among them, and such proved to be the case. The forms of disease which were observed were not, however, with one or two exceptions, such as are generally occasioned by any violent muscular exertion, as rupture or injury of the aortic valves. The prevalent form of cardiac defects appears indeed rather to be mitral valvular disease, resulting probably from dila- tation of the left ventricle and consequent ill adjustment of the valves, so as to render them incompetent to close the go orifice. In four cases patients complained of palpitation of the heart, increased on exertion and incapacitating them from following their employment. In two of these the symptoms were first experienced after severe sprains, and some injury had probably been sustained by the heart, though no signs of valvular or other defect could be detected. In one of the two other cases the heart was apparently dilated, and in the fourth there were marked dyspeptic symptoms. In four cases there were the usual symptoms and signs of 7 0 more or less aggravated mitral valvular disease. In one of them the affection had supervened on acute rheumatism; in another the patient had had some jiain, redness and swelling of the hands at the time the heart first became affected, which might have been rheumatic. The other cases had no connexion with rheumatism. The ages of the men who wei'e thus affected were 21, 31, 36, and 36 ; had first commenced working underground when 13, 1.5, 16, and 17 years of age respectively, and when examined they had been incapacitated from work for two and a half to three 80 years, seven months, ten or eleven years, and four years. In addition to these cases, there were others classed under the head of miners' asthma, in which palpitation was a pre- dominant symptom, the heart was dilated, and the action of the mitral valves probably defective. Indeed it will be remembered that in that form of affection, shortness of breath and palpitation were common symptoms, even at an early jieriod, and often existed to an extent altogether dis- proportionate to any signs of pulmonary disease which could be detected. They were therefore probably connected f)0 with some failure of muscular power and dilatation of the cavities of the heart. In the later or more advanced stages of miners' astlima there could be no doubt of the existence of dilatation of the right side of the heart, and the affection probably invoh^ed the left side also. The pulsation was generally visible over a large space in the praecordia and to the right of the left false ribs in the epigastrium ; the im- pulse of the heart was feeble, the sounds indistinct, and the pulse at the wrist also weak. In the only case of miners' disease which I had the oppor- tunity of examining after death, the heart was found some- 100 what large, and weighed probably about 10| oz. avoir. The cavities were dilated, but the walls not increased in thickness. The attached pericardium was loose and (Edematous, and the muscular substance of the heart pale and flabby. The valves were healthy, but the aorta and pul- monary artery were both considerably dilated, though not otherwise diseased. A case of aortic valTOlar disease was met with in a miner 51 years of age, who laboured also under hemiplegia. He stated that he had commenced to go underground at the 110 age of 15, and had always worked in good air, having been employed as a coacher, or in pushing the trucks along the tramways from the places where the men were getting the ore or driving levels to the shafts. The work was severe and he had been much exposed to cold draughts, but had never had any rheumatic symptoms. The date of' the first occurrence of the cardiac symptoms could not be ascer- tained, but the first attack of paralysis had occurred five years before I saw him. Another man, 44 years of age, laboured under symptoms of 120 angina pectoris. He had first worked in a mine when 14 years old, and had chiefly been employed in damp shafts, repairing them when forking out, or being pumped out to be re-worked after having been abandoned. He com- plained of suffering severe pain at the sternum and in the region of the heart, extending through to the left shoulder blade and down both upper arms especially the left. He was first attacked when walking to the mine one morning ; and the pain had since continued to recur, especially on exertion, with such severity that he had been quite incapa- 130 ble of undertaking any employment whatever. It was accompanied by breathlessness, but was unattended by any sense of faintness or insensibility. It usually subsided in a few minutes if he immediately stood still when it came on ; and under the rigid observance of rest and freedom from excitement had become less severe and of less frequent occurrence. On careful examination no signs of disease of the heart or aorta could be detected. 5. Affections of the nervous system and organs of special sense.—I have already mentioned that in the case of aortic 140 valvular disease the patient had hemiplegia. He had bad two attacks of paralysis; of which the first occurred five years before he was seen, since which, time he had been unable to work. In the other case the patient had com- mencing miners' asthma. He was 69 years of age, had worked as a miner from the age of 10, and had been laid by with paralysis for eight and a half years. In three cases the patients were paraplegic. In one of them a man 50 years of age, who had first worked in a mine at 17 or 18, had been laid by for one year and seven months 150 mth loss of power over the lower extremities, which came on after he had been working in cold water. In the second case the patient was 49 years of age; he had first gone underground at the age of 18, and had been paraplegic for six years. In this instance the power of speech was affected and the paralysis was becoming general. In the third case the paraplegia was less complete. It occurred in a man 44 years of age, and was ascribed to a fall in the mine from a height of 24 feet which had occurred seven months before. 160 I met also with a case of very marked paralysis agitans in a man 52 years of age, who had begun to work as a miner when nine years old, and laboured undervery severe miners' asthma. He had been ill and unable to work for seven or eight years. In addition, howev^er, to these more serious affections, symptoms of nervous disorder are very often complained of by the miners. Deafness is extremely comm.on, and frequently exists to a marked degree in men who have worked several years underground, and this too when they have never sus- 170 tained any injury from blasts or other accident to which the condition could be assigned. In the cases of slow fever, miners' asthma, and indeed in almost all the forms of affection to which the miners' are liable, the men very generally complain of suffering from headache, giddiness, noises in the ears, depression of spirits, &c., and these symptoms often exist to a very dis- tressing extent. 6. Drojjsical affections.—In one of the most marked cases of miners' asthma which was seen, the patient stated that 180 when his asthmatic symptoms were more severe, as during winter or when he took additional cold, his feet and ankles became swollen. He was 49 years of age; had first begun to work as a miner when 14, and had been incapable of

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