Pathology Spotlight: A Historic Black Lung

lung

The specimen shows Coalworker’s Pneumoconiosis or ‘Black Lung’, the scarring lung disease caused by inhaling the dust produced in coalmines. In the 19th century a burgeoning British coal-mining industry supplied fuel for the Industrial Revolution and by the 1830s, around 200,000 British miners were producing 36 million tons of coal per year. It seems obvious now that inhalation of dust-laden air by colliers might result in harmful accumulations of dust in their lungs, but this was not initially apparent to physicians and surgeons. In fact, the first report of a link between working as a coal miner, the accumulation of a black pigment in the lungs and debilitating lung disease was not made until 1831. In that year, the physician James Craufurd Gregory received John Hogg, aged 59, into his care at Edinburgh Royal Infirmary. Hogg had worked as a miner in Dalkeith for the previous decade and was suffering from severe heart and lung disease. When he died, Gregory carried out an autopsy and noted:  “When cut into, both lungs presented one uniform black carbonaceous colour, pervading every part of their substance”. There was also a considerable degree of concurrent scarring and cavitation of the lung. Gregory speculated that the black pigment might be coal dust and handed the lungs to Sir Robert Christison, the Edinburgh toxicologist famed for his forensic investigations. Christison analysed the black pigment extracted from the lungs and confirmed that it was indeed coal dust. Gregory published a paper, describing John Hogg and his lungs which was the first to suggest that lung disease arose from employment in coal-mines. In it, he proposed that the coal-mine dust “remaining unabsorbed and acting as a foreign body… led ultimately to disorganisation of the pulmonary tissue”. He also issued a perceptive public health warning to medical practitioners in coal-mining areas regarding “…a disease to which a numerous class of the community would appear to be peculiarly exposed”. Although prescient in this regard, Gregory could scarcely have imagined the epidemic of lung disease that was to develop throughout the world due to coal mining, claiming millions of lives and disabling millions more. In 1840, Christison gave Hogg’s lung to the Museum of the Royal College of Surgeons of Edinburgh, where it lay undiscovered until 2016 when it was recognised for its historic significance as the first lung in which Coalworker’s Pneumoconiosis was ever described.

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