THE COLLIERY GUARDIAN

AND

JOURNAL OF THE COAL AND IRON TRADES.

Vol. CVII.

FRIDAY, MARCH 6, 1914.

No. 2775.

The Hygienic Aspect of the Coalmining Industry.
(Continued from page 457).

CO POISONING AND ITS AFTER = EFFECTS—DUST DISEASES—THE DANGERS
OF STONEDUSTING—INFLUENCE OF HIGH TEMPERATURES.

The second of the Milroy lectures by Dr. F.
Shufflebotham, Newcastle, Staffordshire, on “ The
Hygienic Aspect of the Coalmining Industry in the
United Kingdom,” before the Royal College of
Physicians, was delivered on Tuesday evening, Feb-
ruary 24, at the College, Pall Mall East, London, the
subject being “ Colliery Explosions and Poisonous Gases
of Mines.”

Dr. Shufflebotham, in the first place, dealt with the
causes of explosions and the influence of coaldust. He
afterwards referred to the suggested remedies of
watering and stonedust.

The lecturer’s next division of his subject was
“ poisonous gases,” and he pointed out that the poisonous
gases found naturally in mines were blackdamp, fire-
damp, carbonic acid, and in small quantities sulphuretted
hydrogen and sulphurous acid, and as a result of the
use of explosives they might find also oxides of
nitrogen. He went on to discuss these gases in detail,
dealing with their properties and detection, the effects
upon man, treatment and post-mortem appearance,
quoting Haldane, Cadman, Whalley, Le Chatelier,
Oliver, Chamberlin, Chauffard, Ruata, Mosso and other
authorities.

Experience at Senghenydd.

Dr. Shufflebotham then spoke of carbon monoxide
with special reference to examination of the blood,
and gave some interesting notes of a visit he paid
to Senghenydd two days after the explosion, when he
had the opportunity of examining many men who were
rescued from the pit on the day following the explosion.
The principal clinical features of these cases were that
in those who had been badly gassed the pulse rate was
most irregular, not only as regards frequency, but as
regards volume and character, and examination of the
pulse gave no indication of the physical condition of the
patient. At one time the pulse might be slow, feeble
and irregular, apparently the pulse of a patient slowly
sinking; but, without apparent cause, 10 minutes after-
wards the pulse would be of normal rate and would have
materially improved in quality. In one case the pulse
rate of a patient varied in 10 minutes from 60 to 84,
and in another from 60 to 120 in the space of half an
hour. Dr. Phillip James, of Senghenydd, the principal
medical officer to the colliery, told him that this was a
special feature of these cases, and it made it impossible
to give a correct prognosis to the friends of the patient.

The large majority of these cases showed large
patches of an erythematous rash, of a bright cherry-
coloured hue, the characteristic colour of carbon mon-
oxide poisoning. These patches had clearly defined
margins, and were irregular in shape; they varied in
size from areas of 6 in. long by 4 in. or 5 in. broad, down
to areas 1J in. long by J in. broad. These patches were
tender to touch, and they were tense on pressure, and
there was a considerable amount of induration around
the patches. These patches were principally located
upon the buttocks, sometimes only on one side, but in a
few cases on both sides. When both sides of the
buttocks were affected, the patches were not sym-
metrical, and they varied in size and location on both
sides of the buttocks. In one case there was a patch
on the outside of the right knee, and in another case a
patch on the outer side of the middle of the left leg,
and in one of two cases small patches were seen around
the ribs. He was not aware that this condition had
been described before, and in these cases they were
reported to him as superficial burns. He was sure they
were not burns, not only because of the location of the
rash, but also because there was no blister over any of
these areas: further than that, some patches developed
for days after the explosion, and there had been no
superficial marks on the area of skin which were so
affected. The patches that he found on the thoracic
wall were not shingles, and he attributed this con-
dition to some toxic (poisonous) condition due to the
inhalation of carbon monoxide, which might have
been brought about through irritation of nervous

centres. These patches of induration were very slow
in clearing up. Six weeks after the explosion, he made
a second examination of these men, and found that the
induration had to a large extent subsided, but not
completely.

The third striking clinical point that he wished to
record in connection with this explosion was the
development of peroneal palsy, or ankle-drop, in seven
of the cases who were rescued. Previous writers had
recorded paralysis of different kinds as being a symptom
of carbon monoxide poisoning, but he had never found
any special reference to peripheral neuritis affecting the
peroneal nerve and causing ankle-drop. In these cases,
this symptom developed from two to four days after the
explosion. The early symptoms were pains in the leg
(for in each case only one leg was affected), which in
two cases the patients said were due to rheumatism. On
examination he found that there was tenderness along
the peroneal nerve, and there was the well-known condi-
tion of talipes equinovarus. In each case there was a
diminished knee-jerk on the affected side. The peroneal
paralysis passed on from the acute to the chronic stage,
and in some cases he feared that the paralysis would be
permanent. Six weeks after the explosion, the symptoms
were loss of power of dorsiflexion of the foot. In one or
two instances there was complete paralysis in this
respect, and in some cases there was diminished power
of plantiflexion. The cutaneous reflexes were absent
over the area of skin supplied by the peroneal nerve,
and in some cases there were irregular areas of skin,
apart from the distribution of this nerve, which were
similarly affected. Individual cases were then described
in detail.

Pneumonia.

Dr. Shufflebotham next stated that, after many
explosions, it had been frequently observed that
pneumonia of a particularly dangerous type was a
frequent sequela, and the Senghenydd explosion was no
exception in this respect. Several of the patients
developed pneumonia almost immediately they had been
rescued, but it was not the ordinary type of lobar
pneumonia, where there was a high temperature and
one lobe of the lung was affected. In these cases one
found that the temperature was very little raised above
the normal, the pulse was variable in frequency and
quality, as he had already indicated, the respirations
were quick, and the expectoration from the onset of the
disease contained blood of a dark blue colour, thus
differing from the rusty sputum of the ordinary lobar
pneumonia. Examination of the blood showed
irregular patches of dulness on both sides of the lung,
and in this way differed again from pneumonia of the
ordinary type.

It was interesting to consider how this type of pneu-
monia was set up after exposure to afterdamp, and he
believed that it might be due to one or more of four
causes. He presupposed that in every case pneumococci
were present in the mouth or throat of the patient, and
that they invaded the body through the vitality being
reduced either by the inhalation of carbon monoxide
itself, or carbon monoxide along with either sulphurous
or nitrous fumes, both of which gases might be present
in small quantities in the mine air after the explosion,
but it might also be attributed to exposure in the mine
for some hours after the explosion had taken place and
before the patient was rescued. In the case of pneumonia
which he saw after this explosion, there was no irritation
of either the conjunctiva or the throat, as evidenced by
the absence of conjunctivitis and pharyngitis, and there-
fore he believed these patients were not exposed to
either sulphurous or nitrous fumes. . Bronchial pneu-
monia, bronchitis and pleurisy were all recognised
sequelse of extensive burns, especially when the skin
over the thorax had been injured; but in none of the
cases in which lung trouble was set up after the
explosion at Senghenydd were there any signs of burns,
and when an attack of pneumonia followed a severe
burn there was invariably a high temperature, reaching,
perhaps, to 103 or 104 degrees Fahr. Retention of urine
was a striking symptom in every case, and in two cases
there was paralysis of the sphincter ani.

The lecturer gave details of cases, and remarking that
it was only possible to obtain a complete knowledge of
the symptonautology of poisoning by afterdamp by
observations made on persons actually rescued after an
explosion, went on to refer to Dr. Shaw Lyttle’s notes

on a dozen miners rescued from the Albion Colliery
explosion, which took place in 1894, and as a result
of which 270 lives were lost. He also referred to the
post-mortem appearances due to afterdamp poisoning,
with special reference to the Tylorstown explosion, 1896,
the Micklefield explosion, 1896, the Darran explosion,
1909, and the Whitehaven and Hulton explosions, 1910.
He quoted Judson Berry, Dr. Turner (Darran), Le Neve
Foster, Sir Thomas Oliver, &c.

He said the after effects of CO poisoning were often
of a serious nature, and he had known severe headaches
to persist for six months afterwards. Symptoms of
indigestion might also persist for an equally long time,
and there were recorded cases in which muscular weak-
ness was present for a week or two after the explosion.
Another noticeable symptom was the coldness of the
legs and feet; the legs might also feel heavy and numb,
and occasionally the patient might complain of shooting
pains. These symptoms of muscular weakness were, in
his opinion,, due to neuritis. One of the most striking
after-effects was the alteration in the voice; in addition
to aphasia, one might find that the voice had become
high pitched. The toxic effects produced by CO were
so similar to those produced by other poisons that it
almost seemed as if-toxaemia, no matter how produced,
had the same effects upon the central nervous system.

As to chronic poisoning by CO, Dr. Shufflebotham
observed that a large number of miners were pale in
appearance, although this was not by any means an
invariable rule, and it was a matter of speculation if the
paleness was due to the daily inhalation of very small
quantities of CO. He had taken blood counts of many
miners, and had examined the blood for CO, but with
only negative results. Sir Thomas Oliver had ques-
tioned whether miners’ nystagmus might not be due to
the toxic effect upon the central nervous system of
small quantities of CO continuously inhaled while the
miner was at work in the pit.

Beds at Colliery Offices.

Dr. Shufflebotham dealt in some detail with the
treatment of carbon monoxide poisoning, and said that,
as far as he knew, there was no provision in the colliery
districts of this country at the pithead for patients being
immediately put to bed after they have reached the
surface. At Senghenydd 18 men were rescued between
18 and 24 hours after the disaster occurred, and seven
of them were sent to the Cardiff Infirmary, a distance
of eleven miles; one died on the way and only one of
the remaining six survived. The conveyance of patients
long distances to their homes or to hospitals after being
brought out of the mine might aggravate their condi-
tion and even cause death, and he suggested that in
colliery offices a few folding beds should be kept, so that
they could be used at a few hours’ notice for cases of
afterdamp poisoning should they arise. In every case
of an explosion it was always some hours before victims
were brought to the surface, and in this time proper
provision could be made in some of the offices or
adjoining buildings for putting up beds in rooms that
could be properly ventilated and heated, so that the
patient was not exposed to any risk by a journey either
to a hospital or his own home. As the treatment
of pneumonia was very largely a matter of nursing, it
was essential that patients suffering from this com-
plaint should be attended by trained nurses from the
very onset of the pneumonic symptoms. While the Red
Cross nurses might be very willing to do what they were
told, and might have very good intentions, unless they
had been properly trained as nurses their efforts in such
cases as these might be and had proved to be in many
cases of little avail. He wished to emphasise this point,
because he felt that it was useless to rescue men from
a mine after an explosion at great personal risk to the
members of the rescue parties unless everything was
done that was possible to save the lives of those who
were rescued.

The experience at Senghenydd clearly pointed to the
fact that cases of peripheral neuritis would not cure
themselves, and it was most important for patients to
have the advantage of massage and electric treatment
carried out under medical supervision and in a systematic
way, so as to endeavour to restore the functions of the
injured parts at the earliest possible moment.

Towards the end of his lecture Dr. Shufflebotham
dealt with the effects of sulphuretted hydrogen, smoke,
sulphurous acid, nitrous fumes, &c.

Dust Diseases.

Dr. Shufflebotham’s third lecture was given on
Thursday, February 26, the subjects being “ The Effect of
Mine Dust upon the Health of the Workers” and “The
Influence of Temperature and Humidity of the
Atmosphere on the Health of the Miners.”

Dr. Shufflebotham, in the course of his lecture,
said that fibroid lung (such as potters suffer from) was