ly 1836. From his statement regarding the
cause of the disease, I was led to understand that his cough, which
never left him from the time he was first seized, was induced, at an
early period, by bad air generated in the coal-pit at Black Wells, from
the work being ill ventilated, and from the general use of coarse
linseed oil for the lamps.

When I first saw this man professionally, he was labouring under general
weakness; his pulse was not above 40 in the minute, small and thready.
He suffered from drowsy headach, anorexia, cold and slightly
oedematous limbs. He had incessant cough, with tough mucous
expectoration. During a severe paroxysm, he vomited a mouthful of black
paint-like fluid, followed by considerable relief, and ever after till
his death, he continued to expectorate the same substance in great
quantity, often to the extent of 15 oz. daily. In examining the chest
with the ear, the sound, from the distinct pectoriloquy, indicated a
cavernous state of both lungs; otherwise the bruit was obscure.

The remedies were merely of a palliative character, knowing the patient
to be rapidly sinking. In this exhausted state he remained for some
months; his appetite was almost entirely gone; the oedema of limbs
increasing. There was also a leaden hue over the surface of the body,
which was constantly cold. At this stage, the quantity of urine voided
was small and dark in colour. Bowels obstinate; occasional vomiting. The
pulse ranged from 38 to 40. The lips and ears were livid, and his
drowsiness became more overpowering as death approached.

_Post-mortem examination._--The body was much emaciated; the ribs were
prominent and unyielding. On removing the anterior part of the thorax,
the lungs were found firmly adhering to the pleura costalis, and of a
dark blue colour. There was an effusion to the extent of about sixteen
ounces of light-brown fluid, found in the cavities of the pleura. The
greater part of the effusion was into the left side. The lining membrane
of the chest was almost wholly covered with false membrane of a dark
brown colour. The right lung filled almost completely the right cavity
of the thorax, while the left lung appeared much contracted,
particularly towards the apex. The pleura of both lungs was much
puckered, and interspersed with dark red patches around the adhesions.
Three or four of the substernal glands were found considerably enlarged,
and filled with black fluid, and a cluster of the anteri