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Excerpts from a Clinical Report and Autopsy by Professor Traube on a Patient with Lung Disease caused by Coal Dust (1860)

The excerpts from the clinical report and autopsy performed in 1860 by Professor Ludwig Traube (1818-1876) of Berlin's Charité Hospital on a 54-year-old working-class patient suffering from lung disease reveal in drastic detail the effects of coal dust in conjunction with malnutrition and other circumstances typical for workers in the period of early industrialization. At the time, German medical science gradually came to understand the causes and symptoms of the respiratory disease known as black lung.

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I. Part 1

I believe that the following observations deserve to be reported, not only because they answer a question that has been pending for some time: whether or not coal particles are able to penetrate in larger quantities into the interior of the respiratory organ and accumulate in the pulmonary alveoli; but also because they relate to some general pathological questions, making important contributions to their eventual resolution. I shall therefore be forgiven for offering a more detailed account of the specifics that strike me as conclusive, and even of the accompanying circumstances.

H., laborer, 54 years old, was admitted to the Charité on October 21, 1860. For about twenty years he has been suffering from a cough with white sputum. Often times the cough would disappear completely, but given the patient’s irregular lifestyle (he is by his own admission a drinker), it soon returned. For a number of years he has also been afflicted by shortness of breath, which has manifested itself especially after more strenuous exertions. Haemoptysis or chest pain was reportedly never present when it happened. Patient used to submit to a bleeding every year around Midsummer's Day, though he has not done so the last 12 years. He states that he never sought medical attention at any time.

Three and a half months ago, supposedly as a result of hard labor during which the patient was continuously exposed to unfavorable weather, the cough and sputum – but especially the difficulty breathing – increased to the point where he had to give up his job. After several weeks, these complaints were joined by swelling of the legs. A doctor who was then summoned sent him to a hospital, but since the cough grew stronger, the sputum more abundant, and the difficulty breathing and the edematous swelling increased as well, he left again after only 4 weeks. Back at home, feeling very faint and weak, he was confined to his bed all the time. After he had spent another 14 days in this state, without feeling any improvement in his sickness, on the contrary, the dropsy getting worse and spreading also to his upper body, he sought help at the Charité. There his condition is said to have improved quickly, even though he developed some bloody sputum about 8 days after being admitted. As the information I have obtained shows, the diagnosis at the time was a diffuse bronchial catarrh with pulmonary emphysema. The urine was free of protein. The dropsy was initially treated with various diuretics, without success. Eventually, with the use of a saturatio communis, there was an adequate diuresis. The disappearance of the hydropsy also diminished the cough, the sputum, and the difficulty breathing. Another ailment, a swelling of the right leg caused by venal thrombosis, which had joined the chief complaint shortly after his admission, was also cleared up (by rubbing it with gray ointment and applying tinctura jodi).

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