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Sir,

In compliance with your request I have the honour to report to you upon the effects of poisoning by carbon monoxide at Snaefell Mine.

On the morning of Monday, 10th May, 1897, about 6 a.m., thirty-one miners commenced their descent down the ladderway in the main shaft of the mine, in complete ignorance that anything unusual had taken place ; and no one at the surface had the slightest suspicion of the tragedy which was being enacted below ground until about 7 a.m., when some of the miners returned to the top of the pit in an exhausted condition. The manager at once perceived that something serious had taken place, and without a moment's delay sent down to the village of Laxey for assistance. On reaching the mine about 8.30 a.m., I found that eight of the men had managed to reach the surface by their own exertions. None of them presented any symptoms of note, except that they were all more or less unduly excited. They stated that they had not noticed anything unusual in the shaft till they had descended for a considerable distance below the 60-fathoms level, when some of them thought they perceived a smell of "singeing" ; but as there was no smoke, and as their candles were burning brightly, they continued to descend till they were told to go back by some of the men who were below them on the ladders. On commencing to ascend they found they had great difficulty in climbing ; their legs soon gave way at the knees, and they suffered from extreme palpitation of the heart and breathlessness. The more they hurried the more pronounced were these symptoms, till they were forced to rest. While at rest they did not experience much discomfort, with the exception of a feeling of weight over the cardiac region ; there was also extreme disinclination for further exertion. In their journey upwards some of them had passed several of their comrades, who were either clinging to a ladder quite unable to get any higher, or were resting on one of the landings too worn out to continue the struggle to the surface. I would here remark that the younger and more robust seemed to suffer much more than the older men. Of the eleven who either reached the surface by their own exertions or were sent up by the rescuing parties alive, the large majority were men of middle age and over, while the nineteen who were quite dead when discovered were mostly young men well under thirty years of age. This is to be explained by their relatively greater activity. On the alarm being given they would naturally begin climbing the ladders at a very rapid rate, passing many of those who eventually reached the surface alive, only to be re-passed by these who had been obliged to take it more leisurely. The effect of this rapidity of motion would be to greatly accelerate respiration and the heart's action. They would consequently absorb much more of the poisonous gas in a given time, so that when they finally sank exhausted they were too far gone to make any effort to save themselves.

The following clinical notes refer to the four men brought to the surface alive by the rescuing parties :—

No. 1, aged 50.²⁹ He had been dragged up the ladderway by means of a rope, and when he arrived at the surface about 10 a.m. he was in a very exhausted condition, though not unconscious. He could neither walk nor stand without support. He was moaning piteously and seemed in a very muddled state of mind. When offered a stimulant he took the glass but did not know what to do with it. He complained bitterly of being cold, and had to be prevented from getting into a large fire before which he was placed. Skin pale ; lips livid ; no pulse ; faint heart sounds could just be detected with a stethoscope. Breathing did not seem to be impaired, though somewhat hurried. Pupils dilated, but reacted to light. In the course of some minutes he vomited freely, which seemed to give him munch relief. After remaining for some hours in a warm room he recovered sufficiently to go home, though the pulse was still almost imperceptible. A day or two later he was little the worse for his experience, with the exception of some weakness of the lower limbs and slight headache.

No. 2, aged 70.³⁰ He was brought to the surface about 4 p.m. and was immediately put to bed in a temporary hospital. He was quite unconscious, skin deathly pale and cold ; lips livid ; no pulse ; very faint heart, sounds could be heard with the stethoscope. The breathing was sterterous with much frothing at the mouth. Pupils dilated, and would not react to light; Conjunctival reflex absent. There was considerable rigidity of the muscles, especially of the arms, which were tightly crossed over the chest, and could not he moved even when considerable force was used. I gave him a hypodermic injection of ether, and applied hot-water bottles to the abdomen and to the feet. At 6 p.m. he was in munch the same state, though the breathing was a little less sterterous, and the pupils not quite so dilated. Still there was no pulse and the muscles were yet very rigid. At 8 p.m. he was partially conscious, muttering to himself, and jerking his limbs about so much that he had to be held in bed. Conjunctival reflex was present, and the muscles contracted. The muscular rigidity had almost disappeared, and he was able to swallow a little fluid, after which he vomited. His skin felt warm and colour much improved, but still no pulse was perceptible at the wrist, although the breathing was quiet and natural. At 10 p.m. he was quite conscious, though much confused and unable to sit up. He tried to pass water, but had great difficulty in doing so. The pupils were now normal, and there was a slight pulse perceptible at the wrist. He passed a good night with the exception of a constant desire to empty his bladder, and considerable difficulty in maturation. He was sent home on the Tuesday afternoon, and in a few days had practically recovered.

No. 3, aged 44.³¹ He was brought up about 4.30 p.m. His symptoms corresponded exactly with those observed in No. 2, except that he was more profoundly unconscious, and his breathing though sterterous was shallow and irregular. The same treatment was adopted as in No. 2, but by midnight there was no change in his condition, for he was absolutely unconscious. At 10 o'clock the next morning he was still unconscious and pulse less, though the breathing was not so sterterous and was less shallow. His skin was getting warm and its colour improving. Pupils still dilated, and no conjunctival reflex. A catheter was passed drawing off about ten ounces of apparently normal urine, and a rectal injection of egg and brandy was given. At 8 o'clock the same evening his temperature was 100°, and his skin was warm and moist; breathing quiet and regular ; still no pulse. Pupils not quite so dilated. The catheter was again passed and the rectal injection repeated. On Wednesday morning he was still unconscious, but could be partly roused with difficulty. Very faint pulse at wrist. Temperature 1010, perspiring freely. Breathing strong and regular. Considerable amount of crepitation over base of both lungs. Pupils now abnormally contracted and conjunctival reflex present. During the day he gradually regained consciousness, and became so restless that he had to be held in bed. He vomited several times, the vomited matter containing altered blood. He was able to swallow a little liquid. At 8 p.m. he could be easily roused; temperature 102°; breathing rapid and difficult. Pulse somewhat stronger, though still thready and fast ; perspiring freely ; muscular rigidity had quite passed off. On Thursday morning he was quite conscious and complained of pain in the abdomen and back. Pulse 120, temperature 1010; breathing easier, but dullness over base of both lungs; he was taking liquid nourishment freely, but still required catheter. On Thursday evening he was still conscious, but very restless and much disturbed by cough. There was considerable expectoration of frothy mucus, slightly tinged with blood. Temperature 103°, pulse 130°. Area of dullness considerably increased over both lungs. All these symptoms became aggravated during Friday, and on Saturday he gradually relapsed into unconsciousness, and died early on Sunday morning of acute pneumonia, six days after the accident.

No. 4, aged 32 years.³² He was sent up at 5 p.m., and was the last survivor. Though quite conscious when brought to the surface, he had been lying unconscious for a considerable part of the day at the same place in the mine as Nos. 2 and 3. The rescuing party had punched holes in a compressed air pipe, which passed down the ladderway, and as the air improved he gradually regained consciousness. When put to bed he looked fairly well, though somewhat pale and cold. Pulse imperceptible; breathing natural; pupils normal. He could not remember any of the events of the day, after commencing to climb up the ladders when the alarm was first given, although it is known he came up a considerable distance before becoming unconscious. He had no recollection of experiencing anything unusual when descending the mine in the morning, and said he only commenced to return on being told to do so by some of his comrades. By midnight he appeared perfectly well, but had still no pulse, though his colour and temperature were natural. He had also considerable difficulty in passing water. On Tuesday morning he was up, and only complained of pains in his legs, which had been considerably bruised in effecting his rescue. His pulse was fairly strong. He was sent home, and was all right in a few days, with the exception of the injury to his legs.

I had many opportunities of observing the effects of the gas upon those engaged in recovering the bodies of the nineteen miners who were quite dead when discovered. Nearly every member of the different exploring parties was affected to a greater or lesser extent. The intensity of the symptoms varied with the length of time to which they were exposed to the influence of the gas, and the depth in the mine to which they had descended. The deeper they went the more pronounced were the symptoms, on account of the greater impurity of the air, and the consequently larger amount of gas absorbed by the blood. The first definite symptom most generally experienced was severe palpitation of the heart. This was succeeded by a feeling of weakness in the lower limbs, which gradually increased until they were forced to sit down and rest. If they could then get some fresh air from a hole in the compressed air pipe they gradually recovered sufficiently to enable them to reach the surface ; but in several instances they became rapidly unconscious and had to be drawn up the shaft by the winding engine in a special "box" always kept at the mine for the purpose. On arrival at the surface they presented the same symptoms as described in cases 1, 2, and 3, but in a lesser degree, and they soon responded to treatment. Recovery was usually rapid, being ushered in with nausea and vomiting and shivering. This was succeeded by a period of mental excitement, almost hysterical in intensity, which was followed by severe and persistent headache. One member of an exploring party, who, though not unconscious, had to be sent to the surface in the "box," after being in the open air for about an hour had a true epileptic fit, though he had never previously had a similar seizure. The most constant of all the symptoms in poisoning by carbonic oxide is undoubtedly its effects on the heart. In every instance cardiac depression was most marked, and was the last symptom to be recovered from. This accounts for the great improvement seen in all the cases after hypodermic injections of ether, which, together with the external application of warmth and the enjoinment of perfect rest in the recumbent posture, I consider to be the essential treatment. Artificial respiration has been recommended in these cases, but I cannot conceive how it can be performed on account of the muscular rigidity observed in the more serious forums of carbon monoxide poisoning. If the patient can be removed into a pure atmosphere, the breathing can be allowed to take care of itself, as the action of the heart fails before breathing ceases.

I made a careful examination of all the dead bodies brought to the surface. Three bodies were recovered late in the evening of Monday, and fifteen others on Tuesday and Wednesday. One body remained in the mine for a month, because it was not considered prudent to try and recover it until it was certain that the air was all right.

The three bodies recovered on the night of the accident were immediately examined by me. There re were no marks of violence with the exception of a few superficial scratches. Rigor mortis had set in, and was peculiar in that the muscles appeared to have passed from their last contraction during life directly into a state of rigidity. On account of want of light, the further examination was put off till the next day, when they were examined together with the other bodies by that time brought to the surface. The external appearances were almost identical in every instance, and were most characteristic of death from carbon monoxide poisoning. The peculiar bright red colour of the blood, as seen in the lips and skin of the face, and in the palms of the hands, was most striking. The expression on every face was calm and peaceful, and remarkably lifelike. The characteristic colour of blood was well seen in the face of every one of the bodies and recalled the appearance often observed in persons with a very fair skin, after rapid exertion. This peculiar appearance, due to the colour of the blood, evidently persists for some time, as it was quite as distinct on the Wednesday when decomposition had already advanced to a considerable extent, and was very evident on Thursday morning, seventy-two hours after the accident, though the bodies were by this time much decomposed.

Unfortunately, permission for an internal examination of the bodies could not be obtained.

I am,

Sir,

Your obedient servant,

A. E. Miller, M.B.

The Right Honourable,
Sir Matthew White Ridley, Bart., M.P.,

Secretary of State for the Home Department,
Whitehall, London.

29 No. II in Appendix I.
30 No. IV in Appendix I.
31 No. I in Appendix I
32 No. III. in Appendix I.