The black lung movement that erupted in West Virginia in 1968 was not simply a struggle for recognition of an occupational disease; it grew into a bitter controversy over who would control the definition of that disease. This article examines the historical background and medical politics of that controversy, arguing that black lung was socially produced and defined on several different levels. As a medical construct, the changing definitions of this disease can be traced to major shifts in the political economy of the coal industry. As an occupational disease, the history of black lung is internally related to the history of the workplace in which it is produced. As the object of a mass movement, black lung acquired a political definition that grew out of the collective experience of miners and their families. The definition of disease with which black lung activists challenged the medical establishment has historical roots and justification; their experience suggests that other health advocates may need to redefine the diseases they hope to eradicate.
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References
1.
NOVA. A plague on our children. WGBH Educational Foundation, Boston, 1979, film transcript, p. 35.
2.
For a clear presentation of the overall argument, see DoyalL. (with PennellI.) The Political Economy of Health. Pluto Press, London, 1979. See also TurshenM.The political ecology of disease. Review of Radical Political Economics9(1): 45–60, 1977. See also EyerJ.Hypertension as a disease of modern society. Int. J. Health Serv. 5(4): 539–558, 1975.
3.
Many analysts have pointed out this relationship on a theoretical level, but only a few have attempted to apply it in concrete investigation. See the discussion concerning the relationship between capitalist work relations and technology and the scientific model of brain function (as factory manager, telephone exchange, and, today, computer) in RoseA.The Conscious Brain. Alfred A. Knopf, New York, 1974. For a more general discussion, see FiglioK.The historiography of scientific medicine: An invitation to the human sciences. Comparative Studies in Society and History19: 262–286, 1977. See also FoucaultM.The Birth of the Clinic. Vintage Books, New York, 1975.
4.
The most comprehensive discussion I found was Sheafer, H. C. Hygiene of coal-mines. In A Treatise on Hygiene and Public Health, edited by BuckA. H., vol. 2, pp. 229–250. William Wood and Company, New York, 1879. Sheafer wrote: “Any one who has seen a load of coal shot from a cart, or has watched the thick clouds of dust which sometimes envelop the huge coal-breakers of the anthracite region so completely as almost to hide them from sight, can form an idea of the injurious effect upon the health of constant working in such an atmosphere. The wonder is not that men die of clogged-up lungs, but that they manage to exist so long in an atmosphere which seems to contain at least fifty per cent of solid matter” (p. 245). See also CarpenterJ. T.Report of the Schuylkill County Medical Society. Transactions of the Medical Society of Pennsylvania, fifth series, part 2, pp. 488–491, 1869.
5.
Figlio (3). JewsonN. D.The disappearance of the sick-man from medical cosmology, 1770–1870. Sociology10(2): 225–244, 1976.
6.
On early financing of medical care in the coalfields, see GingerR.Company-sponsored welfare plans in the anthracite industry before 1900. Bulletin of the Business Historical Society27(2): 112–120, 1953. See also FalkL. A.Coal miners' prepaid medical care in the United States—and some British relationships, 1792–1964. Med. Care4(1): 37–42, 1966.
7.
A comprehensive survey of health care under the company doctor system was extracted from the U.S. government by the United Mine Workers of America during temporary federalization of the mines in 1946. The result was the so-called Boone report. U.S. Department of the Interior, Coal Mines Administration. A Medical Survey of the Bituminous-Coal Industry. Government Printing Office, Washington, D.C., 1947.
8.
HayhurstE. R.The health hazards and mortality statistics of soft coal mining in Illinois and Ohio. J. Ind. Hygiene1(7): 360, 1919.
Those who persisted in their complaints of breathlessness were eventually referred to psychiatrists, according to the testimony of miners and their families during interviews with the author. The argument that miners' symptoms of lung disease were psychological in origin may be found in RossW. D., Emotional aspects of respiratory disorders among coal miners. JAMA. 156(5): 484–487, 1954.
11.
My thoughts on this relationship were stimulated and clarified by Figlio, K. Chlorosis and chronic disease in 19th century Britain: The social constitution of somatic illness in a capitalist society. Int. J. Health Serv. 8(4): 589–617, 1978.
12.
This view persists today. Abundant examples may be found, especially in journalistic and sociological literature on Appalachia. Miners are alternately romanticized and reviled; in either case, they are “a breed apart.”
13.
See BrownE. R.Rockefeller Medicine Men. University of California Press, Berkeley, 1979. On the germ theory and its implications for the doctor-patient relationship, see Jewson (5), Figlio (3), and BerlinerH. S.SalmonJ. W.The holistic health movement and scientific medicine: The naked and the dead. Socialist Review9(1): 31–52, 1979.
14.
“One radiologist in southern West Virginia says until five years ago he regularly encountered chest X-rays from physicians that showed massive lung lesions labeled ‘normal miner's chest.”’ AronsonB.Black lung: Tragedy of Appalachia. New South26(4): 54, 1971.
15.
MeiklejohnA.History of lung disease of coal miners in Great Britain: Part II, 1875–1920. Br. J. Ind. Med.9(2): 94, 1952. This view apparently originated in Britain and was picked up by physicians in the United States.
16.
See SeltzerC.Health care by the ton. Health PAC Bulletin79: 1–8, 25–33, 1977.
17.
MartinJ. E.Jr.Coal miners' pneumoconiosis. Am. J. Public Health44(5): 581, 1954. See also HunterM. B.LevineM. D.Clinical study of pneumoconiosis of coal workers in Ohio river valley. JAMA. 163(1): 1–4, 1957. See also the numerous articles by Lorin Kerr in this period, especially Coal workers' pneumoconiosis. Ind. Med. Surg.25(8): 355–362, 1956.
18.
Nonmedical literature from all over the world suggests that coal miners have long experienced black lung. Friedrich Engels discusses miners' “black spittle” disease in The Condition of the Working Class in England. Alden Press, Oxford, 1971. Emile Zola's character Bonnemort in the novel Germinal is clearly a victim of black lung. And John Spargo, a progressive era reformer intent on the prohibition of child labor, discusses the respiratory problems of the anthracite breaker boys in The Bitter Cry of the Children. Macmillan Company, New York, 1906, p. 164.
19.
U.S. Public Health Service. The health of workers in dusty trades, Part III. Public Health Bulletin Number 208, Government Printing Office, Washington, D.C., 1933; U.S. Public Health Service. Anthraco-silicosis among hard coal miners. Public Health Bulletin Number 221, Government Printing Office, Washington, D.C., 1936; U.S. Public Health Service and Utah State Board of Health. The working environment and the health of workers in bituminous coal mines, non-ferrous metal mines, and non-ferrous metal smelters in Utah. 1940.
20.
A lucid discussion of the labor process in this period may be found in DixK.Work Relations in the Coal Industry: The Hand-Loading Era, 1880–1930. Institute for Labor Studies, West Virginia University, Morgantown, West Virginia, 1977. On the economics of the industry, see SuffernA. E.The Coal Miners' Struggle for Industrial Status. Macmillan Company, New York, 1926. See also HamiltonW. H.WrightH. R.The Case of Bituminous Coal. Macmillan Company, New York, 1925.
21.
One study actually found an inverse statistical relationship between employment levels and the rate of fatal accidents. See the discussion in Dix (20), pp. 101–104.
22.
RoyA.History of Coal Miners of the U.S.J. L. Trauger Printing Company, Columbus, Ohio, 1907, p. 119.
23.
In some cases, state law or local practice dictated that coal be shot down at the end of the day, allowing the atmosphere to clear overnight. However, this was not uniform practice throughout the industry.
24.
Physicians, miners, and government officials seem to agree on this point; representatives from industry in some cases demur. There is also disagreement about the magnitude of any increase in respiratory disease. See Papers and Proceedings of the National Conference on Medicine and the Federal Coal Mine Health and Safety Act of 1969. Washington, D.C., 1970. Debate on these questions also runs through the many volumes of testimony on the 1969 act. See U.S. Senate, Committee on Labor and Public Welfare, Subcommittee on Labor. Coal Mine Health and Safety. Hearings, 91st Congress, 1st Session. Government Printing Office, Washington, D.C., 1969.
25.
United Mine Workers of America. Proceedings of the 33rd Consecutive Constitutional Convention. United Mine Workers of America, Indianapolis, Indiana, 1934, vol. 1.
26.
United Mine Workers of America. Proceedings of the 42nd Consecutive Constitutional Convention. United Mine Workers of America, Washington, D.C., 1956, see pp. 306–331.
27.
Lewis clearly articulated this position in his book, The Miners' Fight for American Standards. Bell Publishing Company, Indianapolis, Indiana, 1925.
28.
This paragraph compresses an enormous social and economic transformation into a few sentences. For a detailed description of the changed industrial relations in this period, see SeltzerC.The United Mine Workers of America and the coal operators: The political economy of coal in Appalachia, 1950–1973. Ph.D. dissertation, Columbia University, 1977.
29.
See DavidJ. P.Earnings, health, safety, and welfare of bituminous coal miners since the encouragement of mechanization by the United Mine Workers of America. Ph.D. dissertation, West Virginia University, 1972. David demonstrates how miners fell behind workers in certain other unionized industries during this period.
30.
In 1969, the U.S. Surgeon General estimated that 100,000 coal miners were afflicted with CWP. A study of 9,076 miners, conducted between 1969 and 1972, found a 31.4 percent prevalence of the disease among bituminous miners; among those who had worked 30 to 39 years in the mines, prevalence rose to over 50 percent. See MorganW.K.C., The prevalence of coal workers' pneumoconiosis in U.S. coal miners. Arch. Environ. Health27: 222, 1973. Current prevalence in the work force runs around 15 percent. These data are all on CWP. Black lung, i.e. the whole disease experience that miners consider occupational in origin, is not considered a legitimate concept by scientific medicine, and its prevalence is unknown. In scientific medical terms, black lung includes CWP, bronchitis, emphysema, and possibly other unrecognized disease processes. The prevalence of this ensemble of diseases is of course higher than that of CWP alone.
31.
Dr. Rowland Burns, as quoted in the Charleston (West Virginia) Daily Mail, January 15, 1969.
32.
Dr. William Anderson, as quoted in the Charleston (West Virginia) Gazette, April 16, 1969.
33.
U.S. House, Committee on Education and Labor. Black Lung Benefits Program. First Annual Report. Government Printing Office, Washington, D.C., 1971.
34.
The views of W.K.C. Morgan and his associates represent the dominant position of the medical establishment on CWP. See Morgan, W.K.C. Respiratory disease in coal miners. Am. Rev. Resp. Dis.113: 531–559, 1976.
35.
For example: “The presence of severe shortness of breath in a coal miner with simple CWP is virtually always related to a nonoccupationally related disease, such as chronic bronchitis or emphysema, rather than to coal mining… . Smoking is by far the most important factor in producing respiratory symptoms and a decrease in ventilatory function.”Morgan (34), pp. 540–541.
36.
Several physicians took the side of miners in the black lung controversy, arguing that the degree of respiratory disability does not correlate with X-ray stages of CWP and that disability in miners with simple CWP is often occupationally related. Some explained this phenomenon by hypothesizing that the disease process is pulmonary vascular in nature, i.e. it affects the small vessels of the lungs, impairing their ability to exchange gases with the bloodstream. See HyattR. E.KistinA. D.MahanT. K.Respiratory disease in southern West Virginia coal miners. Am. Rev. Resp. Dis.89(3): 387–401, 1964. See also RasmussenD. L.Respiratory impairment in southern West Virginia coal miners. Am. Rev. Resp. Dis.98(10): 658–667, 1968.
37.
This is a line from a famous song by Florence Reese, “Which Side Are You On?”, inspired by the mine wars in Harlan County, Kentucky, during the 1930s.
38.
Author's interview with disabled coal miner, Logan County, West Virginia, September 6, 1978.
39.
Author's interview with disabled coal miner, Raleigh County, West Virginia, September 19, 1978.
40.
Author's interview with working coal miner, Raleigh County, West Virginia, August 24, 1978.
41.
Author's interview with disabled coal miner, Raleigh County, West Virginia, September 19, 1978.
42.
By 1978, approved claims exceeded 420,000, and amendments enacted in that year are pushing the total even higher. This does not mean, however, that eligibility requirements will not be tightened in the future. Indeed, the current trend is to do so. See General Accounting Office. Legislation Allows Black Lung Benefits To Be A warded without Adequate Evidence of Disability. Report to the Congress. Government Printing Office, Washington, D.C., 1980.
