Black Lung: Anatomy of a Public Health Disaster
- Book Review,
by Alan Derickson
From Library Journal
In 1900 miners who breathed a lifetime of coal dust were known to suffer from what is today called black lung disease. Derickson (Pennsylvania State) shows how black lung was defined out of existence for decades until a 1960s grass-roots revolt in the West Virginia coal fields refocused the medical community and pressured the federal government to deliver a program of prevention and compensation. His book is a study in the social construction of disease and is a brief against the mine owners, physicians, union leaders, and government officials who all helped to create a tragedy in industrial health. It is a brief, though, that has been filed before, most recently in Barbara Ellen Smith's Digging Our Own Graves (1987). Derickson's book differs chiefly in emphasis and detail and in his extensive oral history research on the 1960s insurgency. It is a good selection for strong collections in labor, medicine, and Appalachia but optional for more general collections, particularly for those owning Smith's book.?Robert F. Nardini, Chichester, NHCopyright 1998 Reed Business Information, Inc.
From The New England Journal of Medicine, June 3, 1999
In the classic story that exemplifies the public health approach to disease prevention, John Snow removed the handle of the Broad Street pump in London to halt a cholera epidemic. Snow knew neither the agent of the disease nor its mechanism, but he acted after making reasoned conclusions drawn from systematic observations of the distribution of the disease. In his carefully researched and exhaustively referenced book, Black Lung: Anatomy of a Public Health Disaster, historian Alan Derickson asks why the "pump handle" was not removed -- why dust was not controlled -- when so much was known for so long about the harmful effects of excessive dust exposure among coal miners. Black Lung is a cautionary tale, warning of the consequences of allowing economic and political considerations to control public health decisions. Engaging, well-organized, and fast-paced, the book guides the reader through a century of change in the mining, scientific, and regulatory communities. Beginning in the mid-19th century, first in the United Kingdom and then in the United States, lung diseases, commonly called "miner's asthma" or "miner's consumption" and medically labeled "anthracosis," were observed in coal miners. Sick miners had progressive dyspnea, chest discomfort, and cough, sometimes dramatically accompanied by the expectoration of copious quantities of black, inky sputum. Medical textbooks, including Osler's classic Principles and Practice of Medicine (New York: D. Appleton), first published in 1892, described a lung disease observed in miners and caused by exposure to dust. But early in the 20th century, according to Derickson, conventional scientific wisdom seemed to have undergone a critical transformation. The observation in the United Kingdom that rates of tuberculosis were lower among miners than among laborers in urban areas led to the assertion in the United States that inhalation of coal-mine dust had a beneficial effect and that dust-induced pulmonary fibrosis hardened the lungs against infection. Derickson argues that as concern about the devastating effects of silica dust became widespread, a "reductionist" approach equated all dust-related hazards with silica, thereby deflecting attention from the independent risk posed by coal-mine dust. From this arose the belief that in the absence of silica, coal-mine dust is benign -- discoloring the lungs but not causing impairment. The belief that exposure to coal-mine dust had only benign effects could have been challenged by scientific inquiry. In fact, Derickson cites reports produced for the U.S. Department of Labor and the results of field investigations conducted by the U.S. Public Health Service indicating that miners had high death rates; diminished longevity and reduced pulmonary function as compared with other manual laborers; and a high rate of absence from work due to lung conditions. These reports, however, were not widely distributed, because access to workplaces was granted to government agencies in return for agreements to restrict communication of the results of investigations. For this reason, scientific evidence of the hazards of coal-dust exposure did not prompt requirements for improved ventilation or other preventive actions. Derickson also explores how efforts to minimize compensation to miners with lung disease may have affected the willingness of official bodies to recognize the connection between work and disease. Unfortunately, Derickson fails to describe accurately the current concept of diversity in the lung diseases of coal miners. Exposure to coal-mine dust causes not only coal workers' pneumoconiosis but also chronic bronchitis and emphysema and, depending on the quartz content of the inhaled dust, silicosis. A clearer presentation of this complex of diseases would have provided readers with context for understanding the evolution of the varied beliefs and approaches to lung diseases among coal miners. Compensating for this weakness is an important strength of the book: Derickson's description of the social and economic consequences of lung disease in the coal fields. Young boys began work as slate pickers, cleaning and sorting coal for entry-level wages in densely dusty environments. As the children grew older and stronger, they moved progressively up the job and pay ladders, helping to transport, load, and ultimately mine coal. When injury or disease incapacitated miners, these men, having no social safety net and minimal employment alternatives, climbed back down the job ladder, sometimes ending their careers in the breakers, cleaning coal as they did in their youth, still for entry-level wages, only this time in failing health. The ultimate lesson of Derickson's book is one worth heeding: to prevent public health disasters, prudent action may be necessary, even in the face of scientific uncertainty. Reviewed by Gregory R. Wagner, M.D.
Copyright © 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
From Book News, Inc.
Derickson (labor studies and history, Penn State U.) recounts how for decades after methods of prevention were known hundreds of thousands of American miners suffered and died from black lung. He discusses the late 19th century discovery of the disease, efforts by medical professionals and mining representatives to discredit knowledge about it, and the activist movements which eventually won protections and compensation with the enactment of the Federal Coal Mine Health and Safety Act in 1969. Book News, Inc.®, Portland, OR
Book Description
In the definitive history of a twentieth-century public health disaster, Alan Derickson recounts how, for decades after methods of prevention were known, hundreds of thousands of American miners suffered and died from black lung, a respiratory illness caused by the inhalation of coal mine dust. The combined failure of government, medicine, and industry to halt the spread of this disease--and even to acknowledge its existence--resulted in a national tragedy, the effects of which are still being felt. The book begins in the late nineteenth century, when the disorders brought on by exposure to coal mine dust were first identified as components of a debilitating and distinctive illness. For several decades thereafter, coal miners' dust disease was accepted, in both lay and professional circles, as a major industrial disease. Derickson describes how after the turn of the century medical professionals and industry representatives worked to discredit and supplant knowledge about black lung, with such success that this disease ceased to be recognized. Many authorities maintained that breathing coal mine dust was actually beneficial to health. Derickson shows that activists ultimately forced society to overcome its complacency about this deadly and preventable disease. He chronicles the growth of an unprecedented movement--from the turn-of-the-century miners' union, to the social medicine activists in the mid-twentieth century, and the black lung insurgents of the late sixties--which eventually won landmark protections and compensation with the enactment of the Federal Coal Mine Health and Safety Act in 1969. An extraordinary work of scholarship, Black Lung exposes the enormous human cost of producing the energy source responsible for making the United States the world's preeminent industrial nation.
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