Book Review

Canada and the United States

In the nineteenth century, physicians diagnosed coal miners who spit up black ink and suffered lack of breath with the occupational disease of "miner's asthma." Beginning in the first decades of the twentieth century, miner's asthma petered out of existence. Medical experts now attributed black sputum and shortness of breath to tuberculosis, smoking, and poor personal hygiene. To the extent that physicians and public authorities did recognize an occupational disease among miners, the disease was "silicosis," but since few coal mines were dug through rock with appreciable quantities of silicates, few coal miners were thought to suffer from silicosis. Then, beginning in the 1960s, a new occupational disease of miners, "black lung," was understood to produce their inky sputum and disordered respiration.

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In oversimplified outline, this is how Alan Derickson's book illustrates the principle of the social construction of disease. Long-term coal miners have always spit ink and struggled to breathe, but the "disease," if any, that caused their suffering changed over time. More important, Derickson documents a conscious campaign by twentieth-century coal mine operators to "disappear" miner's asthma. Their motive was financial. Operator negligence killed miners in their midlives, but to prevent the expenses of prevention and compensation, operators refuted the existence of an industrial disease among coal miners. With the assistance of many medical scientists, the operators successfully repressed social knowledge of miners' maladies. Workers won little health and safety regulation and few tort cases or compensation hearings, blocked by their inability—within the confines of accepted medical theory—to prove they suffered harm from working in dusty coal mines. The book is a searing indictment, then, of both mining and medicine.

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