Mechanization and Black Lung in Appalachia

“Black lung” is an umbrella term for lung diseases that afflict coal miners. Its very use is a testament to the importance of workers’ experience in shaping medical knowledge. But the link between coal mining and too often deadly respiratory disease has been known, if obscured, by coal companies and their doctors, since the early-to-mid-nineteenth century. Like many occupational diseases, the struggle for recognition of the disease encountered many obstacles: the tendency of doctors to consider pathologies individually rather than collectively, the structures of medical practice that meant doctors often worked for the companies invested in the link between work and disease not being known, and the professionalization of expertise that discounted workers’ experiences.

Miners never volunteered to die for their work, whether in a roof collapse, methane explosion, or slowly, struggling to draw a breath more and more each day. Smith documents the longer history of worker activism to address the dust problem in the mines. But the problem was exacerbated in the immediate aftermath of World War II, the result of three separate but related trends.

First, underground mining became mechanized, and the huge machines produced much more dust than older methods of mining. That mechanization, which also put nearly two-thirds of the nation’s miners out of work, was supported by the United Mine Workers of America, who had agreed to go along with mechanization in return for the establishment of a UMW Welfare and Retirement Fund, which was paid into by the operators and, in practice, administered under strong union influence.

The Welfare and Retirement Fund was an incredible achievement, a social contract for the coalfields that journalists referred to as UMW president John L. Lewis’s dream of a welfare state. But as the political economy of coal was reshaped by changing markets in the postwar period, the incredible achievement looked to some miners more like a Faustian bargain.

For the next fifteen years, coal mining employment dropped precipitously, and around two-thirds of the nation’s miners lost their jobs. Job losses were even more acute in the anthracite regions of eastern Pennsylvania. UMW leadership — first under Lewis and then his successors Thomas Kennedy and Tony Boyle — accepted the idea that coal had to be economically competitive to survive and pursued greater collaboration with industry leaders than would have been imaginable before WWII. Miners found themselves in a position where the institution that was supposed to protect them was instead browbeating them back into workplaces that had always been dangerous, but had also rapidly become dangerous in new ways.

The miners that survived this first wave of mechanization were terribly afflicted by black lung, helping to precipitate a new wave of organizing efforts. At the same time, Tony Boyle’s corruption and cooperation with the operators further drove rank-and-file organizing, though it struggled to spread across the coalfields under Boyle’s autocratic rule.

But coal miners weren’t just workers. They were part of families, communities, and a region. The War on Poverty, welfare, and women’s activism would play a huge role in shaping the black lung movement. Coal dust accumulated in miners’ lungs, turned them black, and stole their breath. But the costs accumulated much more widely, especially among miners’ wives and widows who often were left struggling to support their families. Especially before the passage of Title VII of the Civil Rights Act, which barred sex discrimination in employment, women who worked in the coalfields tended to work in extremely low-wage jobs: waiting tables for $35 a week, doing textile piecework out of their homes. The UMW’s pension helped, but was not nearly enough to raise a family.

The War on Poverty, meanwhile, targeted Appalachia, especially after the passage of the Appalachian Regional Development Act in 1965. Many Appalachians felt there was a large gap between what was promised and delivered, and although it was shaped by recent discourse pathologizing Appalachian poverty and failed to address structural problems, the impacts of two groups — the Appalachian Volunteers (AV) and Volunteers in Service to America (VISTA) — helped to coalesce regional organizing efforts and connect issues that might otherwise have been kept disparate.

By the end of the 1960s, things escalated, and the political situation in the coalfields grew increasingly volatile. In November 1968, the worst mine disaster since the early 1950s killed seventy-eight miners in Farmington, West Virginia. The arrival of national reporters and renewed political attention to the coalfields helped black lung and mine safety activists raise the profile of their struggles and build wider support for new federal and state regulations.

The apex of the movement came just three months after the Farmington disaster, when the West Virginia coalfields were completely shut down, and miners marched on the state capital in Charleston. The strike lasted for three weeks, and it put disabled miners like Carl Michelbacher before Congress to tell their stories. By the end of the year, President Richard Nixon would sign the Federal Coal Mine Health and Safety Act, which contained a provision for a black lung benefits program.

But as Smith shows, despite the remarkable accomplishments of the movement, the strategy it pursued presented problems for eliminating black lung, or even for ensuring that miners entitled to compensation received it. By acceding to the workers’ compensation model, she writes, “they began a relationship with the established processes of reform that gradually and subtly redefined the target of their anger, the goal of their activism, and the political meaning of their discontent.”

In other words, using the workers’ compensation system took the focus off the operators, the day-to-day experiences of work, and the situation of disease as a political-economic relation. Narrowly defining the disease — though thanks to miners’ activism, it was broader than it might have been — meant that the social meaning of disease was lost to individual diagnoses. And most miners were never compensated even when they were disabled. If we are to reclaim the power of workplace medicine for our contemporary era, we will have to reclaim occupational health not as addressing individual illnesses but social maladies.

In assessing the limits of the black lung movement this way, Smith perhaps underplays the importance of state compensation. Taking a broader view of the black lung benefits program as part of the political side of the political economy of coal, we would see that the federal program played an important part in reshaping energy governance. When the program finally came before the Supreme Court, Thurgood Marshall would note the importance of the program for balancing the burdens and benefits of economic life in a high-energy society. The federal government in these years looked to coal-fired electricity as its lifeblood, and miners understood these political relationships as a central component of their workplace power in a time when coal was synonymous with electricity production.

From my perspective, however, this political component only underscores her central point more: that building workplace power and pursuing policy — even from the grass roots — can present serious challenges with how to navigate the different processes, the different axes of power, the different organizations and political communities that are party to each.