Black Lung: Anatomy of a Public Health Disease (review)

Alan Derickson. Black Lung: Anatomy of a Public Health Disease. Ithaca, N.Y.: Cornell University Press, 1998. xiv + 237 pp. Ill. $22.95.

The plot line is a familiar one in the history of science--particularly of biomedicine, where beliefs about etiology, pathology, and diagnosis may have practical implications for prevention, treatment, or compensation. First, practitioners (and even patients) make a judgment rooted in case experience. Later, that initial empirical assessment is subjected to greater scientific scrutiny and proved to be inaccurate. Finally, as new research techniques--clinical, laboratory-based, or epidemiological--come into use, they vindicate something close to the original judgment.

Alan Derickson lays out the particulars of his case study very well at the start of this book. Before 1900, the harmful effects of coal dust were well understood (and articulated even in Osler's Textbook). Physicians confronted with cases generally acknowledged the condition now popularly known as "black lung" to be a distinct disease entity, different from those--notably silicosis--brought on by the inhalation of other mineral powders. After the turn of the century, however, American medical opinion increasingly regarded coal dust as innocuous at worst. Damage to the respiratory organs of coal miners was attributed to other minerals that might be mixed with coal dust, and the characteristic black spit of these workers was taken as evidence of the body's natural ability to expel anything potentially harmful. Only in the 1960s did the tide turn again, and a reassessment of the damage caused by coal dust become codified in state and federal law.

Of course, this is not a story of disembodied knowledge. No chronicle of scientific development is; and a disease fraught with economic and political consequences provides the easiest case for demonstrating the social correlates of change in scientific knowledge. Yet, while this case may thus be an easy one, Derickson takes no shortcuts in documenting how the economic interests of coal-mine owners converged with the professional and financial interests of some physicians, and how these groups used whatever power was available to them (economic, political, or professional) to counter--or even suppress--clinical and epidemiological findings that might have benefited miners suffering from black lung. Most interesting to readers of this journal may be Derickson's account of the role played by certain radiologists who helped build the prestige of their nascent specialty by using X-ray images to trump postmortem findings. Pathologists well knew that lungs literally turned black after years of breathing concentrated amounts of coal dust, but radiologists asserted that shadows (or the lack thereof) on radiographs of living people should count for more. Derickson further shows how, in the face of ambiguous evidence, physicians professionally committed to denying the harmful effects of coal dust came simply to assert the importance of their scientific expertise.

The reversal of opinion in the 1960s is, of course, no less susceptible to sociological analysis, and Derickson ably shows that clinical, pathological, and epidemiological facts came to have meaning only when sustained by a social movement. He places the movement to compensate victims of black lung in the context of other social upheavals of the time, and he stresses the important role played by reformist physicians committed to the miners' cause.

This volume is a significant contribution to American labor history and to the history of occupational health, but it is also an important cautionary tale whose implications for today's "science wars" should not go unnoticed. Black Lung shows that questioning scientific expertise, looking for sociological explanations of changes in accepted medical knowledge, and proposing democratic controls on the institutions of science and medicine do not necessarily make one an antirational opponent of the Enlightenment. Alan Derickson relies on no incomprehensible jargon or inferential leaps, and he has an evident appreciation of the necessity to tell as true a story as possible while disclosing his own partisanship. He has written an...