Black lung: anatomy of a public health disaster

continue employing physicians who had allowed relatives to die, would have been resolved had she systematically applied her initial insight. The issue was not, as she says elsewhere, about appropriate medical knowledge or setting standards of care, but about the care of the soul in its physical setting, a job which might be done as well by an educated priest with a smattering of medical knowledge, as by a trained physician. Indeed her own emphasis on the "regimen" as a route to health which did not require doctors implicitly makes the same point. This is a solid, scholarly work, but it would have been better had the author thought through the implications of her initial analysis. Princeton University Press might also notice that the stitching is so poor in my copy that after one reading the first quire has already come loose. In the nineteenth century the hazards of coal mining were well known to occupational health specialists. Thus, Thomas Arlidge, that doyen of British occupational medicine, observed in the 1890s that "[m]iners as a rule, are not well-setup -men". They looked anxious and prematurely old; they had a tendency to shuffle with a stooping gait and frequently had misshapen limbs. Aside from the risk of accidental death or injury from explosion, roof fall, or a range of other perils, they faced various health hazards including nystagmus, ankylostomiasis, and respiratory disease. As regards the latter, Arlidge accepted that coal dust, largely on account of its rounded structure, was not the most dangerous dust. On the other hand, its prolonged inhalation did produce dyspnoea, chronic bronchitis, and fibrosis. Accordingly, while the overall mortality rate among coal miners was surprisingly low, the death rate from respiratory disease was high. As for the widespread notion that coal dust accorded immunity against pulmonary tuberculosis, Arlidge was a confirmed sceptic. Notwithstanding the state of specialist knowledge at the end of the nineteenth century, the fact is that in the USA, as Alan Derickson convincingly demonstrates, for "much of the twentieth century, many in positions of authority held that breathing coal mine dust was harmless, or even beneficial, to human health". This being the case, few efforts were made in any states either to provide compensation for coal miners incapacitated by their unhealthy workplaces, or to eliminate dust from mines. Indeed, as mechanical power was applied to the extraction of coal in the course of the …