Soul Full of Coal Dust

Soul Full of Coal Dust: A Fight for Breath and Justice in Appalachia by Chris Hamby (New York: Little, Brown and Company, 2020)

My brother always knew how to adjust the level of his oxygen machine so that he could make it through one of his horrible coughing spasms. Until he couldn’t. When he died, we suddenly noticed the quiet—the absence of wheezing and crashing of the machine that labored as hard as he did to get air in and out of his lungs. He was a woodworker and a smoker. We sometimes said—behind his back—that he brought it on himself, but that wasn’t entirely true. His 18th-century skills brought high prices for custom pieces, but nothing for the time-consuming process. There was no money for a dust collector in his workshop for a long time.

That can’t be said of the A.T. Massey Coal Company, which is the subject of Soul Full of Coal Dust: A Fight for Breath and Justice in Appalachia by New York Times reporter Chris Hamby. Hamby’s research is deep, but we don’t see the suffering as much as we see the paperwork. His hero is a lawyer.

Hamby earned a Pulitzer for this book with some excellent storytelling. He spent eight years researching and interviewing people, mostly in Raleigh County, West Virginia, who patiently explained to him, as coalfield residents have done for more than a century, how they suffer, and the source of their exploitation. In the end, they still suffer, and he, like others before him, has his prize.

Hamby builds his story around the lives of two men: a miner called Gary Fox who died of black lung disease; and a lawyer named John Cline, who came to West Virginia as a volunteer in the War on Poverty during the Johnson Administration. The story centers on Cline. Hamby never actually met Fox, who died before he started his research. His portrait of Fox, drawn from the testimony of friends and family, is less compelling than his attention to Cline, who is the protagonist of this story.

Cline built an eclectic life in West Virginia, fashioned around his desire to be “of use” to the people he met in the region as a young VISTA volunteer. Afterwards, he stayed in the state and made a life there, becoming first a builder, then a counselor in a medical clinic, and ultimately, at the age of 53, a lawyer, in an effort to better help miners and their families receive compensation for lung disease caused by prolonged exposure to coal dust. Gary Fox was one of his clients.

As Cline, Fox, Hamby and the reader discover, miners have long been unsuccessful in proving that their breathing difficulties were related to the workplace. Despite a successful fight by miners and their families for legislation and compensation in the 1970s, coal companies in both the past and the present have successfully evaded laws that require them to provide adequate ventilation for miners at work. Miners are saddled with the burden of proving that their disability is the result of breathing coal dust.

Ironically, the best proof of disease is an autopsy, something that grieving family members, impoverished by the disability of a breadwinner, cannot afford. Like thousands of other miners and industrial workers, Gary Fox and his family tried for 20 years to prove that his disability came from breathing coal dust at work. He died waiting for results.

And here we have a spoiler alert: Cline—and Chris Hamby—uncover evidence of some unethical practices by both lawyers for the coal companies in West Virginia and esteemed medical doctors at Johns Hopkins University who read the x-rays which are supposed to diagnose lung disease caused by coal dust.

For those familiar with the literature of occupational disease and its history, only the details are news. Alice Hamilton, a pioneering medical doctor in the field of industrial disease, recounts in her autobiography, Exploring the Dangerous Trades (Little, Brown and Company, 1943) her work as a researcher on surveys of working conditions in a variety of industries. Her investigations, which began in 1910, include resistance and only occasionally cooperation from employers and their company doctors in a variety of industries, including lead smelting in Utah, copper mines in Arizona, stone cutting in Vermont, textile work in Massachusetts, and rayon factories in Pennsylvania, Rhode Island, Connecticut, New York, Ohio, Virginia, West Virginia, North Carolina, and Tennessee. Fifty years later, investigative journalist Rachel Scott visited more than twelve industries in the “dusty trades”(beryllium and coal mining, steel, chemicals, oil, automobiles, explosives). Her book, Muscle and Blood: The Massive, Hidden Agony of Industrial Slaughter in America (E.P. Dutton, Inc., 1974) was a finalist for the National Book Award. Like Hamby, her work bore witness to dangerous working conditions, callous attitudes of employers, and the complicity of doctors and state legislators in protecting the profits of industry rather than the lives of workers.

The movement by miners and their union for recognition of black lung as an occupationally compensable disease has been well-chronicled by scholar-activist Barbara Ellen Smith (Digging Our Own Graves, 2nd edition, Haymarket 2021) and Alan Derickson (Black Lung: Anatomy of a Public Health Disaster, Cornell University Press, 1998). Yet both Hamby and Smith report that cases of black lung have actually increased among the mining workforce, a consequence of a weaker labor movement, new mining methods and longer shifts, as well as employer neglect.

Hamby’s investigation is a case study of the state of West Virginia, despite the fact that coal mining and its consequences are geographically spread over 23 states in the U.S. His research exposes the curious practice of having medical evidence collected and evaluated by x-ray technology rather than actual physical examinations, and the ways in which clever lawyers and doctors in the service of industry are able to avoid confronting the suffering flesh of living beings as they write their reports denying that they perceive any evidence of disease or disability. This practice, which David Rosner and Gerald Markowitz also identified in other industries in their landmark study, Deadly Dust: Silicosis and the On-Going Struggle to Protect Worker’s Health (University of Michigan Press, 2nd edition, 2006), has its roots in the transformation of the technology of medicine, including the use of x-rays, and its role in the political economy of diagnosis. For the long view of this transformation, see Stanley Joel Reiser, Medicine and the Reign of Technology (Cambridge University Press, 1978).

Hamby’s book is a page-turner worthy of John Grisham, so if you are looking for a socially-conscious beach book, this is it. However, be aware that the event that Hamby counts as a victory—legislation that requires disclosure of medical evidence—does not force coal companies to prevent the conditions that cause disease in the first place.

Reviewed by Janet Wells Greene, who is a native of West Virginia. Her publications include “Cameras in the Coalfields: Photographs as Documents for Comparative Coalfield History.” She is a former Board Member of the New York Labor History Association and received the John Commerford Award for Labor Education in 2011. She was a founding faculty member of the Southern Appalachian Labor School in West Virginia, Assistant Professor of Labor Studies at the Van Arsdale Center for Labor Education at Empire State College (SUNY), Director of the Harry Van Arsdale Labor Documentation Project of the Robert F. Wagner Labor Archives, Tamiment Library (NYU), and co-founder of The Freedom School in Licking County, Ohio.