Brown Lung Blues

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Brown Lung Blues

by Michael Freemark

‘Science for the People’ Vol. 9, No. 3, May/June 1977, p. 6–11

Brown lung is the most important, and least recognized, occupational disease in the Southern United States. Brown lung disables thousands of active and retired textile workers, yet for years the medical profession has denied the significance or even the existence of the problem.

What Is Brown Lung? 

Brown lung, or byssinosis, is a chronic respiratory disease associated with inhaling cotton, flax, and soft hemp dusts. The initial symptoms are chest tightness, cough, sputum production and shortness of breath on the first day of every work week. Symptoms may disappear shortly after leaving work but recur each Monday after a weekend away from dust exposure (“Monday-morning chest tightness”). 

The illness is progressive: in the early stages of the disease, there is occasional chest tightness on the first day of the work week: as the disease gets worse, chest tightness occurs on other days of the week: eventually, brown lung leads to permanent incapacity. Brown lung, in its advanced stages, is similar to and is most often misdiagnosed as emphysema or chronic bronchitis.1 2

Brown lung is a worldwide problem of great magnitude. In the US alone, there are an estimated 300,000 active textile workers constantly exposed to cotton dust. Several studies indicate that approximately 20-25 percent of those working in carding and spinning (preparation) rooms in the mill suffer from the disease. The disease is less prevalent (2-10 percent) in other, less dusty mill areas. Overall, brown lung affects between 25,000 and 35,000 active American textile workers and many more inactive and retired employees.3 4 5 The problem is particularly acute in the Southern United States, where textiles employ more than 25 percent of the total labor force in North Carolina, South Carolina, Georgia, and Tennessee. 

It must be emphasized first and above all that brown lung is a preventable illness, caused by inhaling microscopic dust particles. Several studies have shown that the disease is related to cotton dust concentration within the mill. The incidence of the disease could be significantly reduced by using modern dust-control technology. Merchant, et al.6 have suggested 0.1 mg/m3 as a “reasonably safe level” of lint-free cotton dust: the present Federal dust standard is 1.0 mg/m3

There is evidence that the active agent in brown lung is the leafy bract of the cotton plant, which is harvested together with the cotton, separated, reduced to a fine dust, and dispersed in the mill, where it is inhaled by workers. The active agent may contain allergens, and/or provoke the release of similar substances from the lungs. Responses of the body’s own immune system may play a role in causing the disease. The precise mechanisms which start the development of brown lung are still unknown and require further study.7 8

Smoking may increase the potential effects of cotton dust on the lungs and increase the rate of illness and death related to dust exposure. However, neither smoking, mill fever, weaver’s cough, nor mattress makers’ fever (other acute, cotton textile-related respiratory conditions) cause Monday morning chest tightness; this symptom is specific to brown lung.9 10 And it is clear that brown lung does occur in textile workers who have never smoked. 

What Has Been Done About Brown Lung? 

For the most part, the illness has been consciously ignored by mill owners as well as governmental leaders. Brown lung was first described among flax workers in Italy in 1705. The disease was well known in Britain in the 1800’s, and it was recognized that adequate ventilation in the mill could reduce the incidence of the disease.11 Brown lung was officially designated an occupation-related illness under British workers’ compensation laws in 1941. 

Nevertheless, American industry spokespersons denied the importance or even the existence of the disease. In a 1947 report, the US Public Health Service claimed that serious dust illness was hardly known to exist among American cotton workers. Researchers were often prohibited from entering the mills, and the first serious American epidemiologic study of brown lung was not completed until 1967.12

The coverup has continued despite changes in legislation. The Occupational Safety and Health Act (OSHA), passed in 1970, established standards and guidelines for safety within the workplace and provided for plant inspection. Unfortunately, enforcement has been lax. For example, as of August 1975, only 17 of 124 textile mills in South Carolina had been inspected. Although 14 of these 17 mills were found to have dust levels which exceeded federal standards, the cost of noncompliance was trivial. T. Avery Nye, the North Carolina Commissioner of Labor, recently stated that the average fine for all industrial safety and health violations in North Carolina in 1975 was $34 (Raleigh News and Observer, 11/10/75, p. 2). A North Carolina Public Interest Research Group report (12/75) indicated that no fines at all were assessed for 79 percent of all industry violations under the North Carolina OSHA inspection program. 

Legislation passed in 1971 allows disabled North Carolina textile workers to get compensation for brown lung disease. However, the administrative procedures for obtaining compensation were clearly formulated to prevent workers from collecting these benefits. After being informed of the nature of his or her illness, the active worker must inform his or her employer within 30 days that s/he plans to apply for compensation, and within two years must actually file papers to that effect. The worker with brown lung thus risks and fears demotion or dismissal at an early age in his or her attempt to obtain compensation. As a consequence only 38 workers, all of them retired, have yet received benefits. 

Why Has So Little Been Done? 

Brown lung is a disease of oppression: its tale is one of tragedy and violence. 

The American textile industry began to develop in New England in the early 19th century, when cotton picked and harvested in the South was shipped North where textile production was more efficient and profitable. In the New England factory towns, workers were subjected to harsh working conditions, strict rules and regulations, long hours with low pay, and inadequate food. 

Following the Civil War and Reconstruction, wealthy Southern businessmen began to invest heavily in the developing Southern textile industry. Economic depression in the late 19th century forced farmers to seek work in mill towns: and Northern capital was attracted by the promise of Southern labor which was “cheap”, “contented”, poorly organized, and unwilling to strike.13 

Working conditions in the South paralleled those in New England. Wages were low and actually declined while prices rose in the first two decades of the 20th century. Hours were long, the work routine was harsh, and living conditions were barely tolerable. Young children were frequently employed for strenuous and dangerous work. Moreover, the mill towns were essentially extended “white families” presided over by paternalistic mill owners who excluded blacks and other minority peoples.14 

The “stretchouts” (or “speedups”) in the 1920’s finally brought Southern labor to its feet. In order to increase profits, many workers were fired or laid off and the remaining labor force had to work longer and harder for equivalent or reduced wages. And there was no protection: prior to 1929, no Southern state had minimum wage legislation and four states had no workers’ compensation laws.15

In response to the stretchouts, Southern workers (often with the guidance of Communist Party members) began to organize. Meetings were held, schools for workers were sponsored and union activity was encouraged. Suddenly in 1929 textile workers in Elizabethton, Tennessee struck to protest low wages, dilapidated housing, high living costs, and growing work loads. Similar grievances were voiced by textile strikers from the Loray Mill in Gastonia, NC and by workers from mill towns throughout the South. 

But the strikes progressed in similar fashion. Injunctions were brought against picketers, and state militia (often hired by the companies themselves) were employed to crush the workers’ movement. Many textile workers were killed or imprisoned. Several company presidents refused to negotiate with the unions or made promises which were later retracted.16 17

Company and state resistance, as well as overwhelming economic depression, spelled failure for the strikers, and subsequently union activity in the South fell dramatically. Union membership, once at 270,000, declined rapidly after 1934, until at present, North Carolina union membership is the lowest in the United States.18 As a consequence, the average industrial worker’s annual wages remain lower in North Carolina than in any other state.19 And industrial abuses like the conditions which produce brown lung continue unabated and unchecked. 

Unionization per se has not always provided an adequate solution. A twelve-year union drive at J.P. Stevens, the nation’s second largest textile corporation, has been marked by intense harassment of workers and the illegal firing of 289 workers for union activity. (See box.) In September 1974, the Textile Workers Union of America (TWUA) was officially certified as the bargaining agent for employees at stevens’ seven Roanoke Rapids, North Carolina plants.20 But no contract has yet been negotiated between workers and employers at Stevens: the corporation has given lip service to contract discussions but has shown no intention of reaching a viable agreement. In other situations, Stevens has taken a more direct approach. In the summer of 1975, the corporation simply closed a Statesboro, Georgia plant which was unionized under court order. The complex and time-consuming National Labor Relations Board grievance procedures themselves work against effective union bargaining activity. 

Brown Lung and Health Care Priorities

The lessons of brown lung also shed light upon the glaring inadequacies and the class nature of medical education. 

Brown lung is the most important, and least recognized, occupational disease in the Southern US. For years the medical profession denied the importance of the disease: in contemporary medical schools, brown lung is presented as an “unusual” yet “uninteresting” respiratory condition. The sociopolitical and economic conditions which created and perpetuate this illness are rarely, if ever, discussed. This is characteristic of American medical education which on the whole emphasizes individual disease processes and acute rather than preventive care, and isolates medical illness from its socioeconomic base. 

This lies in stark contrast to medical education in the People’s Republic of China, where students gain instruction in agriculture, industry, political economics and philosophy, history, foreign language (often English), preventive medicine and public health, and where 1/3 of the medical curriculum is devoted to life and work in factories and in the rural countryside. The people of China are served by a health care system controlled by workers and consumers.21


Study Number of Trustees Questioned Number of Hospitals Studied  Occupation (%)
Occupation (%)
Occupation (%)
A (11) 716 29 55 29 16
B (13)  9665 632 54.5 30.4 15.1
C (14) 530 34 55.1 30.0 12.5
D (17) 2043 224 52 a. 19 a.

a. This 52 percent figure does not include bankers who were the “predominating profession in the ‘other’ category.”

The trustees of American health care institutions are members of the upper classes.22 Several studies (Table 1) confirm the following conclusion drawn by Goldberg and Hemmelgarn23 in their recent investigation of Detroit-area hospitals: 

Hospital boards are dominated by business executives, members of the legal and accounting professions, and spokespersons for medicine and hospitals … the consumer and the general community are very seriously under-represented. Obviously, hospital boards are not representative of nor do they reflect the composition of the community generally.

Board members of these powerful institutions exert a significant influence upon federal, state, and local health policy, and set funding priorities for health research and faculty appointments and promotions. Upper class trustees establish policies for medical education which prevent the examination of the relationships between medical illnesses (brown lung is one of many examples) and the political, social and economic conditions for which the board members themselves, or their class as a whole, are responsible. Indeed, the corporate class has a vested interest in maintaining and creating socioeconomic conditions (poverty, pollution, poor housing and nutrition, etc.) which in themselves breed illness. The health care industry “boom”- institutional expansion. skyrocketing costs, and technological overdevelopment – reflects this trend toward increasing domination of health care by considerations of business and profit. 

Organizing for Action in North Carolina 

The Durham, North Carolina chapter of the Medical Committee for Human Rights is an organization of health professionals and paraprofessionals, health workers and students, and health consumers united behind the following principles: 

1.) Problems in health care are not isolated from other problems in American society. The health care system as a whole, based on profit, is incompatible with good health care delivery. 

2.) All people are entitled to health care that is humane, comprehensive, preventive, continuous, and accessible. 

3.) Health services and institutions should be democratically controlled by those who use them and work with them. 

4.) Good health care requires an end to racism, sexism, ageism, class discrimination, and elitism in the health care sector. 

5.) MCHR is committed to action to effect these principles. 

During the spring of 1975, the MCHR Brown Lung Task Force was created with the following goals: 

1.) Brown lung screening of active and retired textile workers with an aim towards providing compensation for disabled persons. 

2.) Education of workers and health care personnel with respect to the medical, historical and sociopolitical aspects of brown lung. 

3.) Encouragement of union activity by active textile workers as a viable means for ultimately preventing the disease within the workplace. 

4.) Presentation of brown lung as a failure in medical education with emphasis on the class nature and structure of contemporary health care. 

To begin to accomplish these goals, MCHR has presented a forum and slide show on brown lung to health care students in the Durham-Chapel Hill area. We are working to build a strong constituency of health care personnel committed to political change in the health sector. Recently, Brown Lung Associations led by retired textile workers have been organized in Greensboro, North Carolina: Spartanburg, South Carolina and Columbia, South Carolina. MCHR has helped by offering educational and screening clinics which reached approximately 280 active and retired textile workers in Greensboro; Roanoke Rapids, North Carolina; Kannapolis, North Carolina and Columbia. 

We uncovered 120 cases of brown lung, mostly in men who had been employed for more than twenty years those with brown lung had never smoked. Only two workers had been previously diagnosed as having brown lung: other cases had been misdiagnosed as chronic bronchitis, emphysema, “breathing problem,” “lung trouble,” “unknown” and “none.” We referred disabled employees to local doctors for treatment and followup chest x-rays. As of January, 1976, forty to fifty workers (all retired) have filed papers for compensation with the North Carolina Industrial Commission, but none have yet received compensation. 

MCHR has supported union organizing as a first step towards decent working conditions, but the combination of big business and state governments anxious to keep big business happy will ensure that the fight is uphill all the way. Textile workers in the South and elsewhere need the support of concerned and organized health care workers. To help, write: Durham Medical Committee for Human Rights, Box 3434, Duke Hospital, Durham, N.C. 27710.

Michael Free mark is a member of the Durham chapter of Medical Committee for Human Rights (MCHR). He is also a resident in pediatrics at the Duke University Medical Center in Durham, N.C.

>>  Back to Vol. 9, No. 3  <<


  1. Arend Bouhuys, Leo J. Heaphy, Richard S. F. Schilling, and J. W. Welborn, “Byssinosis in the United States,” NEJM 277: 170, 1967.
  2. T. Reginald Harris, James A Merchant, Kaye H. Kilburn, and John D. Hamilton, “Byssinosis and Respiratory Diseases of Cotton Mill Workers,” J. Occ. Med. 14: 199, 1972.
  3. T. Reginald Harris, James A Merchant, Kaye H. Kilburn, and John D. Hamilton, “Byssinosis and Respiratory Diseases of Cotton Mill Workers,” J. Occ. Med. 14: 199, 1972.
  4. Harold R. lmbus and Moon W. Suh, “Byssinosis,” Arch. Env. Health 26: 183, 1973.
  5. James A. Merchant, John C. Lumsden, Kaye H. Kilburn, William M. O’Fallon, John R. Ujda, Victor H. Germino, Jr., and John D. Hamilton, “Dose Response Studies in Cotton Textile Workers,” J. Occ. Med. 15: 222, 1973.
  6. James A. Merchant, John C. Lumsden, Kaye H. Kilburn, William M. O’Fallon, John R. Ujda, Victor H. Germino, Jr., and John D. Hamilton, “Dose Response Studies in Cotton Textile Workers,” J. Occ. Med. 15: 222, 1973.
  7. T. Reginald Harris, James A Merchant, Kaye H. Kilburn, and John D. Hamilton, “Byssinosis and Respiratory Diseases of Cotton Mill Workers,” J. Occ. Med. 14: 199, 1972.
  8. James A. Merchant, Kaye H. Kilburn, William M. O’Fallon, John D. Hamilton, and John C. Lumsden, “Byssinosis and Chronic Bronchitis Among Cotton Textile Workers,” Ann. Int. Med. 76: 423, 1972.
  9. 2
  10. James A. Merchant, John C. Lumsden, Kaye H. Kilburn, William M. O’Fallon, John R. Ujda, Victor H. Germino, Jr., and John D. Hamilton, “Dose Response Studies in Cotton Textile Workers,” J. Occ. Med. 15: 222, 1973.
  11. T. Reginald Harris, James A Merchant, Kaye H. Kilburn, and John D. Hamilton, “Byssinosis and Respiratory Diseases of Cotton Mill Workers,” J. Occ. Med. 14: 199, 1972.
  12. Arend Bouhuys, Leo J. Heaphy, Richard S. F. Schilling, and J. W. Welborn, “Byssinosis in the United States,” NEJM 277: 170, 1967.
  13. George Tindall, Emergence of the New South 1913-1945. LSU Press, 1967.
  14. Harry Boyt, Radical America 6:4, 1972.
  15. George Tindall, Emergence of the New South 1913-1945. LSU Press, 1967.
  16. Harry Boyt, Radical America 6:4, 1972.
  17. George Tindall, Emergence of the New South 1913-1945. LSU Press, 1967.
  18. Textile Workers Union of America (TWUA) represents 10 percent of all Southern textile workers.
  19. Textile workers are the lowest paid industrial workers in the nation. averaging approximately $4400 in annual wages.
  20. Since 1967. the National Labor Relations Board has found Stevens to he guilty of unfair labor practices on 13 separate occasions. and has ordered the company to reinstate the 289 illegally fired workers with back pay totalling more than $1.3 million
  21. Tsung O. Cheng, Lloyd Axelrod, and Alexander Leaf, “Medical Education and Practice in People’s Republic of China,” Ann. Int. Med. 83: 716, 1975.
  22. Vicente Navarro, “Social Policy Issues: An Explanation of the Composition, Nature, and Function of the Present Health Sector of the United States,” Bull. N.Y. Acad. Med. 51: 199, 1975.
  23. Theodore Goldberg and Ronald Hemmelgarn, “Who Governs Hospitals?” Hospitals 45: 72, 1971 (August).