SPECIAL ARTICLE Dark as a Dungeon The Rise and Fall of Coal Miners’ Nystagmus Ronald S. Fishman, MD oal miners’ nystagmus was one of the first occupational illnesses ever recognized as being due to a hazardous working environment. It aroused great concern and much controversy in Great Britain in the first half of the 20th century but was not seen in the United States. Miners’ nystagmus became a significant financial problem for the CBritish workmen’s compensation program, and the British medical literature became a forum for speculation as to the nature of the condition. Although new cases of miners’ nystagmus were rare after World War II, the condition continued to be discussed in textbooks through the 1970s, after which it abruptly disappeared without any authoritative summing-up, and thereby hangs a tale. MINERS’ NYSTAGMUS IN tion of miners’ nystagmus appears, in NEURO-OPHTHALMIC TEXTBOOKS Cogan’s typical style—concise, clear, confident: The authoritative chapter on nystagmus, Miners’ nystagmus is...apendular nystag- written by Dell’Osso and Daroff in Glaser’s mus, an exceptionally fine and rapid one, oc- text Neuro-ophthalmology in 1999, lists curring in persons who work in poorly lighted 46 types of nystagmus in 3 columns oc- mines for long periods of time. It is much less cupying an entire page.1 Halfway down the frequent now that mines are better illumi- center column there is a listing called “min- nated. The nystagmus is accompanied by an im- pairment of vision that varies according to the er’s” with a subset called “occupational.” degree of nystagmus and occasionally by an A dagger leads the reader to a footnote illusory movement of the environment.... that consists only of the curiously at- tenuated and enigmatic phrase “may not The condition has been likened to that occur- exist,” from which the reader may justi- ring in animals reared in the dark. The progno- sis is favorable when the patient is removed to fiably infer “may never have existed.” quarters having adequate illumination. The footnote is obscure and provocative at the same time. The authors later give The amount of light at the coal face necessary miners’ nystagmus a few sentences in the to prevent nystagmus must be in the order of section on acquired pendular nystagmus, 0.1 Candle per square foot....Where power lines are not available this light is adequately but nothing else. Miller’s 1985 edition, supplied by cap lamps, and where these are Miller and Newman’s 1998 5th edition, used, as in the United States, miners’ nystag- and the 2005 6th edition of Walsh & mus is practically nonexistent.6(p192) Hoyt’s Clinical Neuro-Ophthalmology do 7 not mention miners’ nystagmus at all,2-4 Walsh and Hoyt in 1969 devoted and neither does the excellent book by 4 columns to miners’ nystagmus; the Leigh and Zee.5 So miners’ nystagmus treatment is essentially a duplication has almost disappeared from modern of Walsh’s first 2 editions in 1947 and textbooks. 1957: This contrasts with its treatment in The cause of miners’ nystagmus remains Cogan’s classic Neurology of the Ocular disputed.... 6 Muscles, a text that taught many of us our The affection is usually considered as “func- neuro-ophthalmology and may still be read tional” but it is not proven that a pathologic with profit. There the following descrip- background does not exist.... (REPRINTED) ARCH OPHTHALMOL / VOL 124, NOV 2006 WWW.ARCHOPHTHALMOL.COM 1637 ©2006 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/27/2021 Since the occurrence of nystagmus with- What happened? What was go- headlamp supplied the main illumi- out symptoms is high among British ing on here? nation at the coal face11 because it miners it would be difficult to explain could be placed as close as possible the condition simply as a manifestation THE TECHNIQUE to where he had to see. Larger lamps of a neurosis. General symptomatology OF COAL MINING could be placed on the floor nearby is that of neurasthenia. There is complaint of dizziness, headache, and but were not heavily relied on. weakness...;photophobia ...; Coal had been used in ancient Rome, The favorite source of light tremors [of] . eyelids ...,head ..., but it was the advent of the steam through most of the 19th century and hands....7(p278) engine that greatly increased de- well into the 20th century was an oil mand for the fuel and made fea- lamp, whose wick could maintain a Now we hear a more complicated sible the deep-shaft mining of the last flameforprolongedperiods,adistinct story in a more uncertain voice: “re- part of the 19th century and the first improvementoverbarecandles.How- mains disputed,” “not proven,” “dif- part of the 20th, when most cases of ever, the bare flame could easily ig- ficult to explain.” miners’ nystagmus were noted.9 nite an explosion if it encountered Even more ambivalent was the Access to the veins of coal usu- pockets of methane. In 1816, Sir 8 work of Duke-Elder and Wybar in ally required a long approach Humphrey Davy invented a safety the multivolume System of Ophthal- through a vertical or horizontal shaft lamp by enclosing the flame in a me- mology series, in its day considered and from there through a warren of tallic meshwork that bled off the heat the encyclopedia of clinical ophthal- rooms and walls to the active coal beforeitreachedtheignitiontempera- mology. The authors were British, face. When a new area of the coal ture of methane. The dimensions of and in 1973 they devoted 6 pages to vein was to be exploited, an ap- the mesh were crucial because the miners’ nystagmus: proach tunnel was dug, shored up open pores had to be small enough The aetiology of the disease is with timbers, and the coal face un- to provide enough metallic surface to disputed.... dermined by creating a cleft as low absorbtheheatadequatelybutnottoo as possible near the floor. The small as to greatly diminish the . one important cause is lack of illu- “holer” or “undercutter” was a man amount of light emitted. The Davy mination at the coal face.... with some skill with a pickax and lamp had an added utility: when in- A second factor...isthecrouched and proud of it, since it often required flammable gas was encountered, the strained attitude of a miner at the coal wielding the ax while crouching or flame suddenly grew in intensity with face with his constant upward gaze at even while prone or lying on the a bluish color, and the miner thus had work which may disturb the vestibular side, striking the bottom of the coal a warning to clear the area before an apparatus and certainly brings about seam with a horizontal swing. If explosionoccurred.However,ifapar- physical and ocular fatigue. wedges pounded in high up on the ticular brand of lamp was not made A third factor may be the inhalation of coal face could not displace the coal to exact specifications, or was not noxious gases over long periods....[B]ut downwards, holes for explosives regularly cleaned, it decreased the in- possibly the most important factor of all were then drilled by hand in the up- tensity of light below a miner’s tol- is the mental make-up of the workman per layer. The blast then brought the erance. Thus, there was no unanim- himself, for many are unable to with- coal face down on the undercut. ity among miners as to the desirabil- stand the stresses of years of hard work With the undercut, larger and more ity of the Davy safety lamp. in an uncongenial environment wherein valuable pieces of coal were yielded There was a similar recalcitrance constant discomfort and occasional dan- ger are too often evident....8(p820) when the upper area was dropped. in using battery-operated electric Some owners paid only for pieces light in the early part of the 20th Now the reader gets 4 “factors” and larger than a certain size, and this century. Batteries were relatively is further confused, usually a sign was important because miners at this large and heavy and were subject to that the writers are confused also. stage usually worked as indepen- failure at inopportune times. More That was in 1973. After that, for 26 dent contractors and were paid only popular was the acetylene light, years there is silence. British and by the bulk or weight of acceptable which gave a brilliant enough flame American ophthalmology journals coal that they produced.10 to make it also the choice for early had been silent since the 1950s. automobile headlights. The acety- Then in 1999 we get “may not ILLUMINATION lene torch is preferred at times even exist.” OF THE COAL FACE to this day by spelunkers, who are Textbooks encapsulate the wis- often drenched while exploring dom of the day and are always sub- Because the generally accepted caves and find their electric batter- ject to revision, but rarely is an en- major factor in the initiation of min- ies shorting out. Although electric- tity given such respect at one time ers’ nystagmus has been poor illu- ity provided better lighting, there only to be given such short shrift and mination at the work site, it is worth- was a certain inertia in the coal min- so ignominiously cast aside 2 or 3 while to take a moment to consider ing industry in accepting the inno- decades later, without explanation. how light was provided to the miner. vation. Electrical illumination was It’s as if an embarrassed fog had de- The albedo of the black coal face fairly standard by the 1930s (at a scended, as if there were a consen- was 7% to 8%, a very dark environ- time when there were still gaslights sus that it would be best to forget the ment that reflected little of the in- on some London streets).