Trouble! At Coal Creek

by Eric Persaud

A conflict between working-class people and companies, centered on racial injustice, unhealthy working conditions leading to black lung disease and death, and wage inequity sounds like a newspaper headline from today. Instead, in the graphic novel Trouble! at Coal Creek by Austin Sauerbrei, the year is 1891 and focused on the Coal Creek War in Tennessee. The Coal Creek War was an armed conflict between White coal miners, who worked for unfair wages in dangerous conditions, and coal companies who replaced the striking workers with Black convicts. The convicts were leased to the coal companies by the Tennessee state prison system.  Sauerbrei, a community organizer and sequential artist with labor organizing experience, richly illustrates this historical conflict using a fictional story in the slim novel across five chapters.

Chapter one introduces us to a White family, who moved from Wales to Coal Creek, Tennessee for freedom and stability. The father, Pa, takes a contract to work as a miner for a fair wage and honest work. However, “he and the other miners signed away that life with their contracts. To the coal operators, my Pa was just kindling on the fire of progress and industry. Necessary. Cheap. Expendable. [unpaginated]” The miners went on strike after decades of building tension. In retaliation, the companies struck a deal with the Tennessee State Penitentiary to lease Black convicts to serve as a cheap source of labor.

Later chapters give us dual perspectives of the conflict leading up to an explosive conclusion. Sauerbrei shows in Chapter 2 how the White miners were driven to form a coalition and made efforts to reach out to the governor of the state. While in Chapter 3, the viewpoint of a wrongly imprisoned Black convict is shown to help capture how leased convicts were essentially enslaved labor, just by a different name. Chapters four and five portrays how some of the White coal miners joined the Knights of Labor, the largest labor movement society of the 19^th century that aimed to educate, uplift, and negotiate fair wages for workers. The novel concludes when the White miners infiltrated a convict coal miner camp with the intention of freeing the prisoners.

Throughout the graphic novel, Sauerbrei often shows us the most powerful points through his imagery, rather than by text alone. When the convicts are introduced, the race is never mentioned but visualized by the drawings. Deeply resonating imagery occurs when the miners are described as “Necessary. Cheap. Expendable.” That text is written over a miner, with his lungs colored black as coal. The black lungs stand out starkly as it is contrasted over white to pop out to the reader.

Black lung disease, recognized as coal worker’s pneumoconiosis (CWP), is an occupational disease caused by inhaled coal dust that may lead to progressive massive fibrosis (PMF).¹ PMF is identified by large masses of fibrous tissues that often blackens the lungs and may lead to death. Even with federal protections and regulatory agencies, more than 75,000 miners died from black lung between 1970 to 2016,² and the prevalence of CWP is increasing.³

It is the reflections of history, either related to labor, race, class, or working conditions that makes this graphic novel so alluring. Occupational medicine professionals may find this graphic novel interesting to learn about labor history and some health repercussions. Other medical professionals, artists, and those engaged in environmental justice may find the book to be a useful example on how to communicate labor history effectively. Sauerbrei’s novel, through vivid storytelling and artwork, reminds us that when workers are suffocated either through harmful health conditions or inequality, it will surely be followed by Trouble!

References

1. Arnold C. A Scourge Returns: Black Lung in Appalachia. Environmental Health Perspectives. 2016 Jan;124(1):A13-8. doi: 10.1289/ehp.124-A13. https://ehp.niehs.nih.gov/doi/10.1289/ehp.124-A13
2. Centers for Disease Control and Prevention. Black Lung. 2024. https://www.cdc.gov/niosh/mining/topics/black-lung.html Accessed November 10, 2025
3. David J. Blackley, Cara N. Halldin, A. Scott Laney, “Continued Increase in Prevalence of Coal Workers’ Pneumoconiosis in the United States, 1970–2017”, American Journal of Public Health108, no. 9 (September 1, 2018): pp. 1220-1222

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Dr. Eric Persaud is a member of the Occupational Health and Safety Section in the American Public Health Association. Dr. Persaud received the 2024 Eula Bingham Award for Excellence in Occupational Health and Safety Education and Training. His educational initiatives have reached thousands of workers, fostering a culture of health and safety that extends beyond the workplace. ORCID: https://orcid.org/0000-0003-4577-7975