This article analyses a neglected piece of labour history within Australian coal mining - the industrial campaigns for the recognition, compensation and regulation of respiratory diseases due to the inhalation of coal dust. Australia is known on the international stage for its successful control of this notorious occupational hazard, but little is known about the basis of this success. This article argues that the origins of success can be found in the industrial disputes and political responses which led to Australia’s relatively early recognition of coal dust disease as a legitimate and serious occupational hazard. Adopting a social constructionist theoretical framework, the article highlights the role of the Miners Federation and the State in mediating and interpreting medical and scientific disputation about whether or not coal dust was harmful. Using the dust issue as a powerful symbol of poor working conditions, the miners’ campaign to resolve the problem coincided with the Chifley government’s initial post-war strategy of industrial appeasement to take control of the chaotic industry. The task for resolving the problem was then given to Chifley’s new post-war regulatory body, the NSW Joint Coal Board, effectively closing opportunities for medical views against the legitimacy of disease to retain a foothold in public policy.