The coal industry developed over time. The earlier anthracite mines of the north had typically operated near a town . But when the "smokeless coal" deposits were exploited in the southern Appalachians, they were often in remote areas. The 1880's saw a lot of that preliminary exploration and development.. First, deposits were discovered, and land bought, and railroad connections to them were laid. Then workers were recruited- in Appalachia, where families were large and good farmland for them was getting scarce, in the early years that was not too hard to do. But mostly in the early days these would be single men, not men with families. Working conditions were awful, and living conditions often bad as well. Though Jedediah Hotchkiss would plan and build towns like Pocohontas WV, in the 1880's, there were many more small operators and careless owners that might put up a boarding house or two, or knock together a collection of tar-paper shacks and drop them along a railroad spur. Cram hundreds of people into a narrow river gorge, and diseases could easily become rampant . Sanitation was nil, with privies located next to sources for drinking water. There would be a considerable problem with water-borne diseases like diptheria and typhoid. There was a company store ( because otherwise there would have been no store at all) and miners would often have money deducted from their pay for medical care. But there's very little information on these early years and it's hard to say precisely what care was available. Likely medical care was provided by a doctor who was brought in, and likely he spent most of his time dealing with work injuries and acted as a coroner, for deaths. If there was a fever, in the 1880's, there might well be patent medicines sold at the company store that could claim treatment, but at this time a doctor who knew something about infectious disease would have only been able to tell the parents to keep the child in bed. For infections up until 1900, it's been suggested, it was the nurses who actually saved patients' lives, keeping them warm, fed, and cared for. Doctors could mostly only explain the problem and assess the odds.

In the 1890's, the industry developed, demand for coal grew and the labor market grew tighter, and it became harder to recruit workers for such a difficult job. It was at this time that you would find at least some companies, like SC&C (or Stonega) working harder to attract and keep their workforce. They would provide better housing, sanitation, and medical care to do so. Stonega even set up a hospital for its miners in 1902. When labor shortages grew even worse, after WWI, Stonega would try even harder, had a medical department trying to improve living conditions in its company towns. Stonega was just one company: smaller ones especially might not be so generous, and medical care over all the camps and towns was therefore variable. However, the company store would be not only a place where the miner would buy things, it would also keep the records for pay and expenses. The use of scrip became a contested feature in the later years, after 1890. Miners were generally not only paid in scrip. But doctor's fees would be deducted at the store directly from the miner's pay, like rent and blasting powder; he would not have had to try to pay the doctor in scrip. As scrip was usually not transferable- couldn't be redeemed by anyone other than the miner and only at the company store- the doctor would likely not have been able to take it, anyway.

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Crandall A Shifflett: Coal Towns