In 1984-1985, medical examinations consisting of a chest radiograph, spirometry test, and questionnaire on work history, respiratory symptoms, and smoking history were administered to 1,061 white males who were employed at 31 coal cleaning plants and strip coal mines in the anthracite coal region of northeastern Pennsylvania. The prevalence of radiographic evidence of International Labour Office (ILO) category 1 or higher small opacities was 4.5% in 516 men who had never been employed in a dusty job other than in surface coal mining. Among these 516 workers, all 4 cases of ILO radiographic category 2 or 3 rounded opacities and 1 case of large opacities had been employed as a highwall drill operator or helper. The prevalence of category 1 or higher opacities increased with tenure as a highwall drill operator or helper (2.7% for 0 y, 6.5% for 1-9 yr, 25.0% for 10-19 y, and 55.6% for greater than or equal to 20 y drilling). Radiographic evidence of small rounded opacities, dyspnea, and decreases in FEV1.0, FVC, and peak flow were significantly related to tenure at drilling operations after adjusting for age, height, cigarette smoking status, and exposures in dusty jobs other than in surface coal mining. However, tenure in coal cleansing plants and other surface coal mine jobs were not related to significant health effects. The apparent excess prevalence of radiographic small rounded opacities in anthracite surface coal mine drillers suggests that quartz exposures have been increased. Average respirable quartz concentrations at surface coal mine drilling operations should be evaluated to determine whether exposures are within existing standards, and dust exposures should be controlled.