Introduction

Abstract

This chapter draws parallels between the Marikana confrontation between police and striking platinum miners in 2012 and the longer history of mining in South Africa. Then as now, mining has been dangerous work performed mostly by migrant workers under the eye of brutal management and a violent state. For most of the twentieth century, South Africa’s gold mines were the most profitable sector of the national economy yet faced formidable challenges in containing costs, dealing with health crises and recruiting sufficient number of workers. It was in the context of the ongoing threat to their viability that the mining houses entered debates about the character and incidence of occupational lung disease, set up clinics and hospitals, employed medical staff, collected (or avoided collecting) statistics, negotiated with public officials, funded research, contracted with insurance companies, influenced the flow of information and helped shape the public perception of risk. The chapter places this dynamic in the context of current scholarly debates about the development of scientific knowledge. It then links post-apartheid political changes with the settlement, in 2019, of a massive class action by former gold miners for occupational injury. The chapter concludes by outlining the concept of manufactured ignorance. Precisely how such ignorance was made, contested and dismantled has informed the research and writing of this book.

In early August 2012, following failed wage negotiations and civil unrest, about three thousand striking platinum miners employed by Lonmin plc gathered on a hill close to the town of Marikana in the North West province of South Africa. Nine out of ten Lonmin miners were migrants, mainly from the Eastern Cape, who lived next to the mine in squalid shacks and informal settlements.¹ During a confrontation on 16 August, police opened fire, wounding 78 miners and killing 34 others. Many of those killed and injured were shot in the back.

As required under the Occupational Diseases in Mines and Works Act, the cardio-respiratory organs of the deceased men, who were deemed to have died suddenly on the mine, were sent to the National Institute for Occupational Health for examination.² The autopsy results were telling. Of the thirty-four, three miners had silicosis, with nodules in both lungs. Another four had silicotic nodules in adjacent lymph glands. Evidence of previous pulmonary tuberculosis was found in two of the miners and a further two had emphysema. One contract worker from the Eastern Cape, who had not been diagnosed in life, had extensive silicosis, warranting first-degree certification. The other two mine workers in whom pulmonary silicosis was found at autopsy had also not been previously diagnosed. The deceased had a median age of thirty-three and more than half had previously been employed in gold mines. Five were migrant workers from neighbouring countries; like all such workers, they had limited previous access to health services. Lonmin had incomplete work histories for the deceased, and this compromised their families’ claims for compensation.

In various ways, Marikana presents a microcosm of South Africa’s mining history. Mining has always been dangerous work, much of it performed by migrant workers under the eye of brutal management and a violent state. For most of the twentieth century, South Africa’s gold mines were the most profitable sector of the national economy. Gold was the single most important export, and gold mining the largest employer. Today, platinum is one of South Africa’s leading exports. By 2010, the industry exceeded the value of gold mining and employed more labour.

Like previous generations of miners, the men who died at Marikana were migrant workers paid below subsistence wages. A number had occupational disease for which they had not been compensated. Most had worked at other types of mines before arriving at Marikana. Over time, the lungs of gold miners fill with dust. As well as leading to silicosis, this greatly increases the likelihood of developing active tuberculosis. Eventually the men fail the entry medical examination. As their health deteriorates, they move along the chain of employment from skilled work in larger and well-resourced mines to poorer paying jobs. Many now work on the platinum mines.

Against the background of continuity, there is one aspect of the Marikana tragedy which is radically different from the past. Under the various twentieth-century Miners’ Compensation Acts, workers had no effective right to legal redress against employers. Prior to majority rule the concept of an individual miner suing an employer for lung disease was foreign to South African law. The compensation system established from 1911 was always assumed to preclude such claims and there is no evidence of a black miner ever bringing a case to court. The law also made no provision for class actions. This has now changed. In July 2019, the settlement of a massive class action in which former gold miners sought damages for their occupational lung disease was approved by the South African High Court. Under the terms of the settlement, all eligible workers suffering from silicosis and/or tuberculosis, who worked in the companies’ mines from March 1965 to date, are eligible for a graduated schedule of compensation. Importantly, the settlement makes no distinction between citizens of South Africa and those of the adjoining states and allows damages to be claimed by the dependents of deceased miners.³

The Political Economy of Mining

When gold was first discovered on the Rand in the 1880s, most Africans lived in subsistence agricultural communities. Expropriation of land by white settlers, the imposition of taxation by colonial administrations and regulations prohibiting black ownership of land outside of ‘native reserves’ were all in part designed to drive indigenous peoples into wage labour and the money economy. Below subsistence wages entrenched Africans’ reliance on paid labour. It was around this dynamic that the South African gold mining industry was built. Extracting the low-grade ore only seemed possible if wages of the huge mining workforce were kept very low. Since most locals could get better pay in other occupations, they preferred to find employment elsewhere. The fixed price of gold made it difficult for companies to respond to changing production costs. The resulting chronic shortages of labour—and the companies’ increasing reliance on migrants—were compounded by the health risks associated with mining. It is probable that at some point in the mid-1920s, the South African industry accepted that it was impossible to engineer dust out of the mines and that silicosis and tuberculosis, especially among migrant workers, were inevitable.⁴ Rather than aiming to eliminate silicosis, the mining industry began attempting to push back its onset.⁵ When, in 1943, the Stratford Commission had the Government Actuary cost recommended compensation of miners with occupational lung disease, it became evident that the industry could not operate at profit if its legal obligations were met.⁶ It was in the context of the ongoing threat to their viability that the mining houses entered debates about the character and incidence of occupational lung disease, set up clinics and hospitals, employed medical staff, collected (or avoided collecting) statistics, negotiated with public officials, funded research, contracted with insurances companies, influenced the flow of information and helped shape the public perception of risk.

While the mining houses grappled with shortages of labour in a dangerous industry, colonial administrations of the adjoining states faced chronic shortages of resources. Next to funding their own bureaucracies, they were responsible for keeping the peace, supporting local agriculture and industry, providing services such as hospitals and schools and ensuring the wellbeing of the population. The administrators’ attempts to steer a path between their responsibilities and constraints spanned vigorous advocacy on behalf of black miners at one end and collusion between the gold mining companies, the South African state and the British Colonial Office in the buying and selling of labour at the other.

Mines, Occupational Lung Disease and the Development of Scientific Knowledge

The establishment of South Africa’s gold mines, the consolidation of colonial empires and the intensification of global trade coincided with a critical period in the making of modern medical science. It also occurred at a crucial juncture in the development of ‘statistical thinking’.⁷ Government attempts to control and to tax unruly populations, entrepreneurs’ struggle to maximise profits, outbreaks of epidemics in new industrial and population centres, debates about risk and occupational health disease, contests about authority and knowledge between different groups of bureaucrats, professionals and scientists, all contributed to this process of intellectual innovation. Importantly, information, technologies, conceptual tools and procedures of governance were not simply disseminated from the metropole to colonial outposts, but rather circulated among different jurisdictions. At times, the colonies became laboratories for refining core administrative techniques, problematics and conceptual distinctions of Western scientific, social and political thought.⁸

What is today known as tuberculosis and silicosis are ancient diseases. In Western cultures, debates about their distinguishing features, diagnosis, causes and cures have stretched back hundreds of years. Spurred on by epidemic crises in several sectors of increasingly mechanised industries, the debates intensified during the nineteenth century. The precision of medical arguments was enhanced by unprecedented accumulations of mortality statistics, more systematic collection of morbidity data and new diagnostic methods and instruments, some based on developments in analytic chemistry. By the late nineteenth century, scientific advances made it possible to distinguish between diseases caused by the inhalation of dust and those due to bacterial infection. The terms pneumoconiosis (a collective name for a large group of chronic lung illnesses and systemic diseases caused by the inhalation of dust) and silicosis were first suggested by scholars in 1867 and 1871⁹; the bacteria that causes tuberculosis was discovered in 1882. In practice, it would be decades before tuberculosis and silicosis could be separately diagnosed in living subjects; in many regions, reluctance to collect relevant statistics hindered epidemiological research.

Importantly, the process of medical knowledge-making did not simply involve discovering and naming something—like a mountain range—that was clearly already there. Rather, debates about tuberculosis mobilised—and helped create—an array of derogatory stereotypes about the nature and habits of working people and colonial subjects. At the same time, the complexity of tuberculosis gave rise to a changing array of technical terms used to describe different forms and stages of the disease and to map its statistical incidence. Today, it is estimated that only between 5 and 10 per cent of people infected with TB bacteria (or those with latent TB) will develop the disease during their lifetime; most do so when their bodies come under additional stress. Since those with latent (rather than active) TB show no symptoms, few are diagnosed, not least since diagnosis is expensive and relies on advanced medical technology. Current World Health Organization statistics distinguish between TB ‘incidence’, ‘prevalence’ and ‘mortality’. Incidence refers to the number of new and relapse cases of TB arising in a year and is derived from the rates of notification of TB cases in countries with well-funded health systems, and a range of other surveys and estimates elsewhere. ‘Prevalence’ refers to the total number of cases of TB at a given point in time and is subject to similar constraints regarding funding and technical capacity.¹⁰ In effect, working out the true extent of TB is a complicated, expensive, technically demanding and highly negotiated process.

Similarly, the complex process of identifying silicosis involved drawing agreed boundaries around a highly complex continuum of interaction between workers’ exposure to various forms of dust and pathogens and their lung tissue, while excluding the role of silica dust in other pathologies (such as auto-immune diseases and some forms of carcinoma).¹¹ The growing body of medical knowledge was never enough to determine these developments. Rather, professionals, political interests and economic constituencies all played important roles in interpreting the events in people’s lives that came to be identified as industrial disease and disability. In turn, these changing interpretations became the basis of claims about causes and origins (or aetiology), latency, onset, incidence, prevalence, morbidity and mortality.¹² Indeed, some scholars argue that the social debates around silicosis set the agenda of national and international controversies about what constituted industrial disability and who should bear the financial and societal burden of dependency, family and community trauma and personal cost.¹³ In this shifting terrain, the older term miners’ phthisis was a useful but unstable category that sometimes described only tuberculosis but at other times included combinations of lung diseases such as silicosis, asbestosis and pneumonia. It is telling that black miners in Southern Africa continued to describe their chest problems as sifuba or phthisis well into the twenty-first century.¹⁴

Health Crises and the Public Perception of Risk

The viability of the South African gold mining industry was profoundly challenged by four health crises. The first three beset the gold mines in the period from 1900 to 1916. These crises overlapped in time, and each was affected by the dust levels underground, the conditions in the mine compounds and the industry’s insatiable demand for labour. The initial crisis was over an acute form of silicosis. In the first decade of mining this disease took the lives of hundreds of rock drillers, many of them tin miners recruited from Cornwall.¹⁵ The second crisis revolved around non-tuberculous infectious pneumonia, which killed thousands of migrant workers in the mine compounds. The death rates were particularly high among recruits from the Tropical north. The focus of the next crisis was tuberculosis, which became more obvious once mechanical ventilation and blasting regulations had reduced extreme dust levels. Those changes saw acute silicosis replaced by a chronic form of fibrosis. Although not in itself immediately fatal, this contributed to high rates of tuberculosis disease among black miners. The final health crisis began in the mid-1980s with the arrival of HIV/AIDS which, combined with silica dust exposure and tuberculosis, again led to the deaths of thousands of workers.

The histories of tuberculosis and the recent HIV/AIDS epidemic show there is no simple path for infection associated with oscillating migration. Tuberculosis, for example, moved in both directions between urban and rural settings. Once a disease arrived in a rural area its rate of transmission depended upon factors such as ‘land hunger’ or chronic shortage of land needed for subsistence, nutritional status, access to public health, crowded living conditions and generational poverty. The complex relationship between the social and material conditions in each labour-sending area and the disease process meant that the impact of migrant labour varied from region to region. The consequences were also uneven within a single setting, with women at times bearing much of the burden.¹⁶

Between the health crises in early twentieth century and the recent class action, the gold mines were widely believed to have resolved the problem of occupational lung disease. Indeed, for most of the twentieth century, the data published annually by the Miners’ Phthisis Medical Bureau showed that the mines were safe. In the period from 1917–1920, the silicosis rate among white miners was reported to be 2.195 per cent, a low figure by international standards. In 1935 it had fallen to 0.885 per cent. The rate for black miners was even lower. In 1926–1927 it was 0.129 per cent and in 1934–1935 it had fallen to 0.122 per cent.¹⁷ In 1946 the official silicosis rate among black miners increased somewhat to 0.178 per cent.¹⁸ Advances in medical diagnosis technologies, such as the introduction of mass miniature radiography in the early 1950s, brought no rise in the reported disease rates. Over time conditions apparently improved still further, and by the early 1980s the Chamber insisted that silica exposure no longer caused disability or death. In 1985 Dr Schroder, from the Chamber’s Air Pollution Division, claimed that: ‘With the dust control in South African … Gold Mines, no one today dies from silicosis’.¹⁹ As late as 1990, the South African specialists Drs Robert Cowie and Salmon Mabena wrote that: ‘In many studies of silicosis under modern mining conditions, including a study of white South African gold miners, silicosis is shown to be a benign disorder associated with little dysfunction and no disability’.²⁰ In answering their critics, apartheid minority governments in Pretoria took great care to publicise the safety of the mines and the benefits they offered to migrant labour.

The dismantling of apartheid in the early 1990s was associated with a radical shift in the public perception of risk. The Commission into Safety and Health in the Mining Industry (Leon Commission), held under the first majority rule government in 1994, found that dust levels were hazardous and that they had probably been so since the 1940s.²¹ More recent research conducted at University of Cape Town puts the silicosis rate in living retired miners at between 22 per cent and 30 per cent.²² Jill Murray’s post mortem data suggests that up to 60 per cent of miners will eventually develop what is a life-threatening and untreatable disease.²³ In addition to silicosis, the mines are also accused of playing a major role in the spread of tuberculosis, a well-known consequence of exposure to silica dust. Recent research shows that even subclinical amounts of dust in the lungs (that is dust not visible or identifiable in scans or X-rays) almost double the risk of contracting TB.²⁴ Not only is the burden of tuberculosis in Southern Africa currently among the highest in the world, the incidence of the disease among miners has been estimated to be as much as ten times higher than in the populations from which they originate.²⁵ As in the past, the majority of miners are migrant workers, whose exposure to silica dust and tuberculosis results in the transmission of disease to rural communities and across national borders.²⁶ There is evidence stretching back to the 1920s that South Africa’s mines have been spreading tuberculosis to neighbouring states.²⁷

By the late nineteenth century, statistics came to play a significant role in the official delineation of risk and in scientific debates more generally.²⁸ Despite widespread problems in identifying and recording the main causes of death, mortality rates were among the most robust statistical indicators of occupational health. Importantly, these figures were contingent on where workers died. In Southern Africa, that depended upon two things: the disease process and the industry’s repatriation policies. The inferior health, accommodation and working conditions of black miners, and of migrants in particular, meant that unlike white workers they were highly susceptible to pneumonia. And even though all who worked on the mines were at risk of silicosis, the superior conditions enjoyed by white miners meant that fewer developed tuberculosis. Because pneumonia killed within a matter of days or weeks, sick men died on the mines. In contrast, silicosis and tuberculosis could take years to kill. Unlike whites, most black ex-miners who succumbed to these diseases had been repatriated to rural areas, and so their deaths were not recorded as mining deaths. Despite repeated requests over several decades, local authorities were not notified of repatriated miners, and no statistics were collected on their subsequent health. These problems were compounded by systematic disagreements about classifying the causes of death, and wide discrepancies in the way statistics were collected and statistical categories made up from place to place and year to year. The messiness and inadequacy of statistical data was the source of a chorus of contemporary complaints, and is reflected in frequent discrepancies in the figures cited in the following chapters.

The silicosis and tuberculosis crises were resolved politically by several commissions of enquiry and the Miners Phthisis Acts of 1912 and 1916, which made both diseases compensable. In contrast, there were no commissions of enquiry into pneumonia, no dedicated legislation—and no compensation. Instead, in 1913 the South African government imposed a ban on recruitment from the Tropical north, and waited for the Chamber to implement a range of public health measures and develop a vaccine to prevent further fatalities.

The system of oscillating migration, whereby people moved periodically between their rural homes and mines or factories, has long been associated with the transmission of epidemic diseases.²⁹ As with the earlier epidemics, from the early 1980s the migrant labour system facilitated the spread of HIV/AIDS throughout Southern Africa. As in the past, in addition, the fear of epidemics infused wider debates about pressing social issues.³⁰ Between 1988 and 1992, for example, about 13,000 Malawi miners were repatriated from South Africa. The official reason given was that in the previous two years some 200 of them had tested HIV/AIDS positive. The Chamber of Mines then requested that the Malawi government screen all prospective migrant workers for the disease before they left for South Africa. The government refused, and the Chamber stopped recruiting. The gold mines were restructuring in response to falling profitability and it is likely that they used HIV/AIDS to justify previously planned retrenchments.³¹

In recent decades, a combination of social and biological factors created a perfect storm for the interaction between silicosis, tuberculosis and HIV. Risk factors such as migrancy and single-sex mine compounds increase HIV rates. Together, silica dust, silicosis and HIV have a multiplicative effect on the development of tuberculosis.³² Silica is a biologically active dust and the biological processes which are initiated with exposure do not cease once it ceases. Silica exposure is associated with tuberculosis even in the absence of silicosis, and the increased risk is life-long. In effect, silica retained in the lung and silicosis represent a type of acquired immune deficiency.³³ Failure to complete treatment has led to the emergence of multiple drug-resistant TB. By 2007, miners in sub-Saharan Africa were shown to have greater incidence of TB than any other working population in the world.³⁴ In its Global Tuberculosis Control Report for 2019, the WHO identified fourteen countries with the most severe burden of TB, multi-drug-resistant TB and TB and HIV combined. Of those fourteen, eight supplied labour to South Africa’s mines.³⁵ Gold miners from these countries were the fittest members of their communities. They were employed in a technologically advanced industry with an admired record of medical surveillance dating back almost a century. From 1912, they were subject to compulsory medical examination before entering the industry. Once employed, they were much better fed than people in their home communities. They were also the only group of black people subject to case finding through regular medical inspections, which after 1955 featured the routine use of mass miniature X-rays. And yet, until majority rule, the extent of the burden of occupational lung disease among gold miners remained all but invisible.

Miners’ Class Actions

The Leon Commission (1994) was highly critical of hazardous conditions on the mines and questioned the claim that they posed negligible health risk to workers. However, it brought no sustained reduction in dust exposures. On the contrary, the use of subcontracting underground labour arguably worsened working conditions, as did the use of production-related bonuses.³⁶ An increase in the average length of service for miners resulted in longer periods of exposure, while the introduction of full-calendar-year operations increased the annual hours worked underground.³⁷ The recorded prevalence of tuberculosis in gold miners increased from 806 cases per 100,000 in 1991 to 3821 in 2004, while HIV prevalence rose from less than 1 per cent to 27 per cent in 2000. The system for dealing with compensation for occupational lung disease was unable to cope with the extent of the crisis. The ANC government was reluctant to assume responsibility for laws enacted during minority rule, or for the citizens of neighbouring states. The South African Medical Bureau of Occupational Diseases (MBOD), which adjudicated compensation awards, had in effect ceased to function because of a lack of staff and the volume of claims. Massive backlogs meant that mineworkers were practically unable to access the statutory compensation to which they were entitled.³⁸ The problems were compounded by the difficulties the men faced in establishing their work histories. Most were only provided with a sheet of paper acknowledging their employment at a particular mine. The following year they might be re-recruited by the same employment agency, but often placed at a different mine, with their name transcribed in a different way.³⁹ The Employment Bureau of Africa (TEBA) electronic employment records are incomplete as are the records held by individual mines.⁴⁰ While the MBOD should have a complete record of all risk shifts worked by gold mineworkers, a substantial breakdown of the MBOD’s system after 1994 resulted in records either lost, destroyed or simply not kept.⁴¹

It was in this climate that, in 2013, Abrahams Kiewitz Attorneys, Richard Spoor Attorneys and the Legal Resources Centre separately commenced class actions against a number of companies on behalf of miners suffering from silicosis and/or tuberculosis. Against strenuous opposition from the mining companies, in 2016 the South African High Court amalgamated their separate actions into one. Importantly, the court also amended the common law regarding what is called ‘the transmissibility of damages’ so it was in line with South Africa’s post-apartheid constitution, and in particular its clauses regarding human rights. In brief, the changes allow for the wives and other dependents of miners taking part in the class action to inherit damages awards in case the men die before the court process is completed.⁴² In May 2018, the parties to the dispute reached an historic agreement to settle the Silicosis and Tuberculosis Class Actions. The settlement was confirmed by the South African High Court in July 2019. Its provisions not only represent a dramatic change in the legal rights of mine workers throughout the region but have considerable symbolic importance as part of South Africa’s transformation from minority rule. Securing the rights of migrant workers has been a highly significant part of that transformation.⁴³

The Manufacture of Ignorance

The making and dismantling of the complex edifice of racialised employment and management of risk in the South African gold mining industry is at the core of the chapters which follow. In particular, the book focuses on the discrepancy between official visibility of the extent of occupational lung disease during most of the twentieth century and since South Africa’s transition to majority rule. A good shorthand description of the construction and maintenance of this discrepancy is the manufacture of ignorance.

The contours of such manufactured ignorance are well captured in the core arguments made by the mining companies through the years of litigation before the class action was settled. In contesting the claims made against them, the companies not only challenged the appropriateness of class action, but also their responsibility and liability for past injuries. The companies’ Defendant’s Pleas emphasised the care the companies took to prevent occupational disease, to comply with legislation and state regulations, to monitor health, to inform labour of the risks of dust exposure and finally to provide appropriate treatment to miners who contracted silico-tuberculosis. At the same time, they drew attention to state failure to deal with a health crisis which was not of the companies’ making, on the miners’ own negligence and on their implicit acceptance of risk when they entered employment contracts.

The miners’ litigation, in contrast, took as its starting point the extraordinarily high rates of occupational disease among retired miners revealed by recent medical research, now established to be up to a hundred times higher than the official rates published annually by the Bureau and its successors in the period from 1916 to 1990. Given this discrepancy, the miners’ legal representatives asked the courts to identify when the mining houses and the Chamber became aware that there were high rates of uncompensated silicosis and tuberculosis? And when were they provided with reliable information that the mines were spreading tuberculosis to labour-sending communities? Did they, in effect, act to manufacture ignorance of workplace risks? On the face of it, these questions were difficult to answer. The documentary trail is fractured, and researchers and the miners’ legal representatives had limited access to the extensive archives of the Chamber of Mines and Barlow Rand.⁴⁴ There is, however, a rich vein of compelling evidence from the 1920s of serious hazards which the mines failed to address. It is from this material that the story of manufacturing ignorance told in this book is woven.

The first strand of evidence concerns the knowledge of risk. The Commissions of 1902, 1912 and 1914, augmented by the 1914 Gorgas Report, provided sufficient evidence of occupational disease for the South African government, under pressure from London, to ban the recruitment of labour from the Tropical north. The decision to suspend the recruitment of miners from tropical regions was supported by research conducted in the 1920s and 1930s. Drs Watt, Mavrogordato and Macvicar all suggested that there were high rates of silicosis and tuberculosis, and that the mines’ policy of repatriating sick men was spreading tuberculosis to rural communities within South Africa and through the migrant labour system to adjoining states. These findings were endorsed by the Stratford and Lansdown Commissions of 1943, and again by the Oosthuizen Committee Enquiry of 1954. The second strand of the story encompasses the Chamber’s failure, over several decades, to inform the administrations of the British High Commission Territories, Nyasaland and of Portuguese East Africa of the risk to public health posed by men with tuberculosis returning from the mines. The third strand comprises the industry’s failure, from 1922 until the 1990s, to carry out follow-up research into the health of miners once they left the industry. The final strand involves the ease with which the epidemic of occupational lung disease was identified in the early 1990s by independent researchers.

As it proudly claimed, the Chamber was the major funder of research into silicosis and pulmonary tuberculosis. During his annual address in June 1990, the Chamber’s President, K.W. Maxwell, for example noted that: ‘Some 60 per cent of the R65 million spent in 1989 by COMRO (the Chamber’s research arm) was devoted to wide-ranging research projects directly related to safety’.⁴⁵ Between the 1970s and 1994, the industry spent almost R1.5 billion on research and development aimed at improving safety and productivity.⁴⁶ The scale of such investment makes the official invisibility of lung disease among miners all the more intriguing. Anna Trapido was a PhD candidate when she uncovered alarming rates of uncompensated silicosis and tuberculosis among former miners at Libode in the Eastern Cape. The total outlay on Trapido’s research—including her salary, the cost of reading X-rays, transport and incidental expenses—was at most R500,000. As the result of her findings, the Chamber paid out more than R5 million in compensation to Libode miners.⁴⁷

The corporate strategy of shifting the costs of production onto labour, the state and civil society has been one of the defining features of modern industrial workplaces. In charting the histories of the asbestos and tobacco industries we have access to internal company correspondence. Released through legal discovery,⁴⁸ those documents reveal how, over decades, senior management and company medical officers in a dozen countries systematically suppressed evidence of hazardous work practices and the risks associated with asbestos and tobacco products. Studies such as those by Castleman, McCulloch and Tweedale, and Proctor and Schiebinger show that those industries also corrupted the science.⁴⁹ This process, which can be described as medical involution, or the creation of scientific ignorance, is very different from simply hiding evidence of hazards. The creation of ignorance, which Proctor and Schiebinger call agnotology, is subtler and more effective than suppression. Suppression simply leaves gaps in knowledge of risks; false knowledge, the outcome of cultural and political struggles, fills such gaps with misleading information.⁵⁰

South Africa’s mines were reputed to lead the world in the prevention, detection and compensation of occupational lung disease. The recent litigation—and this book—shows that this reputation was undeserved. Instead, they provide evidence of a quite different contribution to the world economy and scientific community. They suggest that the gold mines pioneered techniques, later adopted and refined by the asbestos and tobacco industries, for hiding the evidence of disease and denying employees and their families’ compensation. The appropriation and corruption of medical knowledge in South Africa has been on such a scale that without it oscillating migration, especially from the British High Commission Territories, would probably have been politically unsustainable. Such manufactured ignorance had consequences far outside Southern Africa. The systematic downplaying of the risk of silicosis, for example, has arguably contributed to the current worldwide epidemic of occupational disease among stone benchtop manufactures and installers.⁵¹ In all, rather than constituting an example of spectacular biomedical failure, the history of mining, medical knowledge and migrant labour can be read as a particular kind of corporate success.

The successful manufacture of ignorance has a number of possible explanations, ranging from incompetence to collusion between the mining industry and the state. In assessing the relative merits of such explanations, this book builds on the research of many other scholars. The literatures on gold mining and migrant labour are particularly rich, and this project draws upon the work of scholars such as Wilson, Harries, Delius, van Onselen, Moodie, Phimister and Crush. Until recently, surprisingly little has been published on the politics of occupational disease in South Africa and even less on oscillating migration and health.⁵² The exceptions are major histories by Katz and Packard, and more recently McCulloch’s South Africa’s Gold Mines and the Politics of Silicosis.⁵³ Katz’s study of pneumonia and silicosis ends in 1916. Packard was writing a broader and more complex political economy of tuberculosis in South Africa, which takes the story up to the eve of majority rule. While Packard focuses on the complexities of tuberculosis infection among different communities within the borders of South Africa, this text deals with the interaction between the three main occupational lung diseases among miners and focuses on the dynamics of the migrant labour system. Second, while Packard fully acknowledges the political nature of statistics collection, presents evidence regarding the mines’ attempts to minimise mortality and morbidity figures and mentions the synergy between silica dust and tuberculosis, he largely relies on the official rates of occupational injury. Given that the sheer extent of silicosis among miners was unknown at the time he was writing (when the apartheid regime was still in power), his otherwise damning social history of tuberculosis understates the significance of mines as a source of TB infection.⁵⁴

McCulloch’s South Africa’s Gold Mines and the Politics of Silicosis looks at the story told in this book from the outside in. Focusing on South Africa, it situates the mines and mine medicine in a world context. It provides detailed evidence on the political economy of mining, the everyday dynamics of mine medicine, political developments and union struggles. The focus of the book is on the politics of silicosis. Mining gold and manufacturing ignorance looks at the same industry from a different perspective. Rather than silicosis, the main emphasis is on tuberculosis. Rather than looking at the industry from the outside in, it charts how machinations about the buying and selling of mine labour behind closed doors helped engender an epidemic of tuberculosis throughout the Southern African region. This time, the main emphasis is not on South Africa itself, but on the labour-sending states: present-day Lesotho, Mozambique, eSwatini, Botswana, Zambia, Malawi and Zimbabwe. Finally, the underlying theoretical narrative of The Politics of Silicosis revolves around the political economy of mining, while Mining Gold and Manufacturing Ignorance is concerned with the contested making of medical knowledge, and medical involution in particular.