When deep mining began in Southern Africa in the late 1880s, the size of the workforce increased rapidly. Recruits from South Africa, British Protectorates and from Portuguese East Africa were crowded into squalid compounds and fed on a diet of maize meal. As on all hard rock mines, there was lung disease and deaths from rock falls, but the Johannesburg mines were particularly dangerous. In 1903, the deaths of 3762 black miners from disease provoked scrutiny from the South African and British Parliaments.Footnote 1 The Colonial Office was in regular correspondence with the Governor-General in Cape Town, who monitored the death rates among Nyasa recruits.Footnote 2 In addition, from the 1920s the ILO took a keen interest in the health of migrant workers. The Chamber had good reason to be concerned. Occupational disease was a serious threat to the labour supply, and through the compensation system it came to represent a major cost of production.

While the different components of fatal lung disease on the mines were not always easy to distinguish, the three major ones were eventually identified as pneumonia, silicosis and tuberculosis. Silicosis was caused and tuberculosis associated with silica dust exposure while pneumonia was a problem of susceptibility and hygiene, especially for workers from the Tropical north. In addition, pneumonia was a complicating factor in tuberculosis. As one senior health official noted: ‘A large number of natives die of tuberculosis following a pneumonic attack and amongst tropical natives especially tuberculosis runs a very acute course’.Footnote 3 All miners were at some risk of silicosis and tuberculosis, although the lower dust exposures and superior general health of white miners meant their risk, especially of contracting tuberculosis, was relatively low. In contrast, young migrant workers were the most susceptible to pneumonia. Black miners who contracted silicosis and tuberculosis were repatriated, and usually died out of sight in rural areas. The thousands of miners who caught pneumonia died quickly, and their deaths were recorded as mine deaths. These divergent dynamics of chronic and acute lung disease shaped responses to what soon came to be perceived as a profound health crisis.

Men coming from the lowveld, or low-lying regions with subtropical climate, suffered greatly when they reached the much colder altitudes of Johannesburg. From the first years of mining, medical officers noted the high incidence of acute pneumonia among recruits from the Tropical north. Some recruits contracted the disease on the long train journey to the mines in crowded open carriages.Footnote 4 Inadequate or wet clothing and the exposure of exhausted men emerging from the hot and humid mines into the cold surface air in winter produced surges in the mortality rate.Footnote 5 The pneumococcus, discovered in 1881 almost simultaneously by Sternberg and Pasteur, are normally found in the throat and nasal passages and cause no symptoms. The body’s defences against the disease can, however, be broken down by environmental factors. The incidence of respiratory infections increases when people from different communities are suddenly brought into close contact.

Most deaths were in new recruits who had no prior exposure to the pneumococcus bacteria and contracted acute infections from which they died, often within days. Before chemotherapy, pneumonia ran a course of anything up to three weeks before reaching a crisis. This was followed by a minimum of two to three weeks’ convalescence before a miner could resume underground work. In some cases, convalescence lasted for months.Footnote 6 The contributing factors were overcrowded, filthy compounds and poor nutrition. There was also a close association between deaths from pneumonia and meningitis, as those infections are caused by the same organism.Footnote 7 It was common knowledge that when large numbers of new recruits arrived on a mine, pneumonia deaths followed. It was also known that the incidence on the so-called popular mines was lower. The popular mines were those where the work and living conditions were best, and they drew a larger proportion of seasoned men who were more discerning about where they worked. The less popular mines had a larger number of novices.Footnote 8 The conditions on Kimberly’s diamond mines were also hazardous, with pneumonia being the most serious disease. As on the Rand, the predisposing factors were fatigue, undernourishment, overcrowding and exposure to cold and wet.Footnote 9

Defining the Problem

The gold mines closed briefly during the South African War (1899–1902). When they reopened, many of the Cornish rock drillers who had left for Britain never returned. According to the Government Mining Engineer for the Transvaal, in the interim more than 200 men had died of silicosis. His report added to adverse publicity about the dangers of gold mining in the British press, and questions were asked in the House of Commons. There was much concern at the Colonial Office and in February 1902 a party of British MPs visited Johannesburg. Sir Gilbert Parker, who led that delegation, subsequently wrote to the Chamber: ‘I am convinced that the importation of natives from the Zambezi valley and from Central Africa ought to be stopped, the percentage of deaths amongst the natives on mines being seriously high chiefly because of the mortality amongst these particular natives’.Footnote 10

In response, the Commissioner for Native Affairs, Godfrey Lagden, met with the Chamber to discuss what was now widely understood to amount to a crisis. A committee was appointed that included Drs L.G. Irvine, D. MacAuley and Andrew Watt. Their report identified a serious problem with an annual mortality rate of 54.5 per 1000 and noted that: ‘Native workers are particularly susceptible to this disease [pneumonia] and the conditions of mining work favour its incidence’.Footnote 11 Men exposed to cold and damp when coming off shifts were particularly vulnerable, as were those with scurvy.Footnote 12 Despite that warning, recruitment in the north continued—as did the deaths. On the Simmer and Jack mines in March 1904, the official annual mortality rate for Tropicals reached 360 per 1000.Footnote 13 In response to the deaths, the British Colonial Office several times briefly suspended the recruitment of miners from its own tropical areas.Footnote 14 The increasing death toll affected recruitment, and the mines struggled to attract labour. In August 1902, the Rand mines were employing 37,000 men, or less than half the number required for full production.Footnote 15

Understandings and proposed solutions of the health crisis besetting the mines were closely linked to the composition of the mine workforce. This consisted of several distinct groups: British miners, many of them tin miners from Cornwall; white and black South Africans; and recruits from outside South Africa, including men from the High Commission Territories (HCTs) and Nyasaland. The presence of men from territories administered by Britain drew the Colonial Office into the controversy. On 7 November 1902, the High Commissioner for South Africa, Lord Milner, appointed a commission (known as the Weldon Commission) to investigate the causes and extent of what he described as miners’ phthisis.Footnote 16

Like the commissions which were to follow, Weldon was designed to protect the health and interests of white labour. Its report, submitted in 1903, devotes a single page, consisting of case notes taken at the Lancaster West Gold Mine at Krugersdorp, specifically to black miners.Footnote 17 Focussing on conditions underground, the Commission found that what witnesses variously described as ‘miners’ phthisis’, ‘chest disease’, ‘Miners’ Lung’ or silicosis was a major problem for all classes of mine labour but especially amongst rock drillers, who had an average working life of just seven years. In fact, it was probably closer to four, as the dust in Johannesburg mines had particularly high silica content.Footnote 18 Weldon correctly identified the cause of silicosis as the fine dust generated by pneumatic drills and the use of gelignite for blasting, a finding that was verified by the Medical Commission in 1912.Footnote 19 He recommended more stringent blasting regulations, wet drilling, mechanical ventilation and water sprays for laying dust. The Commissioner made little reference to the toll that the different components of chronic and acute lung disease were taking on migrant labour, and his report led to only a small reduction in risk. Not satisfied with the outcome, the British scientists J.S. Haldane and Sir Thomas Oliver continued to pressure the British government to improve conditions on the mines.

Under pressure from the white Mine Workers Union, a second Commission into Miners’ Phthisis and Pulmonary Tuberculosis, usually known as the Medical Commission because most of its members were physicians, was established in 1911. The Commission’s Report, tabled in 1912, is notable for its attempts to distinguish between different constituent elements of phthisis, and its subtle description of the disease process. It was also the first Commission of its kind to use X-rays as a diagnostic tool, putting South African science at the forefront of medical research into occupational lung disease. The Commission helped the term ‘silicosis’ enter the occupational disease lexicon by pronouncing it to be a separate disease, noting that ‘All true cases of miners’ phthisis are thus primarily cases of silicosis; silicosis is the feature common to them all’.Footnote 20 According to the Medical Commission, silicosis is an insidious, life-threatening disease caused by exposure to silica dust. The severity of silicosis and the speed with which it develops will depend upon the volume of dust in a miner’s lungs. However, there is often little symmetry between the disease process and disability. Furthermore, there is a strong synergy between silicosis and tuberculosis, so that a miner with dusted lungs is very likely to contract pulmonary tuberculosis. That synergy was most pronounced among the migrant workers who were drawn to the gold mines from impoverished rural communities. Where dust levels are low the disease will take some years to impair working capacity, but as it advances there will be shortness of breath and a persistent cough. Footnote 21

The Commission noted that Miners’ phthisis, and silicosis in particular, is extremely difficult to diagnose in its early stages, and found that even at post-mortem it may be impossible to arrive at a correct diagnosis. Consequently, the statistics on the prevalence of silicosis were unreliable. To make an accurate diagnosis requires an X-ray, a careful clinical examination and the patient’s work and medical histories. To prevent silicosis and its associated heightened risk of tuberculosis, it is necessary to prevent the release of dust in the workplace.Footnote 22 Dr Andrew Watt, an experienced mine medical officer who assisted the Commission, was convinced that it was impossible to reduce dust to a level at which disease would not occur.Footnote 23 That view is consistent with studies published since 1994.Footnote 24

Regulating the Recruitment of Tropical Labour

Before a blanket ban on all Tropical recruiting was imposed in 1913, the British colonial government several times prohibited recruitment of mine workers from the tropical regions of its African colonies. Formal recruiting from Nyasaland commenced in 1903 when, as an experiment, the colonial government granted the WNLA a quota of 1000 men. In February of the following year the quota was increased to 5000, but recruitment was suspended during the winter because of deaths from pneumonia. In January 1906, the Commissioner for Native Affairs in Pretoria recommended that if the fatalities rose above 100 per 1000, recruitment from the north should be suspended. Twelve months later, the annual death rate for Nyasa rose to 166 and WNLA recruitment was halted again. Despite the ban, many men continued to go south as voluntary labour without a medical examination in what the British authorities designated as ‘unprotected emigration’.Footnote 25

The mines’ demand for labour continued to rise, and recruiters were encouraged to push men through the system. As a result, many seriously ill men passed the medical examinations at the point of embarkation and at arrival at the WNLA Compound and were sent underground. A sample of post-mortems of twenty recruits who arrived at the WNLA Compound between January 1908 and mid-April 1908 is representative of the fate of thousands of young men. All were migrant workers shipped from Ressano Garcia in Portuguese East Africa (Mozambique), all died at the WNLA hospital, and all were subject to a post-mortem performed by a mine medical officer.Footnote 26

The surviving records are distressingly brief. In some instances, such as that of case No. 66864 who died of meningitis, the notes run to only eight or ten words. The men have a serial number but no name. The man’s age, his date of arrival at Johannesburg, the date of hospitalisation if relevant and the date of death are recorded. In most cases the cause of death is pneumonia, meningitis or tuberculosis. There are notes on external appearance, which is usually ‘poorly nourished’, and in a few instances ‘emaciated’. Of those who died from pneumonia, case No. 71347 is typical. He arrived from Ressano Garcia on 13 February 1908 and was admitted to hospital on 8 March, having served less than a month underground. He died on 21 March from pneumonia. He is described as ‘poorly nourished’. Case 70651 was aged 28 and he arrived from Ressano Garcia on 14 January 1908. He was admitted to the WNLA hospital on that same day. He died five weeks later from general tuberculosis. His condition is described as emaciated. The record of No. 66553, who was aged 23, is almost identical. He arrived on 13 January 1908 and died at the WNLA hospital from general tuberculosis on 28 March, having worked underground for only a few weeks.

In February 1910, the Colonial Office finally agreed to the resumption of WNLA recruiting from Nyasaland. By 1912, the Rand mines employed an estimated 23,000 Nyasa. The number of deaths rose sharply and within a year the Secretary of State in London threatened to ban all recruiting from British Central Africa.Footnote 27 When Dr G.D. Maynard of the Johannesburg Municipal Council carried out a study of mine deaths, he found that the recruits were much more likely to die during the initial period of service. The mortality rates from pneumonia, for example, were at least three times higher during the first six months.Footnote 28 In contrast, phthisis (in this instance some combination of tuberculosis and silicosis) became more common with longer periods underground. The territorial origins of labour were also important, with the most vulnerable recruits coming from Nyasaland. The Department of Native Affairs was greatly concerned that if Britain limited recruitment, the Portuguese may do the same. It warned the Chamber: ‘Unless a decided improvement can be effected at an early date the government will have no alternative to the measure of entirely prohibiting the introduction of tropical Natives’.Footnote 29 The WNLA agreed that the mines had to be made safe but denied responsibility. The industry was doing everything it could to ‘bring the death rate to a normal figure’. The problem, it believed, was too much fresh air: the excessive ventilation in the compounds forced on the mines by the Coloured Labourers Health Regulations, it argued, had resulted in many fatalities.Footnote 30 Native Labour Bureau was confident the Chamber would soon find a remedy.Footnote 31

In August 1911, Prime Minister Botha met with officials from the Colonial Office in London to discuss the mine deaths. The officials warned Botha that if the deaths from lung disease continued, Britain would prohibit recruiting from North of 22°. Botha asked that no sudden decision be made as it would damage the industry, and promised that his government would rush through legislation to enforce change. He also promised to appoint ‘a strong Commission on Tuberculosis’.Footnote 32 On his return to South Africa, Botha was reassured by the Chamber that the pneumonia problem would soon be resolved.Footnote 33 The new Tuberculosis Commission, whose brief included identification of the extent and causes of mortality in black goldminers and their susceptibility to pneumonia, was appointed in February 1912, just as the Medical Commission was preparing to submit its report.Footnote 34 The same year, the government and the WNLA founded the South African Institute of Medical Research (SAIMR). The WNLA provided £40,000 for a building and equipment and shared the annual maintenance costs with the government.Footnote 35 The Institute’s brief was to find a remedy for the high mortality rates from lung disease on the mines. One of its first projects was research on a pneumococcus vaccine.

Science to the Rescue?

In Western medical science, the first decade of the twentieth century was the golden era of vaccination, and it is here that the mining industry looked for a solution to the most statistically visible component of mine deaths. The search for a pneumonia vaccine began in 1903, when the Chamber awarded the Transvaal Government Bacteriologist, Dr Pakes, a research grant of £1000. Pakes submitted only one interim report before he resigned amid accusations that he had embezzled the grant.Footnote 36

In early 1911, the Government Bacteriologist, Dr J.C. Mitchell, was commissioned to further explore the development of a vaccine.Footnote 37 Mitchell found that pneumonia among black miners was infectious, and that the organism involved was a common form of the pneumococcus. The incidence of the disease, he believed, was governed by racial susceptibility and environment. The high altitude and cold weather on the Rand lowered resistance to infection, and even after acclimatisation the incidence among Tropicals was far higher than for other groups. Mitchell identified several environmental factors which the mines should address. The compounds needed to be properly heated and well ventilated, and rations should include an abundance of fresh vegetables and lime juice. Mitchell also noted that since dust was a predisposing factor, the work conditions underground were important. Variations in the temperature between work places and where miners waited to be hauled to the surface were also hazardous, and Mitchell wanted miners to be issued with warm clothing and provided with warm change houses. The Government Bacteriologist concluded that the differences in the death rates on individual mines were probably due to variations in conditions, with exposure to infected bedding and clothing a particular threat. ‘It is therefore important’, Mitchell wrote, ‘that the disinfection of infected places, bedding, clothing, etc., should be carried out with the greatest rigour. The receiving compounds should be thoroughly cleansed and disinfected with a Formalin autoclave after the departure of one gang and before the arrival of the next.’Footnote 38 Most mine managers ignored Mitchell’s advice on improving living and working conditions. Instead, the industry commissioned further vaccine research.

While Mitchell was drafting his report, Sir Julius Wernher, Chairman of the Central Mining and Investment Corporation in London, received a visit from the prominent bacteriologist Sir Almroth Wright. Wright had read about Mitchell’s work in the British press, and he offered to develop a vaccine for the WNLA.Footnote 39 Following brief negotiations, Wright was engaged for a period of six months at the extravagant fee of £6000.Footnote 40 Wernher was concerned about a ban on recruitment, and he expected Wright to quickly produce a useful report. Wright arrived in South Africa in September 1911 and immediately began a series of mass inoculations. The programme was poorly designed. Neither the dosages nor the number of injections administered, the locales of the trials or the characteristics of the subjects were standardised in the initial experiments. Wright left Johannesburg abruptly in February 1912 and the trials were continued by his assistant Parry Morgan.Footnote 41

After repeated delays, in December 1913 Wright finally tendered his report. According to him, ‘there was a reduction in the incidence and death rates of pneumonia in the inoculated’ in every one of his trials.Footnote 42 Dr Maynard, a statistician with the South African Institute for Medical Research who reviewed Wright’s data, found that vaccination had no significant impact on the mortality rates. Dr A. J. Orenstein, the powerful Superintendent of Sanitation for Rand Mines, was also highly critical of the programme and did not believe the results ‘justified the adoption of vaccinations’.Footnote 43 A subsequent review by the WNLA concluded that Wright’s pneumonia investigations had produced no positive results.Footnote 44 Wright’s vaccine failed because it contained only four strains of pneumococci. By identifying the numerous strains present and including several more of them in a new preparation, Spencer Lister, a mine medical officer who had assisted Wright, succeeded in producing a more effective vaccine. Despite the scepticism of Maynard and Orenstein, prophylactic vaccination became universal on the Rand in 1917. The programme was gradually discontinued from 1927.

The 1913 Ban on Tropical Recruiting

In their efforts to monitor the health of migrant workers, the South African governments, like the imperial authorities in London, relied upon the data issued by the Chamber. That data was unreliable. A memo from Prime Minister Botha from 12 May 1913 makes clear his frustration that the mortality rates for Tropical labour collated over the previous three years ‘had not reflected the true position’. The figures were confined to those men who died on individual mines and excluded the large number of deaths at the WNLA compound in Johannesburg, through which nine out of ten black miners passed. In 1910 the annual death rate on the mines was 75 per 1000, but that rose to 97 when the WNLA deaths were included. Three years later that gap had widened appreciably. In January 1913 the death rate on the mines was 45 but with the WNLA deaths that rose to 115. The figures for February were 64 and 117 and for March 72 and 119 per thousand respectively.Footnote 45 The revised data (which excluded the significant number of men who died on the way home or soon after repatriation) showed that the death rate had risen in an alarming manner and Botha decided to prohibit further recruitment from the Tropical north.

The bans on Tropical recruitment were the first and only state interventions designed specifically to protect the health of migrant labour. When the general ban was announced by Prime Minister Botha on 13 May 1913, the Chamber immediately began a multi-pronged campaign to have it rescinded.Footnote 46 Within a week, the Johannesburg press published several optimistic reports. The Star noted that much progress had been made in improving mine conditions and in developing a vaccine.Footnote 47 In addition, the Chamber commissioned Major W.C. Gorgas, famous for reducing deaths among workers on the Panama Canal, to investigate the causes of high mortality rates from pneumonia and to find a remedy. Gorgas arrived in Johannesburg in December 1913 and submitted his report the following year.Footnote 48 While Gorgas’s key recommendations on reorganising the mines’ workforce were rejected by the Chamber, the largest and most profitable mining house, Rand Mines Ltd, appointed Gorgas’s assistant to oversee sanitation and to reorganise the company’s health services, a task which A.J. Orenstein undertook with marked success.Footnote 49

Between 1912 and 1920, the official annual mortality rate on the mines fell dramatically, from 12.5 per 1000 in 1912 to 3.4 in 1920. The fall was almost certainly due to improved compounds, better diets and the provision of change rooms to protect miners from chills rather than vaccinations.Footnote 50 The ban on recruitment of Tropical labour imposed in 1913 was also significant in the sustained decline in the mortality rate from pneumonia which followed. Even so, between 1933 and 1938 pneumonia accounted for between 29 and 37 per cent of deaths from disease on the mines.Footnote 51 Importantly, while pneumonia probably remained the major cause of death among black miners, it was never the subject of a commission of inquiry, nor was it ever declared an occupational disease. In this case as in many others, the keenly contested politics of medical classification, rather than the actual burden of mortality, proved decisive.Footnote 52 And while Wright’s attempts to develop a vaccine produced no positive results, his Johannesburg studies did bolster the idea that racial inferiority, rather than squalid compounds, poor diets and hazardous work environments were behind the high mortality rates among black miners.Footnote 53

Negotiating Occupational Disease: Laws, Medicals and Repatriations

While Almroth Wright and his successors worked on a vaccine and the mining houses gradually improved conditions in the compounds and mines, the health crisis was resolved politically by a series of Mines and Miners’ Phthisis Acts. Those acts, passed between 1911 and 1925, established a system of compulsory medical examinations to ensure the fitness of recruits for underground work, and to prevent the spread of tuberculosis. In principle, medical surveillance combined with a compensation system subjected the industry to external review. South Africa was the first state to compensate for silicosis (1911) and tuberculosis (1916) as occupational diseases, and it was the first to introduce medical certification for hard rock miners. The Miners’ Phthisis Act No. 44 of 1916 made tuberculosis a compensable disease in gold miners and barred any person with tuberculosis from underground work. The 1916 Act also created the Miners’ Phthisis Medical Bureau (Bureau), which in theory was responsible for the conduct of all mine medicals. The Bureau also compiled the official disease data. Although the Act appeared to bring medical reviews under the Bureau’s and therefore the state’s authority, it in fact decentralised the system. White miners were examined at the Bureau. In contrast, all pre-employment, periodic and exit examinations of black miners were conducted at individual mines by mine medical officers, or at the WNLA compound. William Gemmill explained how the system worked: ‘Every Mine Medical officer is by law an officer of the Miners’ Phthisis Medical Bureau, and is subject to the instructions of the Bureau in all Miners’ Phthisis matters affecting natives employed by the Mines’.Footnote 54 In theory he was correct, but as with all such legislation there was a gulf between what was prescribed and what actually happened in the workplace.Footnote 55 The crushing workloads of Bureau interns meant that in practice, the medical examinations of black miners were never supervised or reviewed by the Bureau.Footnote 56

It was easy for government to justify outsourcing medical examinations to employers. By 1915, there were over one hundred thousand migrant workers on the Rand, all of whom were subject to compulsory examination. There was also a high labour turnover, which increased the medical workload even further. The cost for the state in running that system would have been prohibitive, and no doubt would have been a source of conflict between the government, the mines and the white electorate. For the mining industry there was another important consideration. Within months of the passage of the 1911 Act, compensation costs began rising, and the Chamber was keen to minimise the number of claims. The mines were willing to bear the cost of medical examinations so long as they also controlled compensation referrals to the Bureau.Footnote 57

Under the Miners’ Phthisis Act No. 40 of 1919, when a miner who had worked underground for a period exceeding one month left employment, he was to be given a final examination by the Bureau or by a designated medical practitioner. The Act’s most important innovation was to lay down the criteria for diagnosing tuberculosis. A miner was to be compensated only where the tubercle bacillus was present in his sputum or if he was suffering from a serious impairment. There was no pathology testing at the WNLA in 1919; indeed, there were no such facilities at the WNLA hospital as late as the early 1950s.Footnote 58 Nor did the Act offer guidelines as to what constituted serious impairment. Despite these constraints, the sophistication of the system increased with each subsequent Act. In terms of scale, longevity and the degree to which it was racialised, the South African medical system was unique. The burden of proof regarding occupational lung disease which was gradually built into it became one of the principal targets of the recent miners’ class action.

Repatriations and Occupational Disease

The first health crisis on the mines was resolved by the legislation and by the creation of two scientific bodies, the South African Institute of Medical Research and the Miners’ Phthisis Medical Bureau. There was, however, a third element which was arguably more important in quelling criticism of the mines’ mortality rates: the repatriation of sick and dying miners.Footnote 59 The extent of the practice varied between different mines and over time but was always substantial. Following complaints from the Department of Native Affairs, the Commissioner appointed in 1913 to investigate the grievances of black mine workers found that the annual repatriation rates from individual mines varied from 2 per cent to more than 13 per cent and reflected a divergence in the practice of individual medical officers.Footnote 60 Between 1916 and 1920, according to the official data, a total of 4121 men were repatriated because of tuberculosis. A further 964 died from that disease at individual mines before they could be sent home.Footnote 61 In 1915, the Rand Mines Group reported that 29.66 per 1000 or 1720 of its 57,990 black miners were repatriated. In 1926, WNLA and the NRC together repatriated 5087 black miners. Two years later the combined total was 6924.Footnote 62 Neither the Chamber nor the government accepted responsibility for repatriations, and it was left to mine doctors to decide if a patient was ‘fit to travel’. Men with pneumonia were acutely ill and far less likely to be sent home than those with silicosis or tuberculosis. Those miners who survived the train ride to the regional depots did not necessarily complete the journey home.

The industry had good reason to repatriate sick men. Hospital wards were overcrowded and there was insufficient staff to provide long-term care. Writing in 1915, the WNLA’s senior medical officer, Dr G. Turner, was blunt about the financial advantages. ‘This system [repatriations] has saved the Mines large sums of money. … Take the case of a native with scurvy. If he stays on the Reef he costs the Mine about 2s 6d per day for two, possibly three, months. … Whereas if returned to his kraal, this expense is eliminated.’ Repatriations had the further advantage of lowering the mines’ official mortality rates. Perhaps the most telling comment on repatriations comes from the 1914 report of the Tuberculosis Commission. It found that the repatriation rate was rising much faster than the mortality rate on the mines was falling, suggesting that repatriations were masking the actual number of deaths.Footnote 63 In other words, the increasingly efficient export of dying men to their home communities made it seem, in statistical returns, that fewer miners succumbed to occupational injury and disease.

The issue of repatriations resurfaced again and again over the following decades. Prior to the passing of the Miners’ Phthisis Act of 1925, for example, there was intense debate about mine medicals, tuberculosis and repatriations. In October 1924, the Chairman of the Miners’ Phthisis Medical Board, A.B. Du Toit, aired his concerns to the Minister of Mines. For some years, Du Toit had a ‘presentment’ that black miners were not getting ‘a square deal’ in regard to compensation, and that if ever he had an opportunity to investigate the situation he would do so. The new Act gave him that opportunity. He was particularly critical of the conduct of mine medicals. Du Toit was also concerned about the mines’ repatriation policies. Tuberculosis was rampant in the Native Territories and the position was made worse by the repatriation of infected miners. ‘Nothing appears to have been done in this matter and I am informed that the condition of affairs in some of the kraals is ghastly.’ He went on: ‘The further one goes back into the records the larger the annual number becomes of tuberculotic natives discharged by the Mines. In 1915 there were 1200. In this way it is computed that during the past 20 years an ARMY OF 20,000 OR MORE TUBERCULOUS NATIVES have been discharged by the mines back to their kraals to spread the disease.’ Mine medical officers were not much concerned about the health of workers leaving the mines. As a result, it was common for men to be discharged from one mine as free from silicosis or tuberculosis and found later by the WNLA or another mine to be ill. Those men were missing out on compensation and would die in their villages. Du Toit warned the minister: ‘The important question of health as it affects millions of people cannot be brushed aside for all time. The day will come when the European will have to answer for it.’Footnote 64 In a lengthy response, the Acting Director of Native Labour addressed each of du Toit’s allegations. Recruits were examined in batches of 200 to 700 but the WNLA medical officers were expert, and the medicals were thorough. It was common knowledge that tuberculosis was a serious menace and he admitted that some men died on their way home.Footnote 65 This was not surprising given the fact that, as a later commentator put it, ‘it appears that the criterion for deciding whether [sick mine workers] are fit for repatriation is fitness to travel, the measurement of which is ability to stand’.Footnote 66

The deaths of East-Coast miners while en route from Johannesburg to Ressano Garcia were a constant source of bad publicity for the mining industry. In February 1925, the Chief Medical Officer of WNLA, Dr A.I. Girdwood, wrote a report on the practice. Convalescent men from mine hospitals were received at the WNLA compound in Johannesburg on Mondays and Tuesdays for repatriation. Those fit to travel were dispatched each Tuesday morning from the Booysens Railway Station. One train went to Ressano Garcia and the other to the Cape Province. A WNLA medical officer saw the train off, but there was no doctor on board. Each train had special coaches for those unable to walk and a white conductor. The seriously ill were given a stretcher while the others were in berths in the third-class carriages. There were no more than six patients in each compartment, so the men could lie down at night. During the journey they were fed and cared for by an attendant.Footnote 67

In addition to the repatriation of injured men, around twenty miners suffering from tuberculosis were repatriated each week. ‘It is this class of case’, wrote Dr Girdwood, ‘that is so liable to die on the train. They differ from the ordinary cases inasmuch as they are suffering from an incurable disease.’ It was common for miners to wait for weeks at the WNLA hospital for the Bureau to process their compensation claims. Consequently, many were seriously ill by the time they were shipped out. ‘If one considers the pathology of the lungs in these cases, large, ragged, breaking-down cavities full of pus, which might at any moment ulcerate through the blood vessel and cause a fatal haemorrhage, it should not be a matter of surprise that cases do die in the train, but that so few do.’ Some miners believed a traditional healer would be able to cure them, and all sick miners wanted to see their families before they died. Dr Girdwood wrote: ‘If we attempted to detain all natives of this class who were not absolutely fit to travel, apart from the fact that we would very soon be overcrowded, there would be continual dissatisfaction and complaints, not only up here but in the Territories’.Footnote 68 For all these reasons, repatriations became a permanent feature of mine medicine.

In 1929, the Director of Native Labour, Major Herbert Cook and the WNLAs Chief Medical Officer, Dr Arthur Girdwood, appeared before the Miners’ Phthisis Commission. Under the Act, Cook was responsible for the payment of compensation to black miners. He told the Commission that the time was coming when his department must know exactly what happened to those men who had received an award and therefore what was being achieved by compensation. Cook had without success canvassed local magistrates, and he believed that the life expectancy of compensated miners was less than three years. Cook was also concerned that neither his department nor the mines provided practical instruction on health care to men who were repatriated with compensable disease.Footnote 69

Dr Arthur Girdwood was asked about the WNLA’s policies aimed at preventing the spread of tuberculosis. Girdwood reassured the Commission: ‘We have been doing everything possible to try and discover ways and means of eliminating tuberculosis in the mines and prevent white miners becoming infected’. The black miners who spread disease were those in a very bad way and Girdwood rejected the suggestion that the mines should educate its workforce about how to reduce the risk of spreading tuberculosis once they returned home.Footnote 70 By 1929, there had been six Miners’ Phthisis Commissions, a Commission into Tuberculosis and Pneumonia and several Parliamentary Select Committees. Cook and Girdwood were key figures within the migrant labour system, yet it is obvious from the Commission transcripts that neither had any knowledge about the post-mining health of the more than 300,000 migrant workers who served each year. Such lack of clarity persists. Today, there is no certainty about the number of former miners eligible for compensation for their occupational lung disease under the recent class action settlement, with estimated numbers ranging from seventeen thousand to half a million.Footnote 71

Conclusion

The first health crisis on South Africa’s gold mines lasted roughly from 1902 to 1916. Resolving it was a messy process. For the mining houses, the key issue was access to labour. There was also the perception of risk, which was important to the imperial authorities in London and later to the ILO. Under pressure from critics at home and abroad, the Chamber set up the South African Institute of Medical Research and the Miners’ Phthisis Medical Bureau and agreed to the world’s most progressive legislation for hard rock miners, under which silicosis (1911) and tuberculosis (1916) became compensable occupational diseases. Pneumonia was managed by the State and the Chamber in a very different way. White miners did not die from pneumonia, and their union, the MWU, took no interest in that issue. There were no commissions of enquiry, no dedicated legislation and no compensation schemes. Despite the huge death toll it caused among black miners, pneumonia was never declared an occupational disease.

Men who succumbed to pneumonia died on the mines, while those with tuberculosis and silicosis tended to die in rural areas. Pneumonia was also different because of the elevated death rate among recruits from Portuguese East Africa and the British colonial territories of Botswana, Nyasaland and Northern Rhodesia, a factor which attracted scrutiny from imperial authorities. Threatened with ban on the recruitment of tropical labour, the Chamber employed the international experts Sir Almroth Wright from Britain and William Gorgas from the USA to find a way of reducing the death rate. That money was not well spent. Wright failed to develop an effective vaccine, and the Chamber largely ignored Gorgas’ excellent advice on how to prevent contagious disease. The fact remains that pneumonia was the only disease that led to a ban on Tropical recruitment, the only state intervention designed specifically to protect the health of migrant labour.

The first health crisis became a model for how the industry would respond to occupational disease. The mining companies gained a decisive role in the scientific formulation of the relevant issues, played a key role in framing the legislation and externalised the principal health costs onto labour-sending communities.