Journal of Southern African Studies

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Medicine, Politics and Disease on South Africa's

Gold Mines

Jock McCulloch

To cite this article: Jock McCulloch (2013) Medicine, Politics and Disease on South Africa's Gold
Mines, Journal of Southern African Studies, 39:3, 543-556, DOI: 10.1080/03057070.2013.818850

To link to this article: https://doi.org/10.1080/03057070.2013.818850

Published online: 15 Jul 2013.

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Journal of Southern African Studies, 2013
Vol. 39, No. 3, 543–556, http://dx.doi.org/10.1080/03057070.2013.818850

Medicine, Politics and Disease

on South Africa’s Gold Mines
Jock McCulloch
(Royal Melbourne Institute of Technology University)

South Africa’s gold mines were the first in the world to compensate silicosis and tuberculosis
as occupational diseases. They were also the first to monitor the health of miners entering and
leaving the industry. While those procedures were much admired by scientists and regulatory
authorities outside South Africa, mine medicine was designed to protect the financial interests
of employers rather than the health of labour. This article examines how that system, which
became a feature of the mines under minority rule, was established during the 1920s.

Citing ill health, on 17 May 1926 Dr Wilfred Watkins-Pitchford resigned as Chair of the
Miners’ Phthisis Medical Bureau (the Bureau) and as Director of the South African Institute
of Medical Research (SAIMR). At that time the most senior scientist in Johannesburg, with
roles at the Bureau and the SAIMR, Watkins-Pitchford also chaired the newly created
Tuberculosis Research Committee, a Chamber of Mines initiative to research the effects of
repatriation on the spread of tuberculosis. The SAIMR voted Watkins-Pitchford an annual
pension of £500 and the Witwatersrand Native Labour Association (WNLA), the Chamber’s
recruiting arm, established a trust fund of £2,000 for his wife.1 Thus, at the age of 58,
Watkins-Pitchford returned to England where he had not lived for 25 years. That decision is
puzzling as it is hard to imagine that England offered a better climate or diet for a sick man
than South Africa. Significantly, his retirement came four months after he had attended a
meeting called by the Minister of Mines to review the system of medical examinations.
In England Watkins-Pitchford’s health improved but he did not attend the 1930 Silicosis
Conference in Johannesburg, organised by a former colleague, Dr A.J. Orenstein.
Surprisingly, Watkins-Pitchford lived on in apparent good health until 1952. During that
period he was an active member of the British Medical Association but, with one exception,
he made no further contribution to the literature on silicosis or miners’ phthisis about which
he was a world authority.
South Africa’s gold mines were the first in the world to compensate silicosis and
tuberculosis as occupational diseases. They also produced more data on silicosis than any
other industry in the world. Yet much of the history of disease and compensation remains
unknown.2 One reason is that despite the huge amount of material in public archives, much of
it is irrelevant to understanding mine medicine or the compensation system.3 The South
African National Archives has extensive holdings on compensation, miners’ phthisis and
tuberculosis but almost nothing on the influence of the Gold Producers’ Committee or the

1 M. Malan, The Quest of Health: The South African Institute of Medical Research, 1912–1973 (Johannesburg,
Lowry Publishers, 1988), p. 37.
2 To date there are only two full-length publications: E. Katz, The White Death: Silicosis on the Witwatersrand
Gold Mines 1886–1910 (Johannesburg, Witwatersrand University Press, 1994) and J. McCulloch, South Africa’s
Gold Mines and the Politics of Silicosis (Oxford, James Currey, 2012).
3 Since 2000 some researchers have gained access to the archives of Barlow Rand and the Chamber of Mines. I am
among a number of historians who have been refused entry.
q 2013 The Editorial Board of the Journal of Southern African Studies
544 Journal of Southern African Studies

Chamber’s Group Medical Officers’ Sub-Committee in formulating policy. The same is true
of influential individuals such as A.J. Orenstein and William Gemmill, the long-time general
manager of the Chamber.4 The TEBA (WNLA) Archives at the University of Johannesburg
hold correspondence from the Gold Producers’ Committee, but it is highly selective and
offers little insight into the struggles over mine safety and occupational disease. The same is
true of the industry’s repatriation policies and its knowledge of risk. The archives do,
however, give occasional glimpses of conflict between industry and the state. The resignation
of Wilfred Watkins-Pitchford is one such episode.

The Historical Setting

South Africa’s gold mines are the largest and deepest in the world and historically among the
most profitable. The mines employed a huge number of migrant workers drawn from rural
communities inside and outside South Africa’s borders. The workforce consisted of a
unionised white labour aristocracy employed in supervisory roles and black migrants who did
the bulk of the manual work. While migrancy has been common to industrial economies
around the world, in South Africa it has been unique in the depth of its political foundations
and in its negative impact upon labour-sending communities.5 In 1910 the mines employed
120,000 black and 10,000 white miners; by 1929 this had increased to 193,221 blacks and
21,949 whites.6 As the workforce grew to over half a million in the late 1970s, that colour
imbalance was maintained.
Politically powerful and dominated by a handful of corporations, the mines were an
important employer, the major earner of foreign exchange and the major source of
government revenue. That in turn shaped the relationship between capital, labour and the
state. On the international stage South Africa’s mines were just as important. By 1923 the
Rand mines produced more than 50 per cent of the gold on which the financial stability of
western economies depended.
Most underground work – including drilling, blasting, loading and transporting ore –
generates dust. The only way to prevent silicosis and, with it, a propensity for tuberculosis, is
to eradicate dust from the workplace. At the beginning and close of the twentieth century the
mines faced a crisis over silicosis, an occupational lung disease common to hard rock miners.
The first crisis lasted from 1896 to 1916; the second, which began in 1996, is currently being
played out in British and South African courts. The current disease rates of between 22 and 28
per cent suggest that even today it is impossible to engineer dust out of the mines.7 Those
rates are over a hundred times higher than the official diseases rates published annually by the
Bureau and its successors in the period from 1916 to 1994. The discrepancy between the two
sets of data raises questions about the South African system of medical surveillance.
The first crisis was focused upon disease among white miners who represented less than
ten per cent of the workforce; the second is about black migrant workers. The current
litigation against AngloGold Ashanti, Gold Fields and Harmony may be the first step in a

4 The only extended treatment of either man is A.H. Jeeves, ‘William Gemmill and South African Expansion,
1920–1950’ (unpublished paper, ‘The Making of Class’, History Workshop, University of the Witwatersrand,
14 February 1987).
5 See F. Wilson, Labour in the South African Gold Mines 1911–1969 (Cambridge, Cambridge University Press,
1972).
6 See Table 5, ‘Employment on the Gold Mines,’ in D. Yudelman, The Emergence of Modern South Africa: State,
Capital, and the Incorporation of Organized Labor on the South African Gold Fields, 1902–1939 (Westport, CT,
Greenwood Press, 1983), p. 191.
7 See J. Murray, T. Davies and D. Rees, ‘Occupational Lung Disease in the South African Mining Industry:
Research and Policy Implementation’, Journal of Public Health Reports, 32, 1 (2011), pp. 65 –79.
 Medicine, Politics and Disease on South Africa’s Gold Mines 545

class action involving hundreds of thousands of miners from Lesotho, Zimbabwe, Malawi,
Swaziland, Mozambique and Botswana, all of which supplied labour to South Africa’s
mines.8 Those men have silicosis and/or tuberculosis for which they have not been
compensated. The gold mining industry is determined that the litigation should fail, and the
case has now been running for more than seven years.
To make the mines safe required mechanical ventilation, restrictions on blasting and
water-fed drills, but each of those changes increased the costs of production, costs which
mine management was determined to minimise. For that reason, as Elaine Katz has shown,
the first crisis dragged on for almost a decade because the Minister of Mines J. De Villiers,
assisted by Jan Smuts, sided with industry against the demands of white labour for safer
workplaces. After a bitter political struggle, eventually from 1911 a series of Mines and
Miners’ Phthisis Acts greatly reduced the dust levels and instituted a system of medical
surveillance.9 In 1912 South Africa became the first state to compensate silicosis as an
occupational disease. Four years later tuberculosis, a well-recognised sequela of silica
exposure, also became a compensatable disease for gold miners. Benefits were based on wage
levels, and thus white miners received more generous compensation than did blacks.10 The
Act of 1916 created the Miners’ Phthisis Medical Bureau. Over the next 40 years it underwent
various name changes but its primary function of performing pre-employment, periodic and
compensation examinations of white miners remained the same.
Dr G.W.H. Schepers was an intern at the Bureau from 1944 until 1954. When he began
working in 1944 he found the doctors ‘careless and unfeeling’, and he was astonished at the
way medical reviews were conducted. In the mornings the interns examined white miners,
who were processed in groups of around 300. The workloads were crushing, and in 1951 the
Bureau’s ten interns each carried out 5,472 examinations. Allowing for other duties –
including a daily team meeting – that left at most 12 minutes to examine each patient, read
his X-rays and make a clinical judgment. Interns were obliged by law to complete a Form A
which contained full medical and work histories. Because of understaffing, such details were
rarely recorded. The medical reviews Schepers saw on his visits to the WNLA hospital were
parades, they were not medical examinations.11
In addition to its primary role with white miners the Bureau also conducted compensation
examinations of black miners at the WNLA hospital. Perhaps most important of all, it
compiled and published the official disease rates used by industry and the state to measure
risk. Those data were based on the number of awards made annually by the Bureau.
Logically, the fewer the awards made, the lower the disease rate, and therefore the safer the
mines.
Black miners, who comprised 90 per cent of the workforce, were migrant workers, and
few were aware of – or able to secure – their rights. Consequently, in the three years to July
1916, the total compensation for whites was 30 times greater than that paid to black miners,12
a pattern continued until the eve of majority rule in 1994.

8 See J. McCulloch, ‘Counting the Cost: Gold Mining and Occupational Disease in Contemporary South Africa’,
African Affairs, 108, 431 (2009), pp. 221– 240; and M. Cohen and C. Lourens, ‘Blowback from the Apartheid
Era’, Bloomberg Businessweekly, 6– 12 June 2011.
9 On the first crisis, see Katz, The White Death, pp. 1– 13, 160–161 and McCulloch, South Africa’s Gold Mines,
pp. 14 –16.
10 See M.J. Smith, ‘ Working in the Grave: The Development of a Health and Safety System on the Witwatersrand
Gold Mines, 1900–1939’ (MA thesis, Rhodes University, 1993), pp. 182 –184.
11 See McCulloch South Africa’s Gold Mines, pp. 110–115.
12 I. Donsky, ‘A History of Silicosis on the Witwatersrand Gold Mines, 1910– 1946’ (PhD thesis, Rand Afrikaans
University, November 1993), p. 196.
546 Journal of Southern African Studies

The Protagonists
In the period to 1930, the two dominant figures in mine medicine were Wilfred Watkins-
Pitchford and A.J. Orenstein. Born in England and qualified in medicine in 1891, Watkins-
Pitchford worked initially in public health in Natal and in 1912 became foundation Director
of the South African Institute for Medical Research. Four years later he also took up the
foundation Chair of the Miners’ Phthisis Medical Bureau.13 While the Chamber funded the
SAIMR and controlled its research agenda, it did not have the same degree of influence over
the Bureau, which fell under the aegis of the Department of Mines. Watkins-Pitchford
established the Bureau’s procedures for diagnosing miners’ phthisis and awarding
compensation. He also prepared the annual reports which contained the official rates for
silicosis and tuberculosis. Watkins-Pitchford wrote the annual report for the year ending July
1924, which for the first time presented the post-mortem data of men who had died suddenly
on the mines. Watkins-Pitchford was a successful researcher and the editor of the SAIMR’s
publications which had such an influence on the international scientific community.14 On his
retirement, his posts at the Bureau and the SAIMR were divided, with the directorship of the
SAIMR going to Spencer Lister, while L.G. Irvine became Bureau chair.
In the scant historical literature on mine medicine it is not Watkins-Pitchford but his
colleague A.J. Orenstein who is often referred to as the father of occupational health.
Orenstein’s career spanned the period from 1914 until 1960, and in the transcripts of the
numerous miners’ phthisis commissions on which he served his is often the dominant voice.
Orenstein received a number of awards and probably exerted more influence over the
perception of risk and state regulation of the gold mines than any other physician.15
Born and educated in Philadelphia, Orenstein worked for six years with Major William
Gorgas on the Panama Canal before his appointment as Superintendent of Sanitation for Rand
Mines Ltd., in 1914.16 He reported directly to the chairman Evelyn Wallers, an arrangement
which gave him considerable authority.17 Orenstein was keen to improve the quality of
medical care, and one of his first recommendations was for the appointment of full-time mine
medical officers. ‘We cannot escape the deduction that the medical officer’s private practice
is pretty sure to command the best efforts of the part-time medical officer. It is my own
opinion that the “full-time” medical officer is entirely to be preferred to the part-time
man . . . ’.18 Wallers did not agree.
The first report Orenstein wrote for Rand Mines Ltd. was on the movement of migrant
workers between Mozambique and Johannesburg.19 The trains and ships transporting recruits
to the mines, or repatriating miners to Delagoa Bay, were overcrowded, and no attempt was
made to segregate men with infectious tuberculosis. Neither were there provisions for
isolation at the WNLA compounds. In such appalling conditions miners commonly died in
transit. Orenstein recommended that tuberculosis cases be isolated and the floors and walls of
their quarters be disinfected. He also advised the WNLA to supply heavy blankets and hot tea

13 See ‘Obituary Wilfred Watkins-Pitchford’, British Medical Journal 2, 4788 (11 October 1952), pp. 834 –35.
14 See R.R. Sayers and A.J. Lanza, ‘History of Silicosis and Asbestosis’, in A.J. Lanza (ed.), Silicosis and Asbestosis
(London, Oxford University Press, 1938), pp. 6, 7.
15 See, for example, J.R. Austrian, ‘Of Gold and Pneumococci: A History of Pneumococcal Vaccines in South
Africa’, Trans American Climatological Association, 89, 2 (1977), pp. 141 –161.
16 See ‘Obituary A.J. Orenstein’, Proceedings of the Transvaal Mine Medical Officers’ Association of South Africa,
LII, 413 (May–August 1972), pp. 1 –2.
17 A.P. Cartwright, Doctors of the Mines: A History of the Work of Mine Medical Officers (Cape Town, Purnell and
Sons, 1971), pp. 41, 70.
18 Quoted in Cartwright, Doctors of the Mines, p. 41.
19 Teba Archives, University of Johannesburg. ‘Report on the Transport of Natives’, from Dr Orenstein,
Superintendent of Sanitation, to R.W. Schumacher, Chairman, Rand Mines, Ltd., 22 May 1914. Dr Orenstein,
23/2/1914 to 8/6/1914. W.N.L.A. 147/3, Health of Natives, Miscellaneous File.
 Medicine, Politics and Disease on South Africa’s Gold Mines 547

or coffee during the long railway journey as protection against the cold on the high veldt. As
with his recommendation for full-time medical officers, these changes were designed to save
the lives of migrant workers who were dying in large numbers from respiratory disease. This
time Wallers agreed, and Orenstein’s intervention saved many lives.
In addition to his role in the Transvaal Mine Medical Officers’ Association (MMOA)
which he co-founded in 1921, Orenstein served for many years as chair of the powerful Gold
Producers’ Committee within the Chamber of Mines. That committee had a major input into
the industry’s policies in regard to recruitment, medical surveillance and compensation. In
1930, with William Gemmill, he organised the International Labour Organization’s (ILO’s)
Silicosis Conference in Johannesburg. The conference was jointly sponsored by the Chamber.
Orenstein acted as conference secretary and edited the proceedings. He resigned from Rand
Mines Ltd. in 1956 at the age of 77 to become the foundation director of the Pneumoconiosis
Research Unit. Commenting on his death in July 1972, The British Medical Journal stated
that Orenstein had greatly improved the safety and medical care of South Africa’s miners.20
That judgment has never been challenged.

Medical Surveillance
The system of medical surveillance which legislators and scientists outside South Africa so
admired began with the Miners’ Phthisis Act of 1911 and was extended by the subsequent
Acts of 1912, 1916, 1919 and 1925. It consisted of pre-employment examinations at the point
of recruitment in rural areas and periodic examinations performed every three months on the
mines. The Acts also required that men who had served their contracts must be given an exit
medical. While there were no set procedures for periodic and exit examinations, the industry
recruiting agencies, the WNLA and the Native Recruiting Corporation (NRC) issued strict
guidelines for entry medicals. Men with any sign of tuberculosis or silicosis, chronic
bronchitis or asthma must be rejected. So, too, were those with heart lesions, blindness or
loose skin suggestive of recent wasting.21 No provision was made for rejects with a mining
history to be referred to the Bureau for compensation.
On their arrival in Johannesburg, recruits underwent examination prior to being
assigned to individual mines.22 Migrants worked on contracts of between 6 and 18 months,
and the massive flow of labour through the system meant that recruits had to be processed
as quickly as possible. In 1913, each of the 39 part-time officers was responsible on
average for around 3,000 black miners. They were also responsible for over 100 hospital
patients, many of whom had suffered serious injury.23 Those figures compared
unfavourably with the Johannesburg Hospital which had a ratio of 75 patients per
doctor, and even the Pretoria Central Prison, which had one medical officer for every 1,500
convicts. The Director of Native Labour considered the medical system ‘shockingly
inadequate’,24 a view not shared by employers. As the size of the workforce rose, the ratio
of mine medical officers to mine workers deteriorated. In 1925 the Van Ryn Deep and
New State Areas had a total of 19,368 black miners and employed one full-time medical

20 ‘Obituary A.J. Orenstein’, p. 478.

21 South African National Archives, Annexure A Native Recruiting Corporation Ltd. ‘Questions Relating to the
Medical Examination of Native Mine Labourers Johannesburg 2 March 1923’ in Miners’ Phthisis NTS 6720
33/315 Vol.1.
22 See B. Penrose, ‘Medical Monitoring & Silicosis in Metal Miners: 1910–1940’, Labour History Review, 9, 3
(December 2004), pp. 285–303.
23 See Annexure 6 ‘Whole-Time Medical Officers’ in Report of the Native Grievances Inquiry 1913–1914 (Cape
Town, Government Printer, 1914), p. 102.
24 Report of the Native Grievances Inquiry, p. 31.
548 Journal of Southern African Studies

officer. The Modder B, New Modder and Modder East, with a workforce of 14,000 miners,
employed one part-time doctor.25 There was no improvement after the war, and in the
1950s medical officers at the WNLA still performed examinations in much the same way
as they had 30 years earlier. In his memoirs, Dr Oluf Martiny, who served with the WNLA
from 1954 until 1980, described how as a young physician he and four colleagues
examined 12,000 recruits in a single morning.26

The End of a Brilliant Career

The need for full-time medical officers was investigated by the Native Grievances Inquiry of
1913. The inquiry found that the ten full-time medical officers were on average responsible
for over 7,000 miners and almost 200 hospital patients. The 39 part-time medical officers had
an average caseload of just under 3,000 and 111 hospital cases.27 The inquiry recommended
periodic medical inspections and that a uniform standard of fitness be applied throughout the
industry. In addition, full-time medical officers should be employed and a limit placed on the
number of patients per doctor. It wanted increased government supervision of mine hospitals
and that every repatriated black miner should be examined for miners’ phthisis by a
government medical officer.28 These recommendations were ignored by both industry and
government.
The workloads of mine medical officers were even more onerous than is suggested by the
raw data. Under the Miners’ Phthisis Act of 1916, in addition to their responsibilities for
examining black miners on entry, mine doctors were required to service their general medical
and surgical needs, supervise mine hospitals and monitor conditions in the compounds.
Finally, medical officers were expected to be familiar with the provisions of the legislation
and where necessary to refer men with silicosis or tuberculosis for compensation.
A Parliamentary Select Committee Report of 1919 questioned the quality of the medical
examinations and the fairness of the compensation system,29 but it took six years before the
Miners’ Phthisis Act of 1925 addressed some of the issues raised in that report.30 Unless
exempted by the Minister, the new Act required every mine to engage at least one full-time
medical officer to work with black and coloured miners. Soon after its enactment a deputation
from the MMOA and the South African Medical Association met the Minister of Mines to
discuss the legislation. The salaries of medical officers were modest and they wanted no
change to the existing system, which allowed mine doctors to conduct lucrative private
practices. The Minister was unsympathetic – he supported the Bureau, which wanted part-
time medical officers replaced and a more effective system of examinations introduced: ‘He
[the Minister] had to consider the possible hardship to medical men as against the general
question of the medical examination of all the native mine labourers’.31

25 South African National Archives. Letter from Major H.S. Cooke, The Director of Native Labour to the Secretary
for Native Affairs 19 November 1925, ‘Employment of full-time medical officers’, Miners’ Phthisis NTS 6720
33/315 Vol. 1.
26 O. Martiny, ‘My Medical Career’ (unpublished manuscript, Johannesburg, November 1995 to September 1999),
pp. 4–10. See also J. McCulloch, ‘Hiding a Pandemic: Dr G.W.H. Schepers and the Politics of Silicosis in South
Africa’, Journal of Southern African Studies, 35, 4 (December, 2009), pp. 835 –848.
27 Report of the Native Grievances Inquiry, p. 102.
28 Ibid., pp. 92–93.
29 Parliamentary Library, Cape Town, SC 14-1919, Parliamentary Select Committee into the Miners’ Phthisis Bill.
30 See Miners’ Phthisis Acts Consolidation Act No. 35 of 1925 (Pretoria, Government Printer, 1925), Sections 12
and 44.
31 South African National Archives. Quoted from the Minister’s correspondence with the MMOA in Letter from A.
B. Du Toit, Chairman of the Miners’ Phthisis Medical Board to Major H.S. Cooke, The Director of Native
Labour, 30 January 1926. Miners’ Phthisis NTS 6720 33/315 Vol. 1.
 Medicine, Politics and Disease on South Africa’s Gold Mines 549

The Act offered no guidelines on caseloads or the criteria for granting exemptions. To
provide an answer, on 18 December 1925 a meeting was held in Johannesburg chaired by
A.B. Du Toit, head of the Miners’ Phthisis Medical Board, and attended by Dr Watkins-
Pitchford as Chairman of the Bureau, the Director of Native Labour Major H.S. Cooke,
Dr A.J. Orenstein representing the MMOA (rather than Rand Mines Ltd.) and Dr L. Hertslet,
a medical officer at the Langlaagte Estates mine.32 It was a tense meeting, with Du Toit and
Watkins-Pitchford opposed by the other committee members. That was surprising, as there
appeared to be little at stake. The system had been operating for more than ten years, and the
official rates of silicosis and tuberculosis in miners were among the lowest in the world. The
industry was highly profitable and at worst, full-time medical officers would have cost
individual mines an extra £200 per annum. The meeting was to prove significant in the history
of mine medicine. At stake was the quality of the medical examinations upon which the entire
system of review and compensation rested.
Dr Orenstein opened the discussion. He endorsed the existing system and suggested
there should be one full-time medical officer for every 12,500 black miners, a proposal
which would have seen virtually every mine granted an exemption. Dr Watkins-Pitchford
and Du Toit objected: far from being successful, the system was barely functioning. They
pointed out that on one of the largest mines the medical officer never examined black
miners unless they were injured and that there had been cases of men dying underground
from tuberculosis.33 As a compromise, Major H.S. Cooke suggested 10,000. Dr Watkins-
Pitchford replied that he would not embarrass the meeting by voting against the proposal,
but he wanted the minutes to record his dissent. He believed 5,000 should be the
maximum and that for efficient supervision 3,000 for each full-time medical officer was
preferable.34
The discussion of exemptions was just as heated. The Langlaagte Estates mine was one of
the first applications considered. Major H.S. Cooke supported exemption, as did Orenstein
who argued that it was in the miners’ best interests. ‘To change over from a part-time to
whole-time would in many instances create a heavy financial burden without increasing the
efficiency’.35 Du Toit would not agree. He wanted the mines’ financial position taken into
account. The Meyer and Charlton Mine, for example, had recently paid shareholders a
dividend of £200,000 and could afford a doctor.36
During the discussion, Dr Watkins-Pitchford remained silent, but at the end of the
meeting he made a significant comment: ‘All those present must know that we were
intentionally surrounding ourselves with a fog when we discussed the medical care of mine
natives’. If blacks were to be treated in much the same manner as Europeans ‘it would be
preposterous to make one medical officer responsible for 10,000 natives’.37 It is possible that
comment may have ended his career.
The meeting was followed by a war of words between Orenstein and Du Toit. In that
correspondence Orenstein defended the care offered to black miners as ‘vastly superior to
any medical attention provided for natives anywhere in South Africa’, a claim which was
probably accurate given the lack of public health care. With the exception of L.G. Irvine, who
for many years had served as a mine medical officer, Orenstein did not regard the members of

32 South African National Archives. The minutes of that meeting are found in ‘Letter from A.B. Du Toit, Chairman
of the Miners’ Phthisis Medical Board to the Secretary for Mines and Industries’, Pretoria, 31 December 1925,
NTS 6720 33/315 Vol. 1.
33 Minutes of meeting 18 December 1925, p. 2.
34 Ibid., p. 3.
35 Ibid., p. 10
36 Ibid., pp. 8–9.
37 Ibid., p. 11.
550 Journal of Southern African Studies

the Bureau as expert on the health of black miners.38 The Bureau’s daily work was with white
miners, not blacks. In reply Du Toit accused Orenstein of lobbying on behalf of the mines. He
pointed out that shortly before the meeting on 18 December, Major Cooke had agreed that
7,000 was the correct figure. Yet at the meeting he argued for 10,000. ‘So you see how
opinions differ and how quickly they differ’, Du Toit wrote. He also questioned the accuracy
of the official mortality rate for tuberculosis. ‘Do all the natives who contract or have
contracted this disease die here where they are employed?’39 As chief medical officer with
Rand Mines Ltd, Orenstein was in a better position than Du Toit or Watkins-Pitchford to
answer that question.

Post Mortems and Repatriations

The conflict between Orenstein, Du Toit and Watkins-Pitchford had its origins in three
events. The first was a letter A.B. Du Toit wrote to the Minister of Mines in early 1924, the
second was a set of post-mortem data published by the Bureau in February 1925. The third
came about when a senior medical officer in Mozambique questioned the WNLA’s
repatriation policies.
On Watkins-Pitchford’s initiative, from 1924 any miner who died suddenly was subject to
a post mortem and the results published in the Bureau’s annual report. Under the Miners’
Phthisis Acts Consolidation Act of 1925, that procedure became law. Each year over 500
miners perished in accidents, and presumably most of the autopsies were performed on that
random group. The post-mortem data show far higher rates of silicosis and tuberculosis than
were identified in living miners. That in itself is not surprising as it had long been
acknowledged that post mortems may uncover lung disease missed in a living subject. What
is surprising is the dramatic difference between the post-mortem results and the official
disease rates published annually by the Bureau.
The sequence of post-mortem results from 1924 until 1950 reveals a tide of disease. In
1924 the lungs of 122 white and of 176 black miners were examined. Silicotic changes were
found in 97, or 79.5 per cent, of whites. Among that group 28 had been certified as free of
silicosis, some within months of death. The lungs of the 176 blacks showed an even higher
rate. Despite being subject to periodic examination, 78 men had died of tuberculosis without
having been diagnosed during life. In another 60 men, post mortems revealed the presence of
tuberculosis with or without silicosis.40 In 1928 the lungs of 227 white miners and 429 blacks
were examined. Of the whites 55 per cent had compensatable disease, while 81 per cent of the
blacks were affected.41 That trend continued, with the data consistently showing a disease
rate a hundred times higher than the official figures published by the Bureau.42 In 1950, after
more than 20 years of embarrassing data, the Bureau ceased publishing the post-mortem
results, giving the lame excuse that they were unreliable. It is almost certain the initial data
shocked Watkins-Pitchford, and it may well explain the stance he took at the meeting with
Orenstein.

38 South African National Archives. Letter from A.J. Orenstein, Rand Mines, to A.B. Du Toit, Chairman of the
Miners’ Phthisis Medical Board, 21 December 1925, Miners’ Phthisis NTS 6720 33/315 Vol. 1.
39 South African National Archives. Letter from A.B. Du Toit, Chairman of the Miners’ Phthisis Medical Board to
Dr. A.J Orenstein, Rand Mines, 31 December 1925, Miners’ Phthisis NTS 6720 33/315 Vol. 1.
40 Report of the Miners’ Phthisis Medical Bureau for the Twelve Months ending July 31, 1924. (Pretoria,
Government Printer, 1925), p. 4.
41 Report Miners’ Phthisis Medical Bureau for the Year ended the 31 st July, 1928 (Government Printer, Pretoria,
1929), p. 7.
42 Report Miner’s Phthisis Medical Bureau for the Three Years ending 31 st July 1941 (Pretoria, Government
Printer, 1944), p. 7.
 Medicine, Politics and Disease on South Africa’s Gold Mines 551

During the drafting of the Miners’ Phthisis Act of 1925, the Minister asked Du Toit
to collect data and interview WNLA doctors and officers from the Native Affairs Department
on the need for legislative change. Du Toit found not only that mine medical officers were
not complying with the existing Act of 1919, but that serious irregularities plagued
the compensation system. In addition little attention was paid to the quality of medical
examinations or the fate of men repatriated with tuberculosis.43
Under the Act black miners should have been examined every three months and at the end
of their contracts. However, no uniform standard of fitness had been established, and the
procedure consisted solely of weighing, which was done by a clerk. In Du Toit’s view it was
not a medical examination.44 As a result, many men with silicosis or tuberculosis missed out
on compensation. In some cases where men had died on the mines, there was no post mortem,
which denied surviving relatives the compensation to which they were entitled. Du Toit
hinted that employers deliberately minimised the number of awards in order to reduce the
cost.45 Du Toit also criticised the repatriation system in particular. He estimated that over the
previous 20 years more than 20,000 miners with active tuberculosis had returned to their
villages to spread disease. Du Toit cautioned 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’.46
In November 1924, a month after Du Toit’s letter, Dr Bostock, the WNLA District
Manager at Lourenc
o Marques in Mozambique, wrote in protest to the Chamber’s general
manager William Gemmill about the increasing number of miners arriving in an advanced
state of tuberculosis. ‘Apart from occasional deaths on the train, at Ressano Garcia, or on the
ship, a number of natives have of late reached our main camps only to die there’. Bostock
suggested that earlier diagnosis would prevent ‘adverse criticism on the humanity of the
present system under which Portuguese native labourers are employed on the Rand’.47 A
week later Bostock wrote to the WNLA Director in Johannesburg about the latest batch of
repatriations:
‘I beg to advise you that some of this week’s sick rejects arrived in a very weak state, one native
No. 8231 dying half an hour after arrival. Our Medical Officer there reports that some of the
tubercular cases are in a very advanced stage’.48
The WNLA correspondence shows the same problem in Basutoland (Lesotho), another
major source of migrant labour. An extract from the NRC Provincial Superintendent’s report
for March 1925 contains the following warning:
The Government Doctors here complain of the bad state of health in which the Basuto are sent
back from Johannesburg; they say in some cases they are unfit to travel, and when they come here
have to go into hospital and die or have to be kept for months. They say that the mines should bear
the expense and keep them there.49

43 South African National Archives. Letter from A.B. Du Toit, Chairman of the Miners’ Phthisis Medical Board to
the Minister of Mines and Industries, 21 October 1924, p. 1, Miners’ Phthisis NTS 6720 33/315 Vol. 1.
44 Ibid., p. 4.
45 Ibid., p. 6. Page 3 of Du Toit’s six-page letter is missing. It appears that page contains statistics on the tuberculosis
rate among repatriated miners.
46 Ibid., p. 6.
47 Letter from Dr Bostock, District Manager, Lourenco Marques, to the General Manager, Transvaal Chamber of
Mines, Gold Producers’ Committee, 20 November 1924, cited in Proceedings of the Transvaal Mine Medical
Officers’ Association, IV, 11 (March, 1925), p. 5.
48 ‘Memo from L. Bostock, District Manager, to WNLA Director, Johannesburg, 29th November, 1924’, cited in
Proceedings of the Transvaal Mine Medical Officers’ Association, IV, 11 (March, 1925), p. 5.
49 Extract from ‘Monthly Report of the N.R.C. Provincial Superintendent for Basutoland’ cited in Proceedings of
the Transvaal Mine Medical Officers’ Association, IV, 11 (March, 1925), p. 5.
552 Journal of Southern African Studies

William Gemmill referred the matter to the MMOA, and the correspondence between
Bostock and the WNLA was tabled at the Association’s meeting in March 1925. Orenstein
attended that meeting.
The Chairman of the Mine Medical Officers’ Association Dr S. Donaldson acknowledged
the issue was important but deferred discussion until Dr Bostock could appear in person
before the Association. That did not happen. Instead, at the May meeting the chairman tabled
a letter from William Gemmill asking the Association to nominate a three-member
committee to lead the Chamber’s campaign against tuberculosis.50 It was a significant change
of policy. As Director of the SAIMR, Watkins-Pitchford had for some years lobbied the
Chamber to fund such research arguing that little was known about the fate of repatriated
miners and there was, he believed, urgent need for a follow-up study.51 In June 1925 the
Chamber, in conjunction with the SAIMR, formed the Tuberculosis Research Committee,
which included Watkins-Pitchford as Chairman, F. Spencer Lister, Dr A. Mavrogordato and
Orenstein. Twelve of the 17 members were tied professionally to the Chamber.52 By May of
the following year Watkins-Pitchford had resigned.
After four years of deliberation, in 1929 the Chamber, in collaboration with the SAIMR,
commissioned a study of tuberculosis with special reference to gold miners. Dr Peter Allan,
the Superintendent of the Nelsproot Tuberculosis Sanatorium and later Secretary of Public
Health, was appointed principal researcher. His surveys of the Transkei and Ciskei formed the
report’s centrepiece.53 The overseeing committee was chaired by Spencer Lister and included
L.G. Irvine and A.J. Orenstein. The report, which was published by the SAIMR, made no
criticism of the repatriation system and found no evidence that the mines were spreading
tuberculosis.

The Endgame
Watkins-Pitchford took no part in drafting the SAIMR’s report and presented no paper to
the 1930 Silicosis Conference. Soon after returning to England, however, he published a
review of the Witwatersrand medical system in which he made a number of telling
observations. While the article contains no direct criticism of Orenstein or the Chamber of
Mines, it suggests that the system of medical surveillance was designed to avoid
identifying compensatable disease. It was to be Watkins-Pitchford’s final publication on
silicosis.
Watkins-Pitchford reminded his readers that silicosis is a subtle disease which often
cannot be diagnosed with certainty during life. There may be no loss of weight, and the
individual may give every appearance of good health until the disease is well advanced.54 A
satisfactory diagnosis requires an X-ray, periodic weighing and a work history, in addition to
placing the patient under observation.55 The massive numbers of examinations carried out by
the Bureau made effective medical review of white miners difficult. Each year from its
foundation in 1916, the Bureau conducted on average 34,890 examinations. The five interns

50 See Proceedings of the Transvaal Mine Medical Officers’ Association, V, 1 (May, 1925), p. 7.
51 See Teba Archives, University of Johannesburg, ‘Minutes of a Conference on Tuberculosis in Natives’ held at the
Law Courts, Johannesburg, 15 October, 1922, Miners’ Phthisis and Tuberculosis Among Natives NRC 135, p. 11.
52 Proceedings of the Transvaal Mine Medical Officers’ Association, VI, 1 (May, 1926), p. 3.
53 See Tuberculosis in South African Natives With Special Reference to the Disease Amongst the Mine Labourers of
the Witwatersrand (Johannesburg, South African Institute for Medical Research, 1932). For an overview of that
report see R.M. Packard, White Plague, Black Labour: Tuberculosis and the Political Economy of Health and
Disease in South Africa (Berkeley, University of California Press, 1989), pp. 205–210.
54 W. Watkins-Pitchford, ‘The Silicosis of the South African Gold Mines, and the Changes Produced in it by
Legislative and Administrative Efforts’, Journal of Industrial Hygiene, 9, 4 (April, 1927), pp. 121 –122.
55 Ibid., p. 121.
 Medicine, Politics and Disease on South Africa’s Gold Mines 553

also prepared and reviewed 24,568 X-rays and carried out over 300 post mortems.56 The
workloads of mine medical officers were so heavy that examinations of black miners amounted
to little more than parades. At best the periodic weighing of black miners detected 50 per cent of
the cases of simple tuberculosis or tuberculosis with silicosis.57 Having identified the numerous
failings in the system, Watkins-Pitchford concluded: ‘If gold mining cannot be carried out
without giving rise to silicosis then the continuance of mining must be questioned’.58
Watkins-Pitchford’s resignation had no effect on the Bureau procedures, and it brought no
change to the legislation. On the contrary, the methods of conducting medicals and awarding
compensation continued as before. Those procedures were given the ILO’s approval at the
1930 Conference and were also endorsed by the Tuberculosis Commission Report of 1932.
The crisis over medical surveillance and compensation had passed.
In contrast to Watkins-Pitchford, whose career ended abruptly in 1926, A.B. Du Toit
survived as Chairman of the Miners’ Phthisis Board. Also in contrast to Watkins-Pitchford,
he changed his mind about medical surveillance and the dangers of gold mining. In 1931 Du
Toit wrote a review of the newly tabled Commission Report into Miners’ Phthisis chaired
by James Young. Du Toit was highly critical of the proceedings which he believed had
produced nothing of value.59 He took particular exception to Young’s finding that miners’
phthisis was difficult to diagnose. Du Toit acknowledged that there were frequent disputes
over awards because the Bureau often rejected the diagnosis given by a white miner’s own
physician. The reason lay not in the subtle disease process described by Watkins-Pitchford,
Du Toit argued, but arose because many miners sought compensation to which they were
not entitled.60
Surprisingly, Du Toit made no comment on the dissenting report by one of the
Commissioners, Willem Boshoff, who repeated many of the criticisms Du Toit had himself
made five years earlier.61 Boshoff found that the medicals conducted at the WNLA
compound were inadequate and that some black miners died from tuberculosis without ever
having been examined. Rejecting the evidence given to the Young Commission by Dr
Orenstein that tuberculosis was not a problem, Boshoff argued: ‘I am convinced that the
figures [published by the Bureau] giving the deaths from tuberculosis among natives on the
mines do not reflect the true position. The majority of deaths do not take place on the
mines’. Boshoff wanted initial examinations to include an X-ray to be carried out by a
government medical officer, more stringent periodic and final examinations, and follow-
up medicals after five years of service. Although none of his recommendations was
adopted, Boshoff’s criticisms were repeated by the Stratford (1943), Allan (1950) and
Beyers (1952) Commissions. They are also consistent with the research carried out since
majority rule which shows a pattern of under-reporting.62 In Jaine Robert’s 2009 study of
former miners from the Eastern Cape, 85.3 per cent of her cohort had not received an exit

56 Ibid., p. 110.
57 Ibid., p. 129.
58 Ibid., p. 133.
59 Du Toit’s review was submitted to the 1931 Parliamentary Select Committee. See Parliamentary Library, Cape
Town, A.B. Du Toit, ‘Analysis and Observations on the Report of the Miners’ Phthisis Commission of Enquiry,
1929– 1930’, Appendix to Select Committee into the Miners’ Phthisis Commission Report AN 756-1931 SC12-
31, p. 8.
60 A.B. Du Toit, ‘Analysis and Observations’, p. 9.
61 See Reservations by Mr W. Boshoff in Report of the Miners’ Phthisis Commission of Enquiry 1929–30 (Pretoria,
The Government Printer, 1930), pp. 46 –52, and pp. 100–101.
62 See A. Trapido, ‘An Analysis of the Burden of Occupational Lung Disease in a Random Sample of Former Gold
Mineworkers in the Libode District of the Eastern Cape’ (PhD thesis, University of the Witwatersrand, 2000),
Chapters 9 and 10.
554 Journal of Southern African Studies

examination as required by law.63 As a result miners with silicosis and tuberculosis are still
being denied compensation.

Shifting Ground
The end of apartheid brought a reassessment of the risks facing miners. In 1994 the Leon
Commission into health and safety found that dust levels were hazardous and that they had
probably been unchanged for more than 50 years.64 Subsequent research at the National
Institute of Occupational Health in Johannesburg and the University of Cape Town has
identified a pandemic of hitherto undiagnosed and uncompensated disease. Those studies put
the silicosis rate in living miners at between 22 per cent and 28 per cent, or over a hundred
times higher than the official rate when Watkins-Pitchford resigned.65 Jill Murray’s post-
mortem research has led her to estimate that up to 60 per cent of miners will eventually
develop silicosis.66 Her results are hauntingly similar to those compiled by Watkins-Pitchford
in 1925.67
There is no evidence that since 1994 work conditions have deteriorated dramatically,
and while diagnostic methods have improved, at no point in the past 60 years have they
been revolutionised. The mine workforce has become more stable since the mid-1980s, with
migrant workers spending longer periods in continuous employment. While it is tempting to
view stabilisation as a break with the past, labour stabilisation has long been a feature of the
industry. As early as 1906, Drs L.G. Irvine and D. Macaulay wrote that it was becoming
common for East Coasters to remain for 18 months continuously on the mines.68 The
Miners’ Phthisis Medical Bureau’s Annual Report for 1924 noted that retaining the services
of experienced workers beyond the usual contract of six to nine months meant a
considerable number were permanent employees.69 By 1930, of the 400,000 men who went
through the system each year, around 80 per cent were re-engagements.70 That finding was
endorsed in 1943 by the Commission into Native Wages on the Rand.71 To summarise,
stabilisation has long been a feature of the industry, and it cannot explain the discrepancy
between the current and past disease rates. Rather than any dramatic increase in the rate of

63 J. Roberts, The Hidden Epidemic Amongst Former Miners: Silicosis, Tuberculosis and the Occupational
Diseases in Mines and Works Act in the Eastern Cape, South Africa (Westville, Health Systems Trust, June
2009), p. 81.
64 See Report of the Commission of Inquiry into Safety and Health in the Mining Industry (Pretoria, Department of
Minerals and Energy Affairs, 1995), pp. 51–53.
65 See T.W. Steen, K.M. Gyi, N.W. White, T. Gabosianelwe, S. Ludick, G.N. Mazonde, N. Mabongo, M. Ncube,
N. Monare, R. Erlich and G. Schierhout, ‘Prevalence of Occupational Lung Diseases among Botswana Men
Formerly Employed in the South African Mining Industry’, Occupational and Environmental Medicine, 54, 1
(1997), pp. 19–26; and B. Girdler-Brown, N. White, R. Erlich and G. Churchyard, ‘The Burden of Silicosis,
Pulmonary Tuberculosis and COPD Among Former Basotho Goldminers’, American Journal of Industrial
Medicine, 51, 9 (2008), pp. 640 –647.
66 J. Murray, ‘Development of Radiological and Autopsy Silicosis in a Cohort of Gold Miners Followed up into
Retirement’ (unpublished paper presented at the Research Forum, National Institute for Occupational Health,
Johannesburg, 26 May 2005).
67 See also Trapido, ‘An Analysis of the Burden of Occupational Lung Disease’, pp. 196 –202; and R. Morris,
‘Silicosis Prevalence among Gold Miners Continues to Soar, Study Finds’, Business Report (15 February 2008).
68 L.G. Irvine and D. Macaulay, ‘The Life-History of the Native Mine Labourer in the Transvaal’, Journal of
Hygiene, 6, 2 (April 1906), p. 155.
69 Report of the Miners’ Phthisis Medical Bureau for the Twelve Months ending July 31, 1924 (Pretoria,
Government Printer, 1925), p. 28.
70 Tuberculosis in South African Natives with Special Reference (1932), p. 74.
71 Report of the Witwatersrand Mine Native Wages Commission on the Remuneration and Conditions of
Employment of Natives on the Witwatersrand Gold Mines (Pretoria, Government Printer, 1943).
 Medicine, Politics and Disease on South Africa’s Gold Mines 555

silicosis over the past two decades, it seems far more likely that the actual rates have always
been high.
In addition to silicosis, the mines have played a major role in the spread of tuberculosis,
the issue which Du Toit and Watkins-Pitchford had raised in 1925. According to current
WHO estimates, the incidence of tuberculosis in South Africa is among the highest in the
world, with the rate among miners ten times higher than for the general population.72
Radiological evidence from Libode in the Eastern Cape puts the incidence as high as 47 per
cent.73 David Stuckler et al. have found that even allowing for HIV/AIDS, South Africa’s
gold miners have a higher rate of tuberculosis than any other working population in the
world.74 South Africa’s mines appear to have played a similar role in spreading tuberculosis
to the general population to that of prisons in the former Soviet Union.75

A Stable System
As Chair of the Bureau, Watkins-Pitchford’s heavy workload included overseeing medical
examinations, dealing with ambiguities in the legislation and responding to the numerous
appeals from white miners and their families. He was also the most prominent researcher in
Johannesburg. However, he had little clinical contact with black miners. It may be that
Watkins-Pitchford first became aware of the actual disease rates when compiling the post-
mortem data from 1924. While the high levels of silicosis could be explained by the
difficulties of diagnosis, they suggested that the mines were unsafe and that all medicals
should include an X-ray and a clinical examination. The large number of black miners with
infective tuberculosis who were working underground at the time of death was far more
serious. Those deaths suggested that the system of medical surveillance was fundamentally
flawed and that the mines were spreading tuberculosis to rural communities. In supporting the
employment of full-time medical officers, Watkins-Pitchford responded to what he viewed
as a crisis.
Orenstein’s position at Rand Mines Ltd. and his role on the Gold Producers’ Committee
meant that he was better placed than Watkins-Pitchford or Du Toit to know the actual rates of
tuberculosis and the risks of repatriation. He was also more knowledgeable about the labour
process under which black miners had far higher dust exposures than did whites. Nevertheless
in public Orenstein never questioned the conduct of medicals nor did he protest about the
compensation system. On the contrary, at one Commission after another, Orenstein was
adamant that the gold mines had conquered lung disease, a claim that he knew from the
Bureau’s post-mortem data to be false.
Even though the Miners’ Phthisis Acts were racialised in favour of white labour, the white
Mine Workers Union complained at numerous public enquiries that its members were
struggling to win compensation.76 The obstacles facing black miners were far greater. The
Acts outsourced the medical examination of black miners to mine medical officers who had
massive caseloads and were required to ensure a steady flow of labour through the system. In

72 Roberts, The Hidden Epidemic, p. 46.

73 Ibid., p. 51.
74 D. Stuckler, S. Basu, M. McKee and M. Lurie, ‘Mining and Risk of Tuberculosis in Sub-Saharan Africa’,
American Journal of Public Health, 1, 3 (2011), p. 524.
75 Ibid., p. 529.
76 See, for example, Report of the Commission of Enquiry Regarding the Occurrence of Certain Diseases, other
than Silicosis and Tuberculosis, Attributable to the Nature of Employment in and about Mines (Pretoria,
Government Printer, 1951).
556 Journal of Southern African Studies

referring sick miners for compensation they were expected to act against the perceived
financial interests of their employers.
The entry medicals were sufficiently rigorous to exclude experienced miners with dusted
lungs, but the periodic exams were reduced to a ritual which met a legislative requirement but
had no clinical value. The failure to perform exit medicals ensured that most cases of silicosis
and tuberculosis went uncompensated and therefore unrecorded. At each point, the medicals
were conducted in such a way as to minimise the number of awards and maintain the fiction
that the mines were safe. That was the conclusion of the Stratford Commission of 1943,
which was highly critical of the repatriation of miners with tuberculosis.77 It was also the
conclusion of the Oosthuizen inquiry of 1954.78 Neither of those inquiries brought any
change to mine medicine.
What would have happened in 1925 if Watkins-Pitchford’s views had prevailed? More
scrupulous medicals at the WNLA and the Bureau would have led to a sudden rise in the
number of compensation awards, thereby imposing higher production costs on the industry.
That in turn would have had an impact upon the gold standard. The political impact in
southern Africa would have been equally great. The gold mines depended on a supply of
migrant labour from surrounding colonial territories. Any damage to the mines’ reputation for
safety would have alerted the British and Portuguese authorities of the need to protect migrant
workers. The labour supply for the gold mines, and hence their profitability, depended upon
an illusion of safety which the system of medical examinations helped to sustain for almost a
century. In the end, those factors explain the resistance Watkins-Pitchford and Du Toit faced
in their meeting with A.J. Orenstein in 1925.

JOCK MC CULLOCH
Professor of History, Global, Urban & Social Studies, RMIT University, GPO Box 2476,
Melbourne, Victoria, 3001, Australia. E-mail: jock.mcculloch@rmit.edu.au

77 See Report of the Witwatersrand Mine Native Wages Commission, 1941– 1943 (Pretoria, Government Printer,
1943), pp. 14–29.
78 Report of the Departmental Committee of Enquiry into the Relationship between Silicosis and Pulmonary
Disability and the Relationship Between Pneumoconiosis and Tuberculosis (Pretoria, Government Printer, 1954).
(Oosthuizen Committee.)