Silicosis, a massive fibrosis of the lungs, results from the inhalation of excessive amounts of silica dust. This severe, irreversible, disabling, and often fatal occupational disease can be prevented by dust control. Only free silica causes the disease, which can develop rapidly but is generally chronic and progresses slowly. (Today a relation to cancer is suspected, based on epidemiological and experimental data concerning the relationship between silica exposure and the development of lung cancer.) Silicosis, one of the oldest known occupational diseases, [End Page 132] still occurs. This fact highlights the dichotomy, now as it did in earlier years, between possession of sufficient technological knowledge to prevent the disease and failure to eradicate it. This gap between the hazard of silicosis and effective action to eliminate it is a recurrent feature of the history of silicosis.
In a well-written and carefully researched account of this extraordinary disease, Elaine Katz has brought to the reader much information and an excellent analysis of the cavalier attitude toward the health of miners on the gold fields of the Witwatersrand, South Africa, during the years 1886 (when gold mining began there) to 1910. Shockingly little attention has hitherto been paid to this facet of South African history, notwithstanding the work of the Weldon Commission appointed in 1902 to investigate the causes and extent of this affliction, which identified the cause of the disease and recommended dust elimination by methods still universally applied. In the years under discussion the prevalence, incidence, and rate of silicosis were higher on the Witwatersrand than at any other metalliferous (hardrock) mining center in the world.
Early in the book Katz states her intent to remedy the striking lack of attention paid to the part of Rand’s social history that focuses on the health of miners. Contrary to what she refers to as conventional wisdom—namely, that the miners’ own carelessness caused their illness, that the disease was not preventable, or that technology alone caused excessive disease—she focuses on a number of other issues to explain the failure to prevent silicosis. The trivialization of the disease leading to failure to prevent it was the consequence of a combination of vested interests and greed. Technology created more dust, but the decisive factor in the growing incidence and severity of silicosis was the labor practices peculiar to the Witwatersrand gold mines, which elevated dust levels. Control of silicosis had a low priority for the Randlords. Public indifference, together with pressure exerted by the Randlords (direct and indirect), encouraged mining practices that were detrimental to health and safety. Given the state of medical knowledge about silicosis and its prevention, physicians’ denial of responsibility for high disease rates was reprehensible. This denial resulted in excessive dust levels.
Katz informs the reader about the medical, economic, social, and political context in which silicosis developed that led to failure to prevent it. I particularly appreciate the author’s understanding of the disease silicosis. While exploring the response to silicosis by the entire community—the state, the medical profession, the industrialists, the press, and the mine workers—she presents a history of greed, indifference, and apathy. This is a well-written book that is worth reading. There are too few accounts of the social impact and response to occupational disease—and fewer balanced accounts.