Tuberculosis, Malnutrition and Mining in South Africa: 1903–1960

Abstract Tuberculosis became a notifiable disease in the Cape in 1907, and throughout the South African Union under the Public Health Act of 1919. The Act, which was designed to limit infection among whites, introduced programmes for early diagnosis, treatment and notification, as well as improved housing, sanitation and education. It also established dispensaries, sanatoria and farm colonies. There was no parallel programme for the majority of South Africans. By mid-twentieth century, the tuberculosis death rate among whites in South Africa was lower than in most European countries and was falling. However, the limited data suggested that the death rates among non-Europeans were disturbingly high. Over several decades, a range of medical officers and commissions of enquiry warned about a looming tuberculosis crisis, but there was no public health response, whether in the form of programmes to tackle malnutrition, diagnosing and treating those infected with tuberculosis or collecting relevant statistics. Effective treatment of tuberculosis, which should have—but did not—completely changed the management of the disease on the mines, became available in the 1950s. The failure to take advantage of the new drugs made the mines’ determination to externalise costs even more visible.