The history of silicosis in South Africa is filled with paradoxes. The Rand mines were the first in the world to invest heavily in dust extraction technologies and instruments, such as the konimeter, to reduce risk. South Africa was the first state to recognise silicosis and tuberculosis as occupational diseases, and the gold mines were the first to use radiography to screen workers. Yet South Africa was unsuccessful in making the mines safe or in providing adequate compensation. The major paradox is between the intensity of public debate about silicosis and the invisibility of the disease burden. In the period from 1902 to 1990 there were twelve select committees, twelve commissions of inquiry, and four official and interdepartmental committees on miners' phthisis. The more the Department of Mines and the Chamber of Mines talked about silicosis and the more data they collected, the less the disease was visible. In South Africa as in the USA, the UK and Australia, the silicosis hazard has been pushed into the public domain by the efforts of organised labour, political activists, independent scientists and regulatory authorities. It was not made visible by capital.

South Africa was a special case, with its racialised state and labour markets dominated by a handful of corporations. The mines' importance to the national economy acted as a constraint on workplace reform. The gold mines were also quintessentially modern. There was medical monitoring to ensure the fitness of workers and compensation for those who became ill or injured.