The five ages of pulmonary tuberculosis and the South African goldminer.

Pulmonary tuberculosis was the inevitable and terminal illness for goldminers during the 25 years after the opening of the Witwatersrand goldmines in 1886. Pioneer research and enlightened legislation resulted in reduced dust levels and less aggressive silicosis and progressively reduced the risk and severity of disease. Later antituberculosis drugs improved the outcome for those miners who still developed the condition. New generation antituberculosis drugs and short-course chemotherapy made it possible to cure pulmonary tuberculosis, even in men with silicosis. Nevertheless the incidence of pulmonary tuberculosis in black goldminers remains high. In the future, attention should be paid to improvement of disease detection; the role of chemoprophylaxis in men with silicosis and in other high-risk groups; and to sociopolitical modification, notably of the migrant labour system.