Sot. Sci. Med. Vol. 31, No. 2, pp. 213-232, 1993 Printed in Great Britain

0277-9536/93 $6.00 + 0.00 Pergamon Press Ltd

DISEASE AND MORTALITY AMONG GOLD MINERS OF GHANA: COLONIAL GOVERNMENT AND MINING COMPANY ATTITUDES AND POLICIES, 1900-l 938

RAYMOND DUMETT

Department of History, Purdue University, West Lafayette, IN 47907, U.S.A.

Abstract-This article traces the causes of high mortality rates among African gold miners in the former British colonial territories of the Gold Coast and Ashanti, 19OlS-1938. No previous studies exist for the early decades owing to the neglect by both mining companies and government officials to keep adequate statistics on African miner death rates, a flaw which reinforced the lackadaisical response of the government to problems of prevention and treatment. A milestone report issued in 1924, demonstrating that sanitary precautions, housing conditions and medical treatment for most African miners were wretched, forced the colonial state to gather regular data on Africans and make long overdue improvements, so that mortality rates for underground miners slowly declined by the time of the Second World War. But the published statistics concealed from view the far greater incidence of general deaths from pulmonary and respiratory tract disease among short-term migrant labourers, who lived in the mining towns, but returned to die in their home villages.

Key words-miners, shanty towns, tropical disease, industrial disease, pneumonia and tuberculosis, colonial administration, West Africa

In approaching questions of sickness and mortality among indigenous miners in the major gold mining towns of the Gold Coast and Ashanti in the early twentieth century one encounters a double barrier to clear understanding. The first was that the colonial state was overwhelmingly concerned with the health of the European population, and especially with the protection of government officials, against the rav- ages of malaria and other tropical fevers. Thus, a substantial portion of the descriptive evidence in health reports and memoranda of the time focussed on this issue alone [l]. A second barrier for the historian attempting to reconstruct those times, was the government’s inability, ascribed to shortage of staff and revenue and to local resistance, to gather accurate data on patterns of African sickness and mortality. Under these circumstances the statistical bases for determining patterns of illness and mor- tality among specialized occupational groups such as miners, are less complete than those series available for Kimberley and the Rand in South Africa and for the copper mining areas of Zaire and Zambia [2]. Not only Gold Coast government archives, but also the extant company records, are conspicuously barren of meaningful statistical series on mortality rates, and even of feeble attempts to count the deaths at a given mine on a regular basis. This was not simply a problem of lack of manpower and the rudimentary state of statistical science at the time; it also reflected policy preferences and goals. The colonial govern- ment wanted to restrict its responsibilities for minis- tering to the health needs of the entire African population. And so the less said about it the better. Until at least 1914, the government even had qualms

about publicizing European sickness and mortality rates on the Coast [3]. As a consequence of the colonial regime’s laissez-faire attitude, it was easier for the mining companies also to drag their feet in providing up-to-date information on African miner’s health and hospitalization. The present paper is part of a larger study on the history of the goldmining industry in Ghana in the late nineteenth and early twentieth centuries. The investigation attempts to stretch the boundaries of historical writing about patterns of indigenous disease and mortality in a poorly staffed European tropical colony where only limited statistical data on the general African popu- lation was made available.

The mining towns of Tarkwa and Obuasi

There were two main mining complexes in the Gold Coast and Ashanti prior to the First World War. The first center included the twin towns of Tarkwa and Aboso in Wassa State which lay about 40 miles inland by railway from the port terminus of Sekondi in the southwestern part of the Colony (see Fig. 1). An adjunct mining center, situated at Himan-Prestea about 19 miles by branch line from Tarkwa, will not be analyzed in this essay. From a tiny African hamlet of several hundred at mid-century Tarkwa grew into a boom town of over 2000 at the height of the first gold rush in the early 1880’s. Construction of the Gold Coast’s first railway from Sekondi to Tarkwa between 1899 and 1902 added to the growth of population congestion and attendant social and health problems in the gold mining region. With a total complement of 12,417 workers stationed at various sections in overcrowded and poorly sanitized

213

214 RAYMOND DUMETT

tent towns along the line of rail. railway construction itself aggravated the spread of disease. even before the mining towns reached their peaks of settlement [4]. Only a few of these short-term railway workers (many from Nigeria and Sierra Leone) stayed on to work at the mines afterwards. Slowly other young workers, attracted by the lure of money wages, were recruited by the mining companies, so that the mines labour force for Tarkwa and Aboso combined rose to a complementof5128by 191Oand6681 by 1921.Other settlers, migrants and hangers-on (wives, children and petty traders) brought the total population of the towns. villages and camps strung out along Tarkwa Ridge (including Tarkwa. Tatnsu, Abontiakoon and Ahoso) to an estimated and fluctuating total of 26,500.

Obuasi, the second major center covered in this survey, had been but a tiny clearing in the forest. inhabited by a few dozen families, prior to the lease of a great gold mining concession by the soon-to-be- famous Ashanti Goldfields Corporation in 1897. Legitimation by the British Government of the C’om- pany’s monopolistic claim to 100 square mile block of territory (called an ‘empire within an Empire’ ) on the basis of treaties forced on Ashanti chiefs coupled with extension of the railhead to the 121 mile mark by 1902 helped turn a small tent town for prospectors into a bustling mining complex. Both Tarkwa and Obuasi received world-wide fame as a result of the great West African gold boom of 19OOHU. By 1904 the AGC’s several mining installations had a

HUNI VALLtY 53 I’ K 0 V I N C‘ t,

Fig. I. Sketch map of the Sekondi-Kumasi railway and the main gold mining centers of Tarkwn and Obuasi.

Disease and mortality among gold miners of Ghana 21s

regularly employed labour force of 1500, while Obuasi town boasted a population of at least 5000. In addition to the usual mining town agglomeration of miners, their relatives, market stall operators and fugitives from the law, the main town of Obuasi and outlying villages contained a labour reservoir of occasional workers, whom the mine owners could draw on for piece work or contract labour-fuel gatherers, porters and tram loaders, etc.-as need dictated. By 1911 the total population of Obuasi and surrounding mining villages was estimated at 15,000, with Obuasi proper at 9000, Ayeinm at 3000 and a second satellite village of Sansu also at 3000 [S].

Sanitary and housing problems

From the very beginning Ghana’s gold rush towns were beset by an awesome congeries of housing, street sanitation, sewage disposal, water supply and hy- gienic problems, commonly compared by officials with the legendary Greek ‘labours of Sisyphus’. The crux of the issue was that the public health problem needed to be attacked ‘systematically’ on many fronts simultaneously [6]. Yet the colonial government had neither the resources, nor the will, for anything more than piecemeal works projects and clean-up cam- paigns. Even during the Colony’s first gold rush in the 1880’s medical officers knew enough about the germ theory to attack the prime sources of disease in contaminated water in ditches and ravines, impure supplies of drinking water and poor latrine facilities. At this time there was practically no hygienic edu- cation for children or for adults. The burial of relatives inside the walls or under the floors of domiciles was a problem that stemmed from tra- ditional religious beliefs [7]. Water supplies for the chain of mining villages that sprouted up at the foot of Tarkwa Ridge in Wassa were not, initially, too bad, being drawn from the multitude of small rivulets that flowed from the ridge down into the valley. But as housing became more congested, drainage and waste from the compounds filtered back into the water used for drinking and cooking at mining villages located further downstream.

Because facilities for sewage disposal and street drainage were almost non-existent, these miners’ shanty towns became the natural dissemination grounds for a wide range of respiratory and fecal tract diseases spread by foul water, bacteria-laden air and contaminated food and soil. Medical authorities made a clear-cut distinction between the leading causes of African deaths and the leading causes of ordinary illnesses, some of which were just beginning to be recorded at the few government medical centers. James Fare11 Easmon, M.D., an African physician, who pioneered in the study of several diseases common among Africans on the coast, noted that the ailments most commonly reported and diagnosed at the hospitals were in order of numbers: (1) diseases of the feet and lower limbs (chiefly tropical ulcers); (2) intestinal diseases (diarrhea and

dysentery); (3) diseases of the skin (such as yaws) plus various worm diseases; (4) rheumatism; and (5) respiratory diseases [8]. (We also know that Africans suffered from a high incidence of malaria, but this was more difficult to measure in this early period and was not a common reason for Africans reporting to hospital [see p. 2261.) What may surprise the untutored western observer, is the extent to which a majority of Africans died from the same groups of killer diseases of the pulmonary and cardio-vascular systems that were the scourges of western industrial- ized countries at this same time. The major causes of death for Africans in the major coastal towns were (1) pneumonia; (2) tuberculosis; (3) dysentery; (4) various fevers; and (5) heart disease and stroke. That the respiratory ailments ranked only fifth on the list of cases treated yet first among deaths is probably explained by the fact that many of the more numerous minor illnesses and injuries were treated quickly on an out-patient basis, whilst large numbers of pneumonia and tubercular cases went undetected in the early stages with patients coming to hospital only when death was near. The African populations were also afflicted by a number of contagious diseases. The most deadly were smallpox (a disease which appeared in both endemic and epidemic patterns and whose deaths among Africans were greatly underreported from year to year) 191, followed by influenza. Cholera was never a threat on the Gold Coast during the years covered here. Typhoid and paratyphoid did occur and cases were usually classified on death charts under the label of ‘enteric fever’. A good many of the prevalent endemic and also epidemic diseases of Ghana had not yet been identified [IO].

Identification of the symptoms of many of the tropical diseases was imperfect, which was the princi- pal reason for the listing of so many causes of death under the catch-alls pyrexia or ‘fever’. It was often difficult to pinpoint the exact causes of a ‘sick’ individual’s death (which might have been traceable to a combination of causes); and a majority of the cases and fatalities in the mining towns, as through- out the country, simply went untreated and un- recorded [ll]. In addition to the basic stinginess and inertia of the government. Dr Easmon traced the dearth of accurate data on the causes of mortality among the general population to (a) the fact that post-mortem examinations were often regarded as a desecration of the dead; and (b) to the “disinclina- tion of natives to tell the government anything about the deaths of relatives or friends lest they be forced to inter corpses in cemeteries” [12]. What has to be stressed here is that even though mechanized mining under European companies began on the Gold Coast as early as 1877, the sickness and mortality patterns of the African workers were a blank sheet until as late as 1925. As one report of the 1890’s noted diagnoses about African deaths even in the coastal towns “are as a rule based on hearsay. [and] we are in perfect

216 RAYMOND DUMETT

ignorance about sickness and mortality amongst tribes of the interior” [13].

The efects of migratory labour

Maintaining public health in the mining towns was complicated greatly by the migratory and fluid nature of the labour forces of a majority of the companies. For perhaps the first 50 years of capitalist mining in the Gold Coast, workers remained more closely tied to the agricultural economies of their traditional up-country villages. Mining company supervisors constantly bewailed how hard it was to keep miners, once trained, on the job for any length of time. They spoke of the constant ‘comings and goings’ of unskilled African workers back to their home villages to take part in the planting or harvest season, to participate in religious customs or funerals, or simply to visit relatives. Paradoxically, this rapid turnover was cited both as a reason why the mining towns had become cesspools for the rapid spread of disease and as a rationalization why the understaffed company medical officers could not keep better track of the numbers of miners’ deaths. As will be noted below, it was the bacterial and viral diseases spread mainly by infected human hosts, rather than the insect-borne diseases that were the chief mortality problem in the mining towns. And this was aggravated by the fact that Tarkwa and Obuasi become virtual ‘crossroads’ for meandering porters, construction workers and diggers during the periods of the gold mining and railway construction booms.

General populations qf mining towns

Early Gold Coast Census Reports are of limited use for the questions at hand because base popu- lations were tabulated according to districts rather than towns or cities [14]. Thus the statistics listed under the names of major towns, such as Accra, Sekondi and Tarkwa are inflated since they included the populations of the surrounding hinterlands. Some of our best nineteenth century estimates on the mining towns proper must be culled from scattered manuscript sources rather than the printed reports. We are further handicapped by the fact that the first census surveys of 1891, 1901 and 1911 neglected to estimate the ethnic subgroup populations housed in the various wards or ‘zongos’ under traditional chiefs and headmen, so that we have no complete picture on ethnic breakdowns in the townships.

Some assistance in this investigation comes from surveys of ethnic subdivisions among the male mine workers employed by the companies, which give some idea of the proportions in the total town populations, although allowance must be made for the fact that local Akan (Fanti and Ashanti) males were more likely to have wives and families living with them than migrant workers from distant colonies, such as Southern Nigeria, Liberia and Sierra Leone. A new departure was seen in 1907 when small groups of men recruited from the Northern Territories (of future

Ghana) were brought to the Abontiakoon mine of Wassa under the supervision of Governor John Rodger [15]. The first reliable ethnic breakdowns of the Wassa and Ashanti labour forces were made in 1911. If we examine the 5 128 workers employed in the Wassa district in that year, we find that indigenous workers from the Gold Coast proper made up 64.2% of the total: of these Fanti men from the central coastal states comprised the most substantial sub- group at 18% of the total [16]. At the Wassa mines non-Akan people made up a far larger percentage of the work force than at the Ashanti mines. For example, Liberians (mainly Kru and Bassa men) comprised 16% of all the mineworkers in Tarkwa and 9% of the underground workers. Dr Easmon ob- served that the Kru and Bassa laborers suffered less from disease than many Gold Coasters because they drank alcohol less. had good personal hygiene and had a nutritious diet based on fresh fruit and green vegetables. After just 4 years of recruiting, the new men from the Northern Territories contributed 15% of the total work force and 17% of all underground labour. As we shall see presently they suffered from a high disease and mortality rate.

In the beginning a far smaller percentage of the Ashanti Goldfields Company’s labour force at Obuasi was drawn from foreign lands. In 1911, 39% of all workers and 51% of the underground work force were recruited locally from Ashanti, while 29% of the general work force and 22% of the under- ground labor were recruited from the Fanti coastal districts. In 1911, men from the Northern Region (Dagombas, Isalas. Dagatis, Mamprusis, etc.) made up just 8% of all mine workers and also 8% of the underground force. The substantial increase in the Northern Territories component in the unskilled mines labor forces at both Tarkwa and Obuasi in the years ahead would have a definite bearing on the miners’ health problem.

Mining town administration

The colonial government was slow in grappling with the problems of slum overcrowding, inadequate street drainage, poor sewage disposal and contami- nated water supply in the mining towns, and it was even slower in assessing their impact on the health of the African miners and surrounding village popu- lations. Part of this was tied up with the problem of the ‘mining frontier.’ During the first 5-7 years of the new century, there was still a vacuum of political power and administrative control at the mining cen- ters; there was a parallel between Tarkwa-Aboso, Himan-Prestea and the unregulated mining camps of the American and Canadian West.

From the start, Obuasi, controlled by a single monopolistic concessionaire-the Ashanti Goldfields Corporation-was more like ‘a company town’ than any of the others; but even the AGC reneged on its responsibilities. At Obuasi and at Tarkwa at least three entities-the mining companies, the colonial

Disease and mortality among gold miners of Ghana 217

state and to a lesser extent the traditional kings and chiefs of the surrounding areas vied for municipal authority, but when the crunch came, each tried to withdraw from responsibilities for expenditure on town upkeep, public works and sanitary improve- ments. It was not deemed appropriate to apply the Town Councils Ordinances of the Gold Coast in the mining towns, since these councils (despite represen- tation by educated African leaders) had experienced potent popular opposition and a very limited effec- tiveness even in the three coastal cities where they had been implemented [17]. There was some variation in the sanitary administration of the Wassa mining towns and those of Ashanti. At Tarkwa housing, street sanitation, sewage disposal and anti-malarial preventive measures were entrusted almost entirely to the companies, with some assistance from the local district commissioner. At Obuasi, because the Ashanti Goldfields Corporation did not want to shoulder the entire burden, responsibility was del- egated to a Towns Sanitary Committee, towards which the company, the government and the local people (through municipal taxes), as represented by the headmen of ethnic subdivisions, made contri- butions. As at all major towns of the Gold Coast, small hospitals with a medical officer were also established at each of the mining towns. But whereas the doctor at Tarkwa was appointed and paid by the government, at Obuasi he was employed directly by the controlling mining entity of that region, the AGC.

THE ADVENT OF SCIENTIFIC TROPICAL MEDICINE

The Gold Coast’s anti-maIaria campaign and its

impact in the mining towns

It cannot be emphasized too strongly that the overwhelming policy emphasis and expenditure by both the colonial state and the mining companies during the first two decades of the twentieth century was geared to improving the housing, water supply, street drainage, sewage disposal and anti-malarial protection of the expatriate staff. This coincided with the revolution in tropical medicine and hygiene that followed the pathbreaking discoveries of Sir Patrick Manson on the plasmodium parasite that caused malaria and of Sir Ronald Ross on the identification its prime vectors, the mosquitoes Anopheles gambiae and A. funestus [18]. The figures on European mor- tality for the Gold Coast for the late nineteenth century were disquieting enough. Year after year the number one and number two killers of expatriates on the Coast were malaria and blackwater fever. Fairly reliable tables show that from 1881 to 1897 the average annual death rates for European officials ran as high as 75.8 per thousand in the Gold Coast and 53.6 at Lagos [19]. This coupled with the high sick- ness and hospitalization rates plus frequent rest leaves to the United Kingdom caused many seasoned hands to lament that effective colonial administration simply could not be carried on [20]. But the image of

West Africa as the ‘White Man’s Grave’, accurate as far as it went, enabled officials to gloss over the greater enormity of the ‘Black Man’s Grave’. Gover- nor Mathew Nathan underscored the colonial state’s prime mission to Dr Ronald Ross at the commence- ment of the mosquito eradication and house protec- tion campaign in 1901: “although I don’t undervalue sanitation for natives, as I fear they themselves do, improvements in the health of Europeans is absol- utely the first desideratum for general improvement in these colonies” [21].

Commencing in 1900, following the publication of Ross’s findings, the British Colonial Office mounted a five-fold attack on the disease. This included (1) an extensive program of public works (improved streets in the towns with cement drainage ditches and culverts, the building of new bungalows for Eu- ropeans and storage tanks for fresh water supply); (2) enforcement of public health laws and regulations (mosquito-proofing of European houses, destruction of mosquito-breeding pools and ditches near those houses, quarantines where required for epidemic dis- eases, and use of scavenging squads for regular refuse collection); (3) education and publicity for improved personal and family hygiene; (4) expansion of medi- cal treatment facilities; and (5) the continuation of tropical disease research, both at universities in Britain and at research installations in West Africa. It is mainly the first two of these strategies that concern us here. This also carried over to the new mining towns. When officials from the coast made inspection tours of such mining towns as Tarkwa, Obuasi, Prestea and Aboso it was mainly the descrip- tion of public works and sanitary measures of benefit to the expatriate managers and supervisors that filled their reports.

Later mining company histories tried to create the impression that they built model villages with neatly

laid out streets with proper drainage, water supply and refuse collection for their African personnel from the very start; but close analysis of both written and oral data shows that such statements misrepresented the truth. African workers for the European mining companies were expected to fend for themselves by building their own huts of bamboo swish and daub or by paying for a room or a bed in the domicile of another African family already living in the ‘native’ town. Whether the construction of a South African- style ‘compound system’-as was in fact proposed at one point by a consortium of the Anglo-Gold Coast mining companies, but never adopted [22]-would have altered the hazards of disease for Gold Coast workers can never be known for certain. But it is possible to speculate, based on the experience of the Transvaal in this same period, that the incidence of respiratory diseases would have been far higher. The research of Packard has revealed that the initial tight quartering of workers (with bunks stacked like shelves) in the overcrowded barracks of the Rand gold mines compounds during the early twentieth

218 RAYMOND DUMETT

century definitely increased the chances of tubucular infection by close contact (231.

Reinforcing official and company indifference to the awesome problems of African ill-health was that segment of the scientific establishment’s anti-malarial strategy (based on Robert Koch’s ‘native reservoir’ theory) which called for strict segregation of Euro- pean bungalows from African residential areas-even without a ‘compound system’. Not only were the houses of government officials and mine managers built on the highest hills above the towns with the coolest breezes and furthest from mosquito breeding places, African houses were actually torn down in order to provide wide cordons of uninhabited land that would supposedly interrupt the flights of mosquitoes from African hosts to European victims [24]. The segregation strategy was largely ineffective and it aroused the hostility of educated Africans in the coastal towns for its racist overtones. The govern- ment liked to argue that as a secondary result their public sanitation programs would ultimately benefit the African as well as the European populations of the major towns and cities. But there was little evidence for this in the mining towns or elsewhere during the first two decades of the twentieth century.

Relations between the goaernment and mining towns with respect to African miners’ health

The colonial government’s pro-company, malaria- centered laissez-faire attitude showed up clearly in discussions about how best to get statistics on sick- ness and mortality of the genera1 mining populations. The Ashanti Goldfields Company and the Wassa companies to a lesser degree, did not like government officials, or other ‘strangers’ entering their properties without prior notice and permission. They accepted the need for government inspection tours of their premises only grudgingly and tried to keep them brief and perfunctory. Normally government inspectors accepted the information that mine managers, gave them uncritically and unquestioningly and afterwards issued superficial and appropriately glowing reports. This reticence also applied to ferreting out important statistical information-especially if it were of a controversial nature. As the G.C. Medical Depart- ment noted sheepishly all mining employees were under the care of their company doctors and “infor- mation as to sick rates appears to be only obtained through the courtesy of those gentlemen” [25]. It was evident to all concerned that no pressure would be applied. It took another 13 years, and the impetus of a major health crisis, before the governor took the obvious step and ordered the companies to send him the basic data that the government was entitled to.

Changing European mortality rates

If we can accept the rough and approximate figures on death rates for European officials in the late nineteenth century and compare these with the rather

complete series available for the first third of the twentieth century, then the conclusions are fairly clear-cut. The first is that there was a dramatic fall in the annual death tolls for government administrators between the horrendous 75.8 per thousand for 1881-97 [26], quoted earlier, and a 14.9 per thousand, average death rate for European officials during the first 20 years of the new century. Our figures for European mining company employees-not well defined for the nineteenth century, but probably well over 60 per thousand in the 1880’s, show an average mortality of 13.6 per thousand for the I5 year period 190221916. The second inference is that these changes--which the Colonial O&e called the ‘lowest on record’-ran parallel to, and were undoubtedly traceable to the new public mosquito control and house protection campaigns and to the government’s promotion of improved anti-malarial hygienic prac- tices, including quinine prophlyaxis [27]. The evi- dence was still sketchy regarding the exact causes of sickness and invaliding among Europeans, but in one test of 310 hospital cases conducted in 1910 it was found that 34.2% were due to mosquito-born dis- eases and 65.8% to other illness and diseases [28]. Malaria and blackwater fever were still the leading causes of death among Europeans; but whereas ear- lier, according to one estimate, various tropical ‘fevers’ had accounted for 66% of the annual Euro- pean deaths and 59% of the invalidings, in 1914 the rates were 36% and 21% respectively 1291.

WC must reemphasize, however, that some of the most loyal colonial civil servants questioned whether these expansive programs for malaria prevention among expatriates were having even an indirect or long range impact on the reduction of disease among Africans. At one point the Gold Coast chapter of the Aborigines Protection Society protested loudly that efforts to protect Europeans from mosquito-borne disease by demolishing large blocks of African houses had wreaked tremendous and unfair hardship on a number of town populations.

People, especially of the poorer classes, were turned out of doors (sometimes by force) in the rains. in some cases without even the inadequate 24 hours notice, and without accommodation being provided elsewhere beforehand. This led to insanitary overcrowding. 1301.

The fact that most Europeans had their own segre- gated hospitals, frequent rest leaves, provision of free housing (often on the best geographic sites) and provision of piped water supply, and all paid for out of revenues and municipal taxes that fell on the mass of the people, then it is easy to see why a handful of critics, including Governor Sir Hugh Clifford, thought that improvements for Europeans had been bought largely at the expense of the indigenous populations [31]. R. R. Kuczynski, in his pathbreak- ing demographic survey doubted whether throughout the first decades of the twentieth century there had been much noticeable reduction in the incidence of malaria amongst West Africans as a result of these

Disease and mortality among gold miners of Ghana 219

Table 1. Statistics relating to fatal accidents at the mines of the Gold Coast and Asante, 190>1914

Surface workers Underground workers Total mineworkers employed

Total no. No. of fatal Death rate Total no. No. of fatal Death rate Total no. No. of fatal Death rate employed accidents per 1000 employed accidents per 1000 employed accidents per 1000

1905” 9226 6 0.65 3703 21 5.67 12,969 27 2.08 1906 9176 8 0.87 4985 65b 13.04 14,156 73 5.16

1907 8995 II 1.22 6282 31 4.77 15,277 42 2.75

I908 8333 9 I .08 6660 33 4.96 14,993 42 2.80

1909 10,127 5 0.49 5768 54 9.36 15,895 59 3.71

1910 12,060 6 0.49 7078 30 4.24 19,138 36 I .88

1911 11,505 3 0.26 7448 37 4.84 19,153 40 2.09

1912 9945 II 0.12 7688 42 5.46 17,633 53 3.0

1913 8330 7 0.84 7328 66 9.0 I 15,658 73 4.66

1914 7700 IO 1.30 8011 46 5.72 15,741 56 3.55

“1905 was the first year in which these Accident Statistics were given. 1904 Mine Rept very brief. b43 persons died in a single accident. 1906 (22 Dec.) as the result of major flooding at the Aboso Mines, Wassa. So&s: G.C. Repts on the Mining Industry, 1905-1914.

efforts, even by the 1940’s, but he despaired of producing any meaningful statistical verification [32].

CALCULATION OF AFRICAN MINERS’ MORTALITY RATES

Fatalities in mine accidents

and enforcement mechanisms [34]. A closer look at the records shows that these figures stood for some- what rare major disasters, as in 1906, for example, when 43 miners (41 Africans and two Europeans) were killed in an underground flood at the Aboso mine [35].

The one category where the companies, prodded by Overall the accident death rates demonstrated fair the Gold Coast Department of Mines, did keep improvement in operating conditions with a generally complete and accurate statistics on African as well as downward trend until the mid-1920’s when they European miners from early in the century onwards held fairly steady at relatively low levels to 1937-38

was in mine accidents [33] (see Fig. 1 and Table 2). (Fig. 2). In the first 9 year period for which we have On the whole, the accident death rates per thousand, figures, 1906-1914, the death rate from accidents for whether for underground miners or for all people underground miners averaged 6.8 per thousand per employed at the mines do not appear as excessive in year. This is roughly comparable to accident mor- comparison with working conditions at Mines of tality rates at the major mines of South Africa during western Europe or at other African mines of the same the early stages [36]. During the 10 year period 1927 period. Some contemporary experts, zeroing in on to 1937 the average fell to 4.94 per thousand. Mean- specific years, thought differently. An editorial in the while the accidental death rate for all miners (surface

Mining Journal argued that the high Gold Coast and underground) fell from an average of 3.39 per accident death rates of 13.04 per thousand for under- thousand during 190614 to 1.7 per thousand ground miners in 1906 and 9.01 in 1913 were exces- 1927-37. A spike in the graph lines for both under- sively high, even in comparison with other mines of ground and general deaths by accident per thousand

the world, and were reflective of lax regulations in 1934 is explained by another major disaster. In a

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.

Disease and mortality among gold miners of Ghana 221

flooding accident at the Ariston Mines of Wassa 45 men were killed. Otherwise, the increase in the total

numbers of accidental deaths 1935, 1936 and 1937 was a natural outcome of a tripling in size of the total mines labour force since 1930.

Of the causes of accidental death amongst under- ground miners, the most common were (1) falling rock and (2) skip, cage and bucket accidents (mainly falls and cable failures) on the mine shafts. Other factors which varied greatly in their incidence year to year were explosions from blasting accidents (still common today) and suffocation. Major disasters in which multiple lives were lost were invariably associated with flooded underground chambers and

cave-ins [37].

The Simpson Report

Incredibly it was not until 1924 that the colonial state and the mining companies received the jolt that they needed to include African death rates from sickness and disease in their annual medical reports. In July of that year, in conjunction with the Gold Coast’s second serious outbreak of bubonic plague in two decades, the Colonial Office commissioned Professor W. J. Simpson of the London School of Tropical Medicine to conduct a special survey to investigate both the causes and the incidence of the plague epidemic and general health conditions throughout the southern forest zone. This was not Simpson’s first trip to West Africa. Even earlier (191&11) he had written about the “very backward state” of the “trading and mining centres in hygienic arrangements”. He noted:

The Sanitary question in West Africa is a large one, and is something more than the maintenance of the health of the officials sent out there Another aspect of the question is the prevention, as far as possible of [all] the inhabitants, European and native, sickening or dying from preventable disease, and linked up with both of these is the future development and prosperity of the country [38].

These practical sentiments were hardly revolutionary, but they were derided at some levels of government at the time for smacking too much of the ‘humanitar- ian view’. By 1924, after seeing that so little had changed, Simpson’s tone had turned into anger. In one of the most thorough and penetrating Gold Coast public health surveys, directed specifically to the mining towns, undertaken by an external medical examiner, Simpson, tramped through every street of the African as well as European quarters of Tarkwa and Obuasi, collecting data, not only on general mortality rates but also on the main causes of illness and death among African miners. In a damning summation he concluded that the miners suffered from severe chronic illness levels as well as a high death rate, and he discerned that the main causes were the respiratory and intestinal tract diseases derived from the generally damp and bacteria-laden air, foul sewage disposal, proliferation of insects and micro-organisms, dust-filled and poorly ventilated

passages underground and from inadequate fresh water supply, congested housing, and subpar hospital facilities.

Castigating the colonial state for failing to take adequate supervisory responsibility, Simpson’s ‘Re- port on the Sanitary Condition of the Mines and Mining Villages of the Gold Coast and Ashanti’, printed for the Colonial Office (1925) constituted one of those rare turning points in the history of public health administration where a commissioned report actually propelled policy change. After a painstaking tour of all the major mining sites of the Colony and Ashanti, Simpson attributed the high death rates among African miners to the following causes. First, there was the presence of anklostomiasis (hookworm) which, he said increased the vulnerability of it victims to a host of other diseases by weakening powers of resistance. It was spread, Simpson declared, by the constant reinfection of community towels at unsani- tary latrines. A second, and more serious issue was the recruitment by unscrupulous company agents of totally unfit workers from the Northern Territories- many already showing signs of tuberculosis-who then collapsed under the strain of grueling under- ground work at the mines. Third, he condemned the fact that housing at some of the mining towns was bursting at the seams to shelter the masses of hastily recruited new miners, especially from the North. There had been no planning and mine managers simply assumed that workers, by hook or crook, could get by with dingy quarters in the towns. Much more care, he noted, should be taken to ensure “that there is no overcrowding.” Fourth, Simpson observed, that the high death rates for miners at the towns of Tarkwa and Aboso were traceable to all the above causes plus “a polluted and insufficient water supply and inadequate medical arrangements” [39]. He concluded with a spate of recommendations.

As a consequence of Simpson’s Report it appeared that the African populations of the Gold Coast and Ashanti for the first time might be considered almost on an equal footing with Europeans. Prodded by London, the Accra Government enacted the Mining Health Ordinance of 1925 and over a period of time pushed forward new regulations which implemented most of Simpson’s recommendations. These mandated on-the spot medical examinations for all labourers recruited outside the Gold Coast Colony proper. A second order required African hospital accommodations and a full-time medical officer for all mines (not simply at major mining towns) employing more than 500 workers. Thirdly, all mines were ordered to provide a pure water supply and decent housing for workers. Plans for new ‘native villages’ were to be drawn up with a minimum width of streets at 30 ft and a minimum distance between houses of 8 ft. After a reasonable period, the compa- nies had to show that the floors of all miners’ cottages were cemented and provided with at least one bed.

222 RAYMOND DUMETT

Fourthly, the Gold Coast Medical Department took cognizance of Simpson’s call for inspection of all mines and villages every 6 months by a senior medical inspector of the public health department [40]. Many of these recommended reforms would be a very long time in coming (particularly good housing for all workers), but a number of the improvements associ- ated with modern Tarkwa and Obuasi-&modern wash houses with showers for miners. sewage dis- posal in place of latrines, piped water supply, etc. stemmed from the report and follow-up work by Gold Coast departmental inspectors.

Miners tnortalit~~ tables: the ,firsr statistical surr3ey.s

One immediate reform. of direct pertinence to evidence gathered for the present study, derived from Professor Simpson’s scathing condemnation of the government’s failure to tabulate general mortality data on the African mining labour force on a regular basis. The recommendation was high time in coming. What makes the statistical series on miners’ sickness and mortality doubly disconcerting is, not only that it was instituted so late, but that the printing of such tables was discontinued owing to the exigencies of war in 1939. Furthermore, the annual tables cover numbers and causes of deaths only and fail to include non-fatal illnesses. Nonetheless. the knowledge con- tained in these reports proved to be extremely valu- able in future disease prevention and treatment. In some instances the data provide valuable corrobora- tion for what had long been suspected in descriptive accounts. In other instances the graphs plotted from these statistical series lead the modern historian to new insights and some unexpected conclusions.

The data confirm that the respiratory and pulmon- ary diseases. which we have seen. were the major causes of death among the general populations of the coastal towns, were also greatest nemeses of African miners. Far and away the single most lethal group of diseases were pneumonia and bronchial pneumonia which accounted for about 30% of all miners’ deaths in both the Colony and Ashanti. This was followed by tuberculosis and bronchitis which claimed 19.8% and 12.6% of mining population fatalities respect- ively. We need to underscore here how the heavily seasonal and migratory aspects of mines labour mo- bilization, coupled with congested housing, made the mining towns crucibles for the proliferation of disease pathogens [4l]. Other symptomatic ailments shown in the figures with a consistently significant annual incidence of mortality were septicemia and pyaemia (synonyms for blood poisoning), which were com- mon owing to wound infections following mine acci- dents, and pyrexia (the omnibus label for all fevers of indeterminate origins) and dysentery. There were a host of other fatal illnesses (see Table 2) but their annual incidence varied so greatly that they cannot be shown in the figures. Taken together, the respirat-

I Pncumr,ni:k ? ‘I 4 “i

7 Tuhcrculo\l\ _. I ‘I x v

3. Bronchitis and Plcur~\y l2.h% B

1. Dysentcr) J.l'i

Fig. 3. Percentage of illness deaths by cause. “Figures on bronchitis and pleurisy were lumped together in official

mining and medical reports.

ory/pulmonary diseases-pneumonia, tuberculosis and various bronchial disorders--accounted for about 62% of the annual miners’ deaths due to sickness in the Gold Coast (Fig. 3).

Epidemic disease und the mining districts

Of course, these proportions might be upset by the occasionally virulent outbreaks of epidemic diseases. There were two types of contagious diseases that affected Ghana: (I) those which had the most devas- tating impact in the dry northern savanna zone, such as trypanosomiasis (sleeping sickness), cerebrospinal meningitis and relapsing fever [42], and (2) those such as plague (which hit the Gold Coast in 1908 and 1924), smallpox (1901-02, 1908-13, 1924-26 and 1930-3l), influenza (I918 and 1931-35) and yellow fever (1910. 19234, 1927-28, 1931-2 and 1937-38) that wreaked havoc mainly in the urbanized coastal districts [45]. Most of these coastal epidemics did not invade the mining areas to any significant extent, although we saw that the plague, which broke out in Accra and Sekondi, spread north to Kumasi by way of the mining railway, and that it was the plague epidemic of 1924 which prompted Simpson’s famous report.

Two yellow fever epidemics in 1910 and again in 1914 created an ever greater stir in Tarkwa and Obuasi owing to its reputation for a fearfully high death rate among anybody who contracted the dis- ease. Very stringent campaigns for the eradication of A. aegypti (or Stegomia) mosquito breeding places were enforced and all Europeans thought to have had contact with known carriers were set apart in quaran- tined houses [44]. Still, it was more the spread of panic than any dire results from the disease itself which temporarily disrupted the routine of the

Disease and mortality among gold miners of Ghana 223

mining companies. In 1933, 1934 and 1935 in the midst of the most devastating influenza epidemic in the country’s history miners were severely afflicted (see Table 2) with mortality running as high as 12, 8 and 39 cases in each of the 3 years-the latter figure close to 21% of all miners’ deaths for that year. This was an extreme instance. As Patterson has noted, in general “spectacular epidemics were not the greatest threats to life and health in Ghana; less dramatic endemic infections took a much higher toll” [45].

The short span statistical series (19251938) pre- sented here raise a number of intriguing questions as well as tentative conclusions for the 14 year period. Figures 2, 4 and 5 show roughly downward-sloping trends for both general mortality rates and death rates for specific diseases for all miners. It is quite likely that the fall-offs would appear more dramatic if we had figures on African miners’ mortality (guessed in some reports at more than 70 per thou- sand) for earlier decades. The sharply fluctuating lines in Fig. 2 (based on Table 2), showing simple percentages of deaths for leading diseases to total deaths each year, show no marked trends. The graph lines on European miner deaths, shown in Fig. 4, being based on a small population of several hun- dred, are bound to show more random fluctuations than the data on the general mining population. As one would expect (Fig. 2) underground miners had higher death rates for both accidents and ‘other causes’ (disease and sickness) than surface miners. That deaths from illness were so much higher for them than for surface workers was due, of course, to the dominance of the respiratory diseases, aggravated by the inhalation of quartz dust in deep level drilling and blasting, as well as close contact with human carriers.

Silicosis

An intriguing question concerns the dearth of

references in both colonial statistical and descriptive reports to silicosis, or miners ‘black lung disease’, common in many gold mines as well as coal and lead mines throughout the world. Two key reasons are that the etiology and clinical treatment of this chronic ailment were not yet fully understood and that the symptoms were not readily distinguishable from the advanced stages of tuberculosis (under which it was often grouped), so that medical textbooks of the time tended to classify black lung symptoms under the archaic label of ‘miners’ phthisis’. We know that the disease derives from the protracted inhalation from underground drilling and blasting of dust, sand or flint containing silicon dioxide which produces nodu- lar fibrotic tissues on the lungs [46]. But it was not until the First World War that one or two Gold Coast doctors started to draw attention to the severe (and probably concealed) effects of this miners’ occu- pational disease on local African workers and the need to undertake research. W. J. Bruce. Medical Officer at the Aboso Mine argued that accurate data on the disease was practically non-existent, but he concluded that Africans were “extremely susceptible” and that almost every miner who worked under- ground “ran the risk of contracting the disease sooner or later” [47].

It strains understanding today why there was not a greater outcry about this problem. In fact official and company silence about the widespread preva- lence of prolonged black lung disease lends credence to the suspicion of a ‘cover-up’. A few doctors conceded that because the presence of silicosis fibrosis was difficult to detect without an autopsy, and since

I 0 I I I

1925 1930 1935 I Y4lJ

Year

Fig. 4. Gold Coast miners’ death rates (all causes). 0: The figures for ‘All miners’ provided in official reports are the closest approximation we have for the data on African miners. 0: The figures on European miners, being based on a small population of several hundred are bound to show more random

fluctuations.

224 RAYMOND DUMETT

patients in the terminal stages of the disease tended to develop either pneumonia or tuberculosis, many deaths attributed to the latter two probably could have been diagnosed earlier as silicosis. Dr Bruce suggested that those miners known to be suffering from the disease should have been screened and prohibited from working underground any longer; but he was not optimistic about the success of such a requirement. For one thing it probably would have necessitated every mine hiring additional doctors to make detailed tests which they could ill afford. The plain fact is that mine supervisors and foremen knew that many of their underground workmen were suffering from coughs that were probably symptoms of serious disease. Black lung disease was part of the miners’ way of life in the coalfields of Yorkshire and Pennsylvania as in most gold mines. It was also a well known fact that many miners were a tough lot who were willing (or who saw no choice but) to work sick. The mine managers resisted all talk of reform because they feared losing their miners to other companies which would have had few scruples avoiding such rules [47].

EVALUATION OF MINERS’ MORTALITY STATISTICS

Having noted these dire facts, it is still possible to conclude that the main body of regularly employed wage-earning miners (including underground workers) during the late 1920’s and 1930’s probably enjoyed better overall health than the general African populations of most urban and rural areas as reflected in the very limited general mortality stat- istics of the time. Available evidence suggests that the general population suffered from the same high inci- dence of lethal respiratory and pulmonary diseases- and in about the same proportion-as the miners.

0 , I I

1925 1930 I’)35 lY40

Year

Fig. 5. Death rates per thousand for pulmonary diseases. 1. Combined death rate for pneumonia, T.B. and bronchi- tis/pleurisy. 2. Death rate for pneumonia. 3. Death rate for tuberculosis. These calculations are based on the death figures and base mines labour force figures for “Mines with Medical Officers”. Figures for mines without medical officers are not included for the reason that they are spotty

and much less reliable.

But the miners on the whole were young men who were drawn from the sturdiest and most resilient age groups in the population. (An important exception were miners drawn from the Northern Territories discussed below.) Because the general Gold Coast population contained larger segments of the most vulnerable age groups-the very old and the very young-it tended to suffer a much higher death rate from sickness and disease than the miners. It must be emphasised, however, that these conclusions are based on the years following the Simpson Report when policies towards indigenous miners’ health re- form altered dramatically.

Figures 2 and 4 (also Table 3) show that a marked fall-off in deaths per thousand for underground min- ers from all diseases (labelled ‘other causes’) brought down the general death rate with it during the period 19241937. From this we conclude that the various public health measures and more accessible hospital treatment slowly adopted by the mining companies did have some belated positive effect. Indeed, what is perhaps most surprising is that the death rates for African miners did not differ that much from the European miner rate during the period of reform (see Fig. 4). Thus for 1928-37 we find that the regular African employees of the Gold Coast mines had an average mortality rate from disease of 8. I7 per thou- sand, only slightly higher than that for European miners-7.78 per thousand for approximately the same period, 192636. If we look only at African underground miners then the mortality rate from disease was a good deal higher-14 per thousand---- but still close to European general death rates on the Coast only 20 years earlier.

Any data on African miner mortality rates per thousand for specific diseases for the period 1924 to 1938 fail to do justice to the far higher death rates for pneumonia and tuberculosis. which undoubtedly afflicted African underground miners, during the preceding 25 year period. The gradual decline in the combined mortality rate for all three leading pulmon- ary and respiratory tract diseases (Fig. 5) from I7 per thousand in 1927-28 to a low of 5.8 per thousand in 1937-38, coupled with a commensurate drop in the rates for each disease (pneumonia, T.B. plus bronchi- tis and pleurisy), reflected the belated application of modern scientific measures to combat these diseases amongst African workers across a broad front-in- cluding (1) prevention, (2) early detection (involving the use of X-rays), and improved hospital treat- ment-which got underway only in the mid-1930’s.

There is, however, one major flaw in these African miners’ statistics. The data appears to have been based entirely on those miners who died on or near the premises, usually in their cottages or in company or government hospitals. It does not include the many miners who contracted a disease during em- ployment at the mines, left the job and died perhaps years later, many miles away in their home villages [48]. One further point is that these statistics, based

Disease and mortality among gold miners of Ghana 225

on the mining industry as a whole, tend to flatten out the sometimes staggering African miner mortality data at more poorly administered individual mines- which the colonial government recorded only on an occasional basis and seldom, if ever, printed for public consumption.

Vital statistics on Northern Territories mines labour

Another of the important contributions of the Simpson Report was to pinpoint for the first time the unusually high incidence of fatal diseases amongst the prospective mine workers who migrated south from the northern Territories. We noted above that the first northerners had been recruited mainly for the Wassa mines with government assistance in 1907. In 1911 the Northern Territories component in the total Gold Coast-Ashanti mines labour force was 2421 or 14%. During the 1920’s the Wassa mines stepped up their recruitment; and in the 1930’s the Ashanti Goldfields Corporation, facing increased competition for labourers from the expanding cocoa-growing industry, was also forced to recruit increasingly in the North. As medical research was to show, however, a majority of the men who arrived in Wassa or Southern Ashanti from the North, were, by reasons of malnutrition and exposure to a variety of bacteria, already disease-prone to begin with.

Twentieth century investigators confirmed the ear- lier speculations of the African physician Dr J. F. Easmon (above) and other doctors that people from the northern savanna zone were extremely suscep- tible, especially during and immediately after the Harmattan season, to nasal and bronchial infections. Common colds frequently gave way to pneumonia and tuberculosis either on the long journey from the region of the Black Volta to the mining districts or to black lung, once at the mines. Thus, at a time when death rates for all African miners at the mines of Wassa and southern Ashanti had been reduced to about 12.0 per thousand per annum, the death from all causes for ‘boys’ recruited in the Northern Terri- tories stood at a shocking 75.2 per thousand in 1923-24 and 60.48 per thousand in 192425 [49]. Close inspection showed that the annual death rates per thousand for Northern Territories workers at particular mines of tire Wassa district were even worse. For example, at the two mines of the Tarkwa and Aboso Gold Mining Company, where 671 men from the North were employed, the average death rate for the 12 months ending March 1924 was an unbelievable 103 per thousand. This reflects on the subpar public health amenities and enforcement of public health regulations which Dr Simpson had found at those two towns. At the Abontiakoon Mine the annual death rate was 65 per thousand [50].

What were the explanations given at the time for the high sickness and mortality statistics on northern region mines labourers? Dr Simpson had observed “a considerable proportion of unfit men and youths sent from the Northern Territories of the Gold Coast,

226 RAYMOND DUMETT

many of whom have tuberculosis, soon break down from underground work, to which they are not accustomed, and which is unsuitable for them in their condition” [51]. However, several of the Wassa min- ing executives, perhaps to divert responsibility from themselves, wanted it known that northern chiefs and headmen were also partly responsible because they sometimes deliberately pressured the weak and sick to serve at the mines in order to keep the healthiest able-bodied men at home for life-sustaining agricul- ture [52]. Another detriment was the lack of sufficient modern transport (motor lorries, etc.) for those who had to make the horrendously long journey- often 300-440 miles on foot. Following these revel- ations all labour recruitment in the North was halted for about a year and then resumed under the stricter guidelines put forward in the Simpson Report. Gor- don Guggisberg, one of the Gold Coast’s most effective governors (1919-27) took the lead in these reforms by insisting on (1) preliminary medical examinations for prospective mine workers in the North, (2) rejection of all recruits found to be medi- cally unfit. (3) provision of motor transport with connexions to the railways, and (4) written regis- tration of individuals immediately upon recruitment in their home villages so that no substitutions could be made with people in ill-health [53]. Company representatives or agents, who wanted to recruit labour in the North had to obtain a government license. With these stricter controls in force the horrendous number of Northern Territories miner deaths abated over the next 10 years.

General (total population) mortality votes und health

conditions ut the mining towns

More than 10 years before the British Colonial Office reassessed its position regarding the need to maintain statistics on African miners as an occu- pational group, two or three conscientious medical officers at up-country posts had come round to the view that either the government or the companies should keep tab on general births and deaths at the mining towns on a systematic basis. But it was little more than a quixotic gesture when Dr C. S. Dowdell, the single overworked medical officer for the Ashanti Goldfields Corporation [54], decided in his own time, without permission or extra pay, to conduct a demo- graphic survey-not simply of the regularly employed miners-but of the entire urban complex of Obuasi and surrounding mining villages for a one year period in 1912. Dowdell’s findings that the general popu- lation of Obuasi town had endured a much higher death rate--17.4 per thousand---than the company had been willing to admit and a higher mortality rate than that of the AGC’s wage labour force helps to explain the company’s disinclination to publish the results or to sponsor further surveys [55].

Dowdell’s disclaimer that his findings cast no as- persions on his employer was not quite convincing. Obuasi was, in truth a ‘company town’, despite every

effort of the AGC to avoid taking full responsibility for urban health and sanitary expenditure there. It was not simply that a majority of the villagers included the miners, and their families; many of the floating population of Obuasi were, in fact, occasional ‘contract workers’ for the company. These workers and townspeople, along with those from the Northern Territories, were among the most wretched and vulnerable to disease of any groups--_ perhaps in the entire colony and protectorate. They were, in fact, prime carriers. As one governor was to note many “cases of illness appear to occur in men who are irregularly employed, and who, passing from mine to mine, seeking a change, spend a few days at a time loafing about the native villages enroute” [56].

Later studies were to show that Dowdell’s 1912 town estimate, was in fact probably too low. But, it was not until 1935 that the first official efforts were made to calculate general urban mortality rates for the whole of the Gold Coast, Ashanti and the North- ern Territories. And it was remarkable to note that even at this late date two of the four major mining towns ranked very high on the list of general death rates. Tarkwa and Prestea led the entire list of 24 total registration towns with death rates of 85.6 per thou- sand and 70.3 per thousand respectively in 1935. Aboso and Obuasi registered general mortality rates of 36.6 and 31.7 which ran close to the average for all towns of 31 per thousand in 1935 [57]. It must be underscored that it was not simply the miners per se. but the mining towns that were the dangerous nodes for the spread of disease. Thus Tarkwa with a relatively small population estimated at from 2 to 6 thousand [58], but with 56 cases of T.B. in 1927-28, ranked second to Accra with a population of about 60.000 and 92 cases of T.B. [59]. It is worth adding that Tarkwa also had the very highest infant mor- tality rates of any major town in the Gold Coast-- another useful statistic made available for the first time in this same period, 1924-37 [60]. The lower general mortality rate for Obuasi during these years would seem to support descriptive evidence that the Ashanti Goldfields Corporation was able to spend more than its competitors on amenities such as piped water supply, and wash houses and so turn the African township into a relatively liveable and dis- case-free place of residence.

There are no statistical data by which we can measure the incidence of non-j&al sicknesses and disease amongst the population of the mining towns, but descriptive evidence combined with data for segments of the general urban population of the Gold Coast in this period allow us to venture some tenta- tive hypotheses. We already mentioned the reference in the Simpson Report to the prevalence of helminthic (worm) diseases. Several other diseases, not discussed previously, also deserve mention here. Although the Gold Coast and Ashanti as a whole suffered less from venereal disease than other parts of

Disease and mortality among gold miners of Ghana 221

Africa, the incidence of gonorrhea rose greatly be- tween 1875 and 1930. And it is clear that the mining centers of Tarkwa, Prestea and Obuasi along with the major coastal trading towns became dissemination points for the spread of venereal disease into sur- rounding rural areas [61]. It is interesting that cases of syphilis were concentrated mainly in the Northern Territories, and were prevalent among miners who had recently returned to their homelands from the mining towns [62, p.4751. Diseases of childhood were extremely common in most of the major towns of the Gold Coast and we may assume in the mining towns as well. In one sampling of 1470 school children in the 1920’s, medical authorities discovered that 64% suffered from one defect or another, ranging from nose and throat problems (with possible later connec- tions to pneumonia and T.B.), to tropical ulcer and the common childhood communicable diseases, such as mumps and measles. The broad issue of malnu- trition was just beginning to attract notice in this period. Children also suffered from tooth and gum disease, from glandular problems, and they desper- ately needed smallpox vaccinations.

There was probably very little that the medical authorities or the companies could have done to stem the tide of malaria amongst the general population before the advent of the residual insecticide DDT in the 1940’s. Malaria, it must be reemphasized was the major cause of African sickness despite all that has been said about the more fatal impact of the respirat- ory and pulmonary diseases, Instruction about the mosquito-proofing of houses, use of nets and the drainage of mosquito-breeding pools and ditches may have helped the increasing numbers of African skilled and supervisory staff who were quartered on the company premises; but would have had little meaning for the bulk of the labor force and indige- nous mining towns populations. And the colonial government certainly did not have the wherewithal for distribution of quinine on a systematic scale, except to Africans who worked for the colonial government. One test for the prevalence of malaria among the general African population was the ex- tremely high incidence of enlarged spleens among children-which reached 34.4% of the population tested [63]. Although this return was for Accra, where drainage facilities were notoriously poor, it gives an indication of country-wide malaria rates, including those for the mining districts. Malaria and the other so-called ‘non-fatal’ diseases amongst Africans were major causes of mine worker absenteeism and low performance on the job, and because of their debilitating effects, they greatly increased a victim’s susceptibility to the other more lethal diseases.

CONCLUSION

The results of 40 years of work by the government and mining companies to improve health and living conditions at the mines were, at best, mixed and

uneven. As their central achievement the colonial authorities exulted in the marked reduction of Euro- pean deaths-specially those due to malaria. To say that for more than half of the period surveyed here, investigation of the causes (let alone individual treat- ment) of African miner’s sickness and mortality was relegated to secondary concern on the health agenda of the colonial state would be an extreme overstate- ment. The topic was ignored. Apart from accidents, between 1895 and 1923 neither the Medical and Sanitary Department nor (after 1904) the Mines Department troubled even to keep count of the annual numbers of African miners who died on the job. Yet we have seen that the nostrum that “the medical department of the Colony was maintained solely for the benefit of the European community” was a mere rationalisation and, not even historically true. We noted that commencing in the 1880’s mini- mal programs for street sanitation, house inspection and refuse collection had been set in train in the coastal towns [64]. Considering the importance of gold mining (which along with cocoa-growing) was one of the Colony’s two most important industries) it is remarkable that more was not done earlier to investigate and monitor the health of African mine workers. Although we lack, thanks to these attitudes, any statistical data, all the descriptive evidence points to the fact the worst killers-pneumonia, bronchial pneumonia, tuberculosis and bronchitis were on Qre rise among miners throughout the period 1890-1925, and even afterwards among the general popufution of what is today Ghana [62, pp.5145191. Even after 1930 the best that can be said is that the incidence and mortality from these scourges levelled out.

Had anyone questioned early on the reasons for official indifference and inaction, most mine man- agers would have pointed out that a majority of their African workers were part of a large floating popu- lation of migrant and occasional workers, many of whom did not work for long continuous periods; therefore, what good would it do to keep track of them for purposes of compiling health statistics? Most miners were not diagnosed for pneumonia and T.B. (if at all) until the diseases were already in the advanced stages. Some company spokesmen even argued that to emphasize regular visits to the infir- mary in cases of illness or minor injury would be to encourage malingering or absenteeism. The fact is that a majority of company managers and govern- ment administrators viewed African unskilled labor- ers (particularly those from the far North) as an expendable resource. If numbers died, whether on the job or after, they were so many digits who could be replaced by new recruits from the upper Volta region, from Nigeria, or even from the French Sudan. As one mining company doctor put it: “we must simply let it [Tuberculosis] kill the most susceptible and immu- nize the others in the course of generations, but it is inconceivable that here we could prevent the sufferers from going underground. .” [65]. The irony is that

228 RAYMOND DUMETT

even in the Union of South Africa at this time, white corporate managers (for highly practical reasons) kept better track of the sickness of Black workers than in the supposedly less racist British Gold Coast [66]. Only the loss of African skilled workers might be a cause of some alarm to mine managers; and this may have been one additional reason why Gold Coast companies began to focus attention on African miner’s health to a more significant degree in the mid-1930’s, as more Ghanaians rose to technical (engine drivers, winch and separation plant oper- ators) and supervisory positions.

Based on the reductions in death rates for mine workers on the regular payrolls, it is possible to argue that general health and living conditions for African underground and surface workers (especially at mines with medical officers), probably did improve during the 1920’s and 1930’s [67]. The better accessibility of doctors and nurses for those afflicted with serious illnesses or who suffered injury on the job was undoubtedly important. Certainly the expanding numbers of African patients treated every year at the Tarkwa and Obuasi hospitals after 1925 offered some testament that ‘western style’ medicine was slowly gaining acceptance among regular wage-earners [68]. The far more detailed colonial medical reports of the 1930’s, buttressed by more complete statistics on causes of sickness and mortality, were reflective of enlarged medical and sanitary staffs and new scien- tific assaults against nearly every disease that afflicted the general population. Special research units were established for the study of river blindness, leprosy, relapsing fever, cerebra-spinal meningitis, trypanoso- miasis, helminthic diseases, malnutrition amongst children and, finally, even the allied problems of miners’ black lung disease and pulmonary tuberculo- sis in the Wassa mining district in 1939 [69]. There was a steady multiplication in the annual number of smallpox vaccinations and by the 1940’s systematic and widespread attention was being given to anti-ma- larial house protection and mosquito eradication campaigns in African living areas.

Against the record of improvements must be listed a number of doubts about deficiencies in the process. Successes were scored more in investigative research than in the treatment of large numbers of persons who were victims of disease. Although the figures on expanded hospital bed facilities for Africans appear impressive [70], these were still but an insignificant percentage in relation to the total town and rural populations. It is highly doubtful whether a sizeable number of ordinary people anywhere in the Gold Coast and Ashanti came into contact with western- style institutionalised medical care [71]. The numbers of miners shown in figures here, suggest somewhat positive trends, but they cover a late period and they do not go into detail on those mines where health standards and worker mortality were far worse than the average [72]. More important, as we have seen, they do not include the figures on the full-time

migrant (particularly N.T.) workers who died far from the scene, nor for the unregistered part-time contract workers and general mining towns popu- lations. Despite easier access to hospital care, most of the miners came into company dispensaries only briefly as ‘out patients’ where they were treated mainly for superficial sores and small wounds. As we have seen, many mine mangers and foremen took a dim view of absences from the job for reasons of illness. and not even the doctors encouraged early diagnosis of the more serious respiratory and pulmonary disorders that would have required long-term hospitalization.

Progress in mining town housing and sanitary maintenance followed a chequered course in which years of steady enforcement of street drainage. refuse scavenging and sewage disposal regulations might be followed by periods of laxity and deterioration. That during the greater part of our period serious differ- ences of opinion ruffled the nerves of government officers and mining firm members as to who bore the primary financial responsibility greatly retarded cooperation on public works and sanitary mainten- ance. Nor did the strong tradition of resistance to municipal taxation by African representatives to town councils help the situation. Town Sanitary Committees were appointed to oversee these matters in Tarkwa and Obuasi. But external inspectors still complained that such bodies lacked adequate funding and enforcement powers [73]. Perhaps more promis- ing was the arrangement at Prestea where the major companies owned all the miners’ houses. leased them out for a small fee. and placed all housing and sanitation problems under the authority of a single “village master” [74].

Though company and colonial reports emphasised the continued expansion of ‘model mining villages’ for all their African labourers. 1920 40. only a small number of skilled workers in this period were able to live in the white-washed and neatly laid out bunga- lows, glorified in the photographs. Most under- ground workers, even at Obuasi, were expected to build their own houses. or rent a room from an older resident in the overcrowded traditional ‘native’ town [75]. The grid system for the layout of streets and houses was never fully adhered to. so that domiciles frequently rubbed together without sufficient breath- ing space between [76]. True. the town sanitary committees employed scavenging squads to pick up refuse between the houses. but they had little power to enforce strict sanitary practices on indrvrdual house dwellers.

Closely allied with the problem of municipal sani- tary administration was the even broader issue of public and private hygienic education. Courses were introduced in the (mainly missionary) schools and notices were posted, but the information did not necessarily reach a wider adult population. The germ theory of disease and the need to separate by wide distances drinking and cooking water sources from washing water and toilet functions were. according to

Disease and mortality among gold miners of Ghana 229

contemporary reports, still not widely understood throughout the country [77]. Although septic tanks and flush toilets were slowly being brought into use for Europeans at major government and mining centers, the main thrust of policy was mainly to increase the number of ordinary pit latrines in up- country towns and rural areas. At a majority of the mines one major improvement over other urban centers during the 1920’s was the use of pan latrines with daily or twice daily removal of nightsoil. These improvements in sewage disposal were probably re- sponsible for the general decline in deaths due to dysentery among miners, suggested in Fig. 3. How far they may have affected sickness and morbity rates for other water-borne and intestinal (such as the helminthic) diseases is unclear in the records. Despite the improvements, contemporary medical authorities conceded that public sanitation, maintenance of bac- teria-free working conditions and pure water supplies in the mining towns were nowhere near the levels desired. As late as 1938 the Medical and Sanitary Department lamented that the tuberculosis problem, “especially in the mining areas” was still acute:

It is depressing to have to record that the unsatisfactory conditions in the rural areas and in the areas surrounding the mines (especially with regard to housing and overcrowd- ing in the mining areas) remain practically unchanged Until the necessary legislation establishing local sanitary authorities with sufficient power is enacted, conditions cannot be improved [78].

Acknowledgements-A version of this paper was presented to the African History Seminar, School of Oriental and African Studies, London University, 28 October 1992. The author would like to thank David Moore, Purdue Univer- sity, K. David Patterson, University of North Carolina, Charlotte, and Randall Packard, Tufts University, for their professional advise and consultation.

REFERENCES

This did not mean, of course, that the government ignored the problems of African illness and disease, but rather that it was relegated to tertiary and longer term importance. (See, for example, statements in G.C. Annual Report for I899, p. 22.) For some of the most detailed recent work on African illness and mortality in mining areas see Packard R. M. White Plague, Black Labor: Tuberculosis in the Political Economy of Health and Disease in South Africa, Univer- sity of California Press, Berkeley, 1989. See also Per- rings C. Black Mineworkers in Central Africa, pp. 14-18, 39957, 80-85, 165-177. Heinmann, London, 1979. At one point the merchants of the Cape Coast Chamber of Commerce derided the colonial government for its ‘policy of concealment’ during a period of epidemic disease in order to placate the fears of the British mercantile community. (Cape Coast Chamber of Com- merce to Liverpool Chamber of Commerce, 30 August 1902; Copy in Nathan Papers, Rhodes House, Oxford.) In 1913 the governor continued to express concern about the Colony’s overly-publicized “unhealthy repu- tation,” (Govr. Clifford. 14 Oct. 1913: C.O. Afr. Conf. Print, lOb8, No. 195, p: 263). During railway construction, workers were housed in miserable tent settlements at various construction points

5.

6.

7.

8.

9.

10.

along the line of rail without adequate water supply, medical or sanitary facilities. The numerous ravines and depressions were natural breeding grounds for the Aedes aegypti bellow fever) and Anopheles (malaria) mosquitoes. Inspectors later noted that rats were preva- lent at all the railway stations. The spread of the Bubonic Plague from the coast to Ashanti in 1915 was traced in part to rapid transport by rats and humans on the railwav. (See Resident Engineer Bradford to Govr. Nathan, i3 ‘May 1901; Nathan papers, Box 293-95. Rhodes House Oxford. For the spread of plague see G.C. Medical and Sanitary Rept. for 1915, p. 18. Also Scott D. Epidemic Disease in Ghana, pp. 18-19. Oxford University Press, London, 1960.) G.C. Rept. on the Census for 1911, p. 28. ADM 51213. Ghana National Archives. [Hereafter referred to as GNA.] European medical officers of the nineteenth century often remarked that Africans of the Gold Coast had high standards of individual cleanliness. Problems, they submitted, stemmed from lack of comprehension of the germ theory of disease and how sickness could spread from contaminated water and soil coupled with un- precedented urban overcrowding. (Copy of desp. fr. Actg. Govr. to Lord John Russell, 1855 (G.C. No. 27): Accts Papers [2052], XLII, 199, 856; also Sanit. Rept. for Keta Dist. (30 Sept. 1887) in Accfs Papers [c.5249-91, LXXII, 6, 1888.) A Towns Police and Public Health Ordinances had been on the books in the Gold Coast since 1878, but these laws tended to be laxly enforced by the local police under whose charge they fell. Rules that turned over the responsibility for digging public latrines to chiefs were not always effectively implemented. (See Ord. No. 10 of 1878: An Ordinance for Better Regulating the Peace of Towns and Populous Places and Promoting the Public Health; also Town and District Sanitary Reports encl. in Govr. Griffith (56) to Knutsford, 12 Nov. 1892: CO. 961222.) This report is listed because it was a pioneering effort by an eminent doctor. One possible omission is malaria, from which Africans suffered a high incidence of mor- bidity, though not of mortality. Two explanations for the omission are that medical doctors did not then have an accurate method for measuring the incidence of the disease and that most Africans so bore up with the recurrence of fever under the disease that they would not have gone to colonial doctors to report it. (Easmon J. F. Rept. on Increased Mortality in the Gold Coast, Encl. in Griffith (I I I) to CO.. 5 April 1887: C.O. 96/180. For a detailed discussion of the career of Easmon, see Patton A. Jr Dr John Fare11 Easmon: medical professionalism and colonial racism in the gold Coast 18561900. In/. J. Afr. Hisr. Stud. 22, (4), 601-636, 1989. David Scott notes major years for smallpox cases beginning in 1901. (See 14, PP. 666701.) But colonial medical officers were recording cases iorig before this time. (See District Sanitary Report for Ada, Encl. in Acta. Govr. Pike (126) to C.O., above; also District Sanitary Repts., for Pram Pram, Akuse, and other towns in Govr. Maxwell (14) to C.O.. Jan. 1895: C.O. _ I

96/254.) Many of the most prevalent tropical diseases among Africans were at least partially understood from about the 1880’s onwards. Three important exceptions were the snail-borne diseases, such as Schistosomiasis, (bil- harzia), trypanosomiasis, and onchocerciasis (river blindness), the vectors of which were not identified by medical scientists until after the turn of the century. See for example, ‘Gold Coast Sanitary Reports for the Year 1889’: Reports on individual districts, encl. in Actg. Govr. Pike (126) to Lord Knutsford, 2 June 1890; C.O.

230 RAYMOND DUMETT

II

12

I?

14

It;

Ih 17

IX

19

20

21

22

21

24

25

Y6,2OY. For the best modern survey see Patterson K. D. Health in Colonial Ghanu: Disease, Medicine and .Socio-Economic Chunge, 1900.- 195.5. pp. 5-7, 33-83. Crossroads Press, Waltham, MA, 1981. Compulsory birth and death registration laws, even for the major coastal towns, such as Accra and Cape Coast were not introduced until 1912-13; and even then they were more often honored in the breach. For the law to be enforced in a particular town there had to be a public cemetary in existence and a registrar of births and deaths. There were numerous revisions of the birth and death registration codes in the 1920’s and 1930‘s. Kuczynski R. R. Dmqyraphic~ Survey o/ the Brilish Colourrd Empire. 1. pp. 451 452. Oxford University Press. London. 194X. Rept. by Dr Easmon. ?I Feb. 1X87: above. Also G.C. .V<V/. & Sat?;/. K~pr. /or IY9?. encl. in Govr. Griffith (266) to C‘.O.. 7 Sept. lXY4, C.O. Y6:248. Go~~rnnlpn/ S<rn:/<rr’~‘ Rc~port fbr 1x91. encl. in Griffith (56) to Knutsford, 12 No\. 1892; C.O. 96,222. Kuczynski R. R. Dcvwpqvhrc LS~urc~~~ of //IB Briri,sh C’oloniul Empiw. I. 417 426. Oxford University Press, i-ondon, IY4X For ri thorough discussion of the genesis of the North- ern Tcrrltorics mints labour problem, see Thomas R. Forced iabour tn British West Africa: the case of the Northrr:l Territol:es of the Gold Coast. 1906 1927. J. .4/r. Ifbcr. XIV, 79 103, lY7.3. (; C‘. ,bfitling Dep. Repr. ,fbr 1911. Sch. F. p. 15. Despite attempts by the colonial government to carefully engineer the success of these early town councils through the appointment of ‘safe’ oficial members and the election of loyal African representatives (including nlerchants. barristers and chiefs). the councils were rendered immobile by mass popular demonstrations against the imposition of any kind of direct taxes or hotis< ‘rates‘. Govr. Hodgson (2X2) to C.O.. 4 July 1x98: (‘.O. %31X. &vr. Rodger (Conf.) to CO.. 21 Mar. IQOS: C‘O. Oh 42X. I‘or the continuation of these prohletns in the lY70’\ see Wraith R. E. Gug~i.+r,q. pp. 110 211. 0l;ford University Press, London. 1967. Ft>r a thorough chronology see Dumett R. E. The campaign against malaria and the expansion of scientific medical and sanitary services in British West Africa. 1898~1910. IV/. J .4/k. Hi.rr. Slur/. I, 153 197, 1968 ‘Vital Statistics Respecting Europeans Employed by the Governments of the Gold Coast and Lagos. 1881 -97’. (‘0. Afr. (W) Conf. Print 727. p. 102. Ciavr. Maxwell (299) to CO.. IO July 1897; C.O. 96,295. Minute by W. Bailey Hamilton. 29:4’1884 on Young to C.0 25 Aug. 1X84; C.O. 96 15’). Nathan to Ronald Ross. 30 No\. 1901 Ross Archives, : ablne! A. Drawer Il. File 13. London School of rroplcal Medicine. Meeting ofG C Mines Mgrs. Assn., 4 Aug. 1910, Encl. rn Gobr. to C.0.. 2Y Dec. 1910; C.O. 4fr. Conf. Print. 660, No 9. Appndx. 2. Also West African Chamber of Mines to C..O.. I I Ma-. IYI I. C’.O Afr. (W) 666. No. 49, pp. 108 IOY. Packard pclints out uhen later the incldencc of T.B. fell at man) of the Transvaal mines. even with retention of the compound bystern, that this was due to other factors >uch ‘IS the nitroduction of hetter food and pit-head changing and wash houses 12. pp. 74-76, I65 1661. The weaknesses in the practical application of the house :,egregation strategy in West Africa are discussed in Dumctt [IX. pp. 170 721, and in Patterson [lo, pp. 39 401. For a similar criticism of this practice by a governor of Lagos, see Joyce R. B. Sir William .I-fcr~~Gre~or, p. 233. Melbourne. 1971. Memo. by Dr A. E. Horn on the 1910 Medical and Sanitary Rept of the Gold Coast, Accra. 19 Dec. 191 I; (‘.O. 96:5 I’.

26.

27

28

29

30

31

32

33

34

35

36

Prior to 1900 mortality rates for European mmers, as opposed to officials were seldom tabulated by the government. We do have a document estimating the death rates for all European non-governmental person- nel (including missionaries and traders, as well as miners) for the decade 1879-1888. This table shows an average decade1 mortality rate of 83.6 per thousand with highs of over 100 per thousand in 1886 and 1887. (Figures enclosed in Hodgson to Knutsford. 19 Oct. 1889; C.O. 96j205.) Mortality rates for the European mercantile and rnls- sionary classes also dropped remarkably, but not quite to the same degree as those for officials and miners. Some argued that of the various classes of Europeans on the Coast, missionaries incurred the highest death rates over a 50 year span. (See informed discussions on the effects of the mosquito-control and household protec- tion campaigns, in Horn A. E. The health of Europeans in West Africa. The Lmcet, X May. pp. 1356 1358. 1912. Gov. Rodger to S. of S.. I8 Oct. 1909: C.O. Afr. 940, No. 40, pp. 60--61. ‘Medical Rept Encl. in Govr. ClifTord to Sec. of State. I4 Oct. 1913’ C.O. Afro. Conf. Print. IOOX No. 195, p. 263. G.C. &fed. R .%n. RPIII. for 190% p. 13: and for Ill.! p. II. The particular government housing segregation cam- paign attacked by the Society was directed against African domiciles thought to be houslng the yellow fever mosquito. PetItIon by Anti-Slavery and Abortgl- nes Protection Society. Encl. in Govr. Thorburn (767) to C.O., I1 Dec.. lUl(j: C.O. 96;51 I. (Check exact date.) Clifford to S. of S.. X Mav 191.3: C.O. Afr. YY9. No. 161, p. 250. Hugh Clifl<)rd served as Governor of the Gold Coast from 1912 to IYIY. Here, and later a\ Governor of Nigeria. he wa\ cone of the most innovative and independent-minded critics of British administration ever to serve in a West African governorship. Another was Sir William MacGregor, Governor of Lagos. Both men wrote lengthy memol-anda on public health ques- tions with a special emphasis on the health of Africans Kuczynski R. R. Demoyruphic~ Sut~ <:I. of /hc Briri.\h Cohmicrl Empire 1. p. I I. Oxford Universlt) Press. Oxford, 1948. For reasons of convenience. we have taken the figure5 for ‘all miners In the government reports as practically identical with the figures for all d/rrc,trt~ mlnc‘ry The overwhelming majority of deaths every year was for Afrxan miners. In the early decades, the number of Euro- pean deaths from accidents ranged from about I 3 per year and seldom more than 5 per year. In no year did thenumberofEuropeanaccidcntaldeathscomprisemo~e than 4.5% of the total. The European percentages were eben smaller if we look only at underground miner deaths. Quoted in The Mining Jmunrd. pp. 1007 1008, 5 Dee 1914. It was discovered that the underground Hood was caused by drilling into an abandoned adit level that had since filled with water. Miraculously. nine African min- ers and one European were rescued after an under- ground entombment lasting 9 days. Following this the Government passed an Amendment to the Mining Rights Regulation Ordinance of 1905. stipulating that no shafts or underground adits into old or abandoned workings he made until after inspection and approval by the Gold Coast Secretary for Mines. enclosures in G. C. (Separate) to Lord Elgin, 9 Feb. 1907: C.O. 96/455. At the DeBeers Company diamond mines in the 1x90‘s deaths from accidents averaged 6 7 per 1000 employed. But the annual average for the entire diamond mining work force was said to be I2 deaths per thousand. Worger W. H. Sour/~ A,frrm’.v C‘ir,, q/ Diumond~ p. 264. Yale University Press. New Haven, 1987.

Disease and mortality among gold miners of Ghana 231

37. 38.

39.

40. 41.

42.

43.

44.

45

46

47.

48.

49.

50.

51.

52.

53.

54.

55.

56.

Gold Coast Mining Dept. Reports for the Years. Memo by Simpson on ‘The New Scheme of Sanitary Organization in West Africa’ (3 Feb. 1910). C.O. Afr. Conf. Print 940: No. 92, p. 144. ‘Health of Labourers Employed at the Mines’ (Sum- mary of Simpson’s findings) in Gold Coasr Medical and Sanitary Dept. Rept. for April 19244March 1925, pp. 20-21. C.O. 98142. G.C. Med. & Sanit. Rept.,for 1924-25, p. 21. Patterson K. D. Health in Colonial Ghana: Disease, Medicine and Socio-Economic Change, 1900-1955, pp. 64-65. Crossroads Press, Waltham, MA, 1981. Cerebro-spinal fever is endemic in the Northern Region but reaches epidemic proportions from year to year during the Harmattan season. Major epidemics occurred in 1907. 1908. 1919 and 1920. (Kuczynski [I I, p. 4921.) For details see Scott D. Epidemic Disease in Ghana, 1901~1960. pp. 2-8, 39-55, 66675, 187-192. Oxford University Press. London, 1965. Response to the yellow fever outbreak by the Ashanti Goldfields Corporation noted in James Mactear to C. W. Mann, 17 May 1910; Mines Corres. Inwards; AGC 14. 171/21. Also C. S. Dowdell, M.O., Obuasi to Manager, Ashanti Goldfields Corporation, 25 May 1914; AGC 14. 171135. AGC Papers: Guildhall Library. Patterson K. D. The influenza epidemic of 1918--19 in the Gold Coast. Trans. Hisr. Sot. Ghana 16, 1977; Also Patterson [lo. p. 1051. See. for examole. Barth P. S. The Tragedv of Black Lung. Upjohn Institute, Kalamazoo, MJ. ‘1987; Smith B. Digging Our Own Graues; Coal Miners and the Slruggie ot’er Black Lung Disease. Temple University Press, Philadelphia, 1987; Foster J. C. Western miners and silicosis: the scourge of the underground toiler, 1890.. 1943. Ind. Labor Relai. Rer. 37. 371-385, 1984. Rept by W. J. Bruce, Medical Officer at the Aboso Mine, I8 June 1917, sub-encl. in Despatch from Govr. H. Clifford to W. Long, 18 Sept. 1918: C.O. 961592. In interviews with the writer, several of the few older underground miners who have remained in Tarkwa or Obuasi after retirement said that the majority of their former co-workers had returned to their home areas unon severing emulovment. Dumett R. E. Field Notes, T’arkwa and %buasi.- Ghana, 1987). Rept 011 the G.C. Mines Dept.,for 1924--25, pp. 9910. NO general tables on mortality rates for Northern Territo- ries labour were provided in subsequent departmental reports. Minute by Ellis C. O., 20 June 1924 on Govr. Guggis- berg (teleg.) to Sec. of State, 19 June 1924; C.O. 96/647. Summary of Simpson’s comments: G.C. Med. Sanif. Repr. for 1924- 25, p. 20. See, for example, letter from Tarkwa and Aboso Con- solidated Mines to C.O., 1 Feb. 1924, and the same company to C.O.. 14 April 1924: C.O. 96/651. Govr. Gordon Guggisberg to Duke of Devonshire, 29 Dec. 1923; C.O. 96/641. Also Tarkwa and Aboso Consolidated Mines to Colonial Office, 1 Feb., 1924; C.O. 96/65 1. Dr Dowdell was greatly praised by the Gold Coast Governor for his efforts to protect Obuasi from Yellow Fever during the severe epidemic of the disease in 1911. (Progress Rept. encl. in Gov. Thornburn to C.O., 30 Jan. 1911; C.O. Afr. Conf. Print, 966, No. 38, pp. 73-81. Estimated Population of Obuasi-17,000

No. of Burials in Year 1912-122 Death Rate Per Thousand-17.4

(Source: Rept by Dr Seymour Dowdell to Mgr, AGC, Obuasi. 4 Mav 1913: AGC 14. 171132; Ashanti Gold- fields Corp. Papers, Guildhall ‘Library.) Govr. Hugh Clifford to Sec. of State, 8 May 1913; C.0 Afr. Conf. Print, 999; No. 161, p. 251.

57.

58.

59.

60.

61.

62.

63. 64.

65.

66.

67

68.

69. 70.

71.

72.

Table VI-vital Stats. on 35 Registration Districts: G.C. Medical Dept. Rept. for 1936-37, p. 14. The first separate census for Tarkwa town was taken in 1921 and listed the population at just 2671. In the reference to T.B. and other diseases in the medical reports, it is not clear whether the investigators were referring only to Tarkwa or to Tarkwa and its sister city Aboso combined. which was about 6500 total popu- lation (Kuczynski [l 1, pp. 410454].) Tarkwa had, by far the highest percentage of T.B. cases to general population of any center in the Colony. G.C. Med. & Health Rept for 1927-28, p. 26. In 1927-28, Tarkwa had an infant mortality rate of 382 as compared with 128 for Accra, 142 for Kumasi and, the next highest, 176 for Koforidua. ‘Infant Mortalit) Rates for Selected Towns’: G.C. Med. & Sanitary Depi. Rept. .for 1927-28. p. 22 and for 1938, p. 13. Dr Dowdell. the AGC physician, outspoken as usual, noted that there was a high incidence of venereal disease among the Europeans working at Obuasi. (Appendices to draft Bill on Sanitary Regulation at the Mines, encl. in Govr. J. J. Thornburn to S. of State, 29 Dec. 1910: CO. Afr. Conf. Print. 966, No. 9, pp. 19-23.) Kuczynski [I 1, p. 4751: Another point, which Kuczynski does not note, is that miners with syphilis probably also suffered a high death rate, but because they died in the northern region the data was not recorded as a major cause of miners’ deaths. G.C. Medical and Health Repr. for 1927--28. p. 29. Patterson K. D. Health in urban Ghana: the case of Accra. Sot. Sri. Med. 13B, 251--268. Medical Officer, Aboso Mine to P.M.O., 18 June 1917, sub.encl. in Clifford to Long, 18 Sept. 1918; C.O. 96/592. Quoted in Thomas [15, p. 1001. Packard R. M. Personal Communication. 25 April 1991. The mining towns of Tarkwa and Obuasi received their first single government medical officers in 1904 follow- ing the completion of the Sekondi railway. Adhering to the usual practice of segregation, at Obuasi there were two adjacent hospitals, one for Europeans and one for Africans with eight beds. (Rept encl. in Govr Rodger (227) to Lyttelton, IO May 1904; C.O. 96/417. Rept. on Obuasi, Appndx. 4 in Thornburn to S. of State, 29 Dec. 1910; above.) Statistical Tables in Govr. Clifford to C.O., II Oct. 1916: C.O. African 1044 Conf. Print. No. 89, pp. 141-42. G.C. Colonial Annual Reports for the years. G.C. Medical & Sanifary Dept. Repis for the years. G.C. Annual Medical Dept. Repl. _tbr 1939, pp. I 2. In 1890 there had been but five hospitals in the Gold Coast Colony. (All were for Europeans. but with small African wards.) By 1915 there were 18 hospitals (incl. dispensaries) in the Gold Coast, Ashanti and the North- ern Territories which dealt with a total of 40,407 (both out and in) patients. By 1939 there were 38 hospitals and dispensaries, of which 32 were for Africans and 6 for Europeans. The number of both out-patients and in- patients treated at all government facilities rose to 388,317 by 1939. (G.C. Med. & Sanit. Dept. Repls. for 1915 and for 1939.) According to Hugh Clifford the main group of Africans who received regular attention from physicians were the educated classes. It was only at times of epidemic disease that a sizeable portion of the general population sought out hospital care. (Govr Clifford to S. of State, 8 Sept. 1915; CO. Afr. 1037 Conf. Print, No. 37, p. 55.) See the rare example of death rates per thousand for individual mines found in ‘Statistics relative to Deaths of Employees at Mines with a Resident Medical Officer’, encl. in Guggisberg to Devonshire. 29 Dec. 1923; CO. 96164 I.

232 RAYMOND DUMETT

73.

14.

By Ordinance No. 12 of 1892 the government made it a punishable offense to contaminate drinking water supplies with any foreign substance. The governor complained, however, that the courts seldom imposed fines for infractions. So long as people continued to draw their main water supplies directly from rivers and from rain barrels, it was difficult to prevent contami- nation of drinking water. (Clifford to S. of State, 16 Anril 1914: C.O. Afr. Conf. Print 1013: No. 140 DD. 243. 249). The same reluctance or inability’to punish’ mfrac- tions also pertained to a many other aspects of regulat- ing working and living conditions at the mines. Masters W. E. A model mining village in the tropics. J. crop. Med. Hygiene XXII, 10, 919. This innovation, however, did not appear to have much positive effect on miners’ respiratory disease, at least in so far as they were

reflected in Prestea town mortality rates. Furthermore, Dr Master’s glowing tribute to housing and sanitation at Prestea as a ‘model mining town’ is not fully sup- ported in other documentary evidence of the period.

75. Oral Interviews. Obuasi, Ghana, May, 1987. 76. Furthermore, many of the reports gave an overly favor-

able impression of both housing and health at the Ashanti Goldfields because they focussed on the head- quarters town-Obuasi-but neglected the adjacent supporting towns, such as Ayeinm, which were said to be- In a far worse condition: (See Rept. by Dr J. B. Alexander “On Obuasi”. 2627 Nov. 1914. AGC 14. I71 137. AGC Papers. Guildhall Library.)

77. G.C. Med. & Sanit. Repts for 1936-37, p. 26. 78. G.C. Med. & Sanit. Rept. for 1937-38, p, 4.