The Transkei is one of two regions from which a majority of South African mine workers used to be recruited, and the destination to which many return. The study was done to determine the prevalences of lung diseases in these ex-workers, links between these diseases and age, links between diseases and duration of mining, and the association between silicosis and tuberculosis. It was done in Umtata General Hospital. Participants' (n = 300) ages ranged from 35 to 66+ years (mean 51.6). Durations of mining ranged from < 1 to 31+ years. 29/300 X-rays (9.6%) were unreadable; 59 (21.8%) were disease-free; and 212 (78.2%) showed lung abnormalities. Pulmonary tuberculosis (PTB) with or without silicosis was evident in 64.2% of the x-rays, silicosis with or without PTB in 34%, COPD in 7%, and asbestosis in 1.5%. The relative risk for tuberculosis was 5.08 (2.58-9.88) for men with silicosis compared with others, p < 0.01. The extremely high burden of lung disease in ex-mine workers places enormous challenges on health service delivery systems and compensation authorities.