Silicosis has been the most lethal industrial pathology in the XX th century, well beyond the mining sector. The industrialization of such developing countries as China makes it more topical than ever, and exemplifies the whole set of problems raised by the medico-legal notion of “occupational disease”.Silicosis belongs with asbestos to the category of pneumoconioses. Its legal recognition literally demanded a tough “battle of surveys” between unions’and employers’medical experts during the interwar period, as well as an enormous transnational pressure which relied on the role of ILO’s international conventions and immigrant workers. The notion of threshold of exposure, which has been applied to silicosis, to asbestos and now to professional cancers, demonstrates how occupational diseases are more “acceptable” than consumers’ diseases. Employers tend to limit the financial “compensation” of these occupational diseases by blaming private workers’behaviours (tuberculosis, smoking) or charging social insurances. This strategy, which is not necessarily mediated by the judicial courts, jeopardizes the insertion of health at work policies within the realm of public health.