The Cape Doctor in the Nineteenth Century: A Social History (review)

The social history of medicine in South Africa is surprisingly underresearched. While the twentieth century has received some historical attention, the history of nineteenth-century medicine remains largely untold. The Cape Doctor thus makes an extremely welcome contribution to this field of scholarship—but it also speaks to key issues confronting the medical profession in contemporary South Africa. Indeed, many contributors make it clear that medical professionalization, ongoing professional boundary disputes, the role and place of traditional and alternative modalities of healing, and the economics of medicine have their roots in the very processes under scrutiny in this book.

This collection is centered on a number of key arguments addressed by various contributors. Licensed doctors do constitute the major focus of enquiry, yet the contribution of other practitioners is located firmly within an understanding of the development of medicine and medical practice in the Cape. Harriet Deacon highlights the plurality and diversity of the medical market and shows that alternative (including traditional and folk) forms of healing were both well established and well utilized by settler, slave, and indigenous communities. She argues that licensed Cape doctors were threatened by "unscientific" medicine (p. 36) . They were most challenged, she suggests, by "unlicensed practitioners in the Western tradition and by apothecaries and druggists who charged for medical advice and prescribed as well as sold medicines" (p. 38). One feature of the struggle to professionalize medicine was precisely the battle to control the boundaries and professional scope of the field. Deacon and Elizabeth van Heyningen map the ways in which medical legislation and regulation were used in the establishment of a male medical elite—an elite that sought to create distance from rural colleagues and to sow division through professional distinction and practice. But professionalization, according to Deacon, was also about acquiring social status, "gentlemanly status" (p. 86), which represented respectability and specialist training.

The professionalization process, which unfolded throughout the nineteenth century, was further cemented with the establishment of local medical training. Prior to the founding of a full medical school in 1920, all Cape doctors were trained abroad, mostly in Britain and Western Europe. Howard Phillips clearly demonstrates the long-lasting consequences of this. The adequacy of local training has regularly been called into question, but more important, Phillips asks if medical training has indeed been appropriate to meet local need.

The debates and themes engaged in this volume are situated in relation to South Africa's wider colonial context. Elsewhere, van Heyningen has described Cape doctors as "agents of empire" after 1880,¹ and this relationship is clear to see. In this collection Deacon and van Heyningen point out that while Cape doctors had a close relationship with colonial states in the nineteenth century, "there were however many nuances within this relationship, and doctors cannot simply be understood as handmaidens of colonialism" (p. 133)—furthering the aims of the colonial state was not always the priority of the Cape medical profession. This volume points to the ways in which Cape doctors furthered their own "professional and personal ambitions, while simultaneously influencing the process and progress of colonisation at the Cape" (p. 135).

This collection provides a wide-ranging, sophisticated, and well-crafted overview of the development of the South African doctor. Set against the backdrop of extraordinary changes in the nature and practice of Western medicine, and the impact of major economic and social transitions in South Africa, this volume makes a significant contribution to our understanding of South African medicine.