Introduction: the Cape Doctor in the nineteenth century.

The Cape Doctor, named after the profession as well as the wind that sweeps the Cape Peninsula of dangerous miasmas, is a social history of medicine, seeking to place formal western medicine within its political, social and economic context. Besides Shula Marks' study of South African nurses, Divided Sisterhood, no previous work has brought such a breadth of material about South Africa's medical past under the framework of social history. This work provides clear evidence of the way in which the Cape medical profession excluded all but a few women and black practitioners, and discriminated along lines of race, class and gender in their practice, but it also moves beyond the classic revisionist tradition (documenting the emergence of a society divided along lines of race and gender) by providing examples of cultural crossover and medical pluralism.

The Cape doctor and the broader medical market, 1800-1850.

Regularly trained and licensed Cape doctors in the nineteenth century operated within a medical market which accommodated other suppliers of medical care, both competing and complementary. These 'alternative practitioners' included shopkeepers selling patent medicines, apothecaries, chemists and midwives, Muslim folk healers and indigenous Khoisan or African healers. Licensed doctors also provided medical services for a wide variety of clients - white settlers, their slaves, servants, free blacks and indigenes, usually in decreasing order of frequency. Most of these patients probably consulted alternative practitioners as well, often in preference to the Western-trained doctor. Cape doctors distanced themselves very firmly from alternative healers and folk medical traditions in order to establish their niche within the medical market and to secure state support by creating a strong profession.

Medical gentlemen and the process of professionalisation before 1860.

In the early-nineteenth century, the professionalisation of medicine at the Cape began in earnest. Although there were key legislative and professional developments in this period, the notion, outlined in Burrows' seminal work on South African medical history, that it was a 'golden' age of medical reform underplays the extent of intra-professional differentiation and draws attention away from the politics of professional regulation at the Cape. The period was a time of inter- and intra-professional conflict as doctors, druggists and shopkeepers competed to sell drugs and medical advice and it spawned a profession that was deeply divided. In spite of early, general and monopolistic legislation passed in 1807, the process of medical professionalisation at the Cape was very uneven, cementing an intra-professional distinction between doctors in Cape Town and doctors or druggists in the rest of the colony. The special status of Cape Town provided the bedrock for an urban-rural divide in professional regulation and services still present in South Africa today.

Opportunities outside private practice before 1860.

This chapter discusses the restrictions and opportunities which salaried employment offered Cape doctors in the pay of government and charitable organisations during the first two thirds of the nineteenth century. Although Cape doctors often acted as agents of the colonial state there were many nuances within this relationship. While military doctors played an important role in the profession during the first few decades of the century, by the 1840s civilian doctors were beginning to assert greater influence in Cape Town, if not yet in the Eastern Cape. Hospital posts and an expanding network of charitable organisations and government-funded district surgeoncies provided part-time employment for some doctors throughout the colony. This helped urban-based doctors to sustain practices and encouraged more doctors to practice in the smaller country towns serving large farming areas.

Mineral wealth and medical opportunity.

With the increase in population and in colonial revenues after the discovery of diamonds and gold in the last quarter of the nineteenth century, public and private hospitals proliferated, particularly in larger centres such as Cape Town. The numbers of practitioners engaged in public health also increased. Perhaps as important, doctors were now accepted as skilled professionals and remunerated accordingly. At the same time there was also a greater demand for doctors in the employment of business and industry, particularly the insurance industry and the railways. These opportunities for salaried employment somewhat reduced doctors' professional autonomy and occasionally encouraged intra-professional squabbles. Yet they also provided a springboard for general professional regulation, growing professional status in specialisms like psychiatry, and a solid base for the economic survival of country doctors.