Pulmonary Tuberculosis in Cape Town and Karoo, 1870-1920 : policy and attitudes

Abstract

This thesis focuses on the attitudes and policies which shaped the history of pulmonary tuberculosis in the Cape from 1870 to 1920 and culminated in the passing of the Public Health Act, Act 36 of 1919. It was this act which formed the basis of public health legislation in South Africa until the 1970s. The thesis is a contribution to the history of medicine and to the history of legislation. Topics explored include pulmonary tuberculosis and its early global history. When the practice of sufferers visiting places with particular climates became fashionable, towns in the Karoo became a popular destination. Their journey to the colony, together with their experience in Cradock is the subject of a chapter. Once the disease spread to the local population, the focus shifted to the attitudes and policies of the local authorities and their failure to address its spread. In contrast, in Cape Town the city council and its medical officer of health took up the challenge, but with limited success. The fight against tuberculosis was assisted by a number of dedicated individuals such as Dr Neil Macvicar who was the founder of the Native Health Society. The Society for the Prevention of Consumption, which was officially launched in Cape Town in June 1904, also contributed to educating the public about the disease. Once the Cape Colony entered into political Union in 1910 there was the added dimension of tuberculosis on the mines and the reluctance of mine officials to take care of workers suffering from the disease. This became an issue during the proceedings of the Tuberculosis Commission. The attitudes and prejudices towards the local population became formalised in the Public Health Act, Act 36 of 1919 because the act was drafted with the health of the white population in mind. By providing a skeleton budget for local authorities to deal with tuberculosis, the legislature ensured that the healthcare of the majority of the population, especially those who were most vulnerable to the disease, was not addressed. The legacy of that decision continues to haunt South Africa to the present day.