(Title of the Thesis)*

1 A 'new experiment in local government'

The Local Health Commission: A Study of Public Health and Local Governance in Black Urban

Areas in Natal, South Africa, 1930 - 1959

Mary Susan Caesar

A thesis submitted to the Department of History

In conformity with the requirements for

the degree of Doctor of Philosophy

Queen’s University

Kingston, Ontario, Canada

(May, 2015)

1 NHSC interview with the LHC, 9 August 1943, LHC Minutes, Vol. 1, 1 November 1941-31 March 1943 i

Abstract

The Local Health Commission (LHC) was established in 1940. Its significance lies in the fact that it adopted a public health-based approach to local governance and that it delivered health and welfare services to residents of the neglected black and multi-racial urban areas. Even though its mandate was the antithesis of the goals of urban apartheid, the LHC expanded its scope after the National Party came into power in 1948. This dissertation is firstly, an institutional history of the LHC. Secondly, it examines the ways in which black urban residents practiced in municipal institutions by demanding that the LHC not only fulfill its mandate but, that it also amend its programs in order to meet their needs. A third and final theme of this dissertation is the role of Advisory Boards in addressing the public health crises specifically, ways in which the ABs held the LHC accountable. By exploring the LHC through these three themes, this dissertation addressed larger historical questions: firstly, the role of white liberal bureaucrats in the development of public health and urban governance in South Africa and secondly, the nature of black people’s participation in state institutions before 1994.

Acknowledgements

I would like to thank Prof. Marc Epprecht, my supervisor. His generosity, support, encouragement and above all, his belief in me enabled me to conduct the research and work through the various research questions and countless drafts. His vast knowledge of South African history was an invaluable resource to me. He also provided me with financial support and introduced me to his contacts in the academy in

South Africa.

I would also like to express my appreciation to my dissertation committee members: Professors Gary

Kynoch, Sandra den Otter, Ishita Pande and Elaine Power. They gave generously of their time and their expertise to help me improve this dissertation. I especially appreciated Professor Kynoch who served as my external examiner and challenged me to think beyond the limitations that I imposed on my analysis.

Professor den Otter was a constant source of support during my time at Queen’s and in Kingston. I’m sure that I am only one of many graduate students who benefitted from her assistance to students in her position as Associate Dean of the School of Graduate Studies. Professor Ishita Pande was and will remain an inspiring historian.

A number of Librarians and Archivists gave generously of their time. I thank especially the staff of the

Pietermaritzburg Provincial Archives especially Thabani Mdladla; the National Archives and South

African National Library, both in Pretoria. In Canada, the Librarians at Stauffer Library were very helpful in finding all the South African resources.

Drafts of this dissertation were presented in Canada and South Africa. I thank the organizers of the

Canadian Association of African Studies (CAAS), a welcoming environment for young scholars; the

'New Directions in the Histories of Health, Healing and Medicine in African Contexts' Workshop,

Durban, South Africa in 2012; and the Studies in National and International and Development (SNID) seminar series at Queen's University. I would like to thank Dr. Scott Rutherford and Prof. Susanne

Klausen who helped me talk through my confusion as I developed the arguments in this dissertation.

iii

Over the years, I received financial support from different sources: Queen's University Graduate Award,

Queen's International Tuition Award, the Ban Righ Centre, Prof. Marc Epprecht, Prof. Crush and the

Southern African Research Centre, The Dean's Travel Grant and family and friends who generously supported and hosted me in Kingston and in South Africa.

There are a number of institutions and people in Kingston, Canada who assisted me during the research for this dissertation. Prof. Jonathan Crush and the staff at the Southern African Research Centre provided me with a nurturing academic environment. They have also become friends over the years. The staff of the Ban Righ Centre provided friendship and a welcome space to reflect and write but most of all, the nourishing bowl of soup and a cup of tea. At the Queen's University International Centre (QUIC) I received not only valuable advice but an international family.

In South Africa I received assistance from family and friends in South Africa: my parents, Joseph and

Catherine Caesar; Mercy Katsenga who traveled from Zimbabwe to South Africa in order to take care of

Fadzai; Sally and Tommy Hudsonberg; Chandré Caesar, who came to Kingston from South Africa to see us through yet another dreary Canadian winter; and Gerald Katsenga. Gerald not only visited us in

Canada but provided us with a home in South Africa.

In Canada, I owe so much to my friends especially those who also became the child's co-parents: Karen

Dubinsky, Susan Belyea, Susan Lord, Paul Kelley, Sayyida Jaffar and Scott Rutherford. Ken McPhail and

Susanne Klausen are my dear friends whose home is our home and sanctuary. Susanne is also my inspiration to do important South African history. Finally, to Fadzai Katsenga, still the “brightest star in the sky”.

Table of Contents

Abstract ...... ii Acknowledgements ...... iii List of Tables ...... vii List of Images ...... viii List of Maps ...... ix List of Abbreviations ...... x Alphabetical List of Public Health Areas, Natal, c.1941 - c.1959 ...... xii Alphabetical List of Types of Local Authorities in Natal, c.1938 and c.1960 ...... xiv Chapter 1: Introduction ...... 1 The "poo revolt" ...... 5 Public Health Defined ...... 14 Public Health and Black Urban Areas Before 1930 ...... 18 Administration of Black Urban Areas ...... 23 Research questions, Significance and Chapter Outlines ...... 28 Chapter 2: A History of Public Health and Governance of Black Urban Areas ...... 32 Public Health ...... 32 Governance of Black and Multi-Racial Urban Areas ...... 61 Conclusion ...... 65 Chapter 3: "A Menace or Potential Menace to Public Health", Black Urban Areas and The Public Health Crisis in Natal, 1930 to 1940 ...... 66 Irregular Urbanization and The Public Health Crises in Natal ...... 69 Official Narratives of Urban and Public Health Crises in Natal ...... 74 The Thornton Committee: A Novel Approach to Health and Urban Governance ...... 78 Making Sense of The Thornton Committee's Recommendations ...... 84 Conclusion ...... 100 Chapter 4: "A New Experiment in Local Government": The Local Health Commission in Natal, 1940 - 1959...... 101 A New Public Health-Based Local Authority ...... 102 Institutional Arrangements ...... 105 PHAs: The LHC's 'zones of influence' ...... 114 v

LHC Functions ...... 128 Personal Health Services ...... 128 Environmental Aspects of Public Health ...... 129 Social Welfare ...... 137 The LHC's Expertise As Provincial Resource ...... 143 Conclusion ...... 144 Chapter 5: The Politics of Public Health: Political Representation, Municipal Politics Services and Apartheid, 1940 - 1959 ...... 146 Citizen Action for LHC Services...... 152 African Political Representation ...... 156 The EDPHA Advisory Board: "Advising" The LHC ...... 167 Negotiating Apartheid ...... 184 Conclusion ...... 194 Chapter 6: Conclusion ...... 196 Bibliography ...... 202

List of Tables

1. African population by sex in Pietermaritzburg and Durban, c.1936-51 p.73

2. Racial Composition in Sections of Edendale, c.1933 p.76

3. Time Frame for Local Authority Regulations by Province p.81

4. Urban and Peri-Urban Local Authorities in the Union, c.1938 and 1943 p.82

5. Senior LHC Staff Members, c.1941 - 1959 p.106

6. Staff Composition, July 1951 p.108

7. List of women that served on Advisory Boards p.113

8. Apartheid laws with an urban impact p.186

9. Race in LHC Building Regulations, c.1950 p.191

vii

List of Images

1. Township of Khayelitsha, Western Cape Province, c. 2011 p.8

2. France, Msunduzi Municipality, KZN, c. 2011 p.8

3. Post-1994 Housing Developments, c.2014 p. 9

4. First Commissioners, 1940 p.106

5. Group Areas Act and Property Sales, Edendale p.193

viii

List of Maps

1. Four Provinces of Union South Africa, c. 1910 p. xv

2. Municipalities in KwaZulu-Natal, c.2013 p. xvi

3. uMgungundlovu-District-Municipality p. xvii

4. ex-PHAs, the Midlands Region and the Edendale District PHA p. xviii

5. ex-PHAs in the Central and Coastal Region p.xix

6. LHC Sketch of Pietermaritzburg and its 'black belt' including Edendale p. xx

7. LHC Sketch of Clermont PHA p.xxii

List of Abbreviations

AB Advisory Board

CWS Child Welfare Society

DPH Department of Public Health

CPHA Clermont Public Health Area

EDPHA Edendale and District Public Health Area

GAA Group Areas Act

HC Health Committee

HAD Housing Development Agency, KZN

KZN KwaZulu-Natal Province (before 1994, Province of Natal)

LHC Local Health Commission

MOH Medical Officer of Health

MPC Member of Provincial Council

NAD Native Affairs Department

NHS National Health Service

NHSC National Health Service Commission also, Gluckman Commission

NIA Natal Indian Association

NMA Natal Municipal Association

NPA Natal Provincial Administration

PHA/PHAs Public Health Area / Public Health Areas PMB Pietermaritzburg

PUAHB Peri-Urban Areas Health Board, Transvaal

SA South Africa

SAHRC South African Human Rights Commission

SAIRR South African Institute of Race Relations

SANNC South African Native National Convention

TPA Transvaal Provincial Administration

TVL Transvaal

UDPH Union Department of Public Health

Alphabetical List of Public Health Areas, Natal, c.1941 - c.1959

Albert Falls

Ashdown & Edendale (EDPHA)

Bermuda Beach (Central Coastal Region)

Bulwer

Cavendish

Cedara

Cleland

Dalton

Duff's Road

Dundee

Dunveria

Escourt

Glen Anil

Hilton Road

Hollingwood (New England)

Howick (Dale and Quail)

Lidgeton

Lincoln Meade

Lion's River

Mhlatuzana

Newlands

Nottingham Road

Ockerts Kraal

Ottawa xii

Plessislaer

Rosetta

Shakaskraal (also appears as Shaka's Kraal and Chakas Kraal)

Tugela

Wasbank (also appears as Waschbank)

xiii

Alphabetical List of Types of Local Authorities in Natal, c.1938 and c.19602

1938 1960 Board of Health /Health Boards Board of Health City Councils Divisional Councils Divisional Councils Health Committees Health Committees Local Administration & Local Boards Local Boards Local Health Commission Magistrates Magistrates Rural Local Authority Town Boards Town Councils & City Boards Town Councils Village Councils Village Councils Village Management Boards Village Management Boards

2 Union Government of South Africa, U.G. No.8, 1940 in NTS 4488, Box 526-313, Part 3; J.J.N. Cloete, Sentrale Provinsiale en Munisipale Instellings van Suid Africa. (Pretoria: J.L. van Schaik, Bpk., 1964)

xiv

Map 1: Four Provinces of South Africa, c. 1910

Map 2: Municipalities in KwaZulu-Natal, c.20133

3 Available at http://www.localgovernment.co.za/provinces/view/4/kwazulu-natal,accessed 20 February 2013

xvi

Map 3: uMgungundlovu-District-Municipality4

4 Available at http://www.localgovernment.co.za/districts/view/20/uMgungundlovu-District-Municipality, accessed 20 February 2013 xvii

Map 4: ex-PHAs - Edendale and District Public Health Area (EDPHA) and PHAs in the Midlands Region5

5 http://www.kwathabeng.co.za/travel/south-africa/destinations.html?map=Natal+Midlands

xviii

6 Map 5: Natal, ex-PHAs in the Central and Coastal Region

6 http://www.weather-forecast.com/locations/Durban xix

Map 6: LHC Sketch of Pietermaritzburg and the 'black belt' including Edendale7

7 GES 964, Files 898/13, 901/13f xx

Description of Map 6

Centre area inside orange circle (solid line) Pietermaritzburg Borough Top left dark / black area Howick Left, inside solid blue line Native Location Yellow-shaded area Edendale Small black area inside yellow-shaded area Georgetown Green-shaded area Plessislaer /Plessislager Brown-shaded area Slangspruit Purple-shaded area New England Pink-shaded area Ockertskraal

xxi

Map 7: LHC Sketch of Clermont PHA8

8 LHC Minutes, Vol. 3(1), 1 April 1944 - 30 September 1944 xxii

Chapter 1: Introduction

The Local Health Commission (LHC) in the province of Natal (KwaZulu-Natal, or KZN after

1994) used public health measures as a way of eradicating slum conditions to improve the lives of black people who lived in urban and peri-urban areas. These slum conditions were manifested largely through housing and sanitation problems: use of inferior building materials; dwellings with insufficient ventilation, floor space and/or lighting; and no or insufficient sanitation services – conditions that facilitated the spread of disease. By 1930 these slum conditions, which may have started out as

'temporary', become permanent for many of the urban poor. The rise in urbanization rates during the interwar years and during World War II only exacerbated the housing and sanitation problems as more people came to live under slum conditions. These emerging urban areas experienced an escalating public health crisis.

The slow and inadequate response by government officials and departments to this urban public health crisis was influenced by at least two issues: race and governance. These urban areas were primarily occupied by Africans. Others spaces were however multiracial, i.e. areas occupied by Africans, Indians,

Coloureds and Whites.9 Many of the African urban residents had no legal right to be in the city and therefore deemed to have no rights to services by urban local authorities. The spatial distribution of these areas was such that they were generally located beyond the boundaries of the local authorities of the white towns. As a result, these emerging urban areas did not receive any sanitary services and construction of houses and roads were unregulated thus creating conditions conducive to the spread of disease.

9 In this dissertation I use the term black to encompass all racial categories except white so as to avoid the derogatory term of the apartheid-era term, "non-whites". I use the individual racial categories, i.e. Indian, Coloured, or African when quoting the official documents or where it is important to make a distinction between specific race groups. In some of the original texts Indians are also referred to as "Asiatics" and Africans as "Bantu" or "Natives". 1

Since the establishment of the Union of SA, the Union Department of Public Health (UDPH), municipal managers and Medical Officers of Health (MOHs), increasingly expressed their concern regarding the shortage of housing and deterioration of sanitary conditions in the emerging urban and peri- urban areas. The fact that SA had a fairly comprehensive public health legislative framework did not prevent or slow down the development of the health and governance crises. The 1919 Public Health Act as well as the 1920 Housing and the 1934 Slums Acts provided for a broad range of health and sanitation services including the allocation of houses.

The overall research theme of this dissertation is an examination of the multiple responses by the public health bureaucrats and African urban residents to the twin crises of public health and governance.

This dissertation addresses two specific research foci. The first is the framing of the urban public health crisis as one of governance and as a result of their analytical framework; public health bureaucrats in the

UDPH designed the Local Health Commission (LHC). This dissertation is therefore an examination of the development of the analytical framework followed by the UDPH officials and an analysis of the LHC, i.e. its mandate, functions and institutional mechanisms. The LHC adopted a broad definition of public health, as provided by South African public health-related laws, in order to inform its mandate and the institutional mechanisms through which to implement its activities. It was established in 1940 and in 1941 it set up its own administration and commenced incorporating Public Health Areas (PHAs). Plessislaer in

Edendale was the first and became the Edendale and District Public Health Area (EDPHA). Other PHAs followed including Pietermaritzburg's 'black belt' (Map 6) and the Clermont PHA, near Durban.

The political implications of the LHC and its work are the second specific research focus of this dissertation. In spite of adopting a public health framework to deal with the urban public health crisis in black urban areas, the LHC had the legal status of a local authority and was therefore a governance

institution. This had significant political implications especially for the residents of the PHAs. Before the attainment of democracy in 1994 black people had limited political rights and were only afforded indirect political representation. During the apartheid era, 1948 until 1994, black people engaged in extra- parliamentary political organizations to achieve freedom. The imposition of the LHC perpetuated the system of indirect representation. With regard to the political implications of the LHC, this dissertation is also an analysis of the responses of PHA residents to the imposition of the LHC. The LHC adopted the

Advisory Board (AB) system in order to allow black residents to participate in the governing of their

PHA. The ABs had no legal or executive authority but black leaders and residents of the PHAs participated in work of the LHC via its AB system. This dissertation focused on the role of a public health framework in relation to the work of the ABs especially the one established in the EDPHA.

The ABs is a particularly controversial issue in the history of SA. Historians focused primarily on the political impotence of the ABs. This research into the work of the LHC and its AB system sought to firstly, expand perspectives on the function of the ABs as well as explore some of the positive results when black people participated in state institutions, such as local authorities, before and during apartheid.

Research on resistance in SA focuses predominantly on organized political organizations, national politics and labor movements. In addition, the approach adopted in resistance history condemns black people’s participation in state institutions and the work on the ABs is a primary example. This case study of the work of the LHC and the responses by some of the black people, who resided in the PHAs, focuses on the public health dimensions black people’s engagement with the state. In particular, the political spaces that opened up for black people by using a public health framework presented to them by the national and local state institutions.

These specific research themes noted above, feeds into broader themes in South African historiography. The first relates to the work of white liberals, politicians and bureaucrats. In recent years,

South African authors sought to save white liberals from contamination through the history of apartheid and the research on public health and social medicine is a prime example. From the late 1990s, there was renewed focus on the role of white liberals in the development of SA’s approach to and implementation of public health services.10 Of particular interests for the analysis in this dissertation is the notion of the

"liberal interregnum" coined by Dubow and Jeeves to describe the moment before 1948 and the introduction of apartheid.11 The fact that health workers in the UDPH made a concerted effort to extend health and welfare services to black people starting during the late 1930s is an example of government programs indicating that perhaps apartheid was not inevitable. William (Bill) Freund is critical of this narrative arguing that inter-departmental rivalry played a big role in the development of state programs.12

Also critical of the health and welfare work of white liberals in the UDPH is Diane Wylie suggesting that these types of interventions were ameliorative.13 All of these perspectives can be applied to the work of

UPDH officials regarding the urban public health crisis and the LHC, set up in order to respond to the public health crisis. In this dissertation, however, I examine more closely what positive contributions the public health approach made with regard to the daily lives of urban black people at a time when they had had no or little access to formal political institutions.

This dissertation is therefore an in-depth study of the LHC as a public health- based governance institution and the nature and extent of the services it provided. I therefore, relied heavily on the LHC records regarding its operations and also its work in the largest PHAs, the EDPHA.

10 See Ann Digby, Saul Dubow, David Duncan, Alan Jeeves and Shula Marks on the topic of the social medicine pioneers, the social medicine experiment and the NHSC. 11 South Africa’s 1940: A world of Possibilities, eds. Saul Dubow and Alan Jeeves (Cape Town: Double Storey, 2005) 12 Freund, W. "The South African Developmental State and the First Attempt to Create a National Health System: Another Look at the Gluckman Commission of 1942-1944", SAHJ, 64, 2 (2012): 170-186; Marks, S. "Reflections on the 1944 National Health Services Commission: A Response to Bill Freund and Anne Digby on the Gluckman Commission," South African Historical Journal, 66 (1), (2014): 169-187 13 Starving on a Full Stomach. Hunger and The Triumph of Cultural Racism in Modern South Africa. (Charlottesville and London: University Press of Virginia, 2001) 4

While the LHC was established in 1940, this dissertation includes an analysis of the decade earlier, i.e. 1930. During the 1930s the UDPH and the NPA tried to find a lasting solution to the urban public health crisis. From 1960 onwards, the apartheid government rolled out Grand Apartheid, which changed the political landscape regarding the governance of black urban areas as well as handing over responsibility for the health and welfare of Africans to the Bantustans or Homelands. As a result, this research project investigated the LHC up until 1959. The actors in this case study are the public health advocates in the UDPH, the LHC Commissioners and officials, and finally the residents of the PHAs, especially the AB members of the EDPHA.

The "poo revolt"14

In 2010, at the beginning of the field work for this project, Pietermaritzburg (hereafter, PMB), the provincial capital and home of the provincial archives; along with the rest of the country, was gearing up for local government elections. One of the contentious electoral issue was the lack of basic services for millions of residents in the informal urban areas and townships throughout the country.15

14 George Matlala and Shanti Aboobaker, "Why our townships are burning," IOL news, 17 November 2013. (http://www.iol.co.za/news/south-africa/why-our-townships-are-burning-1.1608166#.U7SHvvldWSo, 17 November 2013). Accessed 2 July 2014 15 I use township when discussing post-1994 urban areas and informal settlements, and to refer to those urban and peri-urban areas where settlement were both planned and unplanned. (See Images 2 and 3 on p. 23 and image 4 on page 29) These townships are mixed in character: houses that were approved and built according to government health standards and structures that serve as dwellings but were constructed using poor and unhealthy materials, such as wood, corrugated iron or plastic sheets. It is not uncommon for houses in the townships to be overcrowded and for some residents to have running water and electricity while others do not. The reasons for the uneven access to basic services are varied and complex. Researchers who provide a description and an analysis of state of housing, sanitation and water in some of the South African townships include the following: Patrick Bond, Cities of Gold, Townships of Coal: Essays on South Africa's New Urban Crisis (Trenton and Asmara: African World Press, Inc., 2000); J. Bryant, 'Towards Delivery and Dignity: Community Struggles from Kennedy Road', Journal of Asian and African Studies, 43, 1 (February 2008): 41-61; Ashwin Desai, We are the Poors: Community Struggles in Post-Apartheid South Africa (New York, Monthly Review Press, 2002); Alison Goebel, 'Sustainable Urban Development? Low-Cost Housing Challenges in South Africa', Habitat International, 31, 3-4 (September- December 2007): 291-302 and “‘Our Struggle is for the Full Loaf’: Protests, Social Welfare and Gendered Citizenship in South Africa.” Journal of Southern African Studies 37:2 5

While these service delivery problems included lack of clean water and access to electricity the issue that came to epitomize the crisis was the ‘open toilets’.16 The Cape Town Municipality, where this saga began, constructed toilets in a section of Khayelitsha, the largest township in the Western Cape

Province. About 50 of these toilets were 'unenclosed'. (Image 1) The opposition Democratic Alliance

(DA) controlled the Western Cape and the 'open toilet saga' soon became a political football between the

ANC and the DA.17 Service delivery problems were, however, a national phenomenon and not limited to one township in the Cape Province.18 There were about 1600 open toilets in Moqhaka Municipality in the

(2011): 369-388; David MacDonald, World City Syndrome: Neoliberalism and Inequality in Cape Town (New York, Routledge, 2007); Greg Ruiters, 'Social Control and Social Welfare under Neoliberalism in South African Cities: Contradictions in Free Basic Water Services', in M.J. Murray and G.A. Myers (eds.), Cities in Contemporary Africa (London, Palgrave Macmillan, 2007): 289-308. By 2011, the ANC was facing a ‘crisis of legitimacy’ with regard to service delivery failures and in addition to lack of infrastructure and poor service delivery, the deployment of comrades who did not have the requisite competencies for the job, was a contributing factor. See Alexius Amtaika, Local Government, p. 123 16 Mandy Rossouw, ‘The toilet election,’ in The Mail and Guardian, 13 May 2011 available at http://mg.co.za/article/2011-05-13-voting-gets-down-to-basics and accessed on 13 May 2011; Fienie Grobler and Molaole Montshe, ‘Open toilets ‘symbolise lack of delivery,’ in www.news24.com http://www.news24.com/SouthAfrica/Local-Elections-2011/Open-toilets-symbolise-lack-of-delivery- 20110513, accessed 13 May 2011. Erasmus, J. Case No. 213311/10, High Court of South Africa (Western Cape High Court, Cape Town). http://www.politicsweb.co.za/politicsweb/view/politicsweb/en/page71656?oid=233509&sn=Detail KDF, Khayelitsha houses 'more than a third of the population of Cape Town' (Cape Town population 2011 census: 3,740,026) http://www.khayelitshahumansettlement2013.co.za/?page_id=2 accessed 14 July 2013 The City of Cape Town, the local authority, opposed the action arguing, in part, that the 'original agreement was that after the local authority had provided sewerage infrastructure and toilets to each of the 1 300 informal dwellings… the occupants would enclose them' and it was this 50 that had failed to do so that sparked the outrage and legal action. http://www.witness.co.za/index.php?showcontent&global[_id]=61123 17 The ANC held the majority seats in the national assembly and therefore the national government since the first democratic elections in 1994. It also controlled the majority of the provincial legislatures with the exception of KZN and the Western Cape. In KZN, the IFP was in government between 1994 and 2004 when it lost the province to the ANC, which retained political control to this day. The Western Cape has proved more elusive for the NP and the NNP controlled the Western Cape from 1994 until 2004 when the ANC gained control only to lose that province to the Democratic Alliance in 2009. http://www.worldstatesmen.org/South_Africa_provinces.html 18 Steven Robins, ‘Toilets that became political dynamite,’ in The Cape Times available at http://www.iol.co.za/capetimes/toilets-that-became-political-dynamite-1.1089289#.UgusxNLqldc and accessed on June 27, 2011; Aziz Hartley and Babalo Ndenze, ‘Violence erupts over toilets,’ at www.iolnews.com, posted June 1, 2010 and accessed 13 May 2011; Chandré Prince, ‘ANC blasted over open toilets,’ available at http://www.timeslive.co.za/Politics/article1071147.ece/ANC-blasted-over-open- toilets accessed on September 14, 2011. In addition, the SAHRC found that the open toilets were a violation of “human dignity and privacy”’ and it called upon the central government to take ‘urgent measures’. SAHRC Report available at http://www.sahrc.org.za/home/21/files/FS%20Open%20Toilet%20Finding.pdf, accessed on 13 Mary 2011. This investigation and subsequent report arose out of a complaint to the SAHRC by Gareth Van Onselen, Executive Director of the Democratic Alliance in relation to residents of Rammulotsi Township in the Moqhaka Local 6

Free State, an ANC controlled province. The Msunduzi Municipality in KZN, comprising

Pietermaritzburg and the Greater Edendale, which included LHC controlled areas, had its own ‘toilet shame’.19 Since 2006, residents in the township of France had enclosed toilets with outlet pipes but these were not connected to the sewage system.20 In order to remedy this situation, the municipality provided the residents with portable toilets however; the latter were not being serviced regularly, if at all.

Accordingly, none of the sewage options available to or created for the residents of France were effective.

(Image 2) The 2010 local elections in fact highlighted a number of problems regarding health and local governance that were far more systemic in the post-1994 era.

In 2011 only 51.6 percent of the population in Msunduzi municipality who had flush toilets, were connected to the public sewage system.21 In addition, only 53.2 percent of residents had their refuse removed on a weekly basis either by the municipality or a private company.22 Even fewer households

(47.9%) had access to piped water inside their home and the number of people occupying informal dwellings, such as shacks, increased.23

Municipality, Free State Province. Incidentally, the SAHRC reported in 2013 that it was satisfied with the progress regarding its 2010 findings for the 1831 open toilets that were the subject of its 2010 investigation were all enclosed. See ‘SAHRC satisfied with progress made in enclosing toilets in Rammulotsi,’ at http://www.sahrc.org.za/home/index.php?ipkArticleID=204, accessed 15 April 2014 21 Bongani Hans, 'PMB's own toilets of shame,' in The Witness, at http://www.witness.co.za/index.php?showcontent&global[_id]=60796published on 14 May 2011 and accessed on 13 July 2012 19 Bongani Hans, 'PMB's own toilets of shame,' in The Witness, at http://www.witness.co.za/index.php?showcontent&global[_id]=60796published on 14 May 2011 and accessed on 13 July 2012 20 Ibid. http://www.witness.co.za/index.php?showcontent&global[_id]=60796. This area was previously part of the EDPHA under the LHC. 21 Statistics South Africa, http://www.statssa.gov.za/publications/P03014/P030142011.pdf. Population size: 618,536 and number of households: 163,993 22 Statistics South Africa, "Statistics by place," available at http://beta2.statssa.gov.za/?page_id=993&id=the- msunduzi-municipality and accessed on 1 July 2014, p. 174 23 Jackie Borel-Saladin and Ivan Turok, "Census 2011 reveals boom in backyard shacks," ( http://www.hsrc.ac.za/en/review/hsrc-review-may-2013/census-2011-reveals-boom-in-backyard-shacks) Accessed 4 July 2014 7

Image 1: Open Toilets, Khayelitsha24

Image 2: Unconnected water pipes for toilets in France, Msunduzi Municipality25

24 Ibid. (Mandy Rossouw, ‘The toilet election,’ in The Mail and Guardian, 13 May 2011 available at http://mg.co.za/article/2011-05-13-voting-gets-down-to-basics and accessed on 13 May 2011.) 8

Image 3: Example of post-1994 Housing Scheme as part of the ANC government's Reconstruction and Development Program26

Informal settlement residents across the country employed different mechanisms to try and force the government to deal with their service delivery problems. In certain instances, residents also engaged in protest action.27 The service delivery protests were not confined to selected provinces but occurred

25 Op Cit. fn.7 (Bongani Hans, 'PMB's own toilets of shame,' in The Witness, available at http://www.witness.co.za/index.php?showcontent&global[_id]=60796published and accessed on 13 July 2012 26 News24, "KZN premier: Audit of RDP housing needed," Available at http://www.news24.com/SouthAfrica/Politics/KZN-premier-Audit-of-RDP-housing-needed-20140220 (25June 2014) 27 Siyabulela Christopher Fobosi, "Service Delivery, Public Representation and Social Protests in East London, South Africa," BA (Hons) thesis, Rhodes University, October 2011. Available at http://www.academia.edu/2038790/Service_Delivery_Public_Representation_and_Social_Protests_in_East 9

throughout the country. According to Karamoko, Gauteng consistently had the largest number of service delivery protests.28 In 2007, there were 29 incidences, 35 in 2008 and 40 protests for the year 2010. In the

Western Cape there were only 13 protests in 2007 but in 2011, it had 23 incidents of service delivery protests. The number of protests for KZN remained below 10 except for 2008 and 2010, when those numbers increased to 12 and 11, respectively.29 In 2010 especially, residents felt that the government's spending priorities were not in line with people's needs. During June of that year, about 3000 people protested in Durban to denounce the government for the expenses related to hosting the Soccer World

Cup Competition when millions of South Africans were living in poverty.30 One of the organizers of this

Durban protest said, "if we have money for stadiums, we should not have any homeless people or people having to live in shacks".31

These protests came after urban residents exhausted official channels. The 1996 Constitution and the 1998 policies aimed at transforming the pre-1994 system of local government introduced formal structures through which residents could voice their opinions and discuss their grievances.32 These forums

_London_South_Africa, (1 July 2014); Laura Grant, "Research shows sharp increase in service delivery protests," Mail & Guardian, 12 February 2014, at http://mg.co.za/article/2014-02-12-research-shows- sharp-increase-in- service-delivery-protests (1 July 2014); Grant based her article on research by the Social Change Research Unit, University of Johannesburg, in particular "Service Delivery Protests: Findings from Quick Response Research in Four ‘Hotspots’ - Piet Retief, Thokoza and Diepsloot: Research Report," published in 2009 by Sinwell, L., Kirshner, J., Khumalo, K., Manda, O., Pfaffe, P., Phokela, C., Centre for Sociological Research, University of Johannesburg; Jelani Karamoko, "Community Protests in South Africa: Trends, Analysis and Explanations," 1st edition, 2010 by Jain Hirsh. http://www.mlgi.org.za/publications/publications-by-theme/local-government-in-southafrica/community- protests/Community_Protests_SA.pdf 28 The exception was 2011 when 18 ‘community protests were recorded in the Eastern Cape Province. Karamoko, p.18 29 There is no consensus regarding the figures regarding community protests with Alexander and van Holdt et. al. cite much higher numbers. See Peter Alexander, ‘Rebellion of the poor: South Africa’s service delivery protests – a preliminary analysis’, Review of African Political Economy, (2010): 37; pp. 25-40 and Karl van Holdt et. al, “The Smoke that Calls. Insurgent citizenship, collective violence and the struggle for a place in the new South Africa”, Johannesburg: Centre for the Study of Violence and reconciliation and the Society, Work and Development Institute; 2011 30 http://mg.co.za/article/2010-06-16-thousands-protest-against-world-cup-spending 31 Ibid. These service delivery protests also became progressively violent. See for example Karamoko, "Community Protests," Op. Cit. note 21. 32 See the Constitution of South Africa Act, 1996 as http://www.gov.za/documents/constitution/1996/a108- 96.pdf, accessed June 2011 and Jaap de Visser, Developmental Local Government: A Case Study of South Africa (Antwerpen: Intersentia, 2005) 10

included 'imbizos, local councils, and even the president's hotline and the public protector'.33 Fobosi argues that once people felt that their views were not taken seriously, they abandoned the government- sanctioned forums.34 Commenting on the function of the "community protests", respected academic and political scientist Steven Friedman, says that 'service delivery protests could not be premised on the idea of people wanting goods, but rather should be viewed as a manifestation of communities’ demands to be

“taken seriously” by the government'.35

The reasons for urban residents' continued dissatisfaction with municipal services, in spite of the government's development programs, are complex and some of these are beyond the scope of this research themes and questions.36 The one reason that is most relevant to this research is the lack of

33 Ibid. 34 Fobosi, "Service Delivery", 2011 and Laura Grant, Mail & Guardian, 2014 35 Ibid. Laura Grant, Mail & Guardian, 2014. Friedman is the director of the Centre for the Study of Democracy at the University of Johannesburg and Rhodes University in SA. http://www.ned.org/research/research-council/steven-friedman. In spite of the allegations of neglect and subsequent breakdown of communication within these consultative forums, the SA government adopted and implemented various plans to alleviate poverty, more generally but more specifically, to improve the provision of basic services to these urban areas. In KZN alone, it provided 141 949 households with piped (tap) water inside their dwelling compared to 69 759 in 1996. This intervention reduced the numbers of households who used communal stands (from 37 218 to 15 641 households) and those with no access to piped water (from 9 408 to 6 403 households). There were also improvements regarding refuse removal services: in 2011 in KZN, 89 970 households received services by the local authority or a private company compared to 63 751 in 1996. The Msunduzi Municipality also made significant strides regarding the provision of housing and access to more secure tenure. It provided an additional 38 000 households with formal housing in 2011: 82 691 in 1996 (to 120 847 in 2011). There was also an increase in the number of people who owned their homes and the number of rental properties / agreements almost doubled: 24 025 to 42 433. (See Statssa, 2011 KZN report) 36 A number of authors consider the post-1994 government's macro-economic approach as fundamental to the service delivery problems. See Patrick Bond, Ashwin Desai, Rebecca Pointer, Gregory Ruiters and David McDonald, for the effects of privatization of services and the hardship suffered by the poor, in particular Female- headed households. For an alternative perspective, see Alison Goebel, who does not dispute that poverty exists or that female-headed households suffer poverty disproportionately but, Goebel takes issue with authors who denouncing government's programs in support of the poor, especially female headed households. The government's failure to meet the peoples' political aspirations after 1994 is another reason for the dissatisfaction. See Fobosi, "Service Delivery,". Azwifaneli Managa, "Unfulfilled promises and their consequences: A reflection on local government performance and the critical issue of poor service delivery in South Africa," Africa Institute of South Africa Policy Brief no. 76, May 2012. Available at http://www.ai.org.za/wp- content/uploads/downloads/2012/05/No.-76.-Unfulfilled-promises-and-their- consequences.-A-reflection-on-localgovernment-performance-and-the-critical-issue-of-poor-service- delivery-in-South-Africa..pdf, accessed 1 July 2014; Jeremy Seekings and Nicoli Nattrass, "Class, Distribution and Redistribution in Post-Apartheid South Africa," Transformation, 50 (2002) 11

institutional capacity. The root causes of this lack of institutional capacity as a result of urban apartheid policies and economic policies of the post-1994 ANC government.37 I am not debating whether the origins of these institutional capacity problems are the result of apartheid or post-apartheid government policies but rather draw attention to the manifestations and consequences of problems associated with lack of institutional capacity. One of those problems is insufficient and/or inexperienced staff members.

This has a direct effect on local government performance by, for example, creating delays in service delivery and problems related to financial management.38 In March 2010 the KZN Provincial

Administration placed a number of municipalities in that province under administration including

Msunduzi Municipality.39 The Provincial Minister of co-operative Governance and Traditional Affairs cited the 'collapse of governance and financial mismanagement' for this decision. The auditor general reported that the council 'condoned irregular, fruitless and wasteful expenditure' and that the council failed to 'exercise an oversight role over the municipality's administration. In 2011 that the municipality

'owed over R400 million [$27 million] in outstanding payments was due in part to problems in its revenue

37 Regarding apartheid legacies and various aspects of post-1994 challenges for local governments, see: Chris Thornhill, "Local government after 15 years: Issues and challenges," in Review of provinces and local governments in South Africa: Constitutional foundations and practice edited by Bertus de Villiers. Available at http://www.kas.de/wf/doc/kas_15071-1522-2-30.pdf?090204111036 accessed on 5 July 2014. Thornhill documents how a pre-1994 system of local government that was 'fragmented' and consisted of an 'incoherent range of local authorities' affected post-1994 system of local government. (p.60). R. Cameron, The Democratization of South African local government: A tale of three cities. (Pretoria: J.L. van Schaik Academic Press, 1999); A. Zegeye and J Maxted, "Our Dream Deferred: The poor in South Africa (Pretoria: UNISA Press, 2003); E. Pieterse, "From Divided to Integrated City? Critical overview of the emerging metropolitan governance system in Cape Town," Urban Forum, Jan-Mar, Vol. 13, Issue 1, p. 3- 35 38 Department of Cooperative Government and Traditional Affairs, State of Local Government in South Africa. Pretoria: Government of South Africa, 2009 39 The Witness, "City's billing bungles," published online 1 July 2011, available at http://www.witness.co.za/index.php?showcontent&global%5B_id%5D=63701, accessed 1 Julu 2014. Sherlissa Peters, "Praise for turnaround at Msunduzi municipality," Daily News, Mary 31, 2012. Available at http://www.iol.co.za/dailynews/news/praise-for-turnaround-at-msunduzi-municipality-1.1308553#.U7Q4kfldWSo, accessed on 1 July 2014. IOL News, "Msunduzi placed under administration," March 11, 2010. Available at http://www.iol.co.za/news/politics/msunduzi-placed-under-administration- 1.476063#.U7Q-y_ldWSp and accessed on 1 July 2014. Inkatha Freedom Party Press Release, "South Africa: Placing Municipalities Under Administration," All Africa, at http://allafrica.com/stories/201302111672.html, accessed 1 July 2014; 12

collection system'.40 The consequences of being under administration were that the Mayor and the municipal executive were let go and by 2011, 38 officials including two deputy municipal managers, were facing disciplinary action. The Provincial Executive also appointed a team of management experts, with knowledge of local government, as well as two accountants and an auditor to run the municipality's affairs.

Msunduzi Municipality was definitely not the only local government that struggled with institutional capacity. In 2013 there were 16 municipalities under some form of administration for different reasons: ten municipalities failed to 'fulfill their obligations'; three were under 'financial administration'41 and a further three were under 'discretionary financial interventions'.42 Local governments across the country were 'in distress' and residents saw their 'municipalities as a locus of under- performance, corruption and inaccessibility'.43

This post-1994 situation regarding basic service, including the 2011 open-toilet controversy, resonated with the two main themes of this research project, i.e. the development of public health and the institutional arrangements to deliver basic, municipal services effectively. As mentioned above, this dissertation is about the use of a public health framework to address urban health and governance crises.

The rest of this chapter is an exposition of the two main themes: public health and the governance of black urban areas.

40 Daily Witness Roughly $27 million dollars at an exchange rate of 15c:$1 - Z-Rates Historical data at http://www.x-rates.com/average/?from=ZAR&to=USD&amount=1.00&year=2011, accessed on 1 July 2014. 41 www.news24.com available at http://www.news24.com/SouthAfrica/News/13-municipalities-under- administration-20131125 and assessed 15 June 2014 42 Ibid. Eight of the sixteen municipalities were in KwaZulu-Natal. 43 Op Cit. note 38 13

Public Health Defined

Public health is the protection and promotion of the health and welfare of its citizens by the state.44 Therefore, the three constituent features of public health are firstly health and welfare; secondly, the protection against disease and promotion of health and welfare; and finally, the central role of the state. Health is therefore an asset that should be promoted but especially protected from multiple threats such as disease, environmental factors and adverse consequences of social and economic policies.45

The first pillar of public health, health and welfare, includes both personal and environmental health. In addition, disease or the threats to health are considered as a potential harm to groups of people or entire communities and to social institutions.

Public health strategies are both curative and preventive and the overall aim is to ‘counteract’ those multiple threats in an effective manner. Typically, these interventions originate with the health bureaucracy or public health professionals and do not depend on the presence of pre-existing symptoms.

Thus, the target audience can also include those at risk of a disease but not yet infected. Consequently, public health interventions have been perceived as an imposition and limitation of individual autonomy.46

The justification for this approach is that public health privileges the protection of the health of others or, alternatively stated, public health prioritizes the prevention of harm.

Environmental health strategies range from controlling hazards in the physical environment such as the quality of air, food and water to regulating the built environment including housing and town

44 George Rosen, A History of public health. (New York: MD Publications, 1958). Michael Worboys, ‘Public and Environmental Health.’ In The Cambridge History of Science edited by Peter Bowler and john Pickstone, Vol. 6 (Cambridge University Press, 2008) at http://universitypublishingonline.org/cambridge/histories/author.jsf?name=Michael+Worboys (20 April 2011) 45 Frances Baum. The new Public Health. 2nd ed. Victoria, Australia and New York: Oxford University Press, 2002. Baum published the third edition of The New Public Health in 2008. It is a substantial text (680 pages) and while its geographic focus is primarily Australia, it is the introductory theoretical discussion that is most useful here. 46 Deborah Lupton and Alan Petersen. New public health: Health and self in the age of risk.(London and Thousand Oaks, California: Sage Publications, 1996) 14

planning. One public health strategy that emerges at the intersection of disease prevention and health promotion relates to social organization. As a result, public health strategies also focus on what the literature refers to as ‘unhealthy behaviors’.47 These kinds of public health interventions include prescribing the living arrangements of groups of individuals, e.g. maximum number of people who could sleep in one room as well as non-biomedical, or rather social interventions such as sports activities, libraries, and social clubs.

Where public health strategies are non-existent or ineffective, the likely disease-related event is an epidemic. Vaccination programs are therefore an important public health strategy to ensure individuals are immune to certain pathogens, such as influenza viruses. While epidemics are dramatic due to the large numbers of deaths in a short period of time, the prevention of pandemics is just as important. A disease is considered pandemic when it is in excess of normal expectancy and is spread over a whole geographical area, usually crossing national boundaries. Thus, in addition to personal preventive health interventions such as vaccination programs, the social and environmental aspects of public health are just as important.

Writing about the bubonic plague, for example, Howard Phillips says that the control of rodents and its fleas should be the focus of any intervention. The plague 'is primarily a disease of rodents, caused by the bacillus Uersinia pestis, which is most commonly spread from an infected to an uninfected rodent by fleas. Only if infected rodents die in an epizootic in such numbers as to deprive the now infected fleas of rodent hosts, do they seek out other mammals in the vicinity to bite in search of blood, thereby infecting them too.'48 This is where humans become the most likely hosts for infected fleas causing the spread of

47 Medterms available at http://www.medterms.com/script/meain/art.asp?articlekey=5120 and accessed on 13 November 2012 48 Phillips, p. 38 - 39 15

plague amongst people. 49 When public health measures are aimed at human behavior, it also targets pre- existing social formations such as families or households, workers in a factory, neighborhoods, regions or entire populations. For this reason, public health advocates argue that only the state has the resources, the infrastructure and presumably the legitimacy to design and respond to disease or threats to health that have large scale impacts.

The final component of public health, as defined above, is the central role of the state. The latter plays a role in determining public health priorities, the implementation of public health programs and more importantly, has both financial and human resources at its disposal for an effective health program.

This construction of public health is a twentieth century one and reflects the 'modern' understanding of public health.50 Worboys provides the following periodization for the development of public health: 1800 - 1890; 1890-1950; and 1950-2000.51 In spite of this periodization, the goal of public health was always to keep the towns healthy. Medical practitioners sought to address the 'effects of urbanization and industrialization in Europe and North America'.52 Initially, the environment was considered as the main vector of disease however, following industrialization and urbanization, overcrowding, pollution and environmental degradation of early industrial towns became more a prominent factor in the diagnosis of disease. The social conditions in the towns made people vulnerable to epidemics thus leading to high morbidity and mortality rates.

49 See Phillips' account of the introduction of the plague into Southern Africa in 1900 via British naval boats at Cape Town harbor and its subsequent spread to major towns especially on trains with the movement inland of goods and soldiers for SA was at the time involved in the British-South African war. Porter, The History of Public Health and the Modern State (Amsterdam: Rodopi, 1994) and quoted in Worboys, 'Public and Environmental Health,' p. 142 50 Worboys, Op. Cit., note 46 51 The third stage, not discussed here, saw a growing interest in global health espcielly with the establishment of the World Health Organization. The latter was not a new form of collaboration for the Sanitary Conference in 1866 was followed by the Office International d'Hygiène Publique in 1907 and both these were involved in coordinating information on the spread of epidemic diseases and international agreements for disease control. 52 Porter, The History of Public Health and the Modern State (Amsterdam: Rodopi, 1994) and quoted in Worboys, 'Public and Environmental Health,' p. 142 16

In spite of Worboys' periodization regarding the development of public health, multiple constructions of disease and its causal factors co-existed. As 'fevers were shown to spread from person to person by the transmission of pathogenic bacteria' health professionals began to attack pathogens directly but continued to target the modes of transmission, i.e. water supply, food, or insect vectors, as well.53

These different understandings of and approaches to public health were especially evident between 1890 and the 1950s - Worboys' second phase in the development of 'modern' public health. The focus shifted from the environment to people in the urban areas but also to entire nations. Public health measures, including environmental health ones such as clean water supplies, drainage, sewerage, pollution controls; were designed to improve the health of individuals. This new focus also inspired innovations such as the activated sludge treatment of sewage and the chlorination of water supplies. Worboys argues that the shift to people and nations introduced new ways of achieving and measuring domestic and personal hygiene.

The indoor flush toilet connected to sewer mains, he writes, continued the campaign against environmental pollution while requiring and symbolizing new standards of hygiene.54 One of the main indicators of the success of people-centered public health measures was a decrease in mortality rates.55 In addition, increased international economic competition and aggressive imperialism, gave rise to the notion of healthy nations.56 This approach to health 'crystallized around the issue of physical and racial degeneration, with new initiatives aiming to deliver medical services to improve the "quality" of people as individuals rather than to prevent disease in the community'. [My emphasis]

53 Op. Cit. note 46 54 Worboys, p. 150-151 55 Ibid. 56 New imperial and colonial projects after the 1890s, including notions of race and eugenics, placed greater emphasis on healthy bodies: Ryan Johnson and Amna Khalid, eds. Public Health in the British Empire: Intermediaries, Subordinates and the Practice of Public Health, 1850-1960. (NY: Routledge, 2011); Alison Bashford. Imperial Hygiene: A Critical History of Colonialism, Nationalism and Public Health. (Basingstoke: Palgrave Macmillan, 2004) 17

Public Health and Black Urban Areas Before 1930

Before the establishment of the union of SA in 1910, the territory consisted of four regions: the two Boer Republics, Transvaal and the Free State, and the two British colonies, the Cape and the Natal

Provinces. The earliest recorded public health measures were in the Cape Colony in 1723, almost 100 years after the Dutch established the Refreshment Station.57 These public health measures regulated the prevention of epidemic diseases and the strategies employed included the prohibition of the sale of meat from cattle that had died of disease.58 After the formation of the Union, the four new provinces retained legislative and executive control over certain aspects of governance and health care was one of those. As a result, the pre-1910 system remained in place except that the national government became responsible for protecting the new international borders. It was only in 1919 when the first Public Health Act was promulgated that SA had a health law with national application. This Act identified the major public health concerns as 'infectious, communicable diseases'59 and, in fact, went as far as to list a number of

‘formidable epidemic diseases’. The latter included the plague, Asiatic cholera, yellow fever and sleeping sickness, also known as human trypanosomiasis’.60 Other formidable epidemic diseases were small pox and venereal diseases, which included syphilis, gonorrhea, gonorrheal ophthalmia61, venereal warts and venereal granuloma.62

57 The Refreshment Station served sailors from the East to Europe or the Americas. This step in and of itself can be understood as a health intervention. 58 M. Hoffman et al., “From comprehensive medicine to public health at the University of Cape Town: A 40-year journey,” SAMJ, Vol. 102, No. 6 (2002) at www.samj.org.za/index.php/samj/article/view/5681/4220 accessed 23 March 2014 59 The 1919 Act also enumerated the kinds of services to be provided by the different levels of government and the inter-governmental fiscal relationships with regard to those services as well as fiscal responsibilities. 60 Part II chapter 2, PHA 1919 61 Gonorrheal ophthalmia is defined as acute purulent conjunctivitis due to gonococcal infection, see http://medical- dictionary.thefreedictionary.com/gonorrheal+ophthalmia. Accessed 23 May 2014. 62 Part IV chapters III; IV and VI, Public Health Act, 1919. For a detailed discussion of venereal diseases see Karen Jochelson, The Color of Disease: Syphilis and Racism in Sought Africa, 1880-1950(New York: Palgrave, 2001); Sidney Kark, ‘The social pathology of syphilis in Africans,’ SAMJ 23 (1949): 77-84; Alan Jeeves, ‘Public Health in the Era of South Africa’s Syphilis Epidemic of the 1930s and 1940s’, SAHJ, 45 (2001): 79-102 and Mark Hunter, 18

This Act also prescribed responses or interventions to be undertaken by the state and its officials.

It authorized the various MOH and local authority officials to enter any premises during reasonable times if any person suffered or was suspected of suffering from infectious diseases. Any dwelling where disease was present was usually disinfected and any infected person could be isolated and even subjected to hospitalization for appropriate treatment. 63 If an individual failed to take precautionary action while suffering from a notifiable infectious disease, he/she was personally liable and subject to the imposition of a fine.64

Local authorities had more expansive responsibilities including environmental health, i.e. the provision of electricity, water, ventilation, and sanitation, the provision of sound, wholesome and uncontaminated food supplies, town improvements, the abatement of nuisances, and the condemnation of dwellings likely to be injurious or dangerous to health.65 In order to fulfill this mandate, local governments were afforded the authority to enact and pursue a range of strategies. Accordingly, they could 'take all lawful, necessary and reasonable practicable measures'; including the criminalization of individual (mis)conduct, in order to achieve their goals of which prevention of disease was central.66 In addition, the local government shared responsibility for the control of infectious diseases with the national government and the nature of co-operation was primarily the establishment and maintenance of isolation hospitals. The central government adopted detailed regulations, amended when necessary, that governed the 'liberal subsidies' paid over to local authorities in order to run these hospitals. The main function of

Provincial governments was to oversee the work of the local authorities within their (provincial)

‘Beyond the male-migrant: South Africa’s long history of health geography and the contemporary AIDS pandemic,’ Health and Place 16 (2010): p. 26. 63 Sections 24 and 25, 1919 Public Health Act 64 Section 30, Public Health Act, 1919 65 Union Government of South Africa, Report of the National Health Services Commission, 1942 – 1944, UG30, 1944; p. 18 66 Section 111, Chapter VII 1919 PHA 19

boundaries. However, of the pre-1919 functions, which provincial authorities retained was the management and maintenance of general hospitals.67

The 1919 Public Health Act thus reflected the 'modern' understanding of public health as described by Worboys. SA’s public health regime also incorporated the international approaches to health and disease. It recognized the importance of targeting specific pathogens as well as environmental aspects that facilitated transmission of disease. In addition, the Act prescribed the role of government officials and the different levels of government. In spite of this seemingly comprehensive public health legislative framework, however, the SA health system experienced multiple weaknesses by the 1930s.

Tuberculosis (TB) and malnutrition-related diseases were the most common due to the legacies of the migrant labor system, overcrowding and poor living conditions in the cities. TB was rife among mineworkers and both the mining companies and the state implemented various steps to control it.68 The strategy of choice was to send miners back to the ‘reserves’ on the basis that this was their natural environment and that the conditions on the ‘reserves’ would help the miners recover. According to

Packard, this misconception of the ‘healthy reserve’ continued even when these reserves had already deteriorated and could no longer be considered healthy. One of the adverse results of the repatriation of male mineworkers with TB was that many women and children, who were on the periphery of capitalist expansion, became infected. Others, who were exposed to TB and did not work on the mines, were those in the urban slums and squatter areas – also experiencing overcrowded and unhygienic conditions.

Another health concern was sexually transmitted diseases. When men entered the migrant labour system, they lived in the urban areas for long periods separated from their wives. Consequently, some of

67 Ibid. and Gluckman report, p.18 68 H. Coovadia, and S. Benatar. A Century of Tuberculosis: South African Perspectives. Cape Town: Oxford University Press, 1991. Crush et al, South Africa’s labor empire. S. Marks. ‘The Silent Scourge? Silicosis, Respiratory Disease and Gold-Mining in South Africa’, Journal of Ethnic and Migration Studies, Vol. 32, No. 4, May 2006, pp. 569 – 589. R. Packard. White Plague, Black Labour: Tuberculosis and the Political Economy of Health and Disease in South Africa.(Berkeley and Los Angeles: University of California Press, 1989) 20

the men entered new relationships in the towns or bought sexual services from prostitutes and the women also formed temporary sexual relationships, which exposed them to infections.69

Other health consequences of urbanization and migration included depression, anxiety and feelings of bewitchment and alcoholism, which often resulted in physical violence between husbands and wives. Common physical and mental complaints in women were generalized body pains, headache, abdominal pains, diarrhea and marked fatigue, acute and chronic gynaecological disorders, stillbirths, depression and health complications following unsuccessful abortions.70 The organization and lack of access to health care services also contributed to the extent of disease. Most doctors worked in private practice and the cost posed a barrier to these services for the majority of the people. Mine hospitals, mission hospitals and charity organizations tried to meet the health and welfare demands that were not met by the state.71

The lack of services was not limited to personal health care only but also in relation to environmental health services. The 1923 Native (Urban Areas) Act provided the Native Affairs

Department (NAD) with an expanded role due to the new demands by the policy of segregation.72

According to Dubow, the NAD was necessary in order to 'establish the conditions for the long-term reproduction of capitalist relations' but, it also had a specific function in the urban areas, i.e. to 'ameliorate the harsh conditions occasioned by South Africa's process of industrialization, and to prevent the

69 See Jochelson, op cit. note 20. Catherine Coquery-Vidrovitch, African Women. (Boulder, Colorado: Westview Press, 1997); Alan Jeeves, 70 Helen Bradford, ‘Herbs, Knives and Plastic: 150 Years of Abortion in South Africa’ in Science, Medicine and Cultural Imperialism, eds. Teresa Meade and Mark Walker, New York: St. Martin Press, 1991, pp. 120 – 147; Klausen, Race, maternity, 2005; Sydney Kark and Guy Steuart (eds.), A Practice of Social Medicine: A South African Team’s Experience in Different South African Communities. Edinburgh: E & S Livingstone, 1962, p. 298 and Jonathan Crush and C. Amber, eds. Liquor and labor in Southern Africa, Athens, Ohio: Ohio University Press, 1992 71 Anne Digby, Diversity and Division in Medicine: Health Care in South Africa from the 1800s (Oxford and Berne: Peter Lang, 2006) 72 Saul Dubow, "Holding 'a just balance between white and black': the native affairs department in South Africa c.1920-33," JSAS, 12: 2, 217-239. 21

unrestrained formation of an African proletariat'.73 As part of its 'administration of Africans in the urban areas, the NAD worked with municipalities to provide accommodation and basic services such as housing and clean water, to areas officially occupied by black people within the boundaries of the town.

While these municipalities provided services to white residents, they provided no or little services to residents of slum or informal housing areas. In addition, national and local governments and employers could not keep up with the accommodation needs of black people leaving them no option but to occupy backyard shacks in locations or in the inner city. According to official estimates, at least 58 per cent of the urban African population lived as squatters who had no access to approved, serviced accommodation.74

Municipal Managers, who were on the frontlines, asked the national government to grant them greater powers to deal with the public health demands in their areas. Dr. Porter, the first full time Medical

Officer of Johannesburg, articulated the experiences of many municipal managers at the 1918 Public

Health Conference in Bloemfontein, a ‘national consultative conference on Public Health’.75 These men demanded an expanded public health mandate for local authorities or the power to make regulations on matters from housing and water, to infectious diseases’.76 For a long time, neither of these demands were met.

73 Ibid. 74 There is also evidence that some people chose these precarious living conditions for it was close to their place of employment, which meant that they did not have to spend extra money on transport to and from the pass laws and the 1923 Act that afforded black people temporary residential rights in white urban areas and only if their labor was required in that specific urban area, see Posel’s Making of Apartheid and Nicoli Nattrass, ‘Economic growth and Transformation in the 1940s’ in South Africa’s 1940: A world of Possibilities, eds. Saul Dubow and Alan Jeeves (Cape Town: Double Storey, 2005), p. 26. Ellen Hellmann’s Rooiyard, a sociological survey of an urban native slum yard (Cape Town Cape Town: Oxford 75 Susan Parnell ‘Creating racial privilege: the origins of South Africa public health and town planning legislation’, JSAS, 19:3, 471-488 76 Ibid. p.482 22

Administration of Black Urban Areas

The issues of governance and direct access to political institutions were central to the provision of and struggle for housing and sanitary services. Early urban settlements originated when people congregated around the political centers of African chiefdoms or the towns established by European colonizers. The Cape and Natal were more urbanized than the Free State and the Transvaal, which had very few urban centers that could even qualify as towns as many of their administrative centers consisted of about half a dozen houses. When the British took over the Cape in 1795 from the Dutch settlers, there were 14 urban centers and this number increased to 103 in 1870.77

By mid-twentieth century, Natal had 22 towns, villages and hamlets. PMB, the administrative capital, was established in 1838. Ulundi, now in Northern Natal, was a large Zulu royal village established in the 1870s. Other towns that were established during the second half of the nineteenth century include: Bulwer, 1889; New Hanover, 1894; Albert Falls 1899; and Camperdown 1895.78 While almost no new towns were founded after 1910, the pre- existing hamlets and villages were formally incorporated as towns: Mooi River; Greytown, York, Dalton, New Hanover, Richmond and Ixopo,

Margate, Verulam, Stanger and Umkomaas.79

The government also established urban locations for black people.80 In Cape Town, Ndabeni was established in 1901, Langa was officially completed in 1927 and Nyanga in 1948.81 Soweto, in

Johannesburg, started as Kliptown in 1903 and was formally established in the 1930s as increasing

77 Hari Mäki, Water, Sanitation and Health: The Development of the Environmental Services in Four South African Cities, 1840-1920 (Kehrä Media, 2008) 78 Ibid., p.20 79 Ibid., p.24. The LHC worked in and around at least four of these areas, i.e. Dalton, New Hanover, Ixopo and Verulam. 80 There are generally referred to as formal while the shacks that people set up themselves in land occupied, without government approval or houses set up without government approval are referred to as informal. 81 http://www.sahistory.org.za/place/langa-township, and http://www.sahistory.org.za/topic/cape-town- timeline- 1300-1997?page=5 (12 March 2014) 23

numbers of black people were moved into that area. The township of New Brighton was established in

1903, only a few kilometers outside of Port Elizabeth, a major white town in the Eastern Cape Province.82

Edendale and Clermont were two of the largest black urban areas in Natal. Edendale was a freehold

African settlement established in 1851 as a Wesleyan mission under the leadership of James Allison.83

The latter bought the farm Welverdient from Andries Pretorius and settled on this land with 450 amakholwa, educated African Christian converts. The community sub-divided the entire farm into residential and agricultural areas as well as a Commonage. The demographics and relationship to the land changed during the early years of the twentieth century as some of the original land owners moved to other urban centres for work and new migrants, including Indians and whites, bought plots or established new informal settlements on the boundaries of the original Edendale farm. By the early 1930s, there were

6, 779 Africans in Edendale; 1, 038 Indians; 223 Whites and 133 Coloureds.84

Edendale and its surrounding areas experienced different forms of governance structures before the LHC took control of the area. Those areas between Edendale and PMB were considered informal or slum areas, occupied illegally by people who moved to the city. These areas were the responsibility of the

NAD. (See Map 6) The original Edendale community, however, had an appointed headman and a council of elders but both were 'subject to the patriarchal authority of Allison. He was not only pastor, father and

82 Before 1994, the Eastern and Western Cape Provinces constituted the Cape Province. 83 Natal University Economics report, Nuttall, Timothy, A. “Collaboration and Conflicting Interests in a Black Community: Responses to the Introduction of Urban Local Government in Edendale, Natal, 1941 – 1944.” BA Hons. Thesis (Oxford: University of Oxford, 1983): p.34; Sheila Meintjes, "Edendale, 1851-1930. Farmers to Townspeople, Market to Labour Reserve." In Pietermartizburg, 1838-1988. A New Portrait of an African City edited by John Laband and Robert Haswell at http://www.pmbhistory.co.za/portal/witnesshistory/custom_modules/Supplement_PDFs/Edendale.pdf (12 June 2011): p.66-69 84 LHC First Annual Report, 1941-1943, Appendix A, p.1. Areas that were included in this census were Edendale farm, Macibisi, Sutherlands (Plessislaer), and parts of Slangspruit; all of which were combined and became the EDPHA. Initially, there were 99 kholwa household heads whose names appeared on the Edendale Trust Deed for these African men were also partners and foundation members of the Edendale settlement. See the Natal Regional Survey and Report No.3: Experiment at Edendale by the Durban Economic Research Committee. (Pietermaritzburg: University of Natal Press, 1953), p. 3 24

guardian, but also the legal owner of the farm'.85 Meintjes notes that Allison's rights over the property and the people were similar to that of a feudal lord or a chief. When in 1858 the land was paid off and individual (African) shareholders acquired freehold title of their plots, the latter began to play a more authoritative role in the management of Edendale. They felt that Allison deceived them and as a result, he was forced to leave Edendale. The need for a 'missionary presence' and white leadership did not disappear with Allison's departure and the kholwa requested the Wesleyan Missionary Society to take them on.

According to Meintjes, a missionary presence would provide spiritual guidance and 'act as an intermediary between village interests and the colonial government'86 The Edendale Trust was established as part of this arrangement with the Wesleyan Missionaries. The existing local government for Edendale, i.e. the headman and the council of elders were replaced with a Trust. The first Trustees were Revd. H.

Pearse, Theophilus Shepstone and R.J. Mann. According to the Deed of Trust, the first trustee had to be the resident Wesleyan missionary at Edendale; the second was to be elected by a ballot of lot-holders at a general meeting thus giving those residents the right to participate in their governance institution. These two trustees then nominated the third one, giving the people of Edendale a further, albeit indirect opportunity to participate in their own governance. One of the problems was that the Chief's prescribed tasks were already executed by the Trustees except that the former was also tasked with administering

African customary law in spite of the fact that many of the Edendale kholwa 'had been exempted from

Natal's code of Native law'.87

The Clermont PHA (Map no.7), was originally known as Clermont Township. The residents were predominantly African and while there were official expectations that this private township was going to

85 Meintjes, "Edendale", p.66. Individual kholwa bought plots from the mission with the understanding that they would pay off this debt over time. 86 Ibid. See also Norman Etherington as an examples of the role of missionaries vis-à-vis the colonial government and the Africans, respectively: "African Economic Experiments in Colonial Natal 1845-1880," African Economic History, 5 (1978): 1-15 87 Meintjes, Op. Cit. Note 80 25

be developed into a 'native township' in terms of the Private Township and Town Planning Ordinance of

1934; this development did not take place.88 The company that owned Clermont was granted an exemption under the 1934 Ordinance and as a result, the Native Affairs Department had no control over the development including the sale of houses and subdivision of plots in Clermont. The 1937 amendment of the 1913 Land Act was an attempt to remedy this lack of official government control over Clermont. In terms of that amendment, the 'consent of the Governor-General' was required to validate all property sales and 'as from 1 January 1938 the native Affairs Department in effect laid an embargo on such sales until such time as the township had been brought under proper control'.89

Until 1998, the nature and scope of urban local governance was determined by the race of the residents.90 The larger white towns were constituted as municipalities with their own elected representatives and an administration that implemented the municipal mandate. These elected councils had full executive and administrative powers over the area that it governed. The costs of basic services were covered by the financial contributions by the national government and rates paid by residents.9197 In contrast, black urban areas did not have their own municipality or local government. Instead, white municipalities and Advisory Boards (ABs) with non-executive powers were responsible for services and management of black urban areas. The 1923 Native (Urban Areas Act) institutionalized the AB system as the preferred form of governance for black urban areas. This Act regulated urban locations including provisions pertaining to the establishment and general functions of the ABs modeled on pre-existing

Advisory Councils.92 ABs had no executive and legislative powers and served as forums where

88 Ibid. 89 Ibid. 90 Chris Thornhill, "Local government after 15 years: Issues and challenges," in Review of provinces and local governments in South Africa: Constitutional foundations and practice edited by Bertus de Villiers. Available at http://www.kas.de/wf/doc/kas_15071-1522-2-30.pdf?090204111036 accessed on 5 July 2014 91 Cloete, Sentrale, provinsiale, en munisipale instellings, (Pretoria: van Schaik, 1964) Op Cit. Note. 1 92 An institutional history of these Boards can be found here: Simon Bekker and Richard Humphries, From Control to Confusion: The Changing Role of Administration Board in South Africa. PMB: Shuter and Shooter (Pty) Ltd., 26

representatives of the locations communicated the needs and demands of the location residents to the white municipality responsible for that location. Until 1998, these ABs were the only official political forum.

The fact that the majority of black people did not have the right to vote also informed this nature of local governance. Before 1948, the vast majority of black people did not enjoy the vote or any direct political representation. The qualified vote afforded to black men that existed in the Natal and the Cape did not extent to the mainstream political institutions such as the national assembly and certainly not to local authorities. Even the members of the ABs were elected and appointed, thus imposing further restrictions on the right to vote and representation of Africans. However, in spite of these limitations, the

Advisory Boards were the only forum available to residents of urban areas through which to channel their housing and sanitary demands and needs.

The literature on ABs is virtually unanimous in its condemnation of these institutions and equally condemning of the Africans who served on the ABs. Cobley and Gary Baines93 provided case studies on urban location on the Witwatersrand and in East London, respectively, demonstrating how African nationalist and members of the Communist Party used the AB system to channel their demands and garner popular support for their struggle. These authors argue that while the legislation prescribed the functions and the parameters of these ABs, urban residents used them in ways that the drafters did not anticipate in order to advance their own political agendas. This approach to the ABs informed the analysis of the LHC’s system of ABs in this dissertation.

1985 and Alan Gregory Cobley, Class and Consciousness: The Black Petty Bourgeoisie in SA, 1924-1950, New York: Greenwood Press, 1990 93 Gary Baines, “The Contradictions of Community Politics: The African Petty Bourgeoisie and the New Brighton Advisory Board, c. 1937 – 1952.” Journal of African History 35:1 (1994): 79-97 and 'The New Brighton Advisory Board, c.1923-1952: Its Legitimacy and Legacy', Paper presented at the Fifth Triennial History Workshop of the University of the Witwatersrand, Johannesburg, February 1990, available at wiredspace.wits.ac.za/bitstream/handle/10539/7609/HWS-10.pdf?sequence=1 and accessed on 12 June 2012 27

Research questions, Significance and Chapter Outlines

My research was, as noted above, an investigation into the use of a public health framework to define and resolve the health crises in black urban areas, specifically the institutional arrangements, functions and political implications of the LHC. This is an approach to the study of health and health institutions initiated by Howard Phillips in his examination of the health interventions by the

Bloemfontein Municipality during the 1917 Influenza epidemic. This research asked what operational mechanisms the LHC adopted in order to implement a public health mandate. In addition, I analyzed the ways in which racial politics, especially the question of direct political representation, influenced

Africans’ response to the LHC and affected the functions of the LHC.

Public health policy was determined at a national level and as a result, my research examined the developments within the UDPH. The LHC was only established in the province of Natal, the geographic scope of my research also included that province. With regard to the work of the LHC, this research focused primarily on the EDPHA and the Clermont PHA, the two largest PHAs.

Jo Beall argues that gender is central to an analysis of local government.94 The premise for this conclusion is that women are often the ones responsible for the needs of their households. In that context, local government services, if provided effectively and efficiently, have the ability to make a positive impact on their lives. While this dissertation includes examples of LHC services to women and how individual women responded to the LHC; it does not include an extensive gender analysis of the LHC.

94 J. Beall,. "Decentralizing Government and Decentering Gender: Lessons from Local Government Reform in South Africa." Politics and Society 33:2 (June 2005): 253-273 and Beall. and A. Todes. “Gender and Integrated Area Development Projects: Lessons from Cato Manor, Durban." Cities 21:4 (2004): 301–10 28

The time frame for this research was 1930 to 1959. During the 1930s the UDPH officials became actively involved in the search for a solution to the housing and sanitation problems in the urban areas. In

1948, there was a change in the political landscape when the National Party captured the government and started implementing apartheid. 1950 saw the introduction of the urban segregation measures that directly affected the work of the LHC. Hendrik Verwoerd, known as the 'father of apartheid' was one of the leading Afrikaners on apartheid theory and policy. He is also credited for the Group Areas Act and a complete separation of the races. In a re-assessment of Afrikaner leaders under apartheid, Hermann

Giliomee argues that early in the 1950s and after the promulgation of the GAA in 1950, Verwoerd still

'advocated self-government for Africans in their "own areas"' within a unified SA. However, in 1959 the principles of Grand Apartheid and the idea of Independent Homelands, gained more support.95

With these goals and parameters in mind, Chapter Two of this dissertation commences with review of the literature on public health and on the administration of black urban areas. This chapter highlights the authors who explored similar themes, identifies gaps in the literature and comments on how this research relates to that body of work.

Chapter Three focuses on the ways in which UDPH officials framed the urban public health crisis in Natal during the 1930s and the various solutions that preceded the establishment of the LHC. The

Inter-departmental Committee to consider the Administration of Areas which are becoming Urbanised but which are not under Local Government Control (hereafter the Thornton Committee or Thornton

95 The Last Afrikaner Leaders: A Supreme Test of Power. (Cape Town: Tafelberg, 2012). While Grand apartheid is used to refer to significant segregation such as the Homelands and Bantustans, petty apartheid is used to those apartheid laws that were aimed at controlling the daily lives of black and white people. The former were, for example, required to carry passbook indicating that they were allowed in a specific urban centre and endured unreasonable curfews while in the city. Segregation was implemented in relation to beaches, cinema, park benches, and public toilets and was allocated different entrances at government buildings such as clinics and the Post Office. The infamous "whites only" and "blacks only" signs were used to signposts. 29

Report) in 1938-9 is particularly significant. 96 In addition to identifying the critical health care questions that faced the public health advocates; this research also examined how the health reform undertaken by the UDPH influenced the construction of the LHC. There were concerns about the SA health system outside of the UDPH and consequently, Chapter Three discusses the work of the UDPH in a broader context, for example, the ideas and solutions entertained by the national and provincial governments as well as the medical profession. The relevant time period for this is the 1930s and early 1940s.

Chapter Four examines the institutional arrangements of the LHC; its interpretation of its mandate, functions and personnel, i.e. the executive and administrative structures and the kinds of staff or professionals employed by the LHC. This chapter includes an examination of the relationship between the

LHC and its PHAs, specifically the method of governing the PHAs; the range of activities that the LHC undertook in the PHAs; and finally the racial dimensions of the work of the LHC. The time frame for this exposition of the LHC is 1940 – 1959; where relevant I point out how things developed after 1959.

Chapter Five offers a more critical analysis of the LHC and focuses on the way in which PHA residents responded to the imposition of the LHC. For many black people, the lack of political representation was an important issue even before 1948 when the NP introduced apartheid. This chapter asks how the LHC dealt with the question of black political representation. It also explores the ways in which the LHC responded to the consolidation of apartheid. Given its implications regarding political representation, Chapter Five also examined whether the LHC transformed this AB system. Finally, this chapter deals with a section of the research that explored the political spaces that the LHC and its AB system opened up for PHA residents especially Edendale and Clermont.

96 Union Government of South Africa, U.G. No. 8, 1940 30

The bulk of the primary sources for this research project were the LHC minutes, memoranda, regulations, and communications with other government departments and PHA residents. These are the only records available to examine the LHC especially the work of the LHC in the PHAs as there limited records concerning health and welfare statistics in black urban areas. I used secondary sources in order to begin a critique of the LHC. The 1939 Thornton Committee Report is an important government document as it contains the UPDH's construction of the urban crises. Other primary or contemporaneous sources that I used in this research include Debates of the National Assembly, commentaries by the South

African Institute of Race Relations (SAIRR), debates and opinions of doctors in South African Medical

Journal (SAMJ) and finally, local newspapers and interviews with people who were residents of Edendale while it was a PHA. During 2003, Sinomlando Oral History Project at the Pietermaritzburg campus of the

University of Natal started documenting peoples' experiences of life in Edendale before 1994.97 Some of the interviewees lived in Edendale during the time of the LHC and had vivid memories of its activities.

One of the prominent members of Edendale, Henry Selby Msimang (1886-1982), also recorded his experiences with the LHC. 98 Msimang served on the EDPHA Advisory Board and was a prominent politician and activist. Recognizing the pitfalls of autobiographies and problems with recounting events that the author participated in, Msimang's autobiography and reflections on the LHC are valuable contributions that informed my critique of the LHC. 99

97 Sinomlando Centre for Oral History at http://sinomlando.ukzn.ac.za/ 98 Msimang was Secretary of the All Africa Convention during the 1930s (All Africa Convention Files, 1936-1940, Pb11.1.4); participated in a number of meetings of the Location Advisory Boards Congress (B4.2.2: Correspondence between the Congress and the SAIRR); member of the Native Representative Council (NRC) (E3, Native Representative Council, 1940-1951) 99 Jane Starfield, "'Not quite history': The Autobiographies of H. Selby Msimang and R.V. Selope Thelma and the writing of South African history," Social Dynamics: A journal of African studies, Vol. 14, Issue 2 (1988): 16-35 31

Chapter 2: A History of Public Health and Governance of Black Urban Areas

This chapter provides an overview of the literature regarding the development of the theory and practice of public health and of the governance of SA’s black urban areas. The goal of this chapter is to contextualize the research themes and questions. This review primarily sought to examine how public health is included in the existing historiography on health and urban local government.

Public Health

Anne Digby and Julie Parle with Vanessa Noble wrote the most recent overviews of the history of medicine in SA.100 These are excellent, accessible journal articles that document major contributors in the field and gaps in the literature. More importantly, Parle and Noble, in their summary of a health and healing in Southern Africa conference, list a number of important areas for future research identified by conference delegates.101 Both of these articles inform the discussions in the section on public health. The history of public health in SA is not contained in one single text but various authors in articles and manuscripts on health and disease refers to or discusses different elements of public health The major gap however, relates to the role of local authorities with regard to public health.

In one of the earliest attempts to document the history of health and disease in SA, M Gelfand published South Africa, Its Medical History, 1652-1898 - A Medical and Social Study, a manuscript that

100 Anne Digby, "The Medical history of South Africa: An Overview," History Compass, (2007), 6/5, p. 1195; Julie Parle and Vanessa Noble. "New Directions and Challenges in Histories of Health, Healing and Medicine in South Africa," Medical History, Vol. 58, Issue 2 (April 2014): 147-165 101 Ibid. 32

was prepared by Percy Ward Laidler who died before its completion.102 One of the goals of Gelfand's

Medical History was to expand on Edmund Burrows' 1958 A History of Medicine in South Africa up to the end of the Nineteenth Century.103 This latter publication, Gelfand thought, had significant omissions and his own Medical Histories 'contained much that ought still to be revealed'.104 Whereas Burrows focused almost solely on biomedical aspects of disease, Gelfand included non- biomedical aspects including the role of government in health care. He referenced, for example, the early introduction of natural, or non-biomedical, remedies at the Cape by Portuguese and Dutch travelers during the fifteenth and the sixteenth centuries, respectively.105 In addition, he included the ways in which economic and political developments affected health and disease outcomes during the nineteenth century.

Gelfand's Medical Histories has been criticized for being a celebratory history of medical men, specifically for emphasizing the careers, practices and achievements of white male doctors.106 Gelfand also excluded African or traditional medicine, perhaps deliberately given his own research history. Prior to producing History of Medicine, he published work on Zimbabwe, then Rhodesia. In 1957 for example,

Gelfand published Livingstone, the doctor: his travels: a study in medical history and in 1961, Northern

Rhodesia in the days of the charter: a medical and social study, 1878 - 1924.107 He had also researched

Shona culture and traditions108 and was clearly not ignorant of African culture and society.

What Gelfand misses then is how the practices of indigenous medicine and of the environment demonstrate a completely different approach to public health. Indigenous medicine or traditional healing

102 Cape Town: Struik, 1971. See review in The Lancet, November 18, 1972, p. 1070 103 Cape Town: A. A. Balkema, 1958. 104 Laidler and Gelfand, Medical History, p. xi 105 Ibid. p. 10 106 Digby, Op. Cit., Note 96, p. 1195 107 Oxford: Blackwell, 1957 and Oxford: Basil Blackwell, 1961. 108 African background: the traditional culture of the Shona-speaking people. Cape Town: Juta, 1965 and African crucible: an ethico-religious study with special reference to the Shona-speaking people. Cape Town: Juta, 1968 33

practices is one of the few areas that adopt a more holistic approach to health, healing and healing practices. Scholars such as A.T. Bryant and Harriet Ngubane conducted ethnographic and anthropological studies to describe and analyse traditional medicine. Bryant was a missionary when he began his research into Zulu histories in Natal and he later became one of the first researchers in the Bantu studies department at the University of the Witwatersrand.109 In 1966, a few years before Gelfand published

Medical Histories, Bryant published Zulu Medicine and Medicine- Men.110 The book sought to document forms of medical practice among and by the Zulus. Bryant's approach to the topic was evident from his very first sentence: 'Although the Zulu native is sadly lacking in the equipment requisite for the civilised life, he is quite astonishingly learned in the domain of his own environment.'111 While Bryant did not consider Africans as 'civilized' as whites, he did argue that the 'average Zulu can boast of a larger share of pure scientific knowledge than the average European'.112 This descriptive account of Zulu medicine and in particular the training and functions of the Inyanga was an important exposition of indigenous medical practice in Natal. Bryant's contributions served as a source of information on Zulu society and medicine for subsequent scholars.

Unlike Bryant, Ngubane was a Zulu and had an insider's perspective on that society and its healing practices. It was this insider knowledge that she brought to her study entitled Body and mind in

Zulu medicine: An ethnography of health and disease in Nyuswa-Zulu thought and practice. Ngubane used the medical system as a lens through which to describe and understand the community on the

Nyuswa Reserve in the Eastern Cape. She included in her study an examination of people's understanding

109 Carolyn Hamilton. Terrific Majesty: The Powers of Shaka Zulu and the Limits of Historical Invention. (Cambridge, Mass.: Harvard University Press, 1998) 110 Cape Town: C.Struik, 1966. Bryant published at least four books before this history of medicine, which attests to his experience in this field. The books are: Olden Times in Zululand and Natal, 1929; The Zulu People, as they were before the White Men came, 1949 Bantu Origins, 1963 and 1965; and History of the Zulu and Neighbouring Tribes, 1964. This was in addition to his three books on Zulu history. 111 Bryant, Zulu Medicine, p.7 112 Ibid. 34

of the natural causes of disease, the role of ancestors in disease, the role of diviners or healers, and the role of pollution. Both Bryant and Ngubane's accounts of indigenous healing systems considered disease and health status as conditions that were integral to the broader social environment. In doing so, they both conceived of health and disease as integral to social well-being and that the definition of health was sufficiently broad so as to incorporate environmental and social factors.

More recently, Anne Digby and Karen Flint have added a new perspective on indigenous healing practices.113 While their historical case studies were also geographically located in the Eastern Cape (as

Ngubane) and Natal (as Bryant), these accounts also addressed the question of hybridity in health care practices. Digby attempted to bring a more nuanced perspective to the history of medicine so as to write against the existing history of 'triumphal careers of white biomedical doctors'.114 She focuses on the

'diversity' within healing practices by including both "western" and indigenous healers as well as the complex routes that patients take in order to access health care. The "western" practitioners include physicians, nurses, colonial medical officers and public health officials, private practitioners and secular nurses. This expanded category of health practitioners was certainly an important contribution in light of earlier publications that limited the "practitioner" to physicians, who were predominantly male. The inclusion of medical practitioners other than doctors is a more realistic reflection of the range of services provided by a diverse team of health practitioners. With regard to indigenous healers, Diversity and

Division not only describes their practices but also the consequences for their practice as a result of colonial contact. She argues that indigenous healers (and their patients) were resilient and continuously sought ways to adapt to the challenges brought by colonial rule. For example, Part 4 explores the co-

113 Anne Digby, Diversity and Division in Medicine (2007) and Karen Flint produced Healing Traditions. African Medicine, Cultural Exchange, and Competition in South Africa, 1820 – 1948 (Durban: University of KwaZulu-Natal Press, 2008) 114 This explains, for example, why she criticised Burrows and Laidler and Gelfand for adopting a Eurocentric perspective of SA's medical history. 35

existence of "western" and indigenous medicine in more detail highlighting the work of individual traditional diviners. Digby also illustrates ways in which 'western' and indigenous healing practices evolved but also overlapped at different times. She contends that these challenges strengthened medical competition by providing patients with a choice regarding the kind of healer or health care provider they would seek out. Digby attempts to treat both the indigenous and the "western" systems of healing as equal and 'places [the indigenous] healers on an equal footing with biomedical practitioners and does not privilege western knowledge systems over indigenous ones'.115

In spite of its positive contribution, Diversity and Division is not without problems, especially in its treatment of gender. Digby made an important methodological and substantive contribution by including women's role in the development of western / biomedicine. However, the colonial context which frames Digby's project naturally highlights ethnicity as opposed to other social identities. This colonial and ethnic frame also shaped Digby's approach to gender for she includes women medical professionals and women's contribution to the development of medicine but not African female healers.116

The notion of diversity, additionally, does not extend to institutions, such as local governments and does not take into account the public health aspects of health and healing.

Digy's title implies that the book focuses on South Africa as a whole while it is in fact limited to the Northern Cape. Theresa Barnes has provided the sharpest criticism of Digby’s geographical overreach calling it “an ambitious but unsatisfying attempt as a grand, complex historical synthesis of South African cultural practice".117 Barnes argued that the ‘central failure of the book lies in its inability to adequately historicize non- Western medical practice in the South African context’. In addition, she accused Digby of

115 Simone Horwitz, review of Diversity and Division in Medicine: Health Care in South Africa from the 1800s by Anne Digby, JSAS, Vol. 35, Issue 3, (2009): 531 116 Parts of chapters five and six of Diversity and Division. 117 Teresa Barnes, Review of The History of South African Health Care, in the Journal of African History (November 2009), 50 (3), pg. 449-451 36

looking at missionary medicine and ‘western’ medicine as two separate systems; of omitting the voices of mission station tenants and African patients, particularly their experience of missionary health system; of disconnecting the ‘civilizing mission’ of the missionary health system from the colonial project; and finally that conventional ‘western’ medicine is treated much better. In the final analysis, Barnes urges readers to avoid Digby’s Diversity and Division in Medicine for they ‘would be better served by relying on existing monographs and articles on South African medical history. ‘The best use of this weighty, uneven book might be as an example of the difficulties of writing comprehensive national cultural histories with an incomplete set of tools.’118 In spite of Barnes' rather harsh criticism of Digby's Diversity and Division, the book brings an important perspective to the history of medicine in SA. A focus on diversity, however limited in scope, is in and of itself an important contribution Further, by focusing on developments in the Northern Cape, Digby moves away from the tri-city focus (Cape Town,

Johannesburg and Durban) by incorporating an area of SA that is, as she rightly points out, largely absent from the historiography.

The omissions regarding public health, diversity and indigenous medicine were seriously addressed by Karen Flint. She illustrates that ever prior to colonial conquest different healing traditions coexisted in SA. In turn this led practitioners to borrow from each other in order to enhance their own appeal as healers.119 Flint follows a long tradition of engagement with indigenous medicine including authors such as Jean and John Comaroff and Stanley Yoder’s edited collection of the proceedings of

African Health and Healing Systems.120 With reference to Natal, the main focus of the book, Flint

118 Barnes, 'Review,' p. 451 119 Flint, Healing Traditions: African Medicine, Cultural Exchanges, and Competition in South Africa, 1820 – 1948. (Durban: University of KwaZulu-Natal Press, 2008) 120 Yoder, S. ed., African Health and Healing Systems: Proceedings of a Symposium (Los Angeles, California: Crossroads Press, 1982). This collection of papers from the symposium with the same title, responded to the ‘increasing attention to the study of the relationship between medicine, culture, and society. 37

includes the work of Indians healers, a sub group that was omitted from Digby's Diversity and Division.121

Flint included an interesting discussion of the nature of public health in the Zulu Kingdom. She writes that 'healers and individuals of the Zulu Kingdom maintained a complex system of public health'.122

African therapeutics, she argues, 'include the same concerns and practices' as public health and to understand the latter in the African context, 'we must understand Africa's varying notions regarding the origins of illness. These include preventing illness and death, along lines comparable with biomedicine, but also taking steps to appease the ancestors and prevent witchcraft'.123 The Zulu Kingdom's community planning practices and architecture

reflected local knowledge of environmental hazards and were organized to minimize risk. Within the Zulu kingdom, for instance, kraals and communities avoided low- lying malarial areas and distanced buildings and cattle enclosures from forests and known tsetse-fly zones.124

This means that the Zulu understood their environment and worked with that knowledge to secure and maintain the health and welfare of their people. In fact, early Zulu wattle-and-daub houses (see classification of this type of houses as inferior by the LHC in Chapter Four) and were designed 'in such a way that they prevented exposure to the elements while also providing good ventilation'.125

Zulu healers, according to Flint, played an integral part in Zulu life and their practice of medicine incorporated public health strategies, which had a political, military, social and medical function.

Medicine was thus not only important to heal the physical body, it was also important to maintain and

121 Noble's review of Digby 122 Flint, Healing Traditions, p. 46 123 Ibid. 124 Ibid. p.47 125 Ibid. 38

heal the body politic. I quote Flint at length to demonstrate the close relationship between healing practices and politics:126

Politically …healers helped legitimate the power of the king and local chiefs; they prepared ritual muthi to bind the nation and/or clan and could pronounce punishments of banishment or death on any outcast or formidable political rival in the kingdom. Militarily, healers played a strategic role in planning warfare, empowering the army, and disabling opponents with powerful muthi. Socially and medicinally, healers negotiated and communicated with idlozis (ancestors), found lost cattle, detected thieves, brought rain, set broken bones, lanced abscesses, provided minor surgery, administered curative and protective muthi, and, importantly, unveiled umthakathis - a role which, … made African healers particularly powerful individuals and rather unpopular with missionaries and government officials during the colonial period.

Healing Traditions thus addresses numerous underrepresented perspectives in the history of public health in SA. Most importantly, Flint shows that there was fluidity between modes of healing practices; the inter-racial nature of medical practices; and, like Gelfand, highlights the important contribution that the study of medicine can make to general history or a political-economy approach to history. Both Bryant and Flint found evidence of Africans who had knowledge about personal cleanliness that was similar to and sometimes exceeded European knowledge. Flint argues that European doubts as to the level of "civilization" of Africans in the early twentieth century were out of step with earlier times for

'early settlers commented positively on the personal cleanliness and cleaning habits of Zulu-speakers'.127

From the perspective of knowledge production, Flint demonstrates that categories of knowledge are constructed and change over time. An examination of the LHC's construction and practice of public health can contribute to our understanding of public health in SA.

126 Ibid. p.52 127 Ibid. p. 45 39

Environmental history also has the potential to endorse a broad definition of public health and thus contribute to the current understanding of governance of urban health. In her introduction to South

Africa's Environmental History: Cases and Comparisons, Jane Carruthers suggests that environmental history is 'a deliberation on how people use, manage, or interrelate with natural resources and the natural environment, in specific circumstances at given times'.128 For Carruthers, the relationship between humans and the natural environment lie at the 'heart of environmental history' largely because that relationship was shaped by the contestations over natural resources influenced by ideological or cultural meanings and uses of the environment, its exploitation or conservation, or its scientific or ecological particularities and vulnerabilities.129 With this definition, Carruthers suggests a departure from historiography where the environment was included as a sub-theme in the research by social historians.

Examples of the latter body of work that Carruthers cited are studies by B.H. Dicke and P.J. van der

Merwe. Both of these authors documented the choice of settlement and migration routes of cattle owners in East Africa and the Cape Colony, respectively.130136 For Carruthers the post-1994 moment was a time to expand historical research beyond merely criticizing apartheid.

Beverly Ellis and Jabulani Sithole, contributors in South Africa's Environmental History adopted this approach. Ellis' chapter focuses on the 'early phase of colonial rule with the emphasis on the activities of the white settlers' in Durban, particularly the exploitation of natural resources by settlers in 1870, the year when the diamond mines in Kimberley opened.131 In turn, Sithole explored the environmental context for violent conflicts, which erupted in Umlazi location in the Pinetown district, new Durban in

128 "Environmental history in southern Africa: An overview," in South Africa's Environmental History: Cases and Comparisons edited by Stephen Dovers, Ruth Edgecombe and Bill Guest (Athens: Ohio University Press and Cape Town: David Philip Publishers, 2003), p. 4 129 Ibid., p. 4 - 5 130 B.H. Dicke, 'The tsetse fly's influence on South African history,' South African Journal of Science, 29, 1932, pp. 792-96; P.J. van der Merwe, The migrant farmers in the history of the Cape Colony, 1657-1842 (translated by R. B. Deck, Athens: Ohio University Press, 1995) 131 "White settler impact on the environment of Durban, 1845-1870," pp. 34-47 40

Natal, in the 1920s and 1930s.132 According to Sithole, 'the constant shifting of chiefdom boundaries, and the insensitivity of state officials to land shortage, prompted male commoners to participate in the fights' and hence violence that has to date been understood as unconnected to the physical environmental, or access to land.133 Therefore, 'a resource crisis may give rise to conditions in which conflict deteriorates into violence' but this connection can only be made if one takes into account the environment.134

The continuation of a tradition of research focusing on the environment is important especially with a focus on the relationship between humans and natural resources. Connecting this to health and disease, however, is also important and from the perspective of my research, one of the main omissions in the above collection. The impact of the environment on health status can occur as a result of natural disasters but also due to the mismanagement of those resources. The historical effects of the environment on health are not difficult to trace.135

132 " 'I can see my old umuzi where I now am. I had fields over there, but here I have none': AN ecological context for izimpi zemibango in the Pinetown district, 1920-1936,' pp. 61-75 133 Ibid. 134 Ibid. From a medical perspective, Phillips also followed this approach by examining the effects of vectors and epidemics on human history. Phillips explores the active role that epidemics played in shaping the history of SA and of communities within SA thus keeping the close relationship between the environment and human society.Phillips, Howard. Plague, Pox and Pandemics: A Jacana Pocket History of Epidemics in South Africa. (Johannesburg: Jacana Media, 2012) 135 Angela Mathee, H. Röllin, J. Levin, J. and I. Naik., "Lead in paint: Three decades later and still a hazard for African children?" Environmental Health Perspectives 115(3) (2007): 321–322; Mike Agenbag and Thuthula Balfour-Kaipa, "Developments in Environmental Health," South African Health Review 2008 at http://www.hst.org.za/publications/south-african-health-review-2008 (2 October 2014); Angela Matthee, "Environment and health in South Africa: Gains, losses and opportunities," Journal of Public Health Policy, 32 (2011): S37-S43 41

Table 2: Examples of Environmental Hazards136

Category Examples of Hazards Health Risks “natural”137 Earthquakes Injury from effects of earth tremors Floods Drowning, injury, water contamination, famine Drought Health effects due to lack of water and famine Water-related Contamination can include Diarrheal and gastro-intestinal diseases, poisoning, chemical pollution urinary diseases Air-related Air pollution Respiratory, pulmonary and cardiovascular illnesses and cancers Infrastructure- Roads (lightning, Physical injury, poisoning, diseases of the digestive related construction), contaminated and urinary system land, industrial accidents

The above approach to the environment does not include the notion of environmental health or living environment as understood by earlier scholars, especially during the 1930s and 1940s. Ellen

Hellman's ethnographic study of Rooiyard, an urban slum in Johannesburg, by all accounts a classic, was published in 1948. This manuscript was based on research conducted in 1933 and 'is the study of a privately owned slum property'.138 Rooiyard includes a detailed description of the layout of the area:

Hellmann also describes the yard's 107 "rooms", including size, content and occupation rates; and its 376 residents, i.e. demographics and relationships. For example, Hellman writes that there were only 'two

136 World Health Organization, Environmental Health Hazard Mapping for Africa, http://www.who.int/hac/techguidance/tools/healthhazard.pdf (2 October 2014) 137 The authors here employ the term "natural" focusing on the geophysical explanation of events. Graham Tobin writes that a "natural hazard" represents the potential interaction between humans and extreme natural events, where the latter constitutes an ever-present threat to society. Hazards exist, he continues, because humans and/or their activities are constantly exposed to natural forces. For example, people who live on flood plains or in hurricane- prone coastal zone. Not discounting the geophysical explanations of these types of events, one can also emphasize the human-dimensions. For example, "natural" hazards can also occur due to the conflict between geophysical processes and people. The overuse of land can cause flooding or draughts or, the nature and levels of post-flood infectious diseases are as much the result of pre- flood levels of disease and access to health care. See "Natural Hazards and Disasters When Potential Becomes Reality," in Natural Hazards: Explanation and Integration by Graham A. Tobin and Burrell E. Montz (New York: Guilford Press; 1997): 1-46 and for a historical perspective on the health impacts of floods, see Mike Ahern et al. "Global Health Impacts of Floods: Epidemiological Evidence," Epidemiological Reviews, Vol. 27 (2005): 36-46 138 Hellen Hellmann, Rooiyard, a sociological survey of an urban native slum yard. Cape Town: Oxford University Press for Rhodes Livingstone Institute, Livingstone, Northern Rhodesia, 1948 42

water taps and six latrines (often broken)' for almost 400 people.139 With regard to the economic activities of the residents, she describes how 'most men worked as domestic servants and laborers outside the yard, while the women [mainly] raised the children and brewed (illegal) native beer' and also, 'undertook washing, mending, and illegal grocery and liquor sales'. Hellmann also documented the 'life course of the individual' by describing their cultural practices, religious beliefs and practices, child-bearing practices and compared 'the Bantu child's training [with that of the] European child'. Hellmann's book provides insight into the living conditions of Africans in the urban areas. It did not deal with the health and social services that may or may not have been available to people and it certainly did not deal with the question of urban governance, in general or with regard to public health. However, Hellman's research methods and her findings opened the door for similar research across the country by the UDPH that eventually resulted in the 'revolutionary'140 developments in public health in black urban areas.

An account of the public health developments by the UDPH were described by some of the physicians who worked with the Departmental officials during the late 1930s until the mid-1950s. Sydney

Kark, one of the social medicine pioneers, and Guy Steuart produced an edited collection on public health and social medicine drawing on their experience while working in SA's social medicine experiment.141 A total of 16 authors discussed both the theoretical underpinnings, practical challenges and the positive contributions of that social medicine experiment. An important aspect covered in this collection is the institutional arrangements to deliver health and social welfare services to people in under-resourced black and multi-racial urban areas. Another important feature of A Practice of Social Medicine is its emphasis

139 Barbara Celarant, review of Hellmann, American Journal of Sociology, Vol. 118, No. 1 (July 2012), pp. 274-280, p. 275 140 The reference to 'revolutionary' is one used by Cedric de Beer in his evaluation of the recommendations of the NHSC and the social medicine experiment at Pholela Health Centre, implemented by the UDPH. See Cedric de Beer, The South African Disease: Apartheid Health and Health Services (London: Catholic Institute for International Relations, 1986). See discussion below. 141 Kark, Sidney and Guy W. Steuart (eds.) A Practice of Social Medicine: A South African Team's Experiences in Different South African Communities (Edinburgh: E & S Livingstone, 1962) 43

or the multi-disciplinary nature of public health. The book discusses the role and contributions of doctors, nurses, midwives, and community health educators, of which Steuart was one.142

In contrast, Promoting Community Health: From Pholela to Jerusalem by Sidney and Emily

Kark is an account of their personal and professional journeys in the practice of medicine in SA and in

Israel.143 The Karks were the first two doctors appointed to lead the social medicine experiment in SA when they opened the first health centre in Pholela, Natal in 1940. Unlike Hellman's reflections on

Rooiyard, the Karks and Steuart described the kinds of public health interventions required in order to improve the living conditions in Hellman's Rooiyard, Pholela and urban locations across the country. The role of the economic and social conditions of people is central in the Karks' approach to health and disease and that approach is a reflection of Rudolf Virchow's construction of social medicine, i.e. connecting living conditions and social status of people to health status and to the organization of health care services. This is an approach I incorporated in my research, especially in Chapter Five where I looked at the political implications of public health interventions. My research thus contributes to a broader understanding of the institutional arrangements that can best serve effective public health programs. In recent years there have been a number of positive reflections on the social medicine experiment and on the work that the Karks undertook in Natal.144 Only a few critical voices emerge

142 Vanessa Noble, " "People Wherever I Go Believe that I am a Doctor, but in Thinking that they Flatter Me …": Black Community Health Intermediaries in South Africa, 1920-1959." Paper presented at the History and African Studies Seminar, 16 May 2001, UKZN, Durban, South Africa. Available at http://scnc.ukzn.ac.za/doc/Health/Occup/Noble-V_Black_health_intermediaries_1920-90.pdf ( May 2013) 149 Witwatersrand University Press, 1999 143 Witwatersrand University Press, 1999 144 Alan Jeeves, "Delivering Primary Care in Impoverished Urban and Rural Communities: The Institute of Family and Community Health in the 1940s' in South Africa's 1940s, (2005) Op. Cit. note 11; Howard Phillips, ‘The Grassy Park Health Centre: A Peri-Urban Pholela?’ in South Africa’s 1940s, (2005), Op. Cit. note 11; Alan Jeeves, "Health, Surveillance and Community: South Africa's Experiment with Medical Reform in the 1940s and 1950s," South African Historical Journal,43 (2000), pp. 244-66; Kark, Sidney and Emily Kark. Promoting Community Health, Op. Cit. Note 149; Shula Marks, "South Africa's Early Experiment in Social Medicine, Its Pioneers and Politics," American Journal of Public Health, 87 (1997); Yach, D. and S.M. Tollman, ‘Public Health Initiatives in South Africa in the 1940s and 1950s: Lessons for a Post-Apartheid Era,’ American Journal of Public Health 83(1993), 44

focusing especially on the institutional weaknesses of the health experiments of the 1940s.145 I suggested that because the social medicine experiment was a project of the UDPH, it did not command sufficient authority. Freund attributed the rise and failure of the social medicine experiment to the developments within the competition between and growth within government departments. This is one of the interesting elements of the LHC; it was actually a form of local government. In chapter Three I attempt to situate the

LHC in the context of the public health developments of the UDPH of the 1930s and early 1940s.

The way in which historians addressed the controversial race policies of SA in their histories of public health and medicine is an important question. Prior to the 1970s many South African historians avoided commenting on the controversial political policies that shaped the history they were writing. The aftermath of the 1976 Soweto riots and an impatience with Afrikaner hegemony inspired a new generation of historians to write the history of the oppressed; history from below and a history of a class analysis of oppression in SA. This turn also inspired a more vigorous analysis of race and apartheid with a number of histories written as a way of criticizing apartheid, the National Party and the Afrikaners.146

These revisionist historians also challenged the predominantly liberal perspective on SA history and, according to Saunders, revisionists were predominantly concerned with the nature of the South African political structures and how these affected the country's economic development.147 Maynard Swanson is the first to adopt a radical approach in his analysis of epidemic disease and race. He coined the term

1043-50; Tollman, S.M. "Community Oriented Primary Care: Origins, Evolution, Applications," Social Science and Medicine 32(1991), 633-42 145 Bill Freund, "The South African Developmental State and the First Attempt to Create a National Health System: Another Look at the Gluckman Commission of 1942-1944", SAHJ, 64, 2 (2012): 170-186. Freund specifically addressed the NHSC recommendations. I also addressed the institutional weaknesses of the social medicine experiment specifically in Caesar, Mary. "Gender, politics and social medicine in South Africa, 1940-1959." MA Thesis, Queen's University, 2008. 146 Merle Lipton, Liberals, Marxists, and nationalists: Competing Interpretations of South African history. (New York, Houndmills, Basingstoke, Hampshire: Palgrave Macmillan, 2007) and Capitalism and apartheid, South Africa, 1910-1984 (Totowa, N.M: Rowman & Allanheld, 1985); See also work by leading historians Martin Legassick, Stanley Trapido, Shula Marks and Belinda Bozzoli. 147 Saunders, Christopher. The Making of The South African Past. Major historians on race and class. Cape Town and Johannesburg: David Phillip, 1988. 45

'sanitation syndrome' as an explanation for the political role of public health policy during the first decade of the twentieth century. Swanson's article, 'The Sanitation Syndrome: Bubonic Plague and Urban Native

Policy in the Cape Colony, 1900-1909'148 analysed the Bubonic plague that hit SA in 1900 during the

British-South African War. The plague entered the country via the 'seaports of Cape Town, Port

Elizabeth, East London and Durban' and Molefi says that the first cases appeared in February 1901 in

Cape Town 'among coloured and African dock workers'.149 It subsequently moved with people and goods into the interior as these were transported via rail. Swanson's interest was the ways in which political and medical authorities, at local level, used ‘the imagery of infectious disease as a societal metaphor’ to influence and further shape ‘the institutions of segregation’.150 These authorities had the correct understanding of public health, i.e. ‘overcrowding, slums, public health and safety’ constituted urban public health threats however; they viewed these threats ‘in terms of colour differences’.151 As a result

Swanson questioned the idea of the reasonableness of public health interventions with regard to urban development and demonstrated how epidemiology and sanitation operated as ‘motives and rationalizations’ for segregation. Swanson used the context of the bubonic plague and the state’s response to the plague to draw these conclusions for, on the basis of an ‘epidemic emergency’ medical and political authorities removed some Africans from some urban residential spaces into select urban locations, creating a white town and ‘non-white’ location.152158 The creation of urban residential segregation masked in responses to the plague allowed authorities to act upon what Swanson termed the sanitation syndrome. While the latter was a force in its own right’, at the beginning of the twentieth century, it operated as a convenient short hand for economic and political rivalry and white fears of being swamped.

148 Swanson, Maynard. “The Sanitation Syndrome: Bubonic Plague and Urban Native Policy in the Cape Colony, 1900 – 1909.” Journal of African History, 1977, pp. 387 – 410. 149 R.K.K. Molefi, 'Of rats, fleas, and peoples: towards a history of bubonic plague in southern Africa, 1890-1950,' Pula: Botswana Journal of African Studies, Vol. 15, No. 2 (2001), p. 259-267 150 Swanson, p. 392. 151 Ibid. 152 Ibid. p. 388 46

Anne Digby credits Swanson with influencing the methodological approach to public health and racial segregation saying that he initiated the development of 'modern medical history of SA' when he coined the term 'sanitation syndrome'. 153 Marc Epprecht's recent study of Sobantu, a 'model African village' in Pietermaritzburg included a review of how researchers and authors used Swanson's 'sanitation syndrome'.154 Epprecht recognizes that Swanson's theory was and could remain useful to 'illustrate how sometimes-subtle racist or Eurocentric assumptions about Africans and Africa or Indians and "the Orient" imbued the production and application of scientific knowledge in pursuit of narrow political or economic goals'.155 What Epprecht found problematic was how some authors used this theory without specific and direct local evidence. It is obvious that the issue here is to avoid a short-hand reference to the role of race or apartheid in new local, urban research.156 A second issue however, is that other histories were unfolding as apartheid was being implemented or while people resisted the NP government and hence, the story of Sobantu. Epprecht, like Phillips with his study of Bloemfontein during the influenza epidemic, urges historians to tell more complex urban history in spite of the apartheid context or, before 1948, segregation. It was my intention with the LHC to document the development of public health and local governance and ask, in spite of racial discrimination and severe oppression under apartheid, how did various constituencies respond to the public health crises that were developing in the black and multi- racial urban areas? In addition, while this initiative was launched by white, liberal public health advocates before 1940, what happened to the LHC after 1948? When black people organized to dismantle apartheid and fight for liberation, others engaged in local/municipal politics and if they only had the state-appointed

Advisory Boards as the official forum; how did people use that forum to advance their demands for

153 Anne Digby credits Swanson's sanitation syndrome as introducing the revisionist turn in the history of medicine in SA. See Digby's "Medical History of South Africa," op. cit. note 96 154 Unpublished Paper, Department of Global Development Studies, Queen's University, 2014 155 Ibid. 156 Ibid. p.6 47

improved municipal services? These are questions that do not discount or ignore race, but seek to investigate developments that occurred in spite of apartheid.157

These new questions regarding Swanson's influence notwithstanding, Swanson's critique of public health and race inspired an approach to health and disease using race as an organizing principle, whether this was intentional or not. In 1986 Cedric de Beer argued that 'the understanding of the distribution of ill health and medical services is essentially political'.158 The South Africa Disease succinctly - in a total of 86 pages - examined 'the debate inside South Africa about the injustices of apartheid and the requirements for change' and consequently, draws direct connections between patterns of disease, lack of health care reform and the apartheid system.159 Any changes in the nature and organization of health services were going to be cosmetic for, argued de Beer, what was needed was fundamental social change, even a change in government, if not government policy. De Beer articulated his view of the change that was required as follows: 160

…the fight against disease is not simply a technical one. The best possible health for all will not be achieved by medical science alone; it will only arise out of a thorough understanding and critique of the existing service, and a continuing struggle to create a better one. This goal will not be reached until South African society itself has been transformed.

157 There is another dimension to Epprecht's revision of the historiography of the 'sanitation syndrome' and that is the post-1994 moment that allows historians to ask new and different questions or, to revisit old ones. Premesh Lalu, who became a scholar after 1994 but has a long history of political and community activism, brings an interesting perspective to the field of history particularly, the discipline after 1994. See "When was South African history ever postcolonial?" Kronos, 34 (1): 267-281 and The Deaths of Hintsa. Postapartheid South Africa and the Shape of Recurring Pasts. (Cape Town: Human Sciences Research Council, 2009) 158 de Beer, The South African Disease: Apartheid Health and Health Services (London: Catholic Institute for International Relations, 1986): p. 65 159 de Beer, South African disease, p. vii 160 Ibid. 48

In order to illustrate his overall argument, De Beer uses five case studies. The chapter on tuberculosis

(TB) illustrates, for example, that the racially differentiated TB epidemics in SA were a result of the racial capitalism illustrated by the different patterns of disease on white and African mine workers. 161 The former already had weak lungs as a result of silicosis but they 'did not often pass the disease [TB] on to their wives and children because white miners received better pay, worked on easier jobs for shorter shifts and lived in much better circumstances than black workers. In addition, white workers were often given lengthy breaks and a good meal half-way through their shift'.162 Thus, privilege based on race and manifested in better working and living conditions, protected white miners and their families but left black men and their families exposed and unprotected.

In addition to racist economic policies of private companies, de Beer demonstrated how political decisions of the NP government after 1948 prevented progressive changes in the health care system that would have benefitted the poor, including black people. De Beer considered the NHSC of 1944 as one of the 1940s progressive health care developments and concluded that the NHSC's recommendations were

'revolutionary'163 especially because of its vision that a 'new', post-war SA should have a health care system that would make affordable services available to everyone irrespective of 'race, colour or creed'.164

For de Beer, the NHSC 'represented a new departure' for 'since 1652 health services had received scant attention' given that the 1910 constitutional reforms did not change the disparate health policies operating in each of the four independent states that became the four provinces of SA.165 These recommendations were never implemented and de Beer places the blame for that inertia at the door of the NP government.

De Beer did not include the positive contributions by the public health bureaucrats such as Dr. Edward

161 In fact, de Beer traces the introduction of TB into SA and Sub-Saharan Africa generally, to European contact and in particular, slavery. 162 de Beer, South African disease, p. 9 163 Ibid. 164 Ibid. 165 Ibid. p. 18 49

Thornton, the Union Secretary for Health, the country's chief public health bureaucrat and his efforts to expand services to women and the poor.166 His analysis however; drew direct connections between economic conditions, political status and health. He argued that health status was directly related to the environment in which people lived and worked and these social positions that they occupy are predetermined and based on the political and economic structures. He also argued that it was incorrect to conclude that health services were a 'rational response to ill health' for these services was determined by

'realities and policies that have almost nothing directly to do with the health needs of the people'.167

In White Plague, Black Labor Randall Packard expanded de Beer's arguments regarding capital, politics and health.168 Packard argued that the TB epidemic followed the contours of the industrialization process of SA for 'nowhere was the correlation between industrial and urban growth and TB more evident than in the industrial and commercial centers of South Africa' with African workers bearing the brunt of the 'white plague'.169 Packard questioned both the 'virgin population' and the racism theories that attempted to explain the high incidence of TB among Africans, i.e. the medical authorities and those who blamed apartheid policies. On the one hand, medical authorities claimed that the high incidence of TB among Africans was the result of their 'little or no experience with either the disease or the conditions of industrial life' and that they were 'in effect a 'virgin' population and therefore more susceptible to TB'.170

The version put forward by critics of apartheid, on the other hand, contended that 'the disparity between the experience of whites and blacks with TB has been a product of racial discrimination in South Africa.

166 For example, Susanne Klausen documented Thornton's funding for family planning services to poor women including African and colored women, in Johannesburg and Cape Town. See: “The Race Welfare Society: Eugenics and Birth Control in Johannesburg, 1930-1939.” In Science and Society in Southern Africa edited by Saul Dubow. Manchester: Manchester University Press, 2000: pp. 164-187 and, "Poor Whiteism', White Maternal Mortality, and the Promotion of Public Health in South Africa: The Department of Public Health's Endorsement of Contraceptive Services, 1930-1938" South African Historical Journal45(2001), 53-78. 167 Ibid. 168 Pietermaritzburg: University of Natal Press, and James Currey, 1990 169 Packard, p. 3. His inquiry began with the discovery of minerals, diamonds and gold, towards the end of the nineteenth century. 170 Packard, p.4 50

Racism [they continued] caused the squalid working and living conditions associated with the early industrialization of Europe and America to be reproduced among black workers in South Africa, but not among white workers'.171 In addition, according to this latter argument, unequal and inequitable distribution of resources required to 'sustain health … account for the persistence of TB among blacks when the disease has nearly disappeared among whites'. 172 Packard concluded that the development and control of TB in SA was not any different from that of eighteenth and nineteenth century industrial

England. In addition, the 'incomplete proletarianization' of the African workers meant that they were unable to 'push for health reforms'. Most importantly, however, Packard concluded that the economic and political interests that were critical to the development and treatment (or lack thereof) of TB among

Africans were always fragile and elusive. In addition, Packard recognizes the importance of political voice and representation in order to advocate for access to services, including TB treatment. As part of the historiography that is critical of the apartheid regime, Packard demonstrated that the political opportunities that may have been available before 1948 were no longer available after the rise of the NP.

I highlighted the approaches followed by de Beer and Packard, both classics in their own right, as examples of an alternative analytical lens that I could have applied to the LHC. This would have allowed me to investigate the effects of apartheid policies on health and welfare even if those policies were implemented by a different level of government. While a critique of the role of apartheid in people's health, it is also important to examine the role of local authorities before 1994 in relation to health and welfare without necessarily using local authorities and their services as a lens to analyse the nature of apartheid. In any event, I take as a given that the apartheid state contributed to the under-development of black urban areas, as discussed in the literature including de Beer and Packard. However, my approach to the LHC is also an attempt at a local case study and the complex relationship of local government

171 Ibid. (Packard, pp.4-5) 172 Ibid. 51

mandated to implement some of the apartheid policies, especially urban segregation measures. In addition, my research is also an enquiry into the ways in which public health shaped the relationship between the local state and black people in the absence of legitimate political institutions. Since my research focused on the institutional organization and functions of the LHC, I reviewed the literature on health care professionals, health institutions and local government institutions with regard to the organization and provision of health services.

The historiography of medical professionals covers mainly doctors and nurses even though public health programs require a multi-disciplinary team. There is very little on the history of social work and social workers, community health workers, midwives, health educators or dentists.173 The attention paid to white male doctors and black nurses are thus disproportionate from a public health perspective. In a number of instances, doctors recorded their own experiences as medical professionals. Digby cites the short article on John Mehliss of the Transvaal; biographies by Henry Taylor of the Free State,

W.G. Atherstone of the Eastern Cape, and James Mackenzie of Salt River in the Western Cape.174

Those doctors who were worked in the public sector reflected on their contributions to the development of public health and, more importantly, their role as medical politicians. T.N.G. Te Water and Leander Starr

Jameson are two examples cited in Digby's History of Medicine in South Africa. Both Te Water and

Jameson served in the Cape Parliament, 1894 - 1893 and 1910-1912, respectively. Te Water also served

Colonial Secretary from 1896 - 1898.175 While the literature includes only a small minority of white male

173 Alan Jeeves covered this subject extensively. 174 J. T. B. Collins, ‘A Transvaal Medical Pioneer’, SAMJ, 29 ( June 1983): 14–16; P. Hadley (ed.), Doctor to Basuto, Boer and Briton: Memoirs of Dr Henry Taylor (Cape Town: David Philip, 1972); A. Cohen, ‘William Guybon Athestone: South African Medical Practitioner, Botanist and Geologist’, Journal of Medical Biography, 10/4 (2002): 224–31; N. Mathie, Dr W. G. Atherstone, 1814–1898. Man of Many Facets. Pseudo-Autobiography, 3 vols. (Grahamstown: Grahamstown Foundation, n.d.); Mackenzie, B., Salt River Doctor (Cape Town: Faircape, 1981) in Digby, "History of Medicine in South Africa," p. 1198 175 Ibid. In a short article in 1964, J.K. de Kock provided a list of doctors who were elected to parliament commencing in 1854. His objective with this article was to document the important contributions of 'medical men … 52

doctors who contributed to public sector health care and/or politics; it is a dominant theme in the literature on and by doctors who were women or black.

Drs. Eva Salber, Emily Kark, Kesaveloo Goonaruthnum Naidoo (also known as Dr. Goonam) and

Mampela Ramphele published their autobiographies.176 Both Salber and Kark discussed their contributions to the development of social medicine during the 1940s and 1950s.177 Dr. Goonam, born in

1906, was the first SA Indian woman that left SA to study medicine in Scotland.178 When she returned to

Durban in 1936 she opened a practice that included caring for Indians and Africans. Goonam became politically active and was one of the leaders of the Natal Indian Congress (NIC). Like Goonan, Mamphela

Ramphele's biography is the story of her life, her role as physician and also political activism.

The two black male doctors that I include here are Alfred B. Xuma and Dr. Abduraman. In 2000

Steven Gish published Alfred B. Xuma179 commencing with his childhood and missionary education in the

Transkei, an experience which later influenced his education in America from 1913 onwards. Gish also documents Xuma’s return to SA in 1927 and his decision to open a medical practice in Johannesburg.

Xuma was one of those physicians who took an active role in politics and Gish’s biography places

in the development of our country as a whole' thus, recognizing the role of doctors beyond the provision of health care. "Doctors in Parliament," SAMJ, (11 April 1964): 237-241 176 Salber, E. J., The Mind is not the Heart: Recollections of a Woman Physician (Durham, NC: Duke University Press, 1989); Goonam, G., Coolie Doctor. An Autobiography (Durban: Madiba, 1991); and Ramphele, M., Across Boundaries. The Journey of a South African Woman Leader (New York, NY: Feminist Press, 1995) 177 'Infant Orality and Smoking,' JAMA. 1964;187(5):368-369For details of Salber's legacy and her work in the USA, the country to which she migrated with her husband, Harry Phillips, fellow social medicine physician and pioneer in SA; http://www.med.unc.edu/aging/student-awards/salber-phillips-a-history- continuing- legacy 178 http://scnc.ukzn.ac.za/doc/Audio/VOR/GoonamK/GoonamKbackground.htm : Ghandi-Luthuli Documentation Centre; "First South African Indian Lady: Left For England to Study Medicine," Indian Opinion, No. 9, Vol. XXVI (Friday March 9th, 1928) Available at http://scnc.ukzn.ac.za/doc/B/Gs/Biography_GOs/Goonam- K_Passive_Resistance_1946/Pages%20from%20Goonam-K-4.pdf (access 27 September 2014) 179 Gish, S. D., Alfred B. Xuma. African, American, South African (Basingstoke: Macmillan, 2000) 53

Xuma’s ideas regarding health and welfare in a political context, including the African American political exposure while in the USA.

J.H. Raynard took a similar approach with regard to the life, political activism and public service by Dr. A. Abduraman.180 It is therefore interesting to note that this biography, entitled Dr. A. Abduraman was edited by Mohamed Adhikari181 as part of the Cape Town: Voices of Black South Africans Series published by the District Six Museum. His contributions and life as a physician take a back seat and instead, Adhikari's publication emphasizes Abduraman's political life: he was the first “black” city council member in Cape Town and president of the African Political Organization, 1904-1950.

These black doctors opened private practices and, as far as I could establish, did not work for the state in their capacity as physicians. However, none of them divorced their medical practice and their understanding of disease and the health care system from the political realities. Their stories are those of doctors who were intricately aware of the social conditions that brought their patients to their practices.

While the nature of the political contributions of these black doctors, men and women, were different to those of white, liberal doctors; all of them recognized the influence of social conditions on health and that the physician can take that perspective to a larger, political arena.182 While my research on the LHC focuses on the contributions of the collective through the institution of the LHC, this research will support and advance the literature that highlights the political role of health professionals and institutions in the context of segregation and apartheid.

180 Adikhari, M. (ed.), Dr A. Abduraman. A Biographical Memoir by J. H. Raynard (Cape Town: Voices of Black South Africans Series, Friends of National Library of South Africa, 2002) 181 Adhikari is a prominent historian of primarily coloured people in South Africa generally but more specifically, the Western Cape. 182 R J Cooter, ‘The rise and decline of the medical member: doctors and parliament in Edwardian and interwar Britain’, Bull. Hist. Med., 2004, 78 (1): 59–107, on pp. 85–6, 93, 96–7. From a social medicine perspective however, Leon Eisenberg's 'Rudolf Virchow: The physician and politician' in Medicine, Conflict and Survival, 2:4 (1986), pp.243 – 250. 54

The nursing profession is the second category of health care professionals that feature prominently in the literature. This is perhaps not surprising for in 1948, SA had about 800 black nurses and by 1989, that number was closer to 75,000.183 Historians examined different aspects of the nursing profession including its role in the social advancement of black women. With regard to training institutions, it has been established that while the nursing profession was closely associated with religious institutions, such as missionaries; there were also a number of private training institutions and nursing colleges. In Frederika Kotze's doctoral dissertation she discussed a number of different private nursing institutions between 1946 and 2006 noting that the first of these private educational institutions was established on the East Rand, of Johannesburg.184

According to Shula Marks, the story of the nursing profession and especially its racial and gendered features reveals the 'the heart of the South African condition'.185 In Divided Sisterhood: Class,

Race, and Gender in the Nursing Profession in South Africa, Marks places the nursing profession in its social context demonstrating ways in which political and economic developments influenced the professionalization of nursing.186 Nursing is, Marks argued, the ideal lens to investigate questions of class and economic advancement during the twentieth century for African women. With regard to race, Marks connects the entrance and advancement of black women, the "Bantu Nightingales", in the profession to the alarm among 'white male society' because white women had to take care of black men during the early years of the twentieth century / the British-South African war.

183 Helen Sweet and Anne Digby, "Plural Medicine, Tradition and Modernity, 1800–2000." In Plural Medicine, Tradition and Modernity, 1800–2000 edited by W. Ernst (London: Routledge, 2002): p.113. Cecilia Makiwane, 1880 - 1919, was the first registered professional black nurse in SA. (http://www.sahistory.org.za/people/cecilia- makiwane, accessed 29 September 2014) 184 I. Loots and M. Vermaak. Pioneers of Professional Nursing in South Africa. (Bloemfontein: P.J. Publishers, 1975) and Catherine Searle, Towards Excellence: The Centenary of State Registration for Nurses and Midwives in South Africa, 1891–1991 (Durban: Butterworths, 1991); Kotze, "A historical perspective: private nursing institutions in South Africa (1946-2006), North-West University, 2012 at http://dspace.nwu.ac.za/bitstream/handle/10394/8436/kotze_fj.pdf?sequence=1 (29 September 2014) 185 Divided Sisterhood: Class, Race, and Gender in the Nursing Profession in South Africa Johannesburg: University of Witwatersrand Press, 1994) 186 Op Cit. Note. 179 55

The social role of the African nurse is also explored by Digby and Helen Sweet, another eminent medical historian in ‘Nurses as Culture Brokers in Twentieth-Century South Africa’ for an edited collection entitled Plural Medicine, Tradition and Modernity, 1800–2000. 187 African nurses, especially in rural areas, the authors argue were served as mediators or culture brokers where two healthcare worlds intersect, i.e. their training and practice in western medicine and the African traditional medicine practiced by many of their patients.

Catherine Burns made one of the important interventions in the historiography of nursing when she included male nurses into what was largely a historiography of black female nurses.188 In this paper,

Burns examined the 'emergence of male nurses in SA and the debates about training, employment and policy concerning male nurses, particularly black male nurses'. The silence around black male nurses was the product of 'both white health officials and broader public discourses around appropriate masculine roles and careers, as well as by the association of 'professional nursing' with women, irrespective of race.

This was also a sentiment expressed by Prof. Thembani Grace Mashaba, one of the black nurse pioneers, in an interview in 1996 when asked whether any of her sons followed her into the nursing profession.189

She thought that they had no role models, or as Burns would argue no role models in the scholarly or public record. Burns' case study covered the years 1902 to after World War II, at which time, she concludes; male nurses disappeared from the scene. Further research on male nurses by Marks and by

187 See W. Ernst (ed.) Plural Medicine, Tradition and Modernity, 1800–2000. London: Routledge, 2002 194 Ibid. p.113 188 Burns, C., ‘“A Man Is a Clumsy Thing Who Does not Know How to Handle a Sick Person”: Aspects of the History of Masculinity and Race in the Shaping of Male Nursing in South Africa’, Journal of Southern African Studies, 24 (1998): 695–717 189 Janine Simon, "Nursing veteran tells the story of her profession," The Star, (17 April 1996) quoted in Shula Marks, ‘“We Were Men Nursing Men”: Male Nursing on the Mines in Twentieth-Century South Africa.’ In Deep Histories: Gender and Colonialism in Southern Africa, Cross/Cultures, 57 (2002), edited by Wendy Woodward, Patricia Hayes and Gary Minkley. (2002): 177-204, p. 180. Mashaba graduated with a B.Cur in 1979 and B.Cur (Hons.) in 1981. She served as Lecturer and Head of the Department of Nursing at the University of Zululand. She went on to do an M.Cur and finished a D.Litt et Phil in 1986 through the University of South Africa. See African Nurse Pioneers in KwaZulu/Natal, 1920-2000 by Mazo Sybil T. MaDlamini Buthelezi. (UK: Trafford Publishing, 2004) 56

Kotze confirmed Burns' conclusions. Marks found that other than the army and the context of war, male nurses are also found in 'profoundly male spaces' such as prisons and industrial settings.190 In her overview of private nursing educational institutions, Kotze discovered that the 1946 nursing school attached to the Simmer and Jack Native Hospital, trained white male orderlies to work on the nearby mines.

From the perspective of the development of public health, there is an obvious omission regarding the role of nurses as well as other health professionals for that matter. One chapter in Practice of Social

Medicine by Kark and Steuart, focuses on family and community nursing at the Health Centres in and around Durban. Thus silence in the literature, I suggest, is partly due to the absence of institutional histories of Health Centres and of local authorities as public health institutions.

Institutional histories in the field of medicine and public health generally cover individual, more prominent medical schools and hospitals:191 Durban Medical School (1950); Grey's Hospital in

Pietermaritzburg (1955), University of Cape Town Medical School (1969); Valkenberg Asylum (2001);

Baragwanath hospital (2005); psychiatry in Natal and Zululand including the Natal Government Asylum

(renamed the Pietermaritzburg Mental Hospital) (2007); Groote Schuur Hospital from (2008). The School

190 Keith Breckenridge, "The Allure of Violence: Men, Race and Masculinity on the South African Goldmines, 1900-1950," JSAS 24, 4, 1998, pp. 669-694 quoted in Marks 'We were Men Nursing Men'. 198 Op Cit. note 183 191 Hattersley Al Century: Grey’s Hospital, Pietermaritzburg, 1855–1955 Balkema: Cape Town, 1955; Louw, J. H., In the Shadow of Table Mountain. A History of the University of Cape Town Medical School and its Associated Teaching Hospitals up to 1950 (Cape Town: Struik, 1969); Packard, R. M., Tuberculosis and the Development of Industrial Health Policies on the Witwatersrand, 1902–32’, Journal of Southern African Studies, 13 (1987): 177– 209; Louw, J., and Swartz, S., ‘An English Asylum in Africa: Space and Order in the Valkenberg Asylum’, History of Psychology, 4 (2001): 3–23; Horwitz, S. J., ‘“A Phoenix Rising.” Aspects of Baragwanath Hospital, Soweto, South Africa, 1942–1990’, Unpublished D.Phil thesis (Oxford University, 2005); Julie Parle, States of Mind: Searching for Mental Health in Natal and Zululand, 1868-1918 (Scottsville: University of KwaZulu-Natal Press, 2007); Digby, A., and Phillips, H., with Deacon, H. J., and Thomson, K., At the Heart of Healing: Groote Schuur Hospital, Cape Town 1938–2008 (Johannesburg: Jacana, 2008); Vanessa Noble, A School of Struggle. Durban's Medical School and the Education of Black Doctors in South Africa. UKZN Press, 2013. Following Parle's account of mental illness in Natal incorporating colonial practices and policies; Tiffany Jones focused on mental illness during the apartheid era: Psychiatry, mental institutions, and the mad in apartheid South Africa. (New York: Routledge, 2012) 57

of Public Health at UCT was covered in one article. This historiography reflects a bias in favor of major cities, which Digby sought to address when she focused on the Northern Cape in Division and Diversity.

One of the telling omissions in this area is research on Edendale Hospital in Pietermaritzburg. The latter was discussed to date in a mere seven pages: J.E. Cosnett's "Edendale Hospital, Pietermaritzburg: The

First Twenty-One Years" (five pages) and "Edendale Hospital" by David Robbins (two pages) in the edited collection on Pietermaritzburg.192 Cosnett presents a descriptive history of the hospital including the site and establishment of the hospital; doctors; nurses; student activities; and administration.

According to Cosnett, 'Edendale Hospital was unique at the time of its opening in 1954, in that it possessed several far-sighted innovations in hospital design, among which was what was probably the first intensive care unit in any hospital in Southern Africa'. From its humble beginnings in March1954 and

620 beds, Edendale Hospital went on to develop an international reputation for teaching and advancement of both doctors and nursed even though, according to Cosnett, it was a 'non-teaching hospital'.193 A detailed institutional history of the Edendale Hospital is long overdue.

Another institution that requires more research is the role of local authorities as health and development institutions.194 While Maynard Swanson (1977) and Elizabeth van Heyningen (1981) used local authorities as their focus, they were looking more specifically at larger questions of race and

192 J.E. Cosnett, in SAMJ, 23 August 1975 and available at http://archive.samj.org.za/1975%20VOL%20XLIX%20Jul- Dec/Articles/08Aug/4.11%20EDENDALE%20HOSPITAL,%20PIETERMARITZBURG%20- %20THE%20FIRST%20TWENTY-ONE%20YEARS.%20J.E.%20Cosnett.pdf (accessed 25 June 2014) and Robbins' chapter in Pietermaritzburg: 1838-1988, A new Portrait of an African City edited by John Laband and Robert Haswell. (Pietermaritzburg: Shuter and Shooter, 1988): 189-190. This is not an indictment of the authors for Cosnett's article was in the SAMJ that generally published short articles and Laband's book is an overview and allocated two to five pages for each topic. 193 Robbins, "Edendale Hospital,", p. 190 and Cosnett, "Edendale Hospital,", p. 1486. Robbins writes that Edendale hospital 'enjoyed for many years an international reputation as a teaching hospital … as well as attracting thousands of South African doctors of all races, Edendale patients have been tended by young interns from Germany, New Zealand, Canada, Australia, India, Pakistan, Greece, Cyprus, the United Kingdom and the United States'. According to one of Robert's informants, the attraction to Edendale Hospital was its 'concentrated form of experience for young doctors which could hardly be equaled anywhere in the world' and the 'quality of the teachers, the consultants and specialists'. 194 Between 1998 and 2000, the SA government introduced new legislation and the concept of the developmental local government. 58

epidemics. The actions of the Cape Town local authorities served as an example of how the bubonic plague was used to advance racial, urban segregation measures.195 My own research on the LHC is more in line with the work by Howard Phillips, Susan Parnell, Harri Mäki, and Julie Dryer; authors that included an institutional analysis in their research.

Phillips traced the preventive public health measures introduced by the Bloemfontein municipality in response to the 1919 Influenza.196 In this case study, Phillips focused primarily on the uniqueness of the municipality's response which emphasized 'preventive rather than curative medicine'.197

Howard Phillips is a highly respected academic and medical historian whose research interest is not necessarily a political critique of segregation, apartheid and disease thus, unlike Swanson; he avoided the political implications of local responses to epidemics. Instead Phillips used the Bloemfontein case study to 'elucidate the origins of the earliest comprehensive attempt at disease prevention among whites to be undertaken by a South African municipality'. This does not mean that Phillips was completely silent on the question of race. It was virtually impossible given that his analysis clearly looked as 'prevention among whites' and, as he found, the 'protection' of whites against the flu inevitably involved dealing with what the city officials up until then believed was a healthy town because of its 'apparent cleanliness and lack of a conspicuous slum-quarter'.198 As hundreds of location residents became sick and the efforts to protect the white residents were soon seen as futile for 'neither neighborhood nor conditions nor standards of living, the traditional barriers to across-the-town infection, seemed to be proof against the 'flu'.199 In

December 1918 the Town Clerk proposed the Public Health and Social Welfare Survey of Bloemfontein

195 E.B. van Heyningen, 'Cape Town and the Plague of 1901 ' in C. Saunders, H. Phillips and E. van Heyningen (eds.): Studies in the History of Cape Town, vol. 4 (Cape Town, 1981); M. Swanson, 'The Sanitation Syndrome: Bubonic Plague and Urban Native Policy in the Cape Colony, 1900-1909' in Journal of African History, vol. 18 (1977). 196 Philips, 1987, p.210 197 Ibid. 198 Ibid., p.211 199 Ibid. p. 212 59

(emphasis in original) and following this survey, the Bloemfontein municipality 'began a scheme to buy up slum properties, upgrade them and then ensure that they were maintained in this condition. In this way it aimed to abolish slums completely, as it would eventually control all the cheapest accommodation in town itself'.200 An interpretation of these post-influenza epidemic actions could have been an opportunity for Phillips to employ the 'sanitation syndrome' however, he did not.

Parnell and Mäki both included the role of individual municipal civil servants, i.e.Medical

Officers of Health and Engineers, even though their research covers different time periods and addresses different political and social questions. Parnell's review of the town planning measures soon after the founding to the Union included an assessment of the role of Dr. Porter, the then MOH for

Johannesburg.201 Recently, Mäki produced an extensive study on the development of urban environmental health including water, sanitation and health services in Cape Town, Durban, Grahamstown and

Johannesburg between 1840 and 1920. This latter time period saw the introduction and expansion of water and sanitation services in SA, coinciding argues Mäki, with the hygienic revolution in Europe.202 In a city by city study, Mäki traces first the development of water supply and then sanitation services and includes in this study the individual Engineers and Medical Officers of Health.

The final author on the topic of local government as public health institutions is Julie Dyer who published a very detailed account of the health and welfare services provided by the city of

Pietermaritzburg.203 This is an extensive examination of medical reports over time documenting the attempts by the PMB municipality to deal with health and welfare demands within their borders, thus

200 Ibid. p. 224. Philips made the point that this kind of thinking was 'only feasible' because the slums in Bloemfontein were 'far less extensive than those in the larger industrial cities'. 201 Op Cit. note 74 202 Op Cit. note 76, p.2 203 Julie Dyer, Health in Pietermaritzburg (1838-2008). A History of Urbanization and Disease in an African City. (Pietermaritzburg: Natal Society Foundation, 2012) 60

including sections of Edendale especially in as far as the incidence of disease overlapped between the two areas. My study of the LHC overlaps in part with Dyer's mapping of disease and health services for she includes references to some of the personal health services provided by the LHC clinics.

All of these authors adopted very similar approaches: the institutional development of local government as a health institution; politics of decision making at local government level with regard to personal and environmental health services; range of skills and experts involved in local government services; and the function of a local government beyond its political role. My research on the LHC supports and builds on this small body of work on local government and public health.

Governance of Black and Multi-Racial Urban Areas

The previous section looked at the literature on environmental health from the perspective of the history of medicine and of public health. Due to the centrality of the state in the construction and delivery of public health, the second major theme of my research is about local governance. I focus specifically on the administration of multi- racial and black urban areas. Urban studies, as a distinct field of inquiry in

SA, began in earnest in the 1980s and some of this included migration and settlement of Africans as well as their material conditions once in the cities.204 Historians and geographers were among the scholars who developed urban studies with Bill Freund and Rodney Davenport, earning the label 'pioneering historians'.205

204 Paul Maylam wrote one of the earliest historiographies of urban studies in SA in "Explaining the Apartheid City: 20 Years of South African Urban Historiography," JSAS, Vol. 21, No. 1 (March 1995): 19 -38. Bill Freund and Vivian Bickford-Smith updated that overview in 2005 and 2008, respectively: "Urban History in South Africa," SAHJ, vol.52, Issue 1, 2005: 19-31 and "Urban history in the new South Africa: continuity and innovation since the end of apartheid," Urban History, vol. 35, issue 2, August 2008: 288- 315. 205 Ibid., p. 19 61

In his review, Maylam concluded that during the first 15 to 20 years, urban history was 'largely afrocentric, highlighting the black urban experience and urban policy as it affected black people'206. As a result, the geographic focus of these studies included informal and formal black urban areas such as

Soweto, Alexandra, Cato Manor, Langa and New Brighton. 207 In addition to the history of the development of large cities of Johannesburg, Durban, Cape Town and Port Elizabeth, a few smaller towns made it into the historiography since Maylam's overview.208 Pietermaritzburg is only one of three towns that were covered at length before there was any ''coherent, single-authored book- length study of any particular South African city over the full span of its history, written in the critical tradition of urban historiography'.209

Evidence of the multi-disciplinary nature of urban studies can be found in the range of topics covered by the authors. According to Maylam, contributions to urban studies come from history, geography, sociology, town and urban planning, architecture, literary and cultural studies as well as musicology210 Some of the major themes are economic conditions, political policies and laws including urban segregation measures, labour, health and sanitation, and of course, governance.

206 Ibid., p. 21 207 Gavin Maasdorp and A.S.B. Humphries, From Shantytown to township: an economic study of African poverty and rehousing in a South African city. (Cape Town: Juta, 1975) Doug Hindson and Geoff McCarthy, Here to Stay: Informal Settlements in KwaZulu-Natal. (Natal: Indicator Press, 1994); Vivian Bickford-Smith, "South African Urban History, Racial Segregation and the Unique Case of Cape Town?" JSAS, Vol. 21, No. 1 (March 1995), 63-78; Phillip Bonner and Lauren Segal, Soweto: A History (South Africa: Maskew Miller Longman, 1998); Gary Baines, A History of New Brighton, Port Elizabeth, South Africa, 1903-1953: The Detroit of the Union. (Lewiston, New York: Edwin Mellen Press, 2002); Phillip Bonner and Noor Nieftagodien, ALEXandra: A History. (Johannesburg: Wits University Press, 2008) 208 P. Bonner and K. Shapiro, "Company town, company estate: Pilgrim's Rest, 1910-1932,' JSAS, 19, 1993; Lance van Sittert, '"Velddrift": The Making of a South African Company Town,' Urban History, Vol. 28, No. 2, 2001; 209 Maylam, "Explaining the Apartheid City," p.21. Maylam is refering to the edited collection on Pietermaritzburg by Laband and Haswell. Dyer's 2012 contribution on the development of public health in Pietermaritzburg can now be added as the second publication to expand on an aspect of Pietermaritzburg's history. The two other 'histories-of- the-city' that Maylam referred to were Bozzoli's Labour, townships and protests: Studies in the social history of the Witwatersrand (Johannesburg: Ravan Press, 1979); Maylam and Iain Edwards, The people's city: African life in twentieth-century Durban (Pietermaritzburg: University of Natal Press; Portsmouth, NH: Heinemann, 1996) 210 Ibid., p.20 62

There are a number of authors who documented the history of local government and most of these contributions are descriptive, institutional histories: Robert Cameron is one of the leading academics on local government in South Africa published over 60 journal articles and book chapters in the areas of public administration and local government politics.211 Siddle and Koelble drew on the fields of political science, law, public administration and finance, anthropology' to discuss the overall goal and functions of local government. Amtaika joined this field with his 2013 publication on the history of local government, examining the underlying theories that inform local government.212 Like those before him, he included issues such as political leadership, public service, community involvement, traditional leadership and local government elections but with the stated goal of applying the theory of these issues so as to address current problems.

The main approach by these authors is to look at local authorities as one tier of government, including their administrative scope and how the state sought to devise the forms of local government over time. They made reference to or included brief descriptions of the LHC but do not consider the public health functions.213

As noted in Chapter One, the pre-1994 literature on these institutions uniformly condemned their usefulness as political institutions. Simon Bekker and Richard Humphries prepared one of the most extensive examinations of the administration of black urban areas.214 However, their focus on

211 http://web.uct.ac.za/depts/politics/pol_people/people_bio_CameronR.htm. Most recent contributions include: The Democratisation of South African local government. Op. Cit. note 36 212 Amtaika, Local Government in South Africa since 1994. Op.Cit., note 6 213 The Failure of decentralisation in South African local government: Complexity and unanticipated consequences. (Claremont: UCT Press, 2012)Ibid. p.2 214 From control to confusion: The Changing Role of Administration Boards in South Africa: 1971-1983. (Shuter & Shooter, Pietermaritzburg in association with the Institute of Social and Economic Research, Rhodes University, 1985) 63

developments after 1980 meant that they briefly described the early years of these administrations, including Advisory Boards. There are a few micro level case studies focusing specifically on the

Advisory Boards. Christopher examined the ways in which the 1923 Native (Urban) Areas Act affected the Advisory Boards. Nauright and Duncan focused on the Alexandra Health Committee (AHC), while

Baines looked at the New Brighton Advisory Board (NBAB). 215 Duncan’s larger question is the role of liberals as mediators in the race relations conundrum and thus uses the ten years (1933 to 1943) of the

AHC when a liberal was appointed as head of the AHC. Baines considered the role of and participation in

Advisory Boards by location residents. He asked four important questions so as to challenge the conclusions that the ABs were ‘institutions of the oppressor’ and that those who participated were

‘collaborators’ or ‘sell-outs.’216 Thus, Baines asked: ‘Were people who served on such institutions necessarily co-opted by the authorities? Did they articulate the interests of their own class, the petty bourgeoisie, or were they representative of a wider constituency? Is it feasible that an institution with questionable legitimacy could be used to galvanize a community into action? Is it possible to capture such institutions to further strategic political objectives or should they be boycotted as a matter of principle?’217

The unpublished Honor’s thesis by Nuttall is the only other contribution on Advisory Boards and he focused on the EDPHA Advisory Board. His study looked specifically at the contestations surrounding the establishment of that Advisory Board including the motives of the African political elite. Apart from

Baines, the literature on Advisory Boards unanimously condemns these institutions as being of

'questionably legitimacy' at best, and as puppets of the repressive regime and people who served on these

215 John Nauright. "'An experiment in Native Self-Government': The Alexandra Health Committee, the State and Local Politics, 1916-1933," South African Historical Journal 43 (2000): 223-243; David Duncan. 'Liberals and Local Administration in South Africa: Alfred Hoernle and the Alexandra Health Committee, 1993-1943,' in The International Journal of African Historical Studies, Vol. 23, No.3 (1990), pp. 475-493; Baines, “The Contradictions of Community Politics,' Op. Cit.note 99; and John Nauright,. "'An experiment in Native Self-Government': The Alexandra Health Committee, the State and Local Politics, 1916-1933," South African Historical Journal 43 (2000): 223-243 and 216 Block and Wilkenson, ‘Urban control and the popular struggle: a survey of state urban policy 1920 – 1970, African Perspective, XX (1982), p.18 and Stadler, A The Political Economy of Modern South Africa,(London: Croom Helm, 1987) quoted in Gary Baines, 'The New Brighton Advisory Board, c.1923-1952, Op. Cit. 99 217 Ibid., Baines, p.79 64

Boards. Similar to my approach to the LHC as a public health institution, my contribution regarding

Advisory Boards will, like Baines, attempt to view these Boards not merely as governance institutions but as alternative political forums for local residents who may have questioned the legitimacy of these Boards but, in the absence of alternatives, used them to focus on their health and welfare needs.

Conclusion

In this chapter I reviewed some of the relevant literature pertaining to my two research themes; i.e. public health and on the governance of black urban areas in SA. The history of medicine is a rich and expanding field especially after 1994. There are a number of omissions particularly with regard to public health. My research on the LHC is partly an institutional history and will support and expand the histories of local authorities as public health institutions. The LHC also allows me to look at the relationship between public health and politics however, not in the way historians examined the relationship between health status, disease and apartheid. Instead, I use the literature on the Advisory Boards to ask how the

LHC and its own Advisory Board system managed to work with and against the urban segregation measures and investigate the LHC and the question of political representation. As a result, I conceptualized the LHC not only as a governance institution, as discussed in the literature on local government but, as a public health institution.

Chapter 3: "A Menace or Potential Menace to Public Health", Black Urban Areas and The

Public Health Crisis in Natal, 1930 to 1940

The Commonest feature of the problems resulting from irregular urbanization was the menace or potential menace to the public health of the inhabitants not only of such uncontrolled areas but also of neighbouring areas under properly constituted local government control

This is how the Thornton Committee summed up the conditions in black and multi-racial urban areas in Natal and in the Transvaal (the TVL) in 1939218. Black urban areas experienced a 'lack of control or inefficient administration [in relation to] housing, sanitation and water supply frequently resulted in dangerously insanitary conditions favoring outbreaks of disease'. 219 During the 1930s white, liberal public health bureaucrats in the UDPH decided that effective administration of urban areas was the most appropriate response to the 'menace to public health'. In this chapter, I trace the conceptualization and institutionalization of a public health-based solution to urban public health crises, specifically the lack of housing and sanitation services, in the black and multi-racial urban areas. The real spike in urbanization occurred during World War Two but due to a steady increase of both Africans and poor whites, unplanned urban areas emerged around the major cities posing a problem for managers and technical staff of white municipalities as well as the UDPH. Physicians in private practice and District Surgeons shared the concerns expressed by municipal managers and decried the injustice that resulted from a failure to give full effect to the1919 Public Health Act. This legislative framework was supposed to prevent these public health problems for in addition to defining the public health priorities, this Act also specified the health care responsibilities of each level of government. This system was, however, flawed and by 1939

218 Op. Cit. note 101 219 Ibid., p. 10 66

the Thornton Committee proposed a way out of the legal and political impasse that thus far prevented the introduction of local governance for these urbanized areas.

The main objective of this chapter is to demonstrate how liberal, public health advocates designed a new kind of local governance system for black and multi-racial urban areas using a race-blind interpretation of the existing law. They did this through the work of the Thornton Committee and when that Committee, in turn, established the LHC in Natal, and the PUAHB in the TVL 220 I further argue that these pre-1940 liberal ideas regarding public health and local governance within the UDPH should be also be viewed as a precursor of the social medicine experiment that was launched in 1940. Consequently, I seek to confirm and build on the arguments about the 1940s as the "liberal interregnum" as suggested by

Saul Dubow and Alan Jeeves in South Africa's 1940s.The significance of this chapter is therefore twofold: the role of public health officials in urban policy and an extension of the notion of the "liberal interregnum" in South Africa's 1940s.

I identify these two issues based on the renewed debates in the historiography regarding the role of white liberals, especially during the decade immediately before the introduction of apartheid. The

Thornton Committee and its recommendations are important for a number of reasons. This report, as an official document, provides insight into the way in which the bureaucrats interpreted the 1919 Public

Health Act and simultaneously managed to sidestep political obstacles that prevented the implementation of the recommendations of previous committees regarding black urban areas. In addition, the Thornton

Committee's findings were instrumental in the establishment of the LHC and the PUAHB. Finally, this

Committee serves as an example of the influence of public health bureaucrats over urban policy. Thus, even though certain segregation measures were in place, the Thornton Committee attests to a time when public health officials could influence urban policy.

220 The national Nutrition Survey of African School Children in 1938 was another UDPH activity that can be added to this list and I refer to it below. 67

While the contributors in Dubow and Jeeves' South Africa's 1940s explored multiple meanings of the "liberal interregnum", it also included developments in public health by Alan Jeeves and Howard

Phillips. The former wrote about the Institute of Family and Community Health in Durban (1945-1959) and the latter focused on the Grassy Park Health Centre. 221 By focusing on aspects of the social medicine experiment and, for Jeeves, the NHSC as well, both these authors use 1940 as their starting point in determining the "liberal interregnum". In this chapter I argue that the Thornton Committee and its recommendations should be understood as part of those liberal public health developments that were initiated during the 1940s and therefore, that the notion of the "liberal interregnum" should be extended to commence at least in 1938, the date when the Thornton Committee was established. The ideas about public health and black urban areas in the Thornton Committee are similar to those that influenced the establishment of the social medicine experiment and Gluckman noted in his NHSC report that he was impressed and influenced by the social medicine type work at the Pholela Health Centre that was run by

Sydney and Emily Kark.

My research was influenced by Shula Marks' contributions in defence not only of the social medicine pioneers but, I would add, public health interventions of the later 1930s and the 1940s including the ideas that influenced the Thornton Committee and the subsequent establishment of the LHC. Marks focuses on the intellectual environment of the time and the difficult political context in which these public health ideas and programs arose thus responding directly to arguments by Randall Packard. Wylie and

Bill Freund on the other hand, are more critical of the UDPH and these public health advocates. Wylie took issue with the framing of public health as a-political issue. Their technical approach, she argues,

221 Jeeves, "Delivering Primary Care in Impoverished Urban and Rural Communities: The Institute of Family and Community Health in the 1940s", pp. 87-107 and Phillips, "The Grassy Park Health Centre: A Peri-Urban Pholela?", pp. 108-128 68

depoliticized hunger, specifically, and poverty more generally. As for Freund, he viewed the work of the

UDPH during this time as part of an inter-departmental rivalry to expand its authority. In addition, the

LHC would not be seen as working well within the contemporary political boundaries imposed upon it and most, if not all its work, was ameliorative as opposed to exceptional.

However, Marks, as well as Jeeves, defend these historical actors arguing for greater attention to the political limitations of that historical moment and the need to deal with real public health concerns such as diseases, and in the case of the black urban areas, lack of environmental health services.

In the first of two sections in this chapter, I document the government's construction of the public health crises in black and multi-racial urban areas in Natal and the TVL, including the different solutions suggested over the years culminating in the Thornton Committee's recommendations. In the second and final section, I contextualize the Thornton Committee's recommendations, especially the establishment of the LHC as a local authority for black people in the urban areas by connecting these with other activities of the UDPH, debates about the health care by the municipal managers and physicians and finally, the larger story of how liberal, health bureaucrats spoke for and on behalf of African about their own health and welfare.

Irregular Urbanization and The Public Health Crises in Natal222

The wave of urbanization during the latter part of the nineteenth century coincided with the establishment and expansion of the mining industry. 223235 Since then, jobs and economic advancement

222 My research focus is Natal but this section includes references to the UDPH's framing of the urban crisis in Natal and the TVL. 223 J.S. Harington, N.D. McGlashan and E.Z. Chelkowska. "A century of migrant labour in the gold mines of South Africa', Journal of the South African Institute of Mining and Metallurgy, March 2004, available at 69

were among the main reasons for migration from rural areas and reserves to SA's mining towns. The effects of global depression (1929-1933) and the drought that followed in 1934 pushed more people off the farms and the African reserves into the cities.224236 This modernization process that began in the

1920s and involved the introduction of tractors and the creation of large farms, resulted in many farm workers including white farm tenants (bywoners) and African farm labourers becoming redundant and as a result, moving to the cities for work.225 In addition, those Africans who lived on the reserves found that local conditions became untenable: limited space combined with natural increase of the population meant that the reserves became overcrowded. The poor soil conditions made subsistence farming less reliable.

Each individual’s social conditions determined economic advancement.226

In spite of the promise of urban employment, limited employment opportunities existed in the cities. The manufacturing sector was still underdeveloped. The government stepped in by encouraging the expansion of domestic industry by offering protective tariffs. In addition, it established the first major capital goods enterprise, the Iron and Steel Corporation (ISCOR) in 1928.227 The steady stream of people

http://www.womin.org.za/images/impact-of-extractive-industries/migrancy-and- extractivism/Harington,%20McGlashan%20and%20Chelkowska%20- %20Century%20of%20Migrant%20Labour%20in%20SA%20Gold%20Mines.pdf and accessed 27 July 2014; Jonathan Crush, Alan Jeeves and David Yudelman, South Africa's Labor Empire: A History of Black Migrancy to the Gold Mines (Cape Town and Boulder: David Philip and Westview Press, 1992); and Alan Jeeves, Migrant labour in South Africa's mining economy. The struggle for the gold mines' labour supply, 1890-1920. (Johannesburg: Witwatersrand University Press, 1985) 224 Henry Bernstein, "South Africa's Agrarian Questions: Extreme and Exceptional?" in The Agrarian Question in South Africa, ed. Henry Bernstein (1996; Reprint, USA: Routledge, 2013), p. 1-52; Charles Feinstein, An Economic History of South Africa (Cambridge and Cape Town: Cambridge University Press, 2005) 225 R. Davies, D. O'Meara and S. Dlamini. The Struggle for South Africa, Vol. 1, 2nd edition (London: Zed Books, 1988); http://www.sahistory.org.za/segregation-apartheid, (accessed 20 August 2014) 226 The non-economic pull factors included ‘proper housing, light, sanitation, churches, schools and amusements (such as sports, bioscopes and theatres). Section 17 of the Thornton Report discussed the Social Reasons for urbanization. Thornton discussed the economic reasons along racial lines but not the social ones for he stated that the 'attractions of urban centers [were] sufficient in themselves to encourage large numbers of persons of all classes and races to migrate to the towns'. (Thornton Report, Ch. II, para. 17, p. 10) See also South Africa, A Modern History by Davenport and Saunders (New York: St. Martin’s Press, 2000) 227 Henry Bernstein, Agrarian Question, p. 66 70

that migrated into the towns picked up only after 1939 due to the expansion of war time manufacturing and the need for labour following the gap left by large numbers of white males who were drafted.228

Before 1936, there were more white people in the cities than black people. The African urban population doubled (from 1.1 to 2.3 million) between 1936 and 1951 and this was the first time that the black population exceeded the white urban population. 229 In 1939, 55% of the white population lived in urban centers while the African urban population was fairly constant at 12 - 13%.230 The Second World

War and expansion of manufacturing industries contributed significantly to this change in urban demographics.

Table 3: Urban Population of South Africa, c.1911-1936231

Year Number of urban areas Total urban population National Share of urban

(with over 5000 people) (thousand) population population (%) 1911 25 1,085 5,973 18.2 1921 36 1,369 6,927(thousand) 19.8 1936 53 2,476 9,588 25.8

In Natal, it was Pietermaritzburg and Durban, the two major urban centres that experienced an increase in population. 232 Pietermaritzburg experienced population growth largely because it was the

228 From 1939 onwards, according to Bernstein, the numbers of African urbanites increased beyond the ranks of male labour migration. These people, says Bernstein, came to work in the manufacturing industry and urban services. This new pull-factor in urban migration also changed the nature of urban settlement. See also Anthony Lemon's Apartheid in Transition. 229 Bernstein, Agrarian question, p. 8 and Office of Population Research, 'The 1936 Census of the Union of South Africa', Population Index, Vol. 9, No. 3, (July 1943), pp. 153-155, http://www.jstor.org/stable/2730411 (accessed 29 July 2014) 230 Lemon, Homes Apart, p.2 231 Ivan Turok, "Urbanization and Development in South Africa: Economic Imperatives, Spatial Distortions and Strategic Responses." Urbanization and Emerging Populations Issues Working Paper 8 ( International Institute for Environment and Development and UNFPA, October 2011), http://pubs.iied.org/pdfs/10621IIED.pdf (accessed June 6, 2014) 71

administrative centre and provincial capital. As with other cities, work opportunities in Pietermaritzburg accounted for urbanization of Africans. However, limited access to housing in the capital meant that new migrants lived in Edendale and other peri-urban areas.233 This area was often the only residential option for workers who were not housed in PMB by their employers or for unmarried couples who could not be accommodated in Municipal hostels because of their living arrangements. Residents and property owners in Edendale and surrounding areas also derived income from renting out rooms or backyard shacks.234

The African male population in Pietermaritzburg increased from 12,155 in 1936 to 17,566 in

1951. The African female population also saw an increase: 4,442 in 1936 to 7,807 in 1951.235 Durban also experienced population growth among African residents but as a major port city, the number of males far outstripped females. One of the main reasons for this discrepancy was the work opportunities for male dockworkers. According to David Hemson, there were 3000 to 4000 day workers employed at the Durban docks in 1940. 236 Between 1936 and 1946, the number of African males almost doubled (57,296 to

92,112) and while this was the same pattern for females; their numbers were less than half (15,964 to

32,368).

232 Julie Dyer, Health in Pietermaritzburg (1838-2008), p.10. During the later nineteenth century Natal had its own mining site in Northern Natal following the discovery of coal and, according to Dyer, the 'collieries started large- scale production in the 1880s' thus attracting labor. 233 Op. Cit. Note 83, University of Natal and Durban Economic Research Committee, Experiment at Edendale. p.10 234 Ibid. 235 See Unterhalter, Forced Removals, p.142 for data on growth of major urban centres. 236 David Hemson, "Dock Workers, Labour Circulation, and Class Struggles in Durban, 1940-59", Journal of Southern African Studies, 4 (1) (1977): 88-124 72

Table 1: African population by sex in Pietermaritzburg and Durban, c.1936-51237

Pietermaritzburg Durban Total 1936 Males 12,155 57,296 69,451 Females 4,442 15,964 20,406 1946 Males 16,119 92,112 108,231 Females 6,329 32,368 38,697 1951 Males 17,566 117,175 134,741 Females 7,807 50,560 58,367

These urbanization processes had significant consequences related to the availability of housing and sanitation services and for race relations. When people arrived in the city, they occupied various urban spaces that were available and affordable. These spaces included municipal townships, freehold or leasehold townships on privately owned land; tenants on white-owned properties; shanties, out-rooms or disused warehouses or workshops let by slum landlords. The Durban dock workers, for example, were housed in municipal barracks and housing provided by private employers.238

The type of accommodation described above clearly raised issues of security of tenure. Those housed by their employers were more secure, even if this was not freehold ownership, than those who constructed shacks on vacant land or lived illegally in backyards. The housing situation alone was a major problem for in addition to the insufficient houses or rooms; the building materials and poor ventilation were also conducive to the spread of disease. New urbanized areas also had no or limited access to clean running water, household waste and refuse removal services. Op. Cit. note 245.The absence of government regulations and oversight in these expanding urban spaces meant that the sale of food and slaughter of animals were unregulated.

237 Ibid. 238 Op. Cit. note 245 73

Official Narratives of Urban and Public Health Crises in Natal

During the 1930s the national and provincial governments launched enquiries to determine the extent of the housing and sanitation needs with a view to design appropriate solutions. While these enquiries focused on the extent of epidemic diseases among the people, it also included a focus on the environmental and social aspects of health. The NPA appointed a Committee of Enquiry in 1933 to consider ‘the desirability of the establishment of a separate system of local government for any area adjacent to the borough of Pietermaritzburg' and what form such local government should take. In addition, the Committee was to determine the 'desirability of extending the boundaries of the Borough of

Pietermaritzburg to include any adjacent areas and to identify which areas should be included. 239 It is important to note that the brief of the Committee included the possible expansion of the boundaries of

PMB so as to include the newly urbanizing areas on its boundaries and as a result, drastically increase the number of Africans officially (my emphasis) resident in the city of PMB.

L.B. Msimang provides an alternative narrative for the establishment of this NPA committee indicating, at least, that it was not only government officials who had concerns regarding the public health crises in Edendale and its surrounding areas. Residents of Edendale, including descendants of the original amakholwa who owned property in Georgetown, the centre of Edendale, were at the coalface of the changes in Edendale. The expansion of backyard shacks and an increase in shacks on vacant land by newly urbanized resulted in unplanned villages and sections around Georgetown. 240 According to L.B.

Msimang and fellow lot-holders, the conditions in Edendale were alarming and that quite possibly, 'one of the worst slums had developed' resulting in deterioration of the residents' 'social life and living condition'.

239 Natal Provincial Gazette No. 20 of 1933, quoted in the Durban Economic Research Committee, Op Cit, Note 90, p. 10 240 Natal Witness, 'Edendale Slum Fears. Residents to Hold Meeting' 2 March 1938; Epprecht, Op. Cit. note 150 74

241 Another Edendale resident, Sister V.V. Mihimkhulu wrote to the press exposing conditions in

Edendale. 242 For L.B. Msimang and his fellow residents, the establishment of a Village Management

Board would go a long way in solving the multiple public health crises and they requested that the NPA institute such a structure in Edendale. In spite of these concrete suggestions regarding the governance and living conditions in Edendale and surrounding areas, the NPA launched its Provincial Committee of

Enquiry.243

The small group of whites who lived in the Edendale areas also raised their concerns about the government's plan for governing Edendale. While the NPA committee was carrying out its investigation, they met to discuss their own proposals and nominated Mr. R.K. Rudman to communicate their demands to the PMB Borough. Noting that the NAD had some control over Edendale because of the large African population, the white residents feared being abandoned by the PMB Borough.

This 1933 Committee found 'that uncontrolled urbanization had taken place within a radius of three to five miles from the Pietermaritzburg borough boundary, and that a racially mixed population had come into being with the following demographics for three areas of Greater Edendale:

241 Msimang, PC 11/1/6 file PC 11/1/6/1. 242 Ibid. Following Mihimkhulu's public exposure of the conditions in Edendale, she received donations which she used to open a clinic. The latter was later incorporated into the LHC health care system. The characterization of living and social conditions in Edendale was contested by other residents including Land Holders in Edendale and Macibisi, Chief Indunas, Councillors (sic), Tenants and Residents of Edendale and Macibisi who met and drafted a petition to the government. 'The Appeal of Chief Stephen Mini, Original Purchasers, Heirs, Indunas, Councillors and Residents of Edendale', 14 April 1938, CNC 37(A) PMB General Administration, Edendale 243 PC 11/1/6 file PC 11/1/6/2 75

Table 2: Racial Composition in Sections of Edendale, c. 1933244

Europeans Coloureds "Asiatics" "Natives" Total Edendale 108 61 543 4,729 5,441 Sutherlands 101 54 364 1,500 2,019 Slangspruit 14 18 131 550 713

The general health and sanitation conditions in Edendale were described as 'deplorable in the extreme'. 86% of houses at Edendale were wattle-and-daub.245 Further, the government, both local and provincial, was not overseeing the sub-division of land, constructing houses or building roads. In addition, 'there was no satisfactory sanitation system; that pit privies were generally used'. As for the water supply, this was 'derived in a few places from roof tanks, in many cases from shallow unprotected wells often sited close to pit privies, and for the rest direct from the Umsinduzi River, which was contaminated.246 It was no wonder that people suffered from cholera, diarrhoea and enteric fever / typhoid. There was also a consistent increase in notifications of tuberculosis between 1931 and 1938 and the 'Natives and Indians' suffered 'serious defects in their diets’.247

One of the recommendations of this NPA Committee was that a 'strict enforcement' of the Native

Urban Areas Act of 1923, as amended, should be implemented so as to deal with the squatters in the area immediately adjacent to Pietermaritzburg. With regard to the question of governance, it recommended establishing a Health Committee in terms of the Health Committee Ordinance of 1930; and finally, to allow a Magistrate to act as local authority in terms of the Provincial Administration Act of 1927 (an option provided for in the 1919 PHA).

244 Ibid., p.11 245 Ibid. 246 Ibid., pp. 11 and 14 247 Ibid. 76

The NAD, the government department responsible for black urban areas, rejected the core proposals of the 1933 NPA Committee. It found those recommendations 'unsuitable' because ‘Edendale was not an area occupied by a racially homogenous people', legal and political barriers that were insurmountable.248 In addition to the legal barriers, those recommendations also came up against political barriers. As mentioned above, by the 1930s the Edendale population included European, including missionaries, government officials, farmers; Coloureds; Indians and Africans. The expansion of the

Edendale area as new people moved in long after the establishment of the Edendale Mission during the mid-nineteenth century changed the racial make-up of Edendale and its surroundings. While some of the

Africans in Edendale were descendants of the original land owners of Edendale Farm under Allison (see

Chapter One), others were recent immigrants, who like the rest of the area's population, were traders, vegetable gardeners, industrial and domestic workers in Pietermaritzburg. Some of residents of Macibise were described as 'sellers of illicit liquor, vagrants and criminals’.249

Given the diversity of residents, especially its racial make-up, the 1933 NPA Committee suggested an independent local authority for the greater Edendale area. This was however, also a proposal that the Native Affairs Department (NAD) did not accept. The law did not provide for a local government where the population was multi-racial because residents would have voting rights in order to elect their representatives. In a multi-racial community, with the majority African, it was highly likely that a number of Africans would be elected to the council thus putting them in a position of authority over whites. A further barrier was the fact that municipal status was also dependent on whether the area could 'raise

248 Op Cit. Note , p.13 249 Ibid. p.14. In addition to the white-owned farms, increasingly ‘non-Natives’ took over lots within the boundaries of Edendale after the Union in 1910 primarily because ‘the descendants of the original owners, having mortgaged their lots, failed to meet the repayment installments. Bond-holders foreclosed and the lots were resold to buyers, many of whom were Indians and Europeans’. 77

sufficient revenue through local rates’, which Edendale surrounding areas were unable to do.250 As mentioned though, even though the Pietermaritzburg Municipality was not completely opposed the recommendations of the 1933 Committee, these recommendations were not implemented because the

NAD, final administrative responsibility for Africans throughout the Union, rejected them.

The Thornton Committee: A Novel Approach to Health and Urban Governance

The UDPH was not pleased that the recommendations of the 1933 NPA Committee were not implemented. Thornton, who was still at the UDPH at the time, was of the opinion that this NPA

Committee would provide that solution to Natal's urban public health crises. In 1938 the UDPH undertook research into nutrition and health (see below). At the same time, it launched an inter- departmental committee on urban public health and governance focusing on all four provinces. Edward

Thornton, previously CMO for the Union, was appointed chairman of this committee.

Appointing Edward Thornton as the chair was an important and strategic decision for the UDPH.

Thornton had a long history in public health advocacy that he brought to the Committee and used to design an institution like the LHC. In 1938 Thornton already had a successful career in public health and undertook various steps to advocate for and implement an environmentalist approach to public health. He served as Chief Medical Officer (CMO) and Secretary for the Department of Public Health from 1932 -

1938, having arrived in SA from England. During his tenure as CMO, Thornton played a central role in the Department's official endorsement of the provision of contraceptives to poor white women because such programmes had the potential to provide both short and long-term physical and social benefits, according to Klausen.251 The latter also argues that Thornton based his approach on 'eugenic and

250 Ibid. 251 Susanne Klausen documented the UPDH and Thornton's role in the inclusion of family planning services into the Department's public health mandate. See especially “The Race Welfare Society: Eugenics and Birth Control in 78

environmentalist' arguments.252 In the 1935 Annual Report of the UDPH, Thornton condemned the fact that access to birth control services was regulated by class.

In addition to his position in the DPH, he served as head of the Housing Board established in the

1920 Housing Act. He was fond of beating 'the anti-slum drum'.253 He co-published with Manfred Nathan, a detailed explanatory guide on the 1919 PHA and the 1920 Housing Act in 1929. During the 1920s and

1930s, Thornton promoted the idea that an improvement of public health services for all races was urgent and these same arguments were evident in the final report of the Thornton Committee.

Thornton's ideas demonstrate an importance of quality of life and prevention of disease. Given his status as an ex-civil servant strongly committed to public health, it is also possible to conclude that

Thornton ascribed to the theory that the state should have a central role in managing the health and welfare. His interventions regarding birth control did not involve the government departments but by sponsoring mothers' clinics, he demonstrated a commitment to health and welfare programs. He could not fund contraceptive programmes legally through any government program and perhaps he would have, if he could. His commitment to the role of the state was certainly uppermost in his mind when he recommended the LHC and the PUAHB as solutions to the public health crises in Natal and the TVL. As discussed below, for Thornton, effective governance was integral to solving the health crises. His appointment to the Interdepartmental Committee allowed him to complete what he started years earlier at the UDPH, i.e. to do what the NPA and especially the Pietermaritzburg Municipality was unwilling or unable to do.

Johannesburg, 1930-1939.” in Science and Society in Southern Africa, ed. Saul Dubow (Manchester: Manchester University Press, 2000: pp. 164-187) and "Poor Whiteism', White Maternal Mortality, and the Promotion of Public Health in South Africa: The Department of Public Health's Endorsement of Contraceptive Services, 1930-1938", South African Historical Journal 45(2001), 53-78. 252 Ibid. 253 SAMJ, Editorial, SAMJ, 27 November 1937, p. 792 79

According to its Terms of References, the Thornton Committee was asked to recommend an effective form of administration for areas that were becoming urbanized but not under the control of any local government; areas that also lacked effective local government and were 'becoming a menace to the health and good order of existing local areas; and finally those areas where a form of local government was in place but due to certain factors, the area was in a condition that was 'inimical to public health or to sound administration'.254 It is clear then that from the outset, the question of governance was connected to any recommendation that dealt with solving the health and housing crises.

The Thornton Committee report summarised the health conditions in the major urban areas and then reported on each province including specific recommendations. One of the areas of enquiry was the extent to which the different laws applicable to black urban areas and Africans in general, were being implemented and their efficacy. As was expected, the Committee found that white Town Councils were spatially and financially unprepared for the influx and settlement of people on their boundaries. Further, some of the Town Councils did not consider these settlements as part of their jurisdiction for service delivery purposes. Thus, if an employer did not provide new migrants with accommodation, as mentioned above, workers entered into sub-letting arrangements, became lodgers or erected their own dwellings on available and conveniently-situated land. The Thornton Committee applied the term irregular urbanization to describe the settlement of people of different race and class status and when that settlement occurred in an unregulated manner. The crux of the problem was, therefore, unregulated construction of dwellings and subdivision of properties; use of materials that were not fit or healthy for occupation purposes; constructing structures that could facilitate the spread of disease. This lack of planning was both a cause and consequence of the absence of administrative oversight.

254 Op. Cit. Note 90, Natal Regional Survey and Report No.3, p. 13 80

These conclusions led the Committee to undertake a situational analysis with regard to the nature and extent of local government. (Table 6) It found that all the provinces had enacted provisions regulating the constitution and powers of local authorities however; some provinces were well ahead of others both with respect to the number of local authorities and their scope. The Cape Province, one of the earliest

Provinces to urbanize, had regulations in place since 1912.255 It adopted further regulations in 1917 and again in 1921. The Free State, as stated in Chapter One, was the last province to urbanize and did not need additional Town Councils. These two Provinces were also the ones that the Thornton Committee concluded as having the least problems and thus required virtually no intervention on the part of the

UDPH. However, the Transvaal and Natal were the two provinces that required national government attention. Natal only adopted their first local government regulations in 1924 and the Transvaal in 1926.

Table 3: Time Frame for Local Authority Regulations256

Provinces '12 '17 '21 '24 '26 '27 '30 '32 '33 '34 '35 Cape Natal Transvaal Orange Free State

The existence of provincial regulations regarding local administration was, according to

Thornton, a positive step in spite of the fact that three out of the four provinces waited for more than a decade following the establishment of the Union, to begin regulating urban settlement. The absence of a centralised system for local governance resulted in a lack of uniform urban policy between and within provinces. (Table 7) In 1938 Natal had 11 Town Councils and 16 Town Boards for its larger and medium size urban centres. The smaller urban centres were governed by Health Committees and Health Boards,

255 The Thornton Committee used the establishment of the Union in 1910, as its starting point. 256 Thornton Report, pp. 6-7 81

19 and 8 respectively. The TVL, being more urbanized than Natal at the time, had 32 Town Councils and

City Boards and 30 villages with dedicated Councils. In addition, the TVL had 38 Health Committees.

Table 4: Urban and Peri-Urban Local Authorities in the Union, c.1938 and 1943257

Types of Local Authorities Provinces Cape Natal TVL OFS

1938 1942- 1938 1942- 1938 1942- 1938 1942-

Town Councils & City Boards 134 1943138 11 194311 32 194336 64 194364 Town Boards - 16 23 - - Village Management Boards 93 89 - - 4 4 Local Boards 23 22 - - Local Administration & Health 8 1 8 - -

Boards/BoardVillage Councils of Health - - 30 - Health Committees 19 - 19 30 38 36 - Magistrates 29 44 43 36 Divisional Councils 95 - - - Total Institutions 250 374 54 108 100 115 68 104

The 'variety of approaches' in connection with local governance that the Thornton Committee found in 1938 had real impacts for poor and Africn residents in urban and peri-urban areas. For one, most of the major cities failed to develop and implement any comprehensive policies for housing urban African populations.258 Some of the existing local authorities also lacked sufficient authority, scope or revenue to deal with 'irregular urbanization' and its public health consequences. Health Committees, for example, could have been one option available to the Thornton Committee. The disadvantage was that these institutions were not fully fledged municipalities as they did not have executive powers nor did they

257 Thornton Report, Ch. II, para. 8, p. 7; UDPH, 1943 Annual Report in GES 1882, 1-32N. By 1943, Natal had the LHC and the TVL, the PUAHB. This categorization did not recognize the governance structures in black urban areas. 258Lemon, Homes Apart, p. 3 82

collect any form of revenue from its residents.259 At best, these Committees were akin to Malaria

Committees set up to respond to specific health issues.

The impotence of existing local authorities was confirmed by the LHC officials in in 1943 when they met with the NHSC during its nation-wide tour.260 When asked about the health conditions in Natal and the country as a whole, the LHC representatives said that the existence of Divisional Councils in the

Cape Province was in part the reason why the level of 'irregular urbanization' was the lowest in the country. In addition, the LHC noted that the fact that Magistrates were the local authorities in Natal was a

'fiction’261, for while Magistrates were the de jure authorities, evidence of the work of the Magistrates was few and far between. According to the LHC this was the main reason for the housing and health crises in

Natal.

Based on their findings, the Thornton Committee recommended a completely new form of local government based not on governance and political representation but rather, on the model of existing

Town Councils prevalent in large white towns. The LHC and the PUAHB came to manifest this new idea of urban governance; i.e. a mandate informed by the 1919 Public Health Act with the scope and authority of a Town Council. (Chapters 4 and 5)

Such a recommendation would have allowed the UDPH to avoid any conflict with existing political and legal positions but most importantly, it opened the door for the institution of a formal local authority for those areas that were in the process of becoming urbanized and had as yet no local authority.

It also allowed the government to respond favourably to white Town Councils by taking over the responsibility for black and multi- racial areas bordering their towns. Further, a new form of local

259Cloete, Sentrale, provinsiale, en munisipale instellings, (Pretoria: van Schaik, 1964) 260 NHSC interview with the LHC, 9 August 1943, LHC Minutes, Vol. 1, 1 November 1941-31 March 1943 261 Ibid. 83

authority based on public health principles gave effect to the health-based local authority as described in the 1919 Public Health Act.

Making Sense of The Thornton Committee's Recommendations

While we now know that the Thornton Committee's recommendations were acted upon, what I would like to pursue for the rest of this chapter is the broader context that facilitated the ideas contained in the Thornton Committee's Report and assisted in the subsequent establishment of LHC and the

PUAHB.

The first aspect is the role of the UDPH. Since its early years, the UDPH was committed to the development of a particular form of public health, i.e. one that prioritizes prevention of disease and in particular, the importance of environmental health, as opposed to maintaining racial boundaries. This does not mean that UDPH officials did not have racial biases or were oblivious to the question of racial segregation in SA. A number of key UDPH officials demonstrated however, through their work and ideas, that disease can be a universal threat and that the health of all communities could be compromised by disease in one community.

Thornton's work in the department and his personal commitment to social and environmental aspects of health, discussed above, was crucial to the department's perspective on public health. As the first MOH for the Union, he set the tone for future direction of the UDPH. His successor, Dr. J.A

Mitchell, also recognized the importance of a medico-social approach to disease and thus, the connection between social and biomedical dimensions of health.262 Prof. Eustice Cluver, previously a lecturer at the

University of the Witwatersrand (Wits) and Chief Health Officer after Mitchell, also demonstrated these perspectives on health and disease. Dr. Emily Kark, co-founder of the Pholela Health Centre, remembered

Cluver as being ‘one of [a] few teachers who critically referred to the neglect of the African people in

262 Op Cit. note 12 84

medicine and public health [and his] non- racist approach was quite unusual for the time’.263 In 1936, Dr.

Harry S. Gear, the Assistant Health Officer in the UDPH wrote that264

For various reasons, improving sanitary conditions in many areas has been slow, and there still exist indescribable methods of night-soil, refuse and water waste disposal, dirty stable, dairy, butchery and bakery premises, and filthy, unfit dwellings in too many instances.

These environmental or non-personal health conditions, for Gear, were urban health issues; however, he added that 'defects and ill health arise in large part from the play of social and economic factors, the study and treatment of which thus becomes a health function’. 265 Gear therefore also adopted a broad perspective on health, a perspective he became familiar with prior to commencing his medical work in SA. Gear studied public health in Britain and his medical practice included a stint at the Henry

Lester Institute of Medical Research of Shanghai, Chinese in the Department of Preventive Medicine and

Medical Statistics.266 According to the Karks, Gear had many 'innovative ideas' on his return to South

Africa regarding health services for the Africans on the Reserves.267 It was Cluver and Gear who initiated the nutrition survey in 1938 and also oversaw the introduction of the social medicine experiment with the launch of the Pholela Health Centres.268

263 Kark et al, Promoting Community Health, 1999, p.9 264 H.S. Gear, 'South African Public Health Services', in SAMJ, 9 January 1937, p.14 265 Ibid. 266 Op. Cit. note 270 267 Kark et al, Promoting Community Health, 1999, p.10 268 Dr. George Gale was a support of these ideas and programs after 1940. He was Chief Medical Officer and Secretary for Health in 1945 and during his tenure, the UDPH opened and operated more than forty Health Centres as part of the social medicine experiment. Gale's own training and expertise shows a bias in favor of a balance between curative and preventive health including a focus on environmental aspects of health. He was born in Natal, studied Medicine in Scotland and when he returned to Natal, served as a ‘medical missionary’ in Msinga, North Natal. Gale was fluent in Zulu and worked primarily in rural areas with Zulu communities. He published A Suggested Approach to the Health Needs of the Native Rural Areas of South Africa in 1938 demonstrating, according to Sydney Kark, a social conscience and a conviction that a new approach to health care was necessary. (Kark et al, Promoting Community Health, 1999, p. 84 and 194) 85

In 1938 when Thornton commenced his enquiry into governance and public health in urban areas, he brought with him not only his personal experience and convictions but an institution committed to a broad construction of public health, the importance of urban sanitation and housing, and the responsibility of government departments and the different levels of government, especially local government. In his capacity as chairman, Thornton was not constrained by institutional limitations he faced as a full-time civil servant and used this informal political space to make proposals that went beyond his earlier decisions regarding government funding for birth control programs. In addition, he avoided the legal and political limitations that faced the 1933 NPA Committee. Thornton went on to play an active role in the implementation of his Committee's recommendations when the Transvaal Provincial Administration

(TPA) established the Peri-Urban Areas Health Board (PUHAB) in 1942 and asked him to head up that institution. He served in that capacity from 1 May 1944 until his death in October 1946.269

A detailed examination of the PUAHB is beyond the scope of my research. It is important though to mention it because it demonstrates the extent of Thornton's advocacy for a 'new' kind of public health- based local authority. The PUAHB, headquartered in Pretoria, was established in terms of Ordinance 20 of 1943. Its stated objective was ‘to bring into being a form of local and municipal services in areas situated outside and mainly on the perimeter of existing municipalities in the TVL controlled by such bodies as City Councils, Town Councils, Village councils and Health Committees'.270 The PUAHB thus took control of all urban and peri-urban areas that were not being serviced by an existing local authority.271 It is clear that the TPA chose Thornton to lead the PUAHB because of his knowledge of local governance in relation to public health; his role as chairman of the committee that inspired the

269 Transvaal Provincial Secretary, 'Memorandum: Peri-Urban Health Areas Board', in TPB 2117 TALG 17197 270 TPB 2271 TALG 2/18498 Vol. 1 & 2, B.1/26 271 The Thornton Committee's report provided specific peri-urban character for the PUAHB with the following boundaries: south of Vaal River to Bethal district and westward to Potchefstroom district North boundary east to west along the line at approximately 20 miles north of Pretoria. 86

establishment of the PUAHB; his membership of the national Housing Committee and, of course, the fact that he served as the secretary for public health.

Unlike the LHC, the PUAHB came under severe attack from the TPA a mere ten years into its existence. By 1952 it had 22 Local Area Committees, the equivalent of LHC Public Health Areas (PHAs) and provided basic services to approximately '128 728 Europeans and 491 144 Non Europeans'.272 The plan was that once conditions in these LACs were under control, the LACs would become part of existing local authorities, or transformed into independent local authorities. PUAHB officials went so far as to refer to the LACs as 'embryo municipalities'.273 However, before any of this could be achieved, the TPA instituted an enquiry into the effectiveness and future of the PUAHB. A year later, the pressure on this institution and its five-person Board mounted as a banner in a Sunday newspaper reported "Under Attack: the Big 5 of No-man's Land. 5 men ruled 8000 sq. miles of No-Man's-Land"274 The three main accusations against the PUAHB by members of the TPA were that it over-stepped its original purpose; it exercised its powers unsatisfactorily; and instead of nurturing these 'embryo municipalities', it discouraged the development of self-government.275 In spite of Thornton's role in establishing the

PUAHB, it did not survive beyond the first ten years. Taken together, however, the PUAHB, in spite of its brief lifespan, and the LHC, demonstrate the extent to which the UDPH and individuals within that department would go in order to give effect to their construction of public health and their interpretation of the provisions of the 1919 Public Health Act.

272 TPB 2271 TALG 2/18498 Vol. 1 & 2, B.1/26 273 Ibid. 274 Johannesburg Sunday Express, March 15, 1953 275 Ibid. The PUAHB is another institution that requires further investigation, for example, the origins of this controversy that led to its closure, the public health implications for the people who were served by the PUAHB, are but a few questions that should be investigated. 87

The UDPH expanded its work on nutrition and poverty at the same time that it designed and established these novel local authorities in black and multi-racial urban areas. In 1938 the UDPH launched a national nutrition survey, initiated by Cluver and Gale as mentioned above, involving school- children throughout the Union that was carried out by academics and medical officers throughout the four

Provinces of the Union. Doctors Emily and Sydney Kark conducted the Johannesburg component of this survey while Dr. J. Brock implemented the Cape Town one.276 While Dr. Brock used the UDPH survey as a baseline 'to investigate more intensively the problems raised by the general survey', for the Karks, this was another event that they cited as significant in broadening their understanding of the significance of public health. As mentioned above, the Karks set up the first Health Centre in 1940, an initiative that developed into the social medicine experiment. The latter was a new philosophy of health care and a new way of delivering health care services in SA. This model conceptualized health and disease as products of their social and geographical environments: an individual's health status was intricately linked to the health status of his / her social and geographical communities such as families, friendships groups, co- workers and neighborhoods. 277 From a practitioner's perspective, Sydney Kark envisaged that a multi- disciplinary team take care of the individual and factor in all relevant information that could be obtained regarding family, home life, work life, social connections and geographical environment where individuals live and work. A critical component of care was the home visits. A third and final principle of social medicine, which is also important for this research on the LHC, was that health status was no longer limited to physiological aspects and the treatment of symptoms manifested by an individual. One's health status was also affected by a range of non-personal or environmental and social factors. For instance, cleanliness and overcrowded conditions in the house, inappropriate disposal of human and

276 Dr. J. F. Brock, 'The Findings of the Cape Nutrition Survey,' in SAMJ June 11, 1942; Kark et al, Promoting Community Health, 1999, pp. 178-9 277Alwyn Smith, The science of social medicine, (London: Staples Press, 1968); Sydney Kark and Guy Steuart (eds), A Practice of Social Medicine: A South African Team’s Experience in Different South African Communities. (Edinburgh: E & S Livingstone, 1962) 88

household waste and the availability of nutritious food were all thought of as factors that affected an individual’s health. Non-personal health services also included clean water supplies, drainage, sanitary measures, food handling, nuisance and regulation of offensive trades.278

The Pholela Health Centre, first of about 40 Health Centres that became known as the social medicine experiment, was opened in 1940, the same year that the Ordinance establishing the LHC was adopted. I suggest that all these developments were informed by a search for an improved and effective health care model during the latter part of the 1930s and from the above, it is clear that the UDPH was central to any attempts at transforming the health care system. Thornton's ideas about extending state resources to establish a novel form of local authority in order to address the health and welfare of black people and of the poor are ideas that I consider to be on par with the ideas and principles that shaped the social medicine experiment. Thornton, like the Karks and other social medicine pioneers, was committed to combatting disease among the poor, and providing black people with health and welfare services.

In addition to support from the UDPH and some of those in leadership, a second feature that facilitated the ideas in the Thornton report and the subsequent establishment of the LHC and the PUAHB was that physicians in private practice also envisioned a new form of health care.279 Beginning in the

1930s individual physicians turned to their professional journal, the South African Medical Journal

(hereafter the SAMJ), to launch a public discussion concerning the state of affairs within their own profession asking among other things, whether they were fulfilling their professional oath in light of the large numbers of people who were unable to access health services. In 1936, six years before Gluckman called for an enquiry into the nation's health services, the SAMJ published two articles in response to the

278 Government of South Africa, Report of the National Health Services Commission UG 30/1944 279 Anne Digby noted that not all doctors were in fact in support of radical changes to the health care system, especially after 1942 once the social medicine experiment was up and running and the government launched the NHSC enquiry. 89

Government Commission on a National Health Insurance (NHI) scheme.280 The first was an editorial and the second represented the views of SAMA branches, its executive and District Surgeons. These articles questioned the financial burden of accessing health services. The medical association 'attempted to speak in unison in this country [on] the question of medical relief for those who could not afford to pay for medical services' since 1926.281 SAMA struck various committees and participated in government commissions on this matter but, 'it is abundantly clear from the reports of [SAMA] Federal Council meetings, plenary sessions of Congress and Branch and Divisional meetings that the profession as a whole heartily supports some scheme of NHI'.282 It recognized that some workers were covered by an employment health insurance scheme but that there were still workers who were excluded from coverage.

In addition, private practitioners and the District Surgeons were in agreement that medical services should be extended to as large a number of people as possible, including a 'medical service for native territories'.283 The Medical Association stated that ‘all employees, whether white, coloured, Asiatic or natives’ should be members of an insurance scheme.284

While SAMA endorsed an employment-based medical scheme, it also called for a seemingly racially-blind system by including all workers, irrespective of skin colour or racial classification. It also agreed that medical assistance should be within the reach of every citizen.285 In addition, in 1936 SAMA endorsed the training of 'native personnel consisting of medical aids … supplemented by fully or partly trained native nurses and native orderlies'.286

280 Editorial, 'NHI,' in SAMJ Vol. X, No. 7, 11 April 1936, p. 247-48 and 'NHI and Medical Services for Rural Areas,' SAMJ Vol. X, No. 7, 11 April 1936, 249-256 281 Editorial, SAMJ, 1936, p. 247 282 Ibid. 283 Ibid. p.248 284 Ibid., p.249 285 Ibid., p. 251 286 Ibid. p. 250 90

During 1937 the SAMJ included eleven contributions covering various aspects of the role of local government and public health in urban areas but also the question of a NHI. Three of the 11 articles were editorials, also referred to as Leading Articles and two from Cluver reporting on his official visit to Russia where he investigated medical training and Health facilities.287 There were also three articles from doctors who were not employed within the UDPH or state health system.

In the first non-UDPH article, Dr. J. Henson wrote about his personal study of the health conditions in a small South African Town.288 Henson investigated the health and general living conditions of the coloured people in that town and concluded:

No health provisions are made for them. They have to build their own "pondokkies" [shacks] on some wind-swept piece of ground. … Pneumonia and pulmonary phthisis take heavy toll of these people. Syphilis and gonorrhoea play havoc with them.

He continued by saying that some of these problems can only partly be remedied by education, which may turn out to be 'useless' because 'they cannot afford most of the bare necessities of life on their meagre earnings'.289 He was particularly dismissive of the Village Management Board arguing that he conducted his study in part because of 'the indifference, ignorance, and obstinacy of the members of the

Village Management Board. I found them anything but helpful'.290 Henson was critical of this Board's responses to the people's needs and in fact said that 'it should be obligatory on the part of the local authorities to employ the local medical men as medical officer of health'.291 In addition, he called on the

UDPH to 'undertake regular visits' to these 'isolated communities'.292

287 Dr. E.H. Cluver, 'Medical Training in the U.S.S.R,' in SAMJ 22 May 1937 p. 369-371 and 'Medical and Health Institutions in the U.S.S.R,' SAMJ 23 October 1937, p. 727-730. 288J. Henson, "An Analysis of the Health Conditions in a Small South African Town', SAMJ, Dec. 11, 1037, p. 833- 34 289Ibid. 290 Ibid., p. 833 291Ibid., p. 834 292 Ibid. 91

Henson's conclusions and recommendations did not depend on the racial classification of the residents and neither did he recommend local and national government action purely in defence of the health interests of white residents.

Dr. F. Daubenton's article revisited the question of a NHI. He challenged the conventional wisdom propagated by doctors in previous issues of the SAMJ and by politicians that NHI systems were in place internationally. Such systems, he argued, were more of an ideal, one that was 'certainly as old as human feelings, which has been the basis of the aspirations of the medical profession since

Hippocrates'.293 He was even critical of the German health system when he referred to it as the 'so-called

NHI' describing it as an 'effort to patch up the thoroughly deteriorated social conditions'.294 His main objection to NHI systems that were operational was the lack of fundamental pre-requisite systemic changes that should serve as a support system for an effective NHI. Daubenton cited examples of doctors' expressing their frustration with their health systems in Germany, England, Switzerland, Holland and

Austria. More doctoring, he argued, was not the solution and cited at length the developments in Chile.

The latter country instituted a compulsory insurance fund in 1932 that provided for a general sickness, invalidity and old-age insurance. However, when the medical officers of the Chilean fund met in 1937 to reflect on their experience and contemplate the future of the fund, 'the fresh optimism of a year or two ago

[were replaced by] a certain disillusionment, as no appreciable reduction of the morbidity or mortality rates among the general population has yet been observed'. This did not mean that, for example, infant mortality rates did not drop. While curative health services were important, they needed 'to be supplemented by a vigorous campaign for the prevention of social diseases and to be accompanied … by a common effort on the part of all the public authorities concerned, to improve housing conditions, and

293 Dr. F. Daubenton, "NHI", SAMJ 23 October 1937, p. 599-603 294 Ibid., p. 600 92

especially to enable the workers to achieve a higher standard of living'.295 Pre-empting the establishment of the social medicine experiment and the LHC; Daubenton asked, and I paraphrase his words, does the history of NHI not suggest that Government funds should first be spent on improving hygienic conditions and health education before arguing in favour of a National Health Insurance system and should a

National School of Preventive Medicine not be a prerequisite? This is interesting because Daubenton's contribution demonstrates again that there were medical professionals outside of the state system who were conscious of the social conditions within which they practiced and that there was a strong correlation between health status and living conditions. In addition, Daubenton's proposal went further than that of the SAMA position. The latter advocated for the inclusion of all workers of all races in an

NHI system while Duabenton argued that health inequalities would persist if the social inequalities were not addressed at the same time.

Dr. Cluver from Durban emphasized the important role of local government in reducing the incidence of enteric fever. In his opinion, 'the lack of local government'296 was critical in managing this disease. Natal, he concluded, was 'probably the most backward Province in regard to the development of local government';297 a position that the Thornton Committee endorsed a year later.

At the same time as the public health developments unfolded, debates within the SAMJ gained momentum. Eventually the SAMJ editors encouraged more readers to present their ideas or the records of

SAMA branch meetings regarding 'the future' of the health care system of the country in a new, special column by the same name. The initial contributions on this topic were from Drs. J.C. Gie and J.F. Brock both based in Cape Town and suitably entitled 'The Future of Medicine' and 'The Coming New Order in

295 Ibid., p. 602 296 Dr. F.W.P. Cluver, Durban, "The Urban and Rural Aspects of Enteric Fever Control", SAMJ, Jun 12th, 1937, p.408 297 Ibid. 93

Medicine', respectively.298 Both Gie and Brock were bold in their critique of the health care system as well as their recommendations. They questioned the efficacy of the current system and concluded that

'there can be no doubt' that the profession and the way health services were organized, were not fulfilling its primary goal.299 This goal, Brock argued, was to see that the nation was so organized and educated that its citizens could grow up and live in the best possible state of health; a focus on the prevention of disease; the diagnoses and treatment of curable diseases; and amelioration of the effects incurable disease.

Gie was more concerned with the organization of health care, i.e. services, profession, finances, and the role of the state. He also noted the focus on prevention, 'the achievement of positive health', but added that every individual should have access to the services of a doctor of his/her choice and to treatment facilities.

In addition, Gie argued in favour of a 'closely co-ordinated and development medical service through a

'planned national health policy'.300 Gie opined that it would not be possible 'to have a health medical service to the public, in which all these advantages can be incorporated, without advocating a complete

State medical service, in which the right of the individual having a free choice of doctor is taken away?'301

He outright dismissed the suggestion of a health insurance system as it would not avoid the competitive element or the inequality that were already embedded in the system. What was required, however, was that 'we must … alter our organization and methods of bringing medical aid to the public, and in this country, with its sparsely populated areas, with its large ignorant Native population, with long distances of travel, this may present many difficulties - difficulties, however, which should not be insurmountable'.302

298 Dr. J.C. Gie, 'The Future of Medicine,' in SAMJ, June 14, 1941, p. 203-207 and J.F. Brock, 'The Coming New Order in Medicine,' in SAMJ, June 14, 1942, p. 207-209 299 Brock, 'The Coming New Order in Medicine,' p. 207 300 Gie, 'Future of Medicine', p. 203 301 Ibid. 302 Ibid., p. 204 94

Public engagement by physicians in the SAMJ continued even after the Thornton Committee published its findings and the establishment of the PUAHB and the LHC. In the June 1941 edition Dr.

Peter Alan, the then Secretary for Public Health argued that in spite of the requirement of the UDPH to provide curative health care services, preventive services should be the 'most prominent'. 303 His article, entitled 'Changing Order in Medicine', outlined Alan's opinions with regard to the social and environmental aspects of health. He recognized the importance of the government's role in the provision of houses while simultaneously eradicating slums. In addition, he acknowledged the importance of the

'social aspects of medical work', an area of health care which was 'coming into its own' and should therefore be the basis of future policy of medicine. 304

These three contributions by Drs. Brock, Gie and Alan, were only the introduction to what was to become an intense debate amongst physicians about the future of health care in SA. In 1941 SAMA launched a column entitled 'the Future' in the SAMJ stating that it would publish contributions about the future of health care services in SA. The sub-heading or description of this column was as follows: 'This section welcomes contributions, constructive or critical, on the subject of "The Future of Medicine in

South Africa".305 The debate within the SAMJ gained momentum following the establishment of the

NHSC in 1942. It was however, a debate that began during the 1930s and as more doctors criticised the contemporary state of affairs, others added their voice, for and against reform, to that debate, lending further support for my proposal that the liberal interregnum suggested by Dubow and Jeeves should be extended to the mid-1930s.

303 P. Alan, 'The Changing Order in Medicine,' in SAMJ 14 June 1941, p. 205 304 Gie, 'Future of Medicine', p. 207 305 Editorial, 'Planning for the Future', SAMJ, 95

The broader political context and particularly the space occupied by liberal politicians and officials, is the third and final factor that played in role in the creation of the ideas contained in the

Thornton Committee Report. South Africa has a long history of liberalism and of liberal values influencing organized politics even though the Liberal Party never won a single election (or seat in government) at national, provincial or local levels. 306 The 'diffuse' nature of liberalism meant that 'liberal values have long possessed the capacity not only to survive but also to nag at governments and other official and unofficial bodies' and this was, in my opinion, how liberalism influenced the Thornton

Committee and eventually the work of the LHC. 307

The tenets of those liberal values, according to Johnson and Welsh's historical account of liberalism under apartheid, were: 308

a commitment to fundamental human rights and those procedural safeguards known as the rule of law; a commitment to constitutionalism, meaning that state and government are to operate under law and that certain fundamental principles must remain beyond the reach of any (temporary) government; a belief in equality (whose exact parameters remain a matter of on-going debate, but implying at least equality before the law and (for most liberals) the dismantling of entrenched political, economic and social inequalities; an emphasis on the primacy of the individual as the possessor of inalienable rights, though by no means, as critics allege, unmindful of the need for, and claims of, community; tolerance of conflicting viewpoints (spelled

306 R.W. Johnson and David Welsh. Ironic Victory. Liberalism in Post-Liberation South Africa. (Cape Town: Oxford University Press, 1998.) The Liberal Party, as a formal institution, existed from 1953 until 1968 and only ever had about 8000 members, both black and white. 307 The political context that sustained the LHC during the 1940s was a combination of the political and policy spaces. For example, the political history of Natal is characterized as one that facilitated the formation of the Liberal Party and according to David Welch, some of South Africa's 'greatest liberal figures' came from Pietermaritzburg. See Peter Brown, "Liberals in Pietarmaritzburg," as well as Brown and John Aitchson,"Opposing apartheid in Pietermaritzburg," in Pietermaritzburg 1838 - 1938 edited by John Laband and Robert Haswell; R. Vigne, Liberals against Apartheid: A History of the Liberal Party of South Africa, 1953-1968. (London: Macmillan, 1997); Barry White, “Some thoughts on liberalism in Natal, 1920-1950.” In Settlement, Conflict and Development in Natal, Pietermaritzburg: Department of Historical Studies, University of Natal: History Workshop, University of Natal, Pietermaritzburg, April 3-4, 1997. As for the latter, Saul Dubow and Alan Jeeves's World of Possibilities presents some of the examples of a "liberal interregnum" that prevailed after the Second World War to the extent that political space opened up for liberals with regard to the political future of SA. 308 While Ironic Victory is not completely nostalgic, it is a more positive reflection on the endurance of liberal values and those who resisted apartheid based on liberal values. In addition, the authors in this edited collection aim to both interpret the 1994 political settlement as a form of liberal victory. 96

out with force in John Stuart Mill's great essay On liberty). …; an optimistic belief in the possibilities of individual and social 'improvement' … with the implication that no individual, community, or society is irretrievably damned as hopeless and compassion.

There were at least three different occasions on which these liberal values, or at best versions of these values enumerated by Johnson and Welsh, influenced and shaped the political landscape prior to this mid-twentieth century public health and governance framework. Firstly, during the nineteenth century, it served as the rationale for the non- racial, qualified vote in the Cape. Secondly, during the 1909 negotiations for independence from Britain, the Cape liberals fought to retain its qualified non-racial system of governance in the Cape Province but were unsuccessful when they tried to extend that same political system throughout the country. It met fierce resistance from Natal, which was also a British colony but did not inherit the same British liberal tradition as the Cape. The then Prime Minister of the

Colony of Natal, P.R. Moor, said that 'the history of the world proved that the black man was incapable of civilization and would oppose any efforts that saw the black man in a position to legislate for white men'.309

The final example comes from Duncan's description of the ways in which white liberals worked within the system with a view of transforming it. This is the category that is most applicable to my research focusing on the work of white civil servants in the UDPH and elected representatives. From

1910 onwards, the government adopted a range of laws that resulted in further stifling of political actions based on liberal ideals. White liberal-minded Members of Parliament (MPs) were unable to prevent the adoption of the 1913 Land Act as well as the passing of the Hertzog Bills in 1936. One of the consequences of these laws was that all black people lost their right to vote and to direct representation.

309 Vigne, Liberals Against Apartheid, p.2 and "South African Union: General Botha and Natal, Policy Towards Natives," The Age, August 22, 1910 at http://news.google.com/newspapers?nid=1300&dat=19100822&id=HPxUAAAAIBAJ&sjid=95IDAAAAI BAJ&pg=4013,4322413 accessed 28 January 2014 97

However, Duncan argues that during the 1920s and the 1930s liberals saw their 'pivotal role in relations between the state and the African people'.310 In the absence of self-representation and unable to influence the political and economic realities of their lives, white liberals placed themselves in the role of representing African views. This role was of course sanctioned by a political system that provided for

African representatives in parliament.

Duncan discusses the examples of Rheinhalt-Jones and Hoernle who served as chairmen of the

Alexandra Health Committee from 1933 to 1943 as examples of this new role available to liberals. While

Duncan agrees that liberals had limited impact within the state structures, including Rheinhalt-Jones and

Hoernle he is not convinced all of them adopted a form of liberalism that was essentially a 'conservative ideology that accommodated the doctrine of racial segregation'. According to Duncan311:

Hoernle [for example] was not merely concerned with ameliorating the quality of life as an aspect of "social control", he believed in the duty of liberals to "stand up for the liberties of oppressed or restricted individuals and the liberties of oppressed groups.

Hoernle believed, according to Duncan, that the assimilation and development of Africans were

'deliberately retarded' by 'poverty, lack of opportunity, lack of encouragement, artificial barriers erected by whites'.312 Consequently, both Hoernle and Reinhalt-Jones decided to 'work within the system, using

310 Duncan, "Liberals and Local Administration." In this article, Duncan responds to arguments put forward by Bozzoli and Rich, for example, regarding the role of liberals under segregation particularly during the 1930s and 1940s, liberals sought to control of Africans thus preventing them from threatening the existing social and economic institutions. I deal with this issue in more detail in chapter 4. 311 R.F.A. Hoernle, "A Theory of Liberty," in Race and Reason (Johannesburg, 1945) quoted in Duncan, 'Alexandra Health Committee', pp. 475 - 76 312 Duncan, 'Alexandra Health Committee', p. 475 and 476, quoting from Hoernle's Race and Reason, which he published in 1945.) 98

their supposed influence with the powers that be and expertise on African affairs to create opportunities for blacks and to remove the obstacles to African aspirations' 313

Duncan's study focused on the early years of the twentieth century. The question then becomes whether white liberals continued to play this role by mid-century. In his history of white liberalism, Paul

Rich describes this representative role undertaken by whites, as a form of inter-racial mediation that became increasingly sophisticated especially after 1936, when the position of 'Native Representative' was institutionalized in the laws based on the Hertzog Bills.314 Margaret Ballinger and Edward Brooks were two of the outspoken white liberals who served as Native Representatives for Africans in the provinces of the Eastern Cape and Natal, respectively. (See below, chapter Five) However, as these roles became more formal, the scope for white liberal intervention began to change, specifically restricted. There were

Africans who interpreted the role of Native Representative as one that decreased their own opportunities for direct representation. Further, whites who took up this role were seen as not fully committed in their opposition to segregation.315 The broader political climate in 1938, however, supported the work and ideas of the Thornton Committee and those in the UDPH. It is not entirely unimaginable that the years of speaking for and on behalf of Africans, also influenced the work of those public health officials during the late 1930s and early 1940s. A rich political environment at both the local and national levels facilitated the emergence of the radical recommendations contained in the 1939 Thornton Committee Report.316

313 Duncan, 'Alexandra Health Committee', p.477 314 White Power and the Liberal Conscience: Racial Segregation and South African liberalism, 1921-60 (Manchester: Manchester University Press, 1984) 315 Rich argues further that after 1940, the rise of Afrikaner nationalism and unionization of African workers put additional pressure on these white liberals and their public political roles 316 There were also international factors that could be identified as influencing the South African public health civil servants. Social Historian Virginia Berridge identified the interwar years as one moment during the twentieth century when significant changes occurred in the construction of public health. By expanding their role and scope of authority, public health practitioners expanded the bureaucracy run by public health professionals. For example, in 1939 in Britain, local authorities were allowed to provide maternal and child welfare services; school medical services; school meals and milk programs; TB schemes and operate their own health centers. (Virginia Berridge, "Public Health in the Twentieth Century: 1945 - 2000s," in Public Health in History ed. Virginia Berridge, Martin 99

Conclusion

In this chapter I argued that the national government, primarily through the UDPH, was concerned about an urban public health crisis manifesting in a lack of adequate and 'healthy' housing and sanitation. Multi-racial and black urban areas were the main areas that came under scrutiny. Natal was one of the provinces that attracted the attention of the UDPH. When a provincial committee failed to resolve what was perceived as a growing crisis, the UDPH used its 1938 health and nutrition work to appoint the Thornton Committee. The latter, I suggested was able to circumvent legal and political barriers faced by previous commissions and committees, and proposed the establishment of a local authority specifically for black and multi-racial areas. There was however a favourable national and local political context that facilitated these novel recommendations of the Thornton Committee. The significance of the Thornton Committee's recommendations is that it extends the notion of the "liberal interregnum" proposed by Dubow and Jeeves as the 1940s, as commencing in the 1930s. In the next chapter, I provide an institutional history of the LHC.

Gorsky and Alex Mold (London: London School of Hygiene & Tropical Medicine, 2011), 162-178) The connections between SA and Britain were not completely severed in 1910 and especially within the medical profession, doctors in SA were well aware of developments in Britain. 100

Chapter 4: "A New Experiment in Local Government"317: The Local Health Commission in

Natal, 1940 - 1959

SA's search for effective local government did not start in 1994. In this chapter I provide a more detailed description of the LHC, one of those attempts during the twentieth century to find appropriate local governance institutions to respond effectively to urban housing, sanitary and related matters. This chapter is therefore in part an institutional history but it is also a history of public health in SA. What follows therefore is a description of the functions and institutional arrangements of the LHC, which also serves as a discussion of the way in which public health was conceived and implemented between 1940 and 1959.

The goal of the chapter is to ensure that the LHC, as a public health-based local authority, becomes part of the historiography of medicine and of public health. This presentation of the LHC is informed by the gaps in the literature. It is completely absent from the histories of public health and of medicine, in general. The LHC is however mentioned in the literature on local governance and Cloete's

1964 descriptive account of the various forms of government is the only contribution that provides two or three paragraphs describing the LHC as local authority. Timothy Nuttall’s thesis gave a fair account of the political questions that the LHC triggered in the month before it was established and the two or three years after. Neither Cloete nor Nuttall discuss the public health significance of the LHC or the fact that it was fundamentally different from both health-based and governance-based local authorities that were in operation at the time.

317 Op. Cit. note 268, LHC Interview with the NHSC 101

While this chapter provides the detail of the LHC as an institution and its work, the next chapter considers both the political implications of the work of the LHC and the ways in which people responded to the LHC.

This chapter focuses on the years between 1940 and 1959. During the first ten years, the LHC set up its operational mechanisms and incorporated PHAs throughout the different regions of Natal. It continued to operate even after the NP took control of the government and started implementing its urban apartheid measures. Until about 1950, the LHC faced very little opposition and it was only after 1950, when the NP started implementing its urban apartheid policies, that the LHC and the status of public health became less secure. In 1960 Hendrik Verwoerd, then Minister of Native Affairs, began to take a hard line in relation to the black urban areas and the implementation of urban segregation accelerated.

Even though the LHC continued operating, the authority invested in public health was more difficult to uphold.

This chapter begins with a summary of the establishment of the LHC followed by a discussion of its institutional arrangements including its internal administration and its Public Health Areas (PHAs).

The second half of this this chapter outlines the different activities of the LHC.

A New Public Health-Based Local Authority

When the LHC was established in 1940, its overall goal was the 'management, regulation and control of' the PHAs and that meant that the LHC had the authority to 'establish, manage and control certain local works'.318 These 'works' included building and maintaining public infrastructure such as roads, schools, health and recreational facilities. It was also mandated to regulate the sale of food

318 Natal Provincial Administration, Local Health Commission (Public Health Areas Control) Ordinance No. 20 in NOP 5.1.34 102

especially meat; inspect facilities that prepared or sold food; test and treat water sources; and provide curative and preventive health services. I discuss the PHAs below suffice to say here that these were the specified geographical spaces that the LHC controlled, similar to municipal boundaries.319

This mandate of the LHC was very similar to those of regular local authorities that also operated in urban areas but served primarily white residents. The major functions of these local authorities were

'the construction and maintenance of roads, the supply of water and electricity, provision of council housing, traffic control, refuse collection, health services, public library services, museums, fire-fighting services, motor vehicle and business licensing, sewerage, cemeteries and crematoria, ambulance services and storm water drainage, the provision of parks and sports grounds and public transport.320 These local authorities collected revenue to cover their expenses from rates on fixed property and for services such as electricity and water. In respect of the LHC, the drafters clearly intended for the LHC to be a similar kind of local authority but in black and multi-racial areas. Section 5 of the LHC Ordinance stipulated that it had the 'powers and duties conferred or imposed upon urban local authorities by the Public Health Act' (of

1919) and that it would exercise these duties within the PHAs under its control. The LHC had the right to

'impose taxes, fees and any other charges necessary for the implementation of its mandate as well as impose and collect fines in respect of any contraventions of LHC regulations or any other law that the

LHC had the authority to implement.321 The NPA, as provincial executive body, had the authority to amend the terms of the LHC or to replace it with any other local authority and this also meant that the

319 While these PHAs were geographically defined spaces, they were also economic, cultural and political spaces according to Kevin Fitzgerald and Mark LaGory conceptualization of urban spaces and therefore, even before the LHC took control of an area, the latter had a social character with which the LHC officials inevitably had to contend. The implications of this are, among other, that the LHC may have, and in certain instances did, experience resistance to their attempts at taking over (my emphasis) the administration of an area. In addition, this framing of the PHAs as social spaces also means that it is important to consider how the LHC's activities affected the economic, cultural and political dynamics of a particular PHA even before the LHC took over. 320 Cloete, , Sentrale, provinsiale, en munisipale instellings, Op. Cit. note 2 321 Section 6, Ordinance 20 of 1941. The LHC financed its operations through rates imposed on property owners (land and buildings), licensing fees collected from commercial businesses 103

NPA had authority over the LHC as it did over all local authorities within its jurisdiction.322 When the

LHC met with the NHSC in 1943, its officials described the LHC as a 'new experiment in local government' arising out of the Thornton Committee's conception of solutions to urban health crises.323

Once it was up and running, the LHC fostered a relationship with provincial and regional municipal associations. Its officers attended the Natal Municipal Association (NMA) conferences and the LHC

Secretary attended meetings of the Natal Committee of the Southern African Town Clerks Association.324

The first three Commissioners325 were Thomas Mansfield Wadley, John Christopher Boshoff, and

Harry Camp Lugg. At their first meeting as a Commission on the 3rd of November 1941 at the LHC head office in PMB, Wadley, the first chairman, 'expressed the hope that they would make a success of the undertaking [for] in doing so, they would not merely bring credit on themselves, but would greatly enhance the prestige of the Province as a whole. The work offered them an opportunity to perform an important service for the community as a whole.'326 Wadley saw the success of the LHC as reflecting positively on themselves as individuals and also on the NPA and the residents in the PHAs. Lugg and

Boshoff agreed and 'assured [Wadley] of their whole- hearted co-operation in all that lay before them'.327

This sense of commitment was evident in the pro-active role that Lugg and Boshoff took on concerning the establishment of the LHC and their involvement in the development of the LHC's housing policy. (See below and Chapter Six)

322 Section 15, Ordinance 20 of 1941 323 Op. Cit. note, 268 , NHSC interview with the LHC, 9 August 1943, LHC Minutes, Vol. 1, 1 November 1941-31 March 1943 324 LHC 33/14, Annexures to Minutes, 1 April - 30 June 1958, Vol. 17[1](a), Memo by D.R. Donaldson dated 7 June 1958 325 The term 'LHC' will be used to refer to the entire institution and the word 'Commissioners' will be used to refer to the three person executive body of the LHC. 326 Minutes of LHC Meeting, 3 November 1941 in LHC Minutes, Vol. 1, 1.11.41-3.3.41 327 Ibid. 104

During 1942 and part of 1943 the LHC Commissioners and staff developed detailed regulations and designed their organizational structure that would help them to implement their mandate. However, because the LHC was the first of its kind, the pioneers undertook extensive research including perusing existing laws, regulations, institutional visits and interviews in order to inform their decisions regarding the LHC.328 Different LHC officials looked at the provisions of the South African Act; the Public Health

Act; the regulations applicable to Health Committees in Natal established in terms of Health Committee

Ordinance No. 14 of 1930; and the provisions of the Private Township Act. They sought a legal opinion on Local Authorities concerning the extent to which the powers and functions afforded to the latter are applicable in the whole, to the LHC and they interviewed officials in the NPA, PMB Borough and at the

UDPH.

Institutional Arrangements

Within the first five years of its existence, the LHC became a large government bureaucracy with three departments: an executive, an administration and the Advisory Boards (ABs) in the PHAs. The executive branch consisted of our Commissioners, a chairman and two ordinary members, who were appointed by the NPA for a three year, renewable, term. Thomas Wadley, J. Boshoff and H.C. Lugg were the first three Commissioners. These officials had final decision-making powers for the LHC and, given the political context, were always white men.329

328 Minutes, LHC Meeting of 10 November 1941, Vol. 1, 1.11.41-31.3.43 329 Section 15, Ordinance 20 of 1941; GES 963 898/13. The only women who appear in the record as part of the Administration was Ms. B. Anstey, Typist until 1946 105

Table 5: Senior LHC Staff Members, c. 1941 - 1959330

Date Chair Member Member Secretary MOH (Dr.) Engineer 1941-1946 T.M Wadley J. C Boshoff H.C Lugg A.R. Norman D. Landau W. M Chrystal November T.M Wadley J. C Boshoff J. Addison A.R. Norman D. Landau S. Newmark 1946 1957 - J.A Gooding J. Addison R.P Campbell D.R. Donaldson R.P Seymour S. Newmark 1959

Image 4: First Commissioners, 1941

330 LHC, Fifth Annual Report, 1947, LHC, Annexures to Minutes, Vol.16 (2) (a), 1 October 1957- 31 December 1957. The professional positions were occupied by whites, for example, doctors and engineers and their deputies. In non-professional categories, white officials were in managerial positions, for example, the person in charge of the Stores Department was white. Black people were employed mainly as manual laborers except for Social Workers and those trained as Health Visitors. In the EDPHA, the LHC employed an African social worker under the guidance of the Supervisor, a white social worker. 106

The Administrative branch was headed by three senior bureaucrats: an Administrator, an

Engineer and a Medical Officer of Health (MOH).331 While the three Commissioners were the de jure executive authority of the LHC, these three departmental Heads, I suggest, had the real power. The pattern of decision making contained in the LHC records indicates that the Commissioners and these three senior bureaucrats met on a monthly basis to discuss human resource matters, internal administration related matters and their work in the PHAs. A typical agenda for a monthly meeting of the LHC included the reports of the MOH, Engineer, the Secretary and the PHA Superintendents. These reports included information related to all ongoing and future LHC operations. For each activity, the relevant Head of

Department would provide the details / issue that required a decision as well as the recommendation and in the overwhelming majority of instances, the Commissioners would adopt the recommendation proposed. As a result, these departments not only recommended specific actions for the LHC to decide upon, they also implemented those decisions.

In addition to the Heads of Departments, the administrative branch of the LHC employed a wide range of professional and non-professional staff members. In the LHC's Health Department, the MOH supervised the assistant medical officers of health, who serviced one or more PHAs, Health Inspectors,

Health Visitors, Health Assistants, Social Workers, nurses and midwives. The Chief Engineer was in charge of assistant engineers, survey assistants, draughtsman, a survey booker, builders, plumbers, carpenters, plant operators, drivers, artisans and full-time as well as casual laborers.332

331 Interestingly, Dr, Cluver, Deputy Chief Health Officer for the Union in 1941, was of the opinion before the LHC commenced its work that 'a good sanitary inspector would be more useful to the Commission than a doctor' especially during the 'development states of the Commission's work'. This suggestion could have been made because of Cluver's own vision regarding the work of the LHC; however, the absence of the fully qualified medical doctor as its MOH could have had a negative impact on the LHC's status as a public health institution and also as a local authority. In the end, the LHC did not follow Cluver's suggestion. See Minutes of the LHC, Meeting of 17 November 1941 in LHC Minutes, Vol. 1, 1.11.41-31.3.43 332 LHC Engineer's Reports document both work reports and Staff 107

List of Staff Members at June 1944: EDPHA and Clermont and Wilgefontein PHAs

Chief Superintendent Native Clerks (x6)

Superintendents (x2) Indian Clerks (x2)

Assistant Superintendent Native Health Assistants (x8)

Building and Licensing Inspector Indian Health Assistant

Clerk of Works Health Visitor

Works Foreman Native Nurses (x7)

Assistant Works Foreman Social Investigator

Table 6: Staff Composition, c.1951333

Central Edendale Midlands Head Office Waschbank Coastal Region European 4 6 5 26 1 Secretarial Dept. Non- 6 15 1 2 3 European European 3 5 1 8 - Health Dept. Non- 10 21 2 - 2 European European 2 13 1 10 1 Engineer’s Dept. Non- 1 3 - - - European European - 2 - - - Stores Dept. Non- - 2 - - - European

333 LHC Minutes, Vol. 10 (1)[b], 1.7.1951 - 30.9.1951, Staff Leave Report, 20 July 1951 108

The MOH, a registered physician, was the Head of the health department of the LHC. His duties were informed by the Medical Association's professional guidelines, the 1919 Public Health Act and the overall mandate as well as the regulations of the LHC. Naturally, the MOH was responsible for the provision of personal and environmental health aspects and included preventive to curative services. His specific tasks included conducting inspections of houses, sanitation facilities, and water and food sources.

He also reviewed building plans and undertook physical inspections of building sites monitoring compliance with plans and LHC regulations regarding building materials. In addition, he compiled statistics regarding births, deaths, and incidence of infections. The MOH had the authority to launch health related inquiries including status of particular disease in an area or, to determine the nutritional and food security status of residents, including the adequacy and availability of food. His monthly and annual reports were updates on the 'health of the persons and the conditions of the environment in which people lived' but, also included recommendations about LHC interventions in order to 'to safeguard and promote public health'. The MOH could recommend specific actions for the LHC such as issuing new or amending existing regulations, education programs, immunization programs, or setting up mechanisms or infrastructure to deliver health services.

Health Visitors worked in close relationship with the MOH in a managerial capacity. They were responsible for the day-to-day activities in the PHAs. Their duties included supervising 'non-European staff' such as nurses, clinic clerks and Orderlies working at the Health Centers; run the clinics including oversight over medication and equipment; and compile monthly Clinical Reports that were incorporated into the MOH's monthly report.

The Secretary was the head of the administrative and financial divisions of the LHC. The administrative duties included attending meetings of LHC; general supervision of all clerical work;

109

general correspondence within the LHC and between the LHC and external parties such as other government departments, municipalities and residents of the PHA; and attend AB meetings. The accounting aspects of the Secretary's position included drafting regulations or other legal documents required by the LHC and oversee the collection of revenue including rent, taxes and fines. As Head of

Department, the Secretary was responsible for the Accountants, Typists, Registry Clerk and the

Superintendents in the PHAs. Via the Superintendent, the Secretary was also ultimately responsible for the human resource and financial aspects of the LHC and the PHAs.

In the PHAs, the Superintendent was the most senior staff member, invariably a white man who served as the government's official representative in a specified urban area.334 The EDPHA office, for example, employed a Superintendent who was responsible for seven staff members: an Assistant

Superintendent and the six manual labourers, i.e.one Indian and five Africans.335 The Superintendent's duties included keeping himself 'thoroughly acquainted' with the regulations governing the LHC as well as Union and Provincial legislation and regulation pertaining to local authorities; report on the conditions in the PHA; implement or oversee the implementation of the decisions of the LHC; and report on the progress or obstacles regarding LHC activities. The superintendent also attended AB meetings where he acted as chairman.336 In addition, the Superintendent undertook scoping exercises with a view of establishing new PHAs in the region. These scoping reports were important for they influenced the

Commissioners' decision regarding expansion. As demonstrated below, a typical report regarding a potential PHA would provide the description of the area, its history, existing control mechanisms and institutions, population, vital statistics, prevalence of infectious diseases, housing conditions, water

334 Davenport, South Africa, p. 551 - 2. Davenport notes that these men were often ex-police officers or ex- civil servants, where they gained administrative experience. 335 White males occupied the two managerial positions, Superintendent and his Assistant. LHC Minutes, 1.1.47- 31.3.47, Vol. [5] (2)(b), Secretary's Report on Staff / Edendale Administration, 27 February 1947 336 NTS5750 file296-313K. LHC Memo, 24 March 1942 in LHC Minutes, 1.11.41-31.3.43, Vol. 1 110

supply, sanitation conditions, domestic animals, slaughter poles and butcheries, bakeries, dairies, roads, cemeteries, public buildings, open spaces and recreation groups, endowments, proposals for control, and finances. This latter item was usually an estimate of revenue, expenditure, and capital requirements.

The Advisory Boards (ABs) in the PHAs formed the third and final components of the LHC bureaucracy. These ABs and the Superintendents, as the official government representative in any black urban area, formed a two-tier system of governance.337 The LHC system of ABs was in conformance with the 1923 Native (Urban Areas) Act, which sanctioned the ABs as the only governance structures for

Africans in the urban areas. Their stated goal was to represent residents by communicating their demands and concerns to the white local authority responsible for the control and management of their residential area. ABs were the only official forum for residents of black urban areas or ‘native villages to voice their opinions on matters affecting them’.338

One of the first ABs that were established was in Alexandra, north-east of Johannesburg in 1921.

It consisted of 10 members but, this AB was short-lived given the internal conflict.339 In spite of this initiation in Alexandra, the government continued to use ABs throughout the country. Therefore, the LHC adopted this same system of Advisory Boards to represent the residents of its PHAs.

The first EDPHA AB was appointed in 1942.340 Commissioner Boshoff was the first chairman and local resident and activist, H. Selby Msimang, the first Secretary. This first EDPHA AB consisted of

20 members representing the four race groups in Edendale. Africans members included Chief Mini,

337 Op. Cit. note 341 338 Van Tonder, ‘The Western Areas Removal Scheme’, p.330 339 Bonner and Noor Nieftagodien, ALEXandra: A History 340 As this AB was established before the rules governing ABs were finalized, the members were appointed however; the LHC noted that subsequent AB members would be elected and/or appointed in terms of those regulations. Minutes of LHC Meeting, 28 July 1942, LHC Minutes, Vol. 1, LHC Minutes, Vol. 1, 1 November 1941-31 March 1943, 111

George Mtimkulu, E.O. Msimang, L.B. Msimang and F.J. Mazibuko.341 Representatives for white residents included E. Holden, the manager of the Tannery in Edendale and G. Bishoon, Indian businessman, was also elected onto the first AB. Subsequent amendments to the rules governing the election of the EDPHA AB made provision to the following categories of members: one member of the

LHC on the recommendation of the AB; three members of the Edendale Trust; six African owners; three

African tenants; three by European Community; three by the Indian community and two by the Coloured

Community.342

While the regulations made special provision for race, it did not make the same allocation for gender. This is explained by the fact that with a few exceptions, only white men had the right to vote.

White women were only afforded that right in the 1930s and only as a political tool.343 Women however, were elected onto the ABs in the EDPHA and the Clermont PHA from the mid-1950s onward.344 (See table) The presence of women as elected members was significant as this is consistent with the historiography documenting that women were politically active. In 1956, two years before the first women were elected onto the ABs, thousands of women were mobilized to protest against government's plans to extend the Pass Laws to African women.345

341 The Msimangs were a prominent family in Edendale and George Mtimkulu, was a community leader who represented landowners and by the 1940s 'had become a well-established institution'. See Nuttall, Op. Cit. note 82 342 Amendments to Rules adopted 1.11.1944 by AB and submitted to the LHC for approval; GG of Province of Natal, Native Location Regulations 343 C. Walker, (ed.) Women and Gender in Southern Africa to 1945.(Cape Town: David Philip, 2005); D. Posel, The Making of Apartheid 1948 – 1961. (Oxford: Clarendon Press, 1991) and W. Beinart, Twentieth Century South Africa (Oxford and New York: Oxford University Press, 1994) 344 Both Edendale and Clermont have long histories of political activism and residents with higher levels of education or economic status that facilitated their activism. Eminent individuals from these areas include Henry Selby Msimang, born in 1886 in Edendale, (http://www.sahistory.org.za/people/henry-selby- msimang; Jane Starfield, "Not Quite‘ History: The Autobiographical Writings of R. V. Selope Thema and H. Selby Msimang," Social Dynamics 14.2 (1988): 16–35; Herbert Dhlomo (http://www.sahistory.org.za/people/herbert-ernest-dhlomo); Albert Luthuli, while born in Bulawayo, Rhodesia, was educated in Durban and became president of the Natal branch of the ANC (Let my people go. (New York: McGraw-Hill, 1962)) 345 Helen Bradford and William Bienart document women's resistance in rural areas as early as the 1920s and 1930s: " 'We are now the men': Women's Beer Protests in the Natal Countryside, 1929" and "Women in Rural Politics: 112

Table 7: List of women that served on Advisory Boards346

PHA Advisory Board Date of Minutes Board Member 27 Jan 1958 Mrs. Mpanza 24 Feb 1958 Ms. L.N. Msimang Edendale 25 Jan 1960 Ms. L.N. Msimang Ashdown/EDPHA 20 Nov 1972 Miss P. Malinga 12 Dec 1972 Miss D.B. Mngadi Clermont 13 Mar 1973 Mrs B.Mkize Ashdown/EDPHA 19 Mar 1973 Miss P. Malinga

The absence of women from these formal structures did not mean that women were absent from public processes or community meetings convened either by the LHC or the Advisory Boards. There were five women present as part of the delegation that attended a meeting called by the LHC in order to respond to criticism leveled at it by A.W.G. Champion, Member of the Representative Council.

According to the record, the meeting was attended by Mr. Wronsky, Chief Native Commissioner for

Natal; Chief Mini; and about twenty representatives from the EDPHA, which included the five women.347

I discuss the importance of this meeting in Chapter Five.

Herschel District in the 1920s and 1930s" in Class, Community and Conflict: South African Perspectives, edited by Belinda Bozzoli (Johannesburg: Ravan Press, 1987); Jane Barrett, South African Women on the Move, Op. Cit. Note 219; and Nomboniso Gasa (ed.), Women in South African History: Basus'iimbokodo, bawel'imilambo/They remove boulders and cross rivers. Cape Town: HSRC Press, 2007 346 The titles of the women appear here as they are listed in the official LHC Minutes. Ashdown PHA, 1958, Annexures to LH Minutes, 1.1.1958-31.3.1958, Vol. 16[2](b); EDPHA, 1958 - 1960, Annexures to LH Minutes, 1.1.1958-31.3.1958, Vol.16[2](b) and Annexures to LH Minutes, 1.1.60-31.3.60). Both the Advisory Boards for these two PHAs had women until these areas ceased to be PHAs: Ashdown/EDPHA 1972, Miss P. Malinga (1972- 3) and Miss D.B. Mngadi (1971) and Clermont, Mrs B.Mkize (1973). See Ashdown, 1972, LHC Minutes, Vol.31[2](a); Edendale and District Bantu Advisory Board, Annexure to LHC Minutes, 1.10.72-31.3.73 Vol. 31[2](b); Clermont, 1973, Annexure to LHC Minutes, 1.4.1973- 30.9.1973, Vol.32[1](a) 347 None of the African representatives, including the women, were identified by name or affiliation 113

PHAs: The LHC's 'zones of influence'348

The PHAs were the crucial components of the LHC and as the sites where the LHC conducted its work, these PHAs served as justification for the continued existence of the LHC.349 As a result, one of the most important activities was the establishment of PHAs. During the first ten years, the LHC operated in a political and policy environment that was generally supportive of its work. The criteria for the establishment of PHAs were thus not too stringent especially because the Thornton Committee's report served as the blue print.350 In terms of the provisions of the LHC Ordinance, there were two ways in which a PHA could be established. A government institution, such as the UDPH, the NPA or another municipality could recommend that the LHC incorporate an area. Under these circumstances, it would be sufficient for those nominating institutions to state that the area would benefit from LHC oversight. The only other method of establishing a PHA was if the LHC recommended incorporation.351

Within four years, the LHC had established a formula for the incorporation of PHAs. This formula included a number of steps prior and also after the establishment of a PHA. Prior to the proclamation, the following activities were undertaken:352

1. Identification / designation of the Area

2. Investigation of conditions in the area by the LHC's Chief Superintendent

348 NTS 4488 Files 526-313, Part 3, Communication from Chief Native Commissioner, Pietermaritzburg to Secretary for Native Affairs, Pretoria dated 13 October 1949 349 Sections 5 and 16 of Ordinance 20 of 1941. In terms of Section 16(2), the LHC was a local authority within the meaning of the Local Authorities Succession Ordinance of 1931. 350 In 1944, Dr. Landau, MOH and J.W. King, Chief Superintendent, confirmed that the LHC may be regarded as the body established by the NPA to implement the Thornton Committee's proposals. See 'Control of Areas Occupied Mainly, or for the most party, by Natives (Excluding Scheduled Areas)', 3 July 1944, LHC Minutes, 1.4.44-30.9.44, Vol. 3(1) 351 The general rule was that a bounded area was declared a PHA. However, there were instances when the LHC combined two areas to form one PHA or merge two existing PHAs to create a new one on the authority of s.5 of Ordinance 37 of 1956. The Cavendish PHA was established when Mhlatuzana and Cavendish areas were combined in April 1960 352 "Progress Sheet: Showing Steps to be Taken Before and After Local Government is Brought About in An Urbanized Area", January 1945 114

3. Conduct census

4. Chief Superintendent's report: delimitation of boundaries, after consultation with the MOH, Engineer,

neighboring Local Authority, and any organized body

5. LHC considers report, and if necessary, will inspect Area

6. LHC convenes public meeting and 'try to establish a Health Committee, if considered advisable, or

inform residents of intention to proclaim area a PHA. Invitations to local Member of Provincial

Council (M.P.C), Magistrate, Native Commissioner, Police, Residents, Organized bodies

7. LHC submits report and recommendation to the NPA for establishment of a PHA

The survey report listed as step no.4, informed by steps 3 and 2, was crucial as it made the case for the imposition of a local authority and more often than not, incorporation as a PHA under the LHC.

This report generally included the following information: physical description of the land; density of the population; type and number of houses; sanitary conditions; facilities including schools, churches, playgrounds; employments status of residents and place of employment; financial viability of the area; and governance options other than incorporation. During the early years, the LHC adopted the Thornton

Committee’s description of the 'class or character of the area'. The overall goal of these reports was to make a case for the ‘proper management, regulation and control of matters affecting the public health’ of an area.353

The language of the Thornton Committee's Report creates the impression that there were vast ungoverned areas occupied by Africans across Natal. In reality, these areas had one or other form of governance that was for the most part absent. This was confirmed when one examines the processes for the establishment of a PHA. Once the establishment of a PHA under the LHC was the most appropriate

353 Ibid. 115

action, the latter needed the consent of the local authority assumed to be responsible for the area or, from the UDPH or the NAD. Following this agreement, the LHC would commence by appointing its officials.

The Superintendent, as the most senior official, was appointed first for he facilitated the appointment of the rest of the team. The next step was to put in place the financial framework and arrangements that would ensure the PHA could cover part of its own running costs. In this regard, the LHC officials compiled the Property or Valuation Roll; Rates Register; estimates of Income and Expenditure in respect of revenue and capital accounts; and determination of rating method and tariff.354 Once the LHC officials collected the financial information, the LHC undertook the following steps:

1. Convene a meeting to elect an AB

2. Promulgate regulations specific to the new AB and property valuations and rates

3. Apply, with relevant government departments, for the application of the Food and Drugs Act, Slums

Act, and Native (Urban Areas) Act

4. Register the Superintendent as an Assistant Registrar of Births and Deaths

5. Inform other government departments and public institutions of the existence of the PHA, including

the director of Census and Statistics, Secretary for Public Health, Deputy Chief Health Officer,

Registrar of Deeds, Surveyor-General, Private Township Board, Secretary for Interior and Secretary

of Native Affairs. These senior government officials are associated with departments that the LHC

will engage with regarding the new PHA.

Establishing PHAs before 1948 was less complex than after that date. Most of the PHAs established during this time were identified in the Thornton Committee's Report especially the "black belt", and that report already established the case in favor of incorporation by the LHC. The EDPHA and

Clermont PHA featured in the Thornton Report and both areas were established as PHAs because of the

354 Ibid. 116

'public health conditions in the area'.355 Chapter Three includes a description of the conditions in

Edendale. In summary, the critical issues were 'water, then sanitation and coupled with it the question of over-crowding'.356 The latter had a serious impact on the sanitation situation and while pit latrines were a possibility, the high water table should be taken into account for when the ground is saturated with water, especially during the rainy season, contents of pit latrines can spill over. The biggest problem was housing both in terms of over-crowding but also structure and building materials. The large number of wattle-and-daub structures occupied by residents was an enormous problem as the LHC considered this material unsuitable. These types of dwellings or shacks were not high enough, had insufficient ventilation, floor space and did not provide good lighting. These were the problems with all the wattle- and-daub dwellings in all the PHAs and one of the LHC's goals was to replace this type of dwelling with houses made of brick or cement blocks. In 1941, 13 per 1,000 deaths occurred due to pulmonary TB, 3.4 and 3.2 due to enteric fever and syphilis, respectively.357 As mentioned, the LHC conducted its own survey of conditions in Edendale and the surrounding areas once it established the EDPHA but the establishment of the PHA itself did not require any investigation. It was practically handed to the LHC by the Thornton Committee Report, the PMB MOH and the NPA.

Conditions in Clermont were not much better. The LHC opened its offices in Clermont on 7 April

1942 when it took over the Clermont Private Township.358 One of the first tasks was an extensive survey of the area.359 It found 848 families in 757 dwellings on 823 plots. There were about 91 families without homes or that lived in wattle- and-daub shacks. Only 628 families had 'good latrines' while 163 had no

355 GES963, 898-13, Local Health Commission, Natal: Sanitation - General. 356 LHC Notes on an Informal Talk with Dr. Meister on Edendale and its Environs, Minutes of LHC Meeting, 10 November 1941 in LHC Minutes, Vol. 1, 1 November 1941 - 31 March 1943 357 Op. Cit. Note. 83, Experiment at Edendale, p. 16 358 GES963, 898-13, Local Health Commission, Natal: Sanitation - General. The Private Township was established in 1932 when took over the Christianburg Mission Station founded and run by the Berlin Mission Society. 359 Minutes of LHC Meeting, 12 May 1943, LHC Minutes, Vol. 1, 1 November 1942 - 31 March 1943 117

latrine facilities at all. The findings of this 1943 survey were used together with the findings of the

Thornton Committee report to consolidate the LHC's position in Clermont and design a program for the

Clermont PHA.

The Raisethorpe PHA was established in 1943. At the time, there were '90 Europeans, 300

Asiatics, 250 Coloureds and 260 Natives'.360 The area was east of Pietermaritzburg and part of the 'black belt'. A few families lived in brick buildings and wood-and-iron structures but the majority lived in wattle-and-daub shacks. There were four stores and a butchery in Raisethorpe. Infectious diseases were under-reported as there was only one TB notification for the year 1942. This, according to the LHC

MOH, was incorrect based primarily on an assessment of the living conditions in Raisethorpe and the disease burden of neighboring areas. The question of establishing the Raisethorpe PHA was mooted partly because of the health and welfare conditions but also because the residents in the area would not be in a position to generate sufficient revenue to maintain a Health Committee. According to the LHC Chief

Superintendent, the only voters were a 'few poor whites' and if Raisethorpe was not incorporated into

PMB, it would have to become a PHA.361

Another area in the 'black belt' region that became a PHA early on was Bishopstowe.362 The area, also adjoining PMB, consisted of about 10 acres of Bishopstowe belonging to a Mr. Bhoola and a few more plots that were occupied by Africans and Indians. Bhoola, who resided in Plessislaer (Edendale), operated a store and he housed his workers, an 'Indian family and four African families'363 on his property. Housing consisted of wood-and-iron structures but mainly wattle-and-daub shacks. Most

360 LHC Chief Superintendent's report, 9 April 1943 in LHC Minutes, Vol. 1, 1 November 1942 - 31 March 1943 361 Ibid. 362 Ibid. 363 Ibid. 118

residents had no sanitary facilities and those facilities that existed, were in 'very bad condition'364, meaning generally that the disposal of human waste was done in ways that exposed people to disease.

They accessed water from a stream that ran through the area and as in Raisethorpe and parts of Edendale; this stream was used for washing, sanitation and as a source of drinking water. The LHC officials concluded that if it did not take control of the area, the only option was to approach the police to remove those African and Indian tenants and that PMB begin to service Bhoola's property.

Following Bishopstowe, a section of the farm Hollingwood, south-east of PMB was incorporated as New England PHA. There were about 250 Africans, occupying 45 buildings, in the area. While a few of the dwellings were made of brick, the majority of the dwellings were wattle-and-daub houses and shacks of 'poor quality in all respects' and the one road was a '3/4 mile, overgrown and mostly covered in grass'.365 Residents accessed water from one private well and the Umsunduzi river, which presented people in New England with the same problems as others using this river, i.e. water polluted by sewerage.

According to the LHC investigative report, the water was discolored by sewerage and smelt bad. New

England had no butcheries, bakeries, dairies or stores in its 'native area' and the only source of food was at a store on the section of Hollingwood owned by the farmer, who also owned the store. There was one school, for about 50 children, and the school ground served as the recreation grounds. In 1942, there were only three cases of typhoid but again, the LHC concluded that given the condition of the river, infectious diseases were under reported. New England had no option of a local authority for there were 'only

Natives living in the area'.

364 Ibid. 365 Ibid. 119

The incorporation of Albert Falls in July 1948 came about following a request by the Chief

Native Commissioner, PMB. The latter requested that the LHC undertake an assessment of 'the alleged unsatisfactory position which had developed '.366 Albert Falls was first established as a private township in 1899 and by 1947 was 'almost entirely occupied by Natives’367 even though individuals from different race groups owned the land. The LHC assessment report found that most of the dwellings were 'of unsatisfactory construction being of wattle-and-daub and wood-and-iron'.368 Sanitary services were even worse for there were no public toilet facilities and the majority of private ones were badly constructed increasing the risk of soil and water contamination and therefore, infectious diseases. Overcrowding in

Albert Falls also impacted on sanitation services for fifty families shared 32 latrines. The Umgeni River was the main source of water and like the Umsunduzi River was used for multiple purposes, which increased the risk of waterborne diseases. There was no specific institution that maintained the roads in

Albert Falls and the only governance institution was the Umgeni Malaria Committee, which had no authority to deal with sanitation and housing matters due to its narrow focus.

The LHC report addressed the question of governance for even though this was a standard issue included in these LHC investigative reports; it was also specifically requested by the Chief Native

Commissioner. This report on Albert Falls emphasized the LHC's capacity to take over the area and noted its commitment to remedy the 'public health short-comings' that existed in Albert Falls.369 Interestingly, the LHC report found no evidence that the 'Native Settlement [was] becoming more thickly populated' but rather that the new settlement across the Umgeni river, had the potential to 'develop into residential

366 Op. Cit. note 351, Communication from Chief Native Commissioner, Pietermaritzburg to Secretary for Native Affairs, Pretoria dated 13 October 1949 367 LHC Minutes, Vol. [6](1), 1.4.47-30.6.47 368 Ibid. 369 Ibid. 120

settlements upon which undesirable conditions of urbanization are created'.370 Thus, while the Albert Falls area itself may have needed some governance-related intervention, the prevention of further underdevelopment in the adjacent area was highlighted as the most important reason for establishing an

Albert Falls PHA that would incorporate both areas. The LHC considered the potential future expansion of Albert Falls and the demand for housing and health services and, on that basis; it recommended that both areas be incorporated as the Albert Falls PHA.

The supportive environment during its first decade of existence allowed the LHC to expand its operations more easily and the increase in the number of PHA attests to this. Following the establishment of the EDPHA in 1942, the LHC incorporated the Clermont PHA in 1943. It extended the boundaries of the EDPHA by adding Wilgefontein in 1943 as well. Wasbank PHA was founded in 1945 and soon after, the LHC began talking about regionalization for, it argued, that such a step would be 'efficient and economical'.371

The proposal for regionalization was realized in 1946. It was however, also an early sign of the

LHC's attempts to establish itself as an authoritative and an independent, competent local authority. In this same memorandum, it noted that it would be 'unwise' to have more than one local authority governing one area and this made direct reference to the LHC's relationship with the NAD, which legally, was the final authority of all black urban areas. Conflict between the LHC and the NAD became more evident after 1950 (see below). In 1947, however, regionalization was primarily driven by administrative efficiency. The LHC divided the geographical areas under its control into three regions with regional officers to manage those different areas. The Midlands Region expanded very quickly: Hilton Road

370 Ibid. 371 LHC Memo: Control of Areas Occupied Mainly, or for the most part by Natives (Excluding Scheduled Areas), 3 July 1944, LHC Minutes, 1.4.44-30.9.44, Vol. 3(1) 121

(1946); Howick West and Lions River (1947); Lidigetton West, Cedara and Albert Falls (1948); Dalton,

Cleland, Lincoln Meade, Ockerts Kraal and Dunveria (1949); and Tweedie and Rosetta (1950).372 The

Midlands regional office opened in June 1948 in Hay Paddock in property leased from the PMB

Corporation.373

The second region was the Coastal Region and included areas around Durban as well as further along the north coast. PHAs in the Coastal region were Shaka’s Kraal, Duff's Road, Glen Anil and

Umhlatazana.374 Due to its size, the EDPHA was a region on its own.375

Pietermaritzburg remained the administrative center: it housed the Head Office. This was expedient as it was also the Provincial capital and provided the LHC with access to provincial officials to coordinate their work. The working relationship established between the LHC and the PMB

Administration was, for example, one factor that facilitated the expansionist agenda of the LHC. This was evident throughout the 1940s when the LHC dealt with the areas like Raisethorpe, Ockerts Kraal,

Hollingwood, New England, as well as Umhlali and Skaka's Kraal PHAs in 1944.376 The LHC also relied on the PMB Borough for successful delivery of some of its services in its PHAs including the provision of electricity.377

372 GES 963, 898-13C, LHC Annual Report, 1 July 1949 - 30 June 1950 373 LHC Annexure to Minutes, Vol. 18 [2] (b), 1 January 1960 - 31 March 1960, Rationale Abolish Midlands Region 374 The decision to incorporate areas across Natal faced a number of obstacles of which the main one was that a number of settlements were still classified as rural and the LHC could only operate as a local authority in urban areas. This was one of the differences between the PUAHB, TVL and the LHC for the former included peri-urban and rural areas. (Chapter Three) 375 GES 963, 898-13C, LHC Annual Report, June 1947, p3. Pietermaritzburg was also the seat of the municipality and had the infrastructure for a large administration 376 LHC: Umhlali, Chaka's Kraal, Tinley Manor Area - Proposed Control', 20 December 1944, LHC Minutes, Vol. 3[1], 1 April 1944 - 30 September 1944 377 The Memorandum of Agreement made by and between the City Council of Pietermaritzburg and the Local Health Commission of Natal stipulated that PMB would provide electricity to sections of Edendale and that the LHC would pay for that service. PMB 4/5/404, 103/44, Re: R.K. Rudman, Re: Electricity Supply at Edendale and Local Health Commission: Electricity Supply, 1945 and 1946 122

The benefits that accrued to the PMB Borough as a result of the existence of the LHC were obvious. In 1941 it was relieved of its responsibility regarding Edendale and its surrounding areas. PMB

Borough argued that these areas 'could be more economically and conveniently governed' by the LHC than any other institution especially if the LHC took a more holistic approach by incorporating more of the areas in the 'black belt'.378 This question of the LHC taking a holistic approach [my emphasis] was evident when the LHC proposed to take over Raisethorpe only in 1946. The PMB Borough noted that this decision would 'be a mistake' as it would 'deal only with a portion of the problem, and that, to obviate any further deterioration in conditions presently prevailing in Martizburg's peri-urban areas, all the settlements' mentioned should be incorporated.379

In relation to the Raisethorpe decision, the PMB Borough also agreed to pay for any infrastructure and the cost of supplying water to Raisethorpe residents. In addition, the PMB

Administrator confirmed that the city would provide the LHC '£9,500 (payable on the submission of certified progress reports during the course of construction of the proposed water scheme)' if the LHC incorporates Raisethorpe as well as Ockerts Kraal, Hollingwood and New England.

Both the LHC and the PMB Borough benefitted from the existence of the LHC: the former was able to expand its authority while the latter could escape the possibility of being afforded formal responsibility for those areas. The LHC clearly became the answer to the 'irregular urbanization' and the public health problems that faced peri-urban PMB. It expressed concern that 'there is [a] danger of similar conditions arising in the future unless preventive measures [my emphasis] are put in hand without undue delay'. Not only did the PMB Borough play up what the LHC saw as important, i.e. prevention of future housing and health crises, it also used a language that demonstrated an acceptance of the LHC as an

378 LHC Minutes, Vol. 6.1, 1 April 1947 to 30 June 1947 379 Ibid. 123

equal: 'the Administration would not be averse to the Commission dealing, as far as circumstances permit, with the remaining peri-Pietermartizburg areas in so far as the elimination, control and prevention of irregular urbanization is concerned'.380

While the LHC may have been the institution of choice for the problems in the PMB area, after

1948 it had to prove its usefulness and its legitimacy to the national government, especially the NAD. The

1950s saw a change in the nature of urban administration after Verwoerd became Minister of Native

Affairs for 'the department concentrated its attention on the urban areas and launched a full-scale attack on the urban areas and on what the new apartheid cadres viewed as liberals' dangerously pusillanimous approach to managing Africans in the urban areas'.381 This new approach was a direct attack on the vacillating position of the NAD officials. The incorporation of Georgedale in December 1955 demonstrated some of the conflict. While the NAD agreed with the LHC that Georgedale was in need of a local authority, it did not necessarily endorse the LHC as the preferred institution to take over the area.382

In order to promote the LHC as the appropriate authority for Georgedale, Dr. Seymour, the then MOH, prepared a detailed memorandum motivating that the LHC was the best institution to take control of

Georgedale. At the same time, the LHC Secretary disputed the claims that the NAD might have had over

Georgedale, or for that matter, any other urban area that the LHC may want to incorporate. Seymour was aware that the Georgedale case was more than the supremacy of public health and institutional rivalry but that the larger issue of race had become a more critical component in urban governance. Firstly, the memorandum dealt with the legal framework and the LHC Secretary constructed a constitutional argument.383 The South Africa Act of 1909, as amended, ensured that the Provincial Councils were

380 Op. Cit. LHC Minutes, Vol. [6] (1) 381 Ivan Evans Bureaucracy and Race.(Berkeley: University of California Press, 1997), p. 56 382 LHC Annexure to Minutes, Vol. [14] (2), 1 October 1955 to 31 December 1955, LHC Proposal to establish a PHA in Georgedale 383 See Chapter One 124

responsible for local governance and any local authority operating within its provincial boundaries. An expression of this constitution provision was contained in the 1919Public Health Act. Section 7 confirmed the scope and function of local authorities, or 'other bodies', i.e. non-traditional local authorities that may act as local authorities because they are legally constituted and 'endowed with sanitary powers for safeguarding the health of the inhabitants in its district'.384 The LHC Secretary argued that the LHC could legally and legitimately act as the local authority for Georgedale as it was constituted in terms of s.7 of the Public Health Act.

This general authority, however did not necessarily mean that the LHC could control a Scheduled

Area.385 These Areas were created in the 1913 Land Act and amended by the Native Trust and Land Act in 1936. It was land set aside where Africans could purchase land and included the 'native reserves'; specially demarcated urban locations; land that were formally or informally owned by Trusts for and on behalf of Africans; and land purchased by the government to sell to Africans. The NAD was the final authority with regard to African land ownership and occupation but the 1919 Public Health Act still applied because it gave the provinces the responsibility for service delivery, with financial support from the national government. In its bid to control Georgedale, the LHC Secretary invoked s.7 of the Public

Health Act as well as s.9, which allowed a local authority full control of a Scheduled Area in the event of an emergency.386 Dealing with the health and welfare conditions in Georgedale, he argued, should be interpreted as an emergency. A final argument regarding the legal position was the Bantu Authorities Act of 1951. The latter made provision for 'Bantu local authorities but did not provide those authorities with any power to 'carry out works for the purposes of sanitation and for ensuring the satisfactory water

384 This provision was a specific reference to urban areas, i.e. only in urban areas could an institution be established to act as a local authority on the condition that its main objective was the sanitary conditions of the residents. In a rural area, however, such a body could 'be for all or any purpose stipulated in the Public Health Act'. 385 See William Beinart and Peter Delius, "Historical Context and Legacy of the Natives Land Act of 1913," JSAS, 40:4 (2014): 667-688 386 Section 173(2) 125

supplies'.387 After a decade in operation, the LHC saw itself as the primary public health local governance and that it had the requisite expertise. Consequently, Seymour implied that the 1919 Public Health Act should take precedence over the Bantu Authorities Act and that any local authority established in terms of the former, was preferable to ones established under the latter Act.

Seymour also saw the interpretation of the statutes as a matter of principle based solely on his, and the LHC's commitment to and understanding of public health. For example, he contested the fact that the Native Urban Area Act curtailed scope of the Provincial Councils on matters related to local government and Africans.

The third and final issue pertained to the practical arrangements and here the LHC was in an uncontested position with regard to the ability to exercise the functions and powers of a local government.

Seymour relied on ten years of experience but also on the LHC's expertise. The NAD, he argued, was mistaken if it thought that it could act as local authority for it had no qualified personnel from ‘a health point of view’. He went so far as to criticise the public health consequences of the NAD's “closer settlement” policy. South Africa, he wrote,388

is, at the present time, faced with health problems brought about by close settlement without adequate local health control and it is in my view absolutely essential that not only must existing settlements be brought under control but that any new settlements must from their inception be safeguarded by being under the jurisdiction of a body well versed in local government and having under it trained health personnel.

387 Ibid. 388 Ibid. 126

During the period of consolidation of apartheid, the LHC officials were aware of the fact that the notion of public health, in and of itself, was fast losing its status. A report describing the health and welfare conditions of an area was no longer sufficient to warrant incorporation as a PHA.

The LHC officials were not alone in their struggle to retain the importance of public health in urban governance. In September 1952 one of its supporters, Dr. Gale, made the case on behalf of public health in his University of Natal Denny Lecture.389 After discussing the provisions of the Public Health

Act and the health challenges faced by local authorities, Gale told his audience that local government indeed failed in one of its most important functions when it did not 'provide a health environment for so many of the inhabitants of their areas'.390 This failure had multiple causes but the main one was the subsidy system for curative health care services and housing. Local governments paid for services and then claimed their expenses from the national government. According to Gale, the delay in repayments caused local authorities to think twice about what expenses to incur at a time when these authorities were taking on more cases given that the District Surgeon-system was under strain. With regard to housing, the national government took over the responsibility for the provision of housing after 1944 and Gale was critical of this decision. He was of the opinion that it caused confusion and severe backlogs at local level. is solution, of course, endorsed a position he held while at the UDPH and that was that local authorities were the most appropriate institution to deal with housing, in spite of their weaknesses of not attending to these responsibilities before the 1940s. Gale, like Seymour or other LHC officials were optimistic that urban local authorities, especially the LHC, could meet these new challenges.

389 GES 964, 900-13, Public Health Area of Edendale and District, Natal. At this time, Gale was the Dean of the Faculty of Medicine at the University of Natal but he was previously employed in the UDPH and had extensive knowledge of health in Natal and the Union. 390 Ibid. 127

LHC Functions

A study of the LHC functions in the PHAs illustrates how it interpreted and implemented its mandate, how it constructed the notion of public health as contained in the Public Health Act and more importantly, how the LHC conceived of the functions of a local authority if it was informed by a health mandate. The 1941 Ordinance, specifically sections 9 - 10, enumerated its functions and one set of activities were expansive in nature. The LHC had ‘sole control and management' of PHAs and this control naturally included public spaces. It also had the right to access private property or the right to use privately owned land in order to carry out its functions. For example, the LHC had the right to acquire land or the right to use all or part of the land in order to access water supply, construct roads, erect buildings including private dwellings, public buildings, establish cemeteries, disposal of sewage or other forms of waste. Any exercise of these expansive rights had to be within the limits provided by the law, for example, provide compensation to land owners. In addition, the exercise of these expansive rights had to satisfy the underlying rationale, i.e. the benefit of the public.

Personal Health Services

The LHC was responsible for delivering personal health services including preventive and curative ones. (See table below) The different modalities employed to deliver these services included preventive vaccinations and the treatment of diseases at multiple sites included mobile and stationary clinics; home and school visits; testing water sources and regulating food sources including the slaughter of animals and butcheries. The MOH, assistant medical officers of health, nurses and health visitors provided these services. The LHC MOH's monthly and annual reports391 included the types of infectious diseases notified or detected: chicken pox; pulmonary Tuberculosis (P.T.B); Non-pulmonary TB (TB);

391 Monthly and Annual MOH reports provide health statistics including numbers of clinic attendees 128

typhoid; diphtheria; ophthalmia; ophtalmia Neonatorus; smallpox; enteric fevers; whooping cough; malaria, poliomyelitis (polio) and venereal disease (VD).392 Other health conditions included cardiac conditions but also injuries incurred as a result of violence, e.g. assault or stabbings.393

In addition to the LHC clinic services, the medical staff also attended to health needs in the home and at school. In October 1951 there was a ‘small outbreak of measles… at a Girls’ School [in the

Midlands region] and the necessary measures to prevent the spread of infection were taken’.394 Areas that were large enough had a mobile clinic, for example, the one that operated in parts of the EDPHA. These units provided limited services such as immunisations and treatment of minor ailments.395 At the clinics, the MOH and his staff were able to monitor disease outbreaks as well as the emergence of new or recurring diseases396 and map appropriate responses. Where necessary, the staff also referred patients to the hospital.

Environmental Aspects of Public Health

A significant number of LHC services were classified as environmental health services and I highlight housing and sanitation.

The question of housing was a multifaceted problem for the LHC. The overarching problem was, as articulated in the Thornton Committee report, regulation in terms of sub-division of land, plot size, building materials, construction of dwellings, to social housing problems such as over-crowding. In its

392 LHC Minutes, Vol. 12 [2] (b), 1 January 1954 to 31 March 1954; EDPHA Health Inspectors Report for the Month Ending 3rd, March 1943; LHC Annexure to Minutes, 1 January 1958 to 31 March 1958, Vol.16 [2](b) 393 LHC Annexure to Minutes, Vol16 [2] (b) 1 January 1958 to 31 March 1958 394 LHC Minutes, 1 October 1951 to 31 March 1951, Vol. 10 [2] 395 LHC Minutes, Vol. 8[2](b),1 January 1950 to 1 March 1950 396 Towards the end of 1951, medical staff noted a ‘rise in the incidence of enteritis in children’ LHC Minutes, Vol. 10[2], 1 October1951 to 31 March 1951 129

attempt to fulfill its mandate, the LHC tried to address all of these elements. One program provided houses to people, for example, the LHC built houses and made these available for rent or purchase to

PHA residents. This kind of intervention opened up opportunities for those PHA residents. In July 1947,

Lazarus Nyide wrote to the LHC requesting assistance with the construction of 'a brick house' and the

MOH recommended that his request should be approved. Nyide wrote397:

I am the owner of Property described as Sub 28 of Lot A of 21 of Edendale which is bond free. I have submitted the title deed to the Superintendent for his inspection. The valuation of my property is £45 and there are four wattle-and- daub buildings on the property which is half-an-acre in extent and is situated in the Slum area. I would like the Commission to build a brick house for me on a hire-purchase system. Will you please advise me what steps I must now take?

Nyide's description of his situation addressed the two core features of the LHC's housing policy: phasing out slum conditions and the use of inferior and 'unhealthy' building materials. The first, eliminating slum conditions, was part of the initial motivation for setting up the LHC and comprised addressing housing-related issues but, also sanitation. The question of building material was addressed in the LHC's first policy on housing drafted in June 1942 under the leadership of Commissioners Lugg and

Boshoff.398 This policy informed and guided the LHC decisions for many years. This policy condemned the use of wattle-and-daub in the construction of houses and recommended a phasing out of these structures. One policy decision, therefore, was that no new structures were to use wattle-and-daub but rather cement blocks.

In addition to building houses, the LHC monitored any construction very closely. It published regulations requiring residents to submit building plans prior to commencement of building or extension of a building; the LHC inspected buildings in progress, to determine compliance, and issued complete on

397 LHC Minutes with Annexures, Vol. [6] (1),1 April 1947 to 30 June 1947 398 Boshoff, Lugg and Superintendent King inspected the wattle-and-daub houses in Macibisi, EDPHA this visit was instrumental in their decision to phase out the use of this material. The LHC policy also reflected the national housing standards set by the Central Housing Board. LHC Minutes, 1 November 1941 - 31 March 1943, Vol. 1 130

certificates, where applicable. The LHC had the authority to demolish dwellings that did not comply with regulations or ones that were erected unlawfully.

The reality on the ground influenced the application of LHC policy. When Doris Mbambo, owner of Lot 2608 in Clermont, approached the LHC for permission to construct 'an inferior type material dwelling', the LHC relaxed its rules.399 Mbambo's plot was not 'a reasonably level building site for it was situated 'in the extreme north of the township in a deep valley and the only access to the site at present is by means of a steep footpath. The closest road that served the Lot was 'unconstructed' and followed the

'parallel contours of the hill with a slope of about 1 in 2'. Consequently, the plot was sufficiently level to construct a permanent structure but the problems related to access made it 'virtually useless and uneconomical as a site for a permanent structure'. The LHC team including the Treasurer and the

Engineer, concluded that Mbambo and those on the same Lot were in 'an impracticable position [and] that it would be a distinct hardship to deny the owner[s] the right to build a temporary dwelling on the site'.

Mbambo and her neighbors were allowed to use 'inferior building material' and the decision was made not for health reasons for it also suited the LHC if this section of Clermont remained completely underdeveloped [my emphasis] for if it were to insist on the construction of a 'permanent dwelling'; the

LHC would have had to construct a 'most costly road'.400

The regulation of occupation rates was another housing-related policy area where the LHC intervened. The Superintendent monitored who occupied dwellings to ensure that only those authorised to reside in the PHA and in a particular house, occupied that house. For example, only ‘members and their families who do not require lodgers’ permits while ‘renters’ were issued with Lodgers’ permits. The LHC

399 LHC Minutes, Vol. [13] (1) (a), 1 April 1954 to 30 June 1954 400 Ibid. 131

staff collected lodgers’ fee, similar to monthly rent. It should be noted that these lodgers’ permits were not as straightforward as it sounds and caused considerable hardship for families. For example, the formula for issuing new lodgers’ permits, designed by the Union Department of Health, specified that only children under the age of 21 years of age were included on a Lodger’s permit.

Sanitation services were also one of the main environmental functions of the LHC. One of its goals was 'standardizing the type of sanitation' so as to eliminate 'extremely primitive methods usually existing in most Public Health Areas'.401 As a result, some of the LHC's specific activities included providing portable latrine units, consisting of a superstructure, slab set, riser and double-flap seat. Health

Inspectors and Visitors inspected and reported on the number of 'unsatisfactory pit privies'.402

The other critical sanitary-related service that the LHC provided was the provision of clean water.

With regard to water, the LHC’s two objectives were to provide people in the PHAs access to clean water and to ensure that the water supply was treated, e.g. chlorinated, at all times. In 1954 the LHC was negotiating with the Pietermaritzburg City Council for water supply to the ‘peri-urban’ areas surrounding the city and that included EDPHA.403 The LHC tried to capitalise on an existing water supply infrastructure from the PMB Corporation to a private company, the Rhodesian Cables Factory, on the boundary between PMB and the EDPHA. While the PMB City argued that the Corporation could not comply with the LHC request largely due to a lack of capacity of the existing infrastructure, Mr. Wadley, the LHC Chairman continued to advocate on behalf of the EDPHA.404 At a meeting on 21 December

1950 he asked ‘whether the City Council would be prepared in principle to make water available to the

401 Op cit. note 385 402 Ibid. 403 3 PMB Box 4/4/2.209 404 In fact, he was urged by residents to provide them with access to clean water. Wadley that 'the Commission as the local authority concerned was being pressed by the people for a water supply'. See Chapter Five for more detailed discussion on the residents' action in relation to the LHC. 132

Local Health Commission in bulk to enable the Commission to supply water to the areas for which it

[was] responsible around the Pietermaritzburg boundary…’ 405 At this point in time, the LHC wanted to provide water to Lincoln Meade, Ockert’s Kraal and Cleland (immediately); Hollingwood and Dunveria

(‘at some date’) and Edendale (‘ultimately’).406 On 16 January 1951 the City Council confirmed that it was unable to supply the LHC with water for those areas surrounding PMB and it was not until 1953 when a breakthrough was achieved. At another meeting between the LHC bureaucrats, the PMB City

Engineer, Deputy Mayor and three city councilors, the parties agreed ‘in principle to the sale of bulk supply of purified water [as from 1956 or 1957 onwards] to the Local health Commission to be delivered at a point near Scottish Cables to serve the Townships of Cleland, Lynrey, Lincoln Mead, Ockert’s Kraal and Cleland extension’407.

In addition to securing a supply of clean water to a PHA, the LHC also monitored water quality, whether it was an LHC-controlled water source or water that people sourced from natural sources such as rivers and rain-water storage tanks. The MOH monthly reports included data on the number of water samples that were tested; the outcome of these tests; and the corrective action taken in order to secure clean water. The quality of the water of private businesses, especially those involved in the food trade, was also tested. In 1949, the MOH had two samples tested: from Café-de-Move-On, Georgetown and the

Standpipe, Macibisa.408 Both were free of eColi (0 /E.Coli per 100 cc's) and reported as ' fit for human consumption at time of sampling'.409 Examples of unsatisfactory results were when six water samples

405 Op. cit. note 390 406 The references to times, in brackets, were the LHC's proposal to City of PMB. Hollingwood and Dunveria were not PHAs at the time of this meeting and therefore the time period as "as some date" 407 LHC and the PMB City Council discuss the proposed tariffs throughout 1957 and 1958 as the anticipated date for connection was August 1958. However, the records indicate that connection was effected in December 1958. (See 3 PMB Box 4/4/2.209) 408 LHC Minutes, Vol. 8[2](b), 1 January 1950 to 31 March 1950 409 Ibid. See chapter five for a discussion on the problems related to this Café and thus, the significance of the eColi free results. 133

were tested and contaminated water was detected in Cedara PHA. The MOH reported that the 'matter was being taken up with the owners'.410

The third environmental service that I wish to refer to relates to public works, i.e. building roads, schools, hospitals, recreational facilities such as playgrounds, street lighting, bus stops and /or shelters.411

These projects included both construction and maintenance of infrastructural resources for the enjoyment of PHA residents.

Other environmental responsibilities and activities that the LHC undertook on a regular basis included:

Abattoirs: The regulation of slaughtering animals included control over the establishment of and

regular inspection of private Abattoirs as well as the slaughtering of animals for private ceremonial

purposes. For example, in December 1949, the LHC MOH issued 33 permits for Clermont and 98

goats and 3 sheep for EDPHA. The high numbers were due to ‘numerous Celebrations’ according to

the MOH that occurred during that month.412

Food inspections: At a very early stage of the LHC, the MOH clarified his function regarding food.

He said that 'by food inspection, as far as my duties are concerned, is meant the examination of all

foodstuffs exposed for sale with the view of securing that the article offered to the retail purchaser is

genuine, and of the required quality. In other words, to prevent the adding of any foreign substance so

as to increase the quantity, ignoring the inferior quality that results; for example the adding of water

410 LHC Minutes, Vol. 12[2](b), 1 January 1954 to 31 March 1954 411 LHC Minutes, Vol. 10 [2], 1 October 1951-31 March 1952, LHC Secretary D.R. Donaldson Memo, ‘Bus Shelter at Edendale for Despatcher, 7 November 1951 412 LHC Minutes, Vol. 8[2](b), 1 January 1950 to31 March 1950, MOH December Report for EDPHA 134

to milk and to paraffin; the adding of mealiemeal to sugar, which I can ensure you is a common

practice in the Area under our jurisdiction.'413

Domestic animals: The LHC regulated all domestic animals and these regulations required that

applicants who wished to own dogs prove their competence ‘to keep dogs properly’ and if accepted,

were ‘given written authority by the Location Superintendent to keep the dogs’.414 Following this

approval, dog owners were required to register and pay a license fee for their dogs.

Milk sales. The LHC launched its Mobile Milk Scheme on 4th October 1945.415 The reason for

‘introducing the scheme was to sell milk at the lowest possible price in order that this essential food

should be available to as many of the poorer people as possible. A second consideration was to make

the people “milk-conscious” and it was also hoped that the Commission’s efforts would persuade

private suppliers that Edendale was a market worth cultivating.’416 While this initiative increased

people’s access to milk measured by the increase in purchases between 1945 and 1950, this situation

changed in 1950 when there was a drop in sales and the initiative was not profitable for the LHC. The

LHC went from making ‘a small profit’ to running the Milk program as a loss, especially during the

winter months. This did not concern the LHC staff too much for the MOH, in particular, was of the

opinion that the LHC’s Milk program achieved one of its goals for the drop in sales did not

necessarily mean that people were no longer consuming milk for it was established that storekeepers

in the area had started selling milk.417 In his own words, Dr. Seymour concluded that the public was

413 LHC Minutes, 1 November 1941-31 March 1943, Vol. 1, EDPHA: Health Inspectors Report for the Month Ending 3rd, March 1943 414 Ashdown PHA, LHC Minutes and Annexures, 1.4.58-30.9.59 Vol17[1](a) 415 MOH Recommendation to the LHC, ‘Milk Supplies: Public Health Area of Edendale and District,’ in LHC Minutes, 1.10.51-31.3.52, Vol. 10(2) 416 Ibid. 417 A second reason for the drop in sales was the increase in the price of milk. 135

now ‘milk-conscious’ and especially storekeepers were convinced that milk was ‘a commodity worth

stocking418

The LHC also had powers of monitoring compliance with laws and regulations. The list of offences that fell within the jurisdiction of the LHC included traffic offences, unauthorized occupation of

‘dwelling’, failure to pay rent, failing to provide suitable latrine accommodation and possession of

Isishimeyana (home-made alcohol). There was an array of consequences (or punishment) that the Public

Health Area residents faced when found in contravention of LHC regulations. The most common consequence related to housing and accommodation infractions were eviction of persons who were not authorized to be in the house, to be in the Public Health Area or failure to pay rent. There were at least also instances when the LHC shamed people into compliance. In January 1958 the Area Secretary for the

EDPHA reported that he drove through the streets of Edendale on a Saturday and when he arrived at the house of residents who owed rent he used a loud speaker to broadcast their names and the fact that they had defaulted on their rent. This measure, according to the Secretary, was successful as arrears to the amount of £266 dropped to almost £6 soon after this public naming and shaming intervention.419

The LHC generally urged residents to comply with the regulations before taking more drastic measures such as fines, evictions or banning a resident from keeping animals or preventing a resident from extending a house. During their home visits, for example, Health Inspectors checked on the type and number of animals that a household had and whether they had permission to keep those animals, thus monitoring compliance with the dog licenses. The MOH's reports regularly reported on the rate of

418 Op. Cit. note 421 419 LHC Annexures to Minutes, January 1958 – March 1958 Vol. 16[2](b)p.2945, Edendale and District Public Health Areas Advisory Board Meeting minutes, 4 February 1958, p.2. This matter was raised at the Advisory Board meeting and the AB members expressed concern about the Secretary’s methods. For example, they thought that ‘a less hurting method would have been’ better. In addition, Mr. Zondi, one of the AB members argued that rent was a ‘personal’ matter and ‘should not [have] become broadcasting material’. See chapter Five for more detailed discussion on the activist role of the Advisory Boards. 136

compliance, for example, in December 1949 the MOH report for EDPHA noted that ‘two out of the five families known to be keeping pigs without permission have now complied with verbal notices to remove their pigs.’420

It is not surprising that the LHC's enforcement mechanisms included working with the South

African Police to ensure successful prosecutions. When offences were committed within the jurisdiction of their PHAs, for example they assisted the local police force with arrest of individuals who committed crimes within their PHAs.

LHC staff members assisted in the arrest of individuals who were in possession of a dangerous weapon or committed common assault. It appears that the first responders included LHC staff that lived in the PHAs and Police Officers appointed to patrol the PHAs:421

Three of the fir trees planted along the perimenter of the Cemetery were cut down and removed on the 16th December. On the 18th December the two labourers employed at the cemetery took the names and addresses of two youths who had chopped down a tree and the matter was reported to the SA Police, Bellair’…the two youths were found guilty by the court, they were cautioned and discharged.

Social Welfare

'Social work' was an important component of the social welfare aspects of public health as practiced by the LHC. Under certain circumstances, the interventions were targeted at individuals and at other times, at groups of individuals.422 The MOH supervised the social work activities. The LHC employed senior social workers, all white, and where possible, ‘native’ or coloured social workers to

420 LHC Minutes 1.1.50-31.3.50 Vol. 8[2](b) MOH December Report for EDPHA 421 LHC Minutes 1.1.60-31.3.60 Vol. 18[2](b), Secretary's December Report; LHC Annexures to Minutes 1.1.60- 31.3.60 Vol. 18[2](b)] 422 This is a concept of organizing services that was also employed by the social medicine experiment, i.e. directing certain services at groups as opposed to individuals. 137

work amongst 'their own communities'.423 The social workers conducted individual and family interviews; undertook home visits; administered grants such as old age pension, Invalidity Grants, Grants-in-Aid and grants on behalf of the Natal anti-TB Association. The TB-work scheme was also run by the Social

Workers. In terms of this scheme, TB patients were given food rations alternatively, provided with employment either in the 'open labour market or LHC-run projects such as the Tree Planting project.424 In addition to these case work activities, the Social Workers also ran various social clubs.

Vegetable Gardens & Clubs425

The LHC ran both its own demonstration gardens and co-ordinated Vegetable Clubs in the PHAs.

The former was generally a garden on an LHC property, for example, the Clinic and the garden was used to encourage residents to grow their own vegetables and to illustrate how one can cultivate in the urban areas. In Ashdown in the EDPHA, for example, green mealies and carrots were grown at the

Superintendent’s office ground from seeds supplied by the Health Department. Yields from these LHC gardens were distributed in the community or to certain institutions such as patients at the clinic, the

Nursery school and also to TB patients as part of a grant-in-aid as well as a Special Supplementary

Ration, ‘malnutrition cases’, schools and institutions. Vegetable Clubs, though, comprised of a number of individual, residential gardeners who received seeds from the LHC’s health department (MOH)426 and regularly brought their yields to a central point for distribution amongst themselves and also to the same beneficiaries of the LHC demonstration gardens listed above.

423 LHC Minutes, 1 November 1941-31 March 1943, Vol. 1 424 LHC Minutes, 1.1.54-31.3.54, Vol. 12[2](b), MOH Report, 19 January 1953; Annexures to Minutes 1.1.58- 31.3.58, Vol.16[2](b); Annexures to Minutes 1.1.58-31.3.58, Vol.16[2](b) MOH December Report 425 LHC Annexures to Minutes 1.1.58-31.3.58, Vol16[2](b), other: TB Case work, TB ration scheme, Soup kitchen and women's club; LHC Annexures to Minutes 1.4.58-30.6.58 Vol. 17[1](a): Signed by R.P. Seymour, MOH, Vegetable Club: Supply of Vegetables: Ashdown: LHC Resolution No. 3(3) of March 20, 1958 426 Needless to say, the LHC recorded the number and kind of vegetables collected and distributed number of households and patients who benefited from the vegetable gardens, number of packets of seeds distributed and the number of families who received the seeds. For example, in October 1951 454 packets of seeds were distributed to 161 families in Clermont 138

Women’s clubs427

The LHC co-ordinated and provided material including financial, support to a number of women’s clubs in the PHAs. While there were never many women who attended these meetings, the LHC supported the work of these clubs.428 The clubs in Ashdown (part of EDPHA), Macibisa and Georgetown, for example, organized a ‘joint exhibition in the Anglican Church in Macibisa’ to display their ‘knitting, dressmaking, cookery and fancy work’. About 70 members and visitors attended and prizes were awarded for the best work. On another occasion, these same clubs organized a Christmas party. They invited other women from the area and especially children from these PHAs. The Club used money that they received from the LHC to buy gifts for the children.

While the main goal of this Christmas part was to entertain the children; a secondary goal was to recruit new members and the Christmas party was considered as one of the benefits of membership.429

Children’s activities and facilities

A number of the LHC activities were directed specifically at children including the construction and maintenance of recreational facilities. Soon after the LHC took control of Edendale and its surrounding areas, it constructed the Ashdown Park & Playground.430

In addition to their own initiatives, the LHC supported community events. In December 1949 the

Assistant Manager in the LHC's Department of Health provided financial support to '15 young Indian men

427 Zenzele, isiXhosa for 'Help Yourself' of 'Do it yourself', SA women's clubs, goal was to improve women's situation. Rival groups that were set up by the 1920s included the African Women's Self- Improvement Association and the Bantu Women's Home Improvement Association. These groups shared the goal of teaching women domestic skills, public speaking and 'for leadership roles in their community'. Kathleen Sheldon, A Historical Dictionary of Women in Sub-Saharan Africa. (Maryland: Scarecrow Press, Inc., 2005), pp. xxi and 274-5 428 LHC Annexures to Minutes, 1.1.58-31.3.58 Vol. 16[2](b) 429 LHC Minutes 1.1.50-31.3.50 Vol. 8[2](b) MOH December Report 17 Jan 1950, p. 1883 430 In December 1949, 41 children used the facilities and this was considered a low number for there were only ‘18 days during which the weather was fine’. 139

to form the Riversdale Rover Scout Troops' in Howick West'.431 Another community initiative that the

LHC supported was the children's Sports Day in 1953 organized by the Clermont Teachers' Association.

The latter received £5 from the LHC.432 Even an event like the annual Children's Christmas Party was viewed as a health-related intervention. The Child Welfare Society (CWS) invited the 'Maintenance Grant

Families' to these Christmas parties where they enjoyed refreshments and each child was presented with a gift. The MOH reported that he 'could not help being impressed by the clean and tidy appearance of the children, bearing in mind the poverty of some of the homes. It speaks well of the Society's rehabilitation work.'433

The LHC also provided financial support to charity initiatives undertaken by the residents of the

EDPHA. When Selby Msimang, as an LHC employee, participated in a social welfare survey of residents of the EDPHA, he was shocked at the destitution faced by some of its residents. He wrote that

In one building I found it was occupied by a man and his wife. The husband was bedridden and could not move about without assistance. As there was no income of any kind, the wife had to work. Returning from work in the evenings the wife had to clean the invalid and cook food to last another day. She asked a neighbour to help by giving him food during the day. In another house I found a widow with 6 young children and her old mother-in- law. The mother-in-law received a government old age grant of 1,50 per month. The widow had appealed to the Child Welfare Society for help. She could only get R4 per month on condition she did not take any employment which would keep her away from the children. The rent she was paying was R1,50 per month.

Msimang recognized that some of the households in the EPHA required additional assistance and approached the EDPHA AB. The AB supported the idea of a Benevolent Society, which Msimang set

431 Op. Cit. note 395 432 LHC Minutes, 1.4.52-31.3.53, Vol. 11 433 LHC Minutes 1.1.50-31.3.50 Vol. 8[2](b) MOH December Report 140

up.434 A Mr. Holden, manager at the Tannery in Edendale and AB member, offered to donate 50 guineas to help Msimang initiate the Benevolent Society. In addition, the LHC offered to match any donations raised.435

Poor Relief

As with other social welfare programs, the LHC implemented their programs that provided financial and material support to the poor and but, it also assisted government and other agencies to assist the poor. Firstly, the MOH had a General Welfare Fund that he used to purchase vegetables and groceries for families.436 Secondly, the social worker employed by the LHC assisted those in need to access government welfare grants. In December 1949 the following grants were paid out in Clermont following the assistance of the LHC Social Worker: 42 Pauper grants, 233 Old Age Pensions, 72 Validity Grants and 6 ‘Blind’ Pensions to the total of £230.0.0437 And one final example of the poor relief or assistance programs is the employment scheme for TB patients.

Recreation

The LHC also ensured the building of sports facilities, public halls and schools. Wadley Stadium in Edendale, named after the first LHC Chairman, was one of the LHC greatest achievements.438 In an interview in 2010 on the history of Edendale, Charles Donnelly fondly recalled the times they spent at

434 Msimang was the founder of the Edendale Benevolent Society and served as its secretary from 1946 to 1952 and from 1967 as honorary life president. See http://www.sahistory.org.za/people/henry-selby- msimang-0 435 Msimang, PC 11/1/6 file PC 11/1/6/1. This Benevolent Society later became the Edendale Welfare Society. It went on raise funds for and support the building of a public hall and a library. 436 LHC Minutes 1.1.50-31.3.50 Vol. 8[2](b) MOH December Report 17 Jan 1950, p1884 437 Ibid. 438 This soccer stadium, subsequently renamed after one of SA’s biggest financial institutions the First National Bank, to FNB Stadium, is still in operation and was renovated for the 2010 Soccer World Cup Competition. Interview of Charles Donnelly ‘The history of Edendale; Dusale Hotel, the Flood and the Seven Days’ War.’ Sinomlando Oral History Project, University of KwaZulu Natal, at Pelham, KZN,16 May 2010 141

Wadley stadium and by implication, commented on the contribution of the LHC to enhance the quality of life of the residents of the EDPHA. He noted that they played soccer at Wadley Stadium and that was where they ‘felt free’ during the dark days of apartheid: ‘Wadley stadium was like a normal sports filed with a lot of things happening there. Many teams played there’.439 This stadium allowed a strong soccer association to flourish as local teams could not only practice at that facility but also host teams from across the country. On 12 January 1959 the Acting MOH, Dr. R.M. Williams recommended that the LHC recognise the Edendale and District African Football Association.440 In fact, this stadium provided the area with the facilities to establish its own Association, independent of the Pietermaritzburg Association for, as this recommendation in 1959 indicates, the Edendale and District African Football Association replaced the previous association that was known as the Maritzburg and District African Football

Association.

Child Welfare society, PMB

The CWS began operating in EDPHA in 1946 with the express goal of administering child maintenance grants for Africans. Two years later the LHC started making financial contributions to cover the cost of a social worker and provided in-kind support to this branch of the CWS. The LHC provided the CWS with clerical assistance, the time of the Health Assistants to supervise cases and even office space. This turned out to be a valuable resource to the CWS for the latter was unsure whether it could have provided services to Africans without the 'interests and assistance' it received from the LHC. The

LHC paid over £785 between 1948 and 1953 in grants to the CWS. It seems that the LHC provided this support because since its inception, the bulk of their work in the EDPHA was 'African work’441 thus, assisting the LHC in implementing its goals. The CWS, however, was quickly over-burdened and

439 Ibid. 440 Annexures to Minutes, 1 January 1958-31 March 1958, Vol. 16[2]b, p. 2573 441 Ibid. 142

between 1951 and 1955 informed the LHC that it was unable to keep up with this work mainly because of a lack of funds and of volunteers. In response, the MOH said that it did not accept the proposal to close.

In fact, it urged the CWS to continue its work on behalf of the African residents, especially the children, of Edendale. Seymour said the following:

The attention of the Society was once again drawn to the fact that under their constitution they were morally bound to undertake, not only African work, but child welfare work, on behalf of all children in the Magisterial District of Pietermaritzburg, no matter what creed, colour or religion. [my emphasis]

During March 1954 only six areas of work continued: sewing classes for the mothers who received Child Maintenance Grants; the blanket scheme; referral of Africans to other agencies when they arrive at the CWS' office; the distribution of donations such as used school books and clothing for school children would continue as long as there is stock available; and the Christmas parties (see above). These activities could continue because it was not dependent on core CWS funds rather, the CWS received donations for them.

The LHC's Expertise As Provincial Resource

When the opportunity arose, the LHC propagated the importance of a public health-based local authority to the NPA and other municipalities. Its founding Ordinance prescribed that the LHC may be required to undertake 'inspections and preventive work in connection with the rest of the Province'. In

1946 the NPA approached the LHC to assess Vryheid East, an area adjacent to the white town of the

Vryheid Borough.442 Dr. Landau led the investigation on behalf of the LHC and wrote the report, which again indicated that the LHC conceived of urban living conditions primarily through a public health lens and the local governance should be based on the principles of public health and not merely political

442 LHC Minutes, 1.1.47-31.3.47, Vol. [5] (2)(b) 143

governance. The Vryheid East report commenced with a breakdown of the demographics and land ownership. It said that the area was multi-racial with Africans as the majority of land owners but

Europeans and Coloureds also owned land. Vryheid East was in need of 'control' both from a health perspective and from a governance perspective:

Housing: 'nearly all the dwellings were mud shacks and 'unfit for human habitation'

Sanitation: 152 families had no sanitary conveniences, or shared these facilities; the 'pit privies [were]

of very crude construction, being more of a menace to health than a safeguard'; there were no refuse

removal services; sanitary removals at the school was also inadequate

Roads: there were no roads that were 'properly constructed and maintained'

Water supplies: most residents obtain water from shallow wells and streams, which must be grossly

polluted due to the general insanitation of the area'

Businesses: Vryheid East had a 'Butchery, a fresh Produce Dealers shop, and a General Dealer's shop

There were no recreation facilities

Landau's report, as mentioned, also investigated the existing governance structure. He found that the area was controlled by the Native Commissioner, in terms of the Native Administration Act, No. 38 of

1927, as amended, and that it had an Advisory Board. The Landau report recommended that the

Township of Vryheid East should be incorporated in the borough of Vryheid.

Conclusion

The LHC was an exceptional local authority and this chapter was an attempt at setting out the public health significance of the LHC so as to expand our understanding to the LHC beyond Cloete's summary of the LHC as one form of local government. 144

Following its establishment in 1940, the LHC set out to take control of the black and multi-racial urban areas in Natal with a view of combating and preventing the growing public health crises as articulated in the Thornton report and the UDPH. In addition to its three internal, administrative departments, the LHC set up PHAs, with Advisory Boards, as its units of governance. As stated at the outset, this chapter is not an assessment of the LHC as this is the subject of a future project. It would however, be a lost opportunity not to venture some preliminary comments in this regard and proceed with a more critical look at the LHC in the next chapter.

145

Chapter 5: The Politics of Public Health: Political Representation, Municipal Politics

Services and Apartheid, 1940 - 1959

In 1954, following the death of John Christopher Boshoff, one of the first Commissioners, the

EDPHA AB decided to build the Boshoff Memorial garden on the grounds of the Edendale hospital.443

Commissioners were always part-time governance officials but, as the highest decision-making institution of the LHC, they held significant power. However, as discussed in Chapter Four, the exercise of that power was heavily dependent on the work, insight and recommendations of the Departmental Heads.

When Boshoff became a Commissioner, however, all Commissioners and staff members were new.

Along with his co-Commissioner, Lugg, Boshoff spent a considerable amount of time conceptualizing the institutional arrangements of the LHC and undertaking field research in order to inform the LHC agenda.444 Boshoff drafted the first set of rules for the LHC ABs in 1942. In December 1942, he requested permission to join the Clinic Committee in the EDPHA. He advocated for significant changes that improved services at the clinic. He approached the NAD, with the support of the Clinic Committee, to donate funds specifically earmarked for purchasing equipment. In January 1943, he negotiated with a

'native who lived at the back of the clinic' to work as a guard to the nurse on night duty.445 Boshoff and

Lugg also played an important role in developing the LHC's position regarding housing. From 1943 onwards, as the LHC managed to employ more people in the EDPHA, he took more of a hands off approach and for the rest of his term as Commissioner, also served on the Building Plans Sub-Committee.

The latter was more of an oversight committee that reviewed the applications for housing developments that received preliminary approval by the MOH, Engineer and the relevant PHA Superintendent. In this

443 EDPHA Advisory Board minutes, 26 April 1954, LHC Minutes , 1.4.54 - 30.6/54, Vol. 13[1](a) 444 Op. Cit. note 268 445 LHC Minutes, 9 December 1942 and 11 February 1942, LHC Minutes, 1 November 1941 - 31 March 1943, Vol. 1 146

way, Boshoff was able to remain involved in one of the areas of work of the LHC that he started.

However, his most prominent role was as chairman of the EDPHA AB. Boshoff was the face of the LHC in the EDPHA during the first few years and it is thus not surprising that he left an impression on some of the EDPHA residents. The decision of the EDPHA AB to construct a memorial garden is an indication that he was viewed in a positive light.

Another memorial, which still exists today, is the Wadley Soccer Stadium in Georgetown,

Edendale. Victor Madisha, one of the interviewees who lived in the EDPHA and participated in

Sinomlando's project on the History of Edendale,446 recalled the construction and naming of the stadium.

In his account, the stadium was 'one of the good deeds from a white person to the black community' for the 'money came from the Local Health Commission [but] Mr. Wadley was championing the plans of building the stadium' and thus, it was named after him, Wadley.447 Madisha identified an employee named

Wadley however, from my reading of the LHC records; it is more likely that this stadium was named in honor of the first Chairman of the LHC, T.M. Wadley.448

Mahabeer Jayshree, was born in 1948 and grew up in Plessislaer. Her family was classified as

Indian and relocated from the EDPHA to Northdale, north of PMB, in the 1960s.449 Jayshree has fond memories of the EDPHA. She remembers going to the 'library [as a child] at the Local health

446 Op. Cit. note 97 447 Interview of Victor Madisha by Nicholas Ziqubu, Oral History Project, 19 October 2009 in Edendale. Madisha identifies Stuart Wadley, an LHC employee, as the person after whom the stadium was named. I was unable to verify this information with the Interviewee. 448 See image of first Commissioners on p.139 and discussion of LHC officials above. I was unable to confirm the details of his recollection with Madisha or the Interviewer. 449 In her interview, Mahabeer names two dates for this removal, 1963 and 1967. This discrepancy was not followed up in this interview. 147

Commission Hall'.450 She specifically remembered visiting the library 'after school with my cousins and friends [and] the first studio was in Edendale and you must know that back then, it was not easy to get a photo. I remember myself when I was posing for the photo at the studio'.451 Both Madisha and Jayshree's testimonies remind us of the benefits of the LHC's work in the EDPHA. While Madisha credited the LHC for the general development of the area, he included some of the local African leaders for their involvement in that process. According to Madisha, people in Edendale 'can see a milestone in terms of community and infrastructure development. Clinics, schools and roads are being built or renovated. I thank the municipality for that. This started long ago'.452

In spite of the honors bestowed on the abovementioned Commissioners and the positive memories recalled by those who lived in the EDPHA; its work did not go unchallenged nor was its mandate universally accepted. This chapter focuses on the residents' responses to the work of the LHC and the political implications of the LHC as a governance institution. It covers the period 1940 - 1959 and is structured so as to complement the discussion of the LHC in Chapter Four.

One of the issues that interested me was the ways in which PHA residents engaged with the LHC.

Some of the residents took an activist role demanding services that directly met their needs or challenged some of the LHC's decisions. However, a critical question in service delivery is access to political institutions, something that leaders in Edendale demanded for decades. When the LHC was established, it perpetuated the system that denied black people self-governance at the local level and more importantly, it prevented any form of direct representation at this level of government. How did the LHC deal with the demand for self-representation and governance that Africans had been demanding for decades? If the adoption of the Advisory Board system, prescribed for all black urban areas in the 1923 Native Urban

450 Interview with Mrs. Jayshree Mahabeer by Zama Mnguni on 2 June 2010 in Pietermartizburg, Sinomlando Oral History Project on the History of Edendale. 451 Ibid. 452 Op. Cit. note 462. 148

Areas Act, was the LHC's answer, how did the Africans respond to what was essentially second prize in the race for self-governance? What did the LHC do with the ABs recommendations? These governance questions form the subject of the first part of this chapter. I contextualize the question of African political representation and then examine the situation at local level when the LHC took control of Edendale.

As part of a critical analysis of the LHC, I was interested in the impact of the consolidation of apartheid on the LHC. Between 1940 and 1948, when the NP government introduced apartheid, the LHC had unqualified support from the UDPH. It also received support from the Ministry of Health especially after 1945 when Dr. Henry Gluckman took over this ministry once he completed his work as chairman of the NHSC in 1944. During the first 11 years of apartheid, known as the consolidation phase, the NP government extended its influence over state institutions as well as strengthening the segregation measures it inherited from the previous governments.453 The roll out of apartheid meant that the liberal developments of the late 1930s and 1940s were closed down. One of the first setbacks for white liberals was Gluckman's termination as Minister of Health. While none of the NHSC recommendations were implemented between 1945 and 1948, the fact that Gluckman occupied this leadership role, meant that there was the possibility that these recommendations would be implemented.454 In 1948, that window of opportunity closed when Gluckman was replaced. Another major blow was the closing down of the social medicine experiment when the government phased out the Health Centres. From 1950 onwards, no new

Health Centres were opened and the existing ones were transformed into outpatient clinics for the provincial hospitals. This 'starving' of the social medicine experiment was, according to De Beer, based on apartheid ideology.455 The introduction of apartheid had special implications for local authorities.

Thus, about a decade after it was established and firmly entrenched as a third tier of government, the

453 See Davenport and Saunders, South Africa,(2000) 454 Bill Freund has argued that these recommendations would never have been implemented even if the NP did not come into power in 1948. 455 Op. Cit. note 159 149

LHC, like other local authorities, was mandated to implement an array of urban apartheid measures including urban residential segregation. In addition, the NP government strengthened the role of the NAD and this posed a direct challenge to the work of the LHC in the urban areas. The NP government therefore had multiple opportunities to close down the LHC before 1959. It did not and, as stated above, the LHC survived in the EDPHA and Clermont PHA until the mid-1970s and as an implementing agent in smaller areas, until 1994. I was therefore interested in the ways in which the LHC navigated those apartheid laws that directly affected its mandate and the services it provided.

The significance of this issue lies in the liberal roots of the LHC and its commitment to public health. To what extent did the introduction of a more stringent form of racism influence the LHC's public health agenda or its commitment to African health and welfare? Apartheid ideology did not include the creation of a permanent home for Africans in the city while the LHC's activities did the opposite.456 As for racial classification, the LHC took these categories into account even before 1948 when it, for example, regulated the sale and occupation of land between people of different races in scheduled and Released

Areas where non-Africans were prohibited from owning property. After 1950, the national government demanded a far more extensive race-based segregation and the impact on the LHC, which had its roots in liberal public health developments, is worth investigating.

This chapter begins with a brief section documenting the actions by individual EDPHA residents and ways in which they advocated for themselves. In the second section, I explore the implications of the introduction of the LHC for EDPHA's leaders and their political aspirations. The ABs were a central feature in the governance of the PHAs and this section includes an examination of the LHC's AB system,

456 The Sauer Commission Report was prepared in 1947 with a view of transforming apartheid ideology into a workable racial policy. The report became a check list of apartheid measures for the NP. It identified especially firming up of the Influx Control measures, concerted effort to restrict black political and social rights, and formalization of the reserves as official independent Homelands 150

specifically how the LHC and African leaders, respectively, interpreted the 'advising' role of the AB. The final section of this chapter focuses more on the functions of the LHC in light of urban apartheid measures and how the LHC responded to these.

The primary sources comprise communication between the residents and the LHC and the minutes of the meetings of the ABs and of the LHC. There are a number of limitations with this decision.

It prioritizes the written record and thus captures the views and experiences of those who had access to and were able to communicate in writing with the LHC. More importantly, it privileges the views of the officials who compiled the LHC record. While this can introduce a weakness in an analysis of the response of the EDPHA residents and the political implications of the LHC, it is important to mention that these records also contain the original letters and petitions drafted by individuals and by groups representing the residents. A further limitation is that the views and demands of the residents were also expressed by others, for example, AB members and LHC officials. The minutes of the AB recorded the discussions and recommendations expressed by those members. While these minutes were recorded by the LHC officials, they also contain direct quotes from speeches by individual AB members thus giving me access to the ideas and words of those individuals. There are also instances where LHC officials speak for and on behalf of PHA residents. When the views and demands of people are mediated in this way, it is more difficult to establish the authenticity of the voices and the agency of the PHA residents. The LHC records are, however one of the few contemporary records documenting the LHC's engagement with the national government and with PHA residents. These files are comprehensive and meticulous, documenting, in great detail, the work reports, discussions and decisions of the LHC and its Advisory

Boards. I supplemented these records with other primary sources such as newspapers and interviews by the Sinomlando Oral History Project on the history of Edendale.

151

Citizen Action for LHC Services

Residents of the PHAs did not merely wait on the LHC to decide which services it would deliver in the PHAs. Individually and collectively, they either challenged a decision of the LHC or requested the latter to prioritize issues that were important to them. In 1950, Vumisa, a resident in Edendale, launched a successful challenge to the LHC’s demand that he demolish his shack.457 During 1948 the LHC Secretary issued a notice to Vumisa requesting that he complete the new building, according to his application, and that he demolish his slum dwelling. By September of that same year, there was still no change and the

LHC granted Vumisa a further extension until 31 October. In the meantime Vumisa applied to the Natal

Provincial Division of the Supreme Court to set aside the LHC decision and challenged the latter's authority to apply the Slums Act of 1934. The Court found that the LHC's decision in terms of

Proclamation 116 of 1946, issued in terms of this Act, was invalid as it, the LHC, was not a local authority for the purposes of the Slums Act. The result was that ‘the Commission had not been designated in the Proclamation as the local authority responsible for the carrying out of the provisions of the Slums

Act in Edendale’ and as a result, it had no authority to declare Vumisa’s house a ‘slum’ nor could the

LHC instruct him to destroy it.458 This was a setback to the LHC staff for it effectively brought their slum demolition work to an unexpected halt. In order to remedy the legal position of the LHC, its Legal

Advisor drafted a new proclamation that would afford the LHC the necessary legal authority for purposes of the Slums Act. Vumisa did not necessarily challenge the authority of the LHC as the local government in Edendale but, he challenged its decisions that adversely affected him.

457 LHC Minutes, 1.10.48-31.12.48, Vol. 7[2]; LHC Minutes, 1.1.50-31.3.50, Vol. 8[2](b) 458 D.R. Donaldson, LHC Secretary, Memo to Commissioners, 5 December 1950, LHC Minutes, 1.10.50- 31.12.50, Vol. 9[2](a) 152

Marshall Msibi, another resident of the EDPHA, challenged the LHC's housing regulations and its application of the Slums Act.459 The LHC had issued an order to condemn two of Msibi's dwellings In

June 1951 he made representations to the LHC arguing that he should be allowed to build 'one inferior- type house and one substantial house'460 once he demolished his two buildings that the LHC condemned.

Msibi's appeal forced the LHC to review its earlier decision. During the review process, it found that there was no specific LHC resolution / decision that prohibited the construction of another (suitable) inferior- type dwelling on the same land once an unsuitable inferior-type dwelling was demolished. From my reading of the record, Msibi was challenging the particularity of the LHC's decision, i.e. the reasons for condemning the building. Thus, if he constructed a new building with inferior-type material, wattle-and- daub for example, but allowed for sufficient ventilation, floor space, over-crowding and treatment of the wattle to prevent insect infestation, then he should be allowed to construct such an 'inferior-type' building.

The LHC officials who made the initial decision however, argued that it would be counter-intuitive to demolish inferior- buildings in terms of the Slums Act only to allow the construction of another inferior- type building. By this time, however the LHC recognised that it would cause more harm than good, to prevent Msibi's and others from constructing wattle-and-daub houses. (See below) Consequently, Msibi's appeal used the LHC's own insistence on following regulations, against them.

The Vumisa and Msibi decisions attacked two of the core functions of LHC: the demolition of shacks and improvement of slum conditions. People were being evicted from shacks and re-housed or, instructed to remove shacks and build LHC-approved houses. The building of new structures was very slow and there was also a delay in destroying shacks from which people were moved and as a result, different people occupied empty shacks. As one area of intervention that visibly demonstrated progress

459 LHC Minutes, 1.7.51-30.9.51, Vol. 10(1)[b] 460 Ibid. 153

and the success of the LHC's work, its officials in the PHAs expressed frustration. They held the LHC to a higher standard and decisions such as the Vumisa and Msibi cases did not help them. The EDPHA

Superintendent noted that by allowing the re-occupation of shacks, the LHC was no different than any other local authority and 'that no progress will be made in the elimination of unsatisfactory housing in the areas unless steps are taken to see that shacks are demolished'461 as soon as the tenants are re-allocated.

This cycle, he argued:462

reveals a most unsatisfactory state of affairs as the whole intention in dealing with a section of the Public Health Area was to effect the rehousing of people living in shacks and to have the shacks demolished [emphasis in original] so that something could be seen for the Commission's activities in this respect.

On 2 June 1951 a group of women from the Umgeni Area of the Clermont PHA approached

Donaldson, the then LHC Secretary, regarding their limited access to clean water because the position of the well was 'inconvenient'463. According to Donaldson there were approximately 60 families whose nearest point of water was a tank 'a distance of approximately one mile up extremely steep gradients'464.

The women informed Donaldson of the difficulty they experienced and requested that he / the LHC remedy the situation. In his report to the Commissioners, Donaldson acknowledged that the installation of a tank on a plot closer to where the women and their families lived would 'meet with the wishes of the residents' and that a decision about this should be 'given urgent consideration' by the MOH.465 This water tank could only be installed if MOH 'was of the opinion that a water tank was urgent and absolutely necessary'. Dr. Seymour agreed with Donaldson's view and the women received their water tank.

461 Superintendent of the LHC, RE: Slums Act, 30 July, 1947, LHC Minutes, 1.4.47-30.6.47, Vol. [6](1) 462 Ibid. 463 Donaldson's Memo: Water Tank: Umgeni Area - Public Health Area of Clermont, 14 July 1951, LHC. 302/3 in LHC Minutes, 1.7.51-30.9.51, Vol. 10(1)[b] 464 Ibid. 465 Ibid. 154

In December 1957 twenty five people lodged a petition with the Superintendent of the EDPHA concerning the conditions of a road in their area. It read, in part466

We, the undersigned petitioners, being tenants, property owners and ratepayers, wish to draw the attention of the responsible officials of the Local Health Commission for the area of Edendale and District, to the condition of the road that branches off over the Esinadini River. A drain has formed right in the centre of the road and it has large pot holes everywhere. During the rainy season this road becomes a bog, and residents are put to considerable inconvenience.

The petitioners provided a list of these inconveniences that they experienced when the road became inaccessible. It included the fact that goods could not be delivered by shop keepers, emergency vehicles could not reach people, and that 'the clothing and shoes of people using the road and those going to work in town [became] muddy and dirty'467. They demanded that the LHC consider the matter as urgent stating, 'that this matter demanded urgent attention' from the authorities.468 The range of issues that the petitioners included in their petition is interesting. In addition to serious problems [my emphasis] such as access for emergency vehicles, they added the fact that people's clothes became 'muddy and dirty'. This concern was however added to the petition almost as an afterthought for it appears at the end of the petition just before the signatures and was prefaced with the words: 'we might also mention'469. An issue like this may seem trivial but, it is also likely that the petitioners were conscious of the labels such as

'dirty' that were applied to them.470 The designation of Edendale as a public health [my emphasis] area may also have increased the residents' sensitivity to being labeled diseased and unclean.471

466 Petition, 2 December 1957, Annexures to minutes, 1 January 1958 - 31 March 1958, Vol. 16[2](b) 467 Ibid. 468 Ibid. 469 Ibid. 470 Megan Vaughan, Curing their ills: Colonial Power and African Illness. (California: Stanford University Press, 1991); Katherine Paugh, "Yaws, Syphilis, Sexuality, and the Circulation of Medical Knowledge in the British Caribbean and Atlantic World," Bulletin of the History of Medicine, 88: 2 (Summer 2014), p. 225-252 471 Op. Cit. Note. 475 155

These instances of individual and collective action are indications that some of the EDPHA residents were pro-active in their engagement with the LHC. In certain circumstances, their actions against the LHC solved a problem for a small number of people, like the well in Clermont PHA. At other times, it had the potential to address the needs of the wider community, such as the outcome of the

Vumisa decision.

African Political Representation

The leaders and representative bodies in Edendale were under no illusion as to the political consequences of the introduction of the LHC. Many of them had been advocating for direct representation and self-governance for decades. Time and again, the national government responded to these demands with various forms of governance institutions for Africans, none of which met these political aspirations.

Direct political representation continued to elude Africans during the twentieth century. From their perspective, the first opportunity was in 1910 when the Union of South Africa was formed. At this time, the 1909 Act introduced a three-tier unitary system of government including the National Assembly, the Provincial and the Municipal Councils.472 An administrative arm operated alongside each of these elected representative institutions. Only white people, for the large part men, served in these institutions and they were elected by a predominantly white electorate and a small group of black people who qualified to vote. Soon after this 1909 exclusion of Africans, the South African Native National

Convention (SANNC) was formed. One of the SANNC'S goals was to resist the ongoing political and social exclusions.473 In light of persistent political advocacy, the national government introduced the

472 Cameron, Democratisation of South African Local Government. Op. Cit. note 36, p. 75 473 Davenport and Suanders, South Africa, A Modern History 156

position of Native Representatives in 1936. Africans were represented in a form of indirect representation only and the law provided for three Native Representatives in the National Assembly and four in the

Senate.474 Margaret Ballinger and Edward Brookes were two 'Native Representatives' in the Senate who advocated on behalf of 'their constituencies'.475 This was followed in 1937 with the establishment of the

Native Representative Council (NRC). The latter was a national body, which consisted of six white officials and 16 Africans, of which four were nominated and twelve elected. The goal of the NRC was to advise the Government on legislation and other matters affecting African welfare'.476 It did this by reviewing draft laws and regulations that affected Africans and making recommendations to communicate its views to relevant government departments.

According to Matthews, every election, including the two between 1937 and 1947, 'the African people have elected to the Council some of their ablest men among both chiefs and commoners'.477 Africans had high hopes for the NRC, for478

year after year since 1937 the councilors have submitted for the consideration of the Government resolutions on various aspects of African welfare, and have discussed these in debates which not infrequently have been of a very high order.

These resolutions included reports on topics such as 'Native administration', African trade unions,

'the proper financing and control of Native Education'.479 Africans were especially encouraged, at least initially, that the NRC would enjoy high-level political representation given that Jan Smuts, Prime

474 Representation of Natives Act no. 16 of 1936 475 According to Davenport and Saunders, beginning in 1938 'a well-coordinated group of white Natives' Representatives, whose influence was strong enough to transform the debate over native policy from a discussion of control techniques into a discussion of immediate and long-term welfare'. (p. 354) 476 Z.K. Matthews. "The Failure of the Natives' representative council," Pamphlet published in November 1946 available at http://www.sahistory.org.za/archive/failure-natives-representative-council-pamphlet- professor-z-k- matthews-published-november-19#content-top and accessed on 15 June 2013 477 Ibid. 478 Ibid. 479 Ibid. 157

Minister from 1939-48, was to attend NRC meetings. In addition, Smuts 'expressed the hope that [the

NRC] might develop into a "Native Parliament"480

If direct political representation or urban self-governance was not yet on offer, some of the

African political leaders accepted this form of dual governance. This position was most certainly a compromise on the part of Africans as it fell far short of what they expected and this decision can best be understood by gauging the mood among some of these African leaders at the time. Lynette Stewart found the pages of the black press during the 1930s and early 1940s filled with an 'oscillating pattern of hope and despondency'.481 She analyzed two prominent newspapers close to the sentiments within the African community, i.e. the Bantu World and Ilanga Lase Natal. Stewart found a fluctuating optimism expressed alongside the despair of government's inaction or delay in addressing African demands. For example, in the 29 May 1937 edition,

Ilanga Lase Natal verbalized deep pessimism about the fate of black South Africans, particularly the educated, in the future (Ilanga Lase Natal May 29, 1937:11). Two months later, the same publication expressed soaring hopes in an editorial headed: "Swelling Tide of Liberalism: Black man's advance in the scale of civilization could not be checked".

The words of liberal politicians, including Jan Hofmeyr, one of the leading liberals, affected the mood among Africans fighting for direct representation and self- governance. According to Stewart,

Hofmeyr 'seemed regularly to bolster the flagging faith of black intellectuals with soothing words of reassurance and support [and that South Africa] could never permanently secure the wealth and prosperity of the White man by keeping the Black man poor and depressed'. 482 The participation in the NRC seemed a logical next step. However, almost from the very beginning, the NRC failed to live up to the

480 Ibid. 481 "Black South African urban Music Styles: The Ideological Concepts and Beliefs Surrounding Their Development, 1930 - 1960," PhD Dissertation, University of Pretoria (Pretoria, November 2000) available at http://repository.up.ac.za/bitstream/handle/2263/22921/Complete.pdf?sequence=7, accessed 25 January 2015 482 Ibid., quoting from Ilanga Lase Natal July 3, 1937: ll 158

stated and implied goals. Smuts himself only attended the first meeting and according to Matthews, senior government officials in both the national and provincial assemblies, ignored the NRC and its advice.

These officials 'responsible for laying down policy in this country have not considered it part of their duty to attend its sessions [and even the] Minister of Native Affairs makes occasional appearances to open a session and to give formal address'.483 Similarly, other government departments that dealt with 'African welfare' such as Departments of Labour, Justice, Social Welfare, and Education seemed 'completely unaware' of the NRC's existence'.484

The government also ignored any reports and recommendations that the NRC prepared. The

Native (Urban Areas) Act of 1945, one of the most important laws affecting Africans, was not referred to the NRC and did not reflect the views of the NRC. By 1946, the African representatives were convinced that the government was not taking the NRC seriously and they resolved that they gave the 'experiment in political segregation … a fair trial'. The NRC adjourned and this in turn signaled its end.485

This form of "political segregation" in governance institutions at national level was mirrored at the local level especially with regard to the nature of representation and also the experiences of African representatives. Multi-purpose local authorities, with both legal and executive powers, were in control of large urban areas including those occupied by black people.486 While these urban local authorities had jurisdiction over both whites and blacks, only white residents could vote and serve as representatives. As a result, the local level equivalent of the NRC was the Advisory Boards. (Below) This did not mean, however, that there were no political leaders or representative organizations in black urban areas that were

483 Ibid. 484 Ibid. 485 Mia Roth argues that the decisions by the members of the NRC in 1946 should be interpreted as aconsidered and well-planned strategy and it was this decision that caused the NRC to be disbanded. In this revisionist article, Roth rejects previous arguments that events external to the NRC and its African actors caused the demise of the NRC. "The adjournment of the Natives Representative Council 1946-1948," Historia, Vol 41, Issue 2 (1996): 61-73 486 See chapter three and also Amtaika, p. 79 159

willing and able to govern their own areas. The opposition to the LHC in the EDPHA in 1940 was a testimony to the level of political activism and sophistication as well as a confirmation that African leaders demanded self-governance and direct representation.

It should be noted that Africans were not allowed to serve on official local authorities and official

African governance institutions had no authority over white people. This situation was informed by a racist ideology, which pre-dated 1948, that saw Africans as incapable of governing themselves and that the principle of white superiority prohibited black people from positions of authority over whites. These same principles applied in the EDPHA, which was multi-racial. This multi-racial character of Edendale was also one of the reasons why the NAD could not establish a Village Management Committee before

1940. This racial ideology notwithstanding, when the NPA announced that the LHC would take control of the Edendale area there were at least two bodies that were ready to govern the black population: the Chief and the Edendale Trust. The Edendale Landowners Association (ELA), as an organization, would not have had the support of the government for it was not an official, government-supported institution but, the Chief and the Trust expected to be considered for that role. In addition, all three of these bodies hoped to be part of the formal governance institution of the area.

The chief was elected but was a government approved authority. The first chief, Stephen Mini, was appointed in 1890 and he occupied that position until his death. The three-person Trust was an institution that was created by the kholwa community after they expelled Allison, their missionary founder, in 1858.487 During the early years, at least before the 1920s, Trustees were individuals, generally white, who enjoyed social standing in white South Africa.488 The dependence on white leadership was in

487 Meintjes, Op. Cit. note 85 488 Walter Metcalfe Msimang was one of the first African trustees. CNC 37(A) PMB General Administration, Edendale 160

part, to bestow on the kholwa and their community a sense of legitimacy for, in spite of their education and high levels of assimilation, they were still denied full citizenship.489 The significance of the Trust was that it included elements of direct representation and self-governance. While the first trustee had to be the resident Wesleyan missionary at Edendale; the second was elected by a ballot of lot-holders at a general meeting. The first two trustees then nominated a third.490 This arrangement afforded some of the Edendale residents a form of participatory governance and agency, albeit limited.

Neither the NPA nor the Thornton Committee considered any of the existing governance or representative bodies as suitable to deal with both the public health problems in and effective governance of Edendale. As noted in chapter three, these two issues were inter-related for, according to Thornton, the lack of an effective governance institution exacerbated the health and housing crises. This framework led

Thornton to recommend a governance structure with legislative powers and that organized its activities around a public health mandate. None of the three existing bodies had formal public health training or expertise, as understood by Thornton and the UDPH but even if they did, the only legally acceptable governance option for Africans was an advisory forum. In 1941, the LHC enjoyed a broad range of administrative and executive powers that the Chief, the Trust and the ELA never had.

In spite of this, these leaders had a legitimate expectation to become part of the governance structures of Edendale. The promise of self-governance or at least Borough status was made at different times in the history of Edendale. According to Meintjes, the need for self-governance and claims of competencies were made as early as 1882 but 'a short-sighted colonial government refused to see even

489 This is a phenomenon that followed the AB members for an numerous occasions, the LHC officials and/or the Commissioners intervened with official government structures either upon request of the AB members or on their own initiaive (see below) 490 During the 1940s, Oliver Msimang, a legal clerk in Pietermaritzburg, was an Edendale trustee together with Rev. Nichols, an Edendale Methodist Priest and L. Forsyth. 161

'Christian and civilized' Africans as having the capacity to adopt colonial local government'.491 It was this promise that motivated people like Msimang and Mtimkulu to participate in government-sanctioned institutions.492 These African leaders were born in the late nineteenth century and lived through the major political developments in SA, i.e. British-South African war, the formation of the Union, the effects of both world wars on SA. They witnessed the introduction and the effect of the legal and social discriminatory policies suffered by black people. The formation of national liberation organizations, like the SANNC, later the ANC, was one manifestation of black people's struggle for freedom. Another was the participation in state institutions to affect change from within and this is why some African leaders participated in the NRC or, the Advisory Boards at local level. People like Albert Xuma and Msimang did both, i,e. ANC members and participated in government-appointed institutions. In an address in 1970 at a

SAIRR meeting, Msimang expressed the sacrifice and frustration that Africans experienced when they participated in official forums. He said that 'one of my white South African friends once expressed surprise that, in spite of my experiences of condition in this country, I still was as active as before. I have never been able to answer him. But I think I have been sustained and encouraged by my humanism.’493

The aspirations and demands for self-governance and/or direct representation in Edendale was not without its historical context.

When these Edendale leaders were ignored by the Thornton Committee and the LHC was established, they immediately took action and won the first, yet short, victory. When the LHC called its first public meeting in Edendale in 1943 in order to explain its goals and elect the first AB, Msimang addressed those gathered. He pointed out that their freehold status and that property owners also 'owned'

Edendale. This conferred on them the right to represent themselves. He proposed that they petition the

491 Meintjes, Op. Cit. Note 82, p. 67 492 Op. Cit. note, 98 493 H. Selby Msimang, address delivered at the Pietermaritzburg Branch of the SAIRR, 9 June 1970 in PC 14/1/4/5/3, Alan Paton Centre, UNP 162

NPA arguing that Edendale residents were 'neither prepared nor ready to accept an advisory board system for our settlement and demanded representation on the LHC'.494 If they were not allowed their own governing body, these leaders argued, then the least the NPA could do was to allow for resident representation directly onto the LHC and not via an intermediary board, the AB. The meeting endorsed the demand and a multi-racial delegation was selected to meet with the NPA demanding direct representation on the LHC.495

At this meeting with the NPA, the Edendale delegates condemned the decision to impose the

LHC on the area and its people. They proposed that any new local authority should be led by Africans or be comprised only of residents of Edendale and that such a body should be afforded the same legislative and executive powers as regular local authorities. These demands were of course legal impossibilities at the time, especially as a small number of white people still resided in that area. Consequently, the NPA made it clear that the LHC was the only option that the government would consider and that it was the only lawful institution that could receive funding to deal with public health and other development needs of Edendale.496 According to the Administrator, the residents of Edendale would be 'taking part in spending public money although the Local Health Commission may spend it'.497 They were further encouraged to participate in the LHC structures via an Advisory Board (AB) that would be set up for that purpose. (See below). The AB would serve as 'a first step along the line of apprenticeship' and with time, the Board members will be given 'more and more of the responsibility and the work and give [them] control of [their] settlement'.498

494 Ibid. 495 PC 14/1/4/1/3, Selby Msimang File 496 Ibid. 497 Ibid. 498 Ibid. 163

As mentioned above, the victory at the public meeting was short-lived. The Edendale representatives managed to prevent the LHC's public meeting from going ahead and it secured a meeting with the NPA. In their response, the NPA did not raise a public health argument with the Edendale delegation and the main reason for this was that the latter framed their problem as a political governance one. They did not dispute the existence of a public health crisis in Edendale, as discussed in chapter three but, they disputed the solution to that crisis. They were in fact awarded indirect representation, a position which they initially opposed and ironically, yet another government official made the promise of self- governance at some future date. In the broader context of fluctuating political optimism, and with no better offer at hand, the Edendale leaders had no choice but to accept the institution of the LHC and its

AB system. As with the NRC, the Edendale residents hoped for a genuine collaboration.

Opposition to the LHC, however, did not cease after it was established. The ELA was the most vocal in its opposition and rejected the entire idea of an LHC.499 It was particularly upset because a mere five years earlier, they tried to convince the NPA that they were ready and able to lead Edendale. The

Edendale Vigilance Committee also petitioned the NPA but by the 1930s, as demonstrated in chapter three, the official narrative of an urban public health crisis had taken shape and more importantly, technical knowledge of public health was seen as the only requirement for solving the urban crisis.500 In any event, within the limits of the law, Edendale residents were only allowed to establish a village management board and, according to the UDPH public health advocates, including Thornton, such a body would not have sufficient legislative and executive powers to deal with the public health crisis.501

499 Chief Mini, already somewhat entrenched within the state bureaucracy, did not necessarily oppose the introduction of a government appointed governance institution but hoped that his office could be incorporated into the LHC structure. 500 After 1930, according to Meintjes, overcrowding and slum conditions that were unknown during the 19th century began to develop. (Op Cit. note 80) 501 Daily news, 14 June 1939 and University of Natal, Experiment at Edendale,p.26 164

The Natal Indian Association (NIA) also approached the LHC with a view of influencing its agenda regarding the Indian residents. At a meeting on 17 November 1941, the NIA did not dispute the imposition of the LHC. In fact, it proceeded from the point of view that the LHC was the legitimate authority and as a result, agreed to provide the LHC with 'their fullest co-operation' when 'dealing with health measures'.502 This offer of co-operation was based firstly, on the need to secure the future of Indian residents in Edendale and secondly, a reflection of internal politics in the Natal Indian Congress.

Regarding the position of Indians in the EDPHA, the NIA knew that, based purely on demographics, Indian residents were in the minority and while their numbers included business owners, some of the Indian residents suffered the same kind of poverty that Africans did.503 The NIA attempted to advocate for those who, 'owing to the fact that they [Indians] possessed no franchise they would look to the Commission as guardians of their people'. Mr. Pather, leader of the NIA delegation, touched on the discriminatory consequences in the "Flat Rating System", which levied the same rate 'on a palatial dwelling as on a humble shack'. The unfairness in such a system caused the NIA to propose a policy of payment for services rendered'.504 The NIA was also concerned about the impact of low wages and poverty on the housing needs of Indians. Some people were forced to leave the more established areas of

Edendale to occupy shacks in informal settlements because their low wages made it impossible to afford the rent. As a result, it enquired whether it would have the power to lend money for housing for these powers would assist 'the Indian Community as they were unable to raise money from the usual sources due to their economic instability'.505

502 LHC Minutes, 1.11.41-31.3.43, Vol. 1 503 The Bishoon brothers, for example, owned property in Edendale and a transport company that operated a bus service between Edendale and PMB city centre.See p. 148; CNC 37(A) PMB General Administration, Edendale; Advisory Board Minutes, 31 March 1958. LHC Annexure to Minutes, 1 April 1958 - 30 September 1959, Vol. 17 [1](a) 504 Ibid. 505 Ibid. These matters were brought to the attention of the LHC in 1946 by the Indian Ratepayers Association (IRA) this time. Interestingly, the IRA sent their concerns directly to the LHC who in turn presented these concerns to the EDPHA AB. The latter noted that it 'was unaware of the information … and that if it had been 165

Another reason why the NIA met with the LHC was the competing interests within organized

Indian politics, i.e. between the NIA and the NIC. The latter was established in 1894 and revived in the

1920s after years of inactivity.506 Mahatma Ghandhi was one of its founding members. Its goals included advocating on behalf of all Indians since there was no formal representation for this group. However, the

NIC predominantly fought discrimination faced by Indian traders, and specifically commercial elite, at the expense of the interests of petty traders and Natal white collar elite.507 Bhana argued that, at least before 1946 when the NIC's younger and more radical leadership sought alliances with organizations such as the ANC, the NIC emphasized "Indianness", which meant that Africans and their interests were not part of the NIC strategy. According to Bhana, Indians 'considered themselves part of an advanced civilization deserving of equality'. Consequently, their best strategy was to stress separation from other black people. During the 1930s and early 1940s, Indians felt under threat. They only became the target of segregation in the 1920s and especially the 1930s when whites in Natal complained that Indians were encroaching on white areas in spite of the rate of encroachment being negligible. By the 1940s, NIC felt under pressure to secure their position in Natal for in 1943, the government adopted the Occupation of

Land (Transvaal and Natal) Restrictions Act, also known as the Pegging Act. This story of race was however informed by commercial interests. The commercial elite would secure ownership of their property and commercial interests if they accepted some form of segregation. This tension inspired the formation of a break-away group, the NIA, in Natal.508

approached it could have given the enlightenment required or sought the assistance of a member of the Commission' to help them respond to the IRA concerns. (Minutes of the EDPHA AB, 22 January 1947 in LHC Minutes, 1.10.46- 31.12.46, Vol. [5](2a))The question arises as to why the IRA approached the LHC directly and thus, the nature of the relationship between the AB and other race groups in the EDPHA. 506 For a discussion of "Indianness" in the South African NIC, see Surendra Bhana, "Indianness Reconfigured, 1944- 1960: The Natal Indian Congress in South Africa," Comparative Studies of South Asia, Africa and the Middle East, Vol. 17, no. 2 (1997): 100-107 507 Stanley Trapido and Shula Marks, Politics of Race, Class and Nationalism in Twentieth Century South Africa. (London: Longman Group International, 1987) 508 Ibid. Trapido and Marks discusses the NIA in its national context noting that similar politics played out in the Transvaal Indian Congress (TIC) and the South African Indian Congress (SAIC). Some of the 166

Irrespective of the dynamics between the NIA and the NIC, the former's meeting with the LHC also viewed the LHC's work through a political lens. It singled out Indian interests (my emphasis) in its memorandum and noted that it was particularly vigilant regarding government actions even those who purported to deal with health issues. The NIA implied the needs of Indian residents might get lost when the LHC started dealing with the overwhelming number of Africans. The resistance to the LHC on the part of Edendale leaders and representative bodies did not result in their total rejection of the LHC.

According to the Administrator of Natal, they had after all no choice. Only the LHC was authorised to govern Edendale and to take financial responsibility for the area; however, their participation in the AB would not go unrewarded as this could, according to the NPA, eventually lead to some form of self- governance.

The EDPHA Advisory Board: "Advising" The LHC

My focus on the relationship between the LHC and its ABs was an examination of the way in which both institutions interpreted the notion of 'advising'. I used the EDPHA AB as the case study for this section for, as mentioned, it is the PHA for whom the LHC records are the most comprehensive. The questions that guided my analysis were as follows: how did the EDPHA AB implement its advisory role?

What issues did it address? What were some of the results? How was this function understood by the

LHC officials? In order to answer these questions, I reviewed and analyzed the minutes of the EDPHA

AB from 1944 - 1959. I identified the issues that the AB members raised to determine their understanding of their role as well as the effectiveness, of their interventions. The pattern that emerged from my reading

younger, more radical leadership, white collar elites and smaller traders saw their future aligned with African nationalist organizations. 167

of these minutes is that the AB’s decisions can be divided into three categories: expanding or amending the issues that were already part of the LHC program of activities; proposing new issues to be added to the LHC's program of activities; and questions asked by AB members with a view of monitoring the work of the LHC.

The LHC and the AB had their own interpretation of the latter's role within the LHC structure. At the first meeting of the newly elected EDPHA AB in August 1944, Boshoff communicated his understanding of the role of the AB 509 He commended the AB members for 'the keenness evinced by the members in the affairs of the area'.510 AB membership was, according to Boshoff, not 'so much a position of honour as it is of duty and service to the community'. In Boshoff's view, AB members were supposed to understand their 'advisory role' as one that accepts 'equality of responsibility with the Commission in the management and control of the area so that they may guide the people wisely and cautiously'. AB members were thus first and foremost seen as an extension of the LHC and not so much, representatives of the residents. In addition, Boshoff's statement conveyed the message that the AB members were to manage the expectations and demands of the residents. He said:511

It is almost a natural thing to find mal-contents under any system of local government, and the primary duty of the representatives of the people is not to exploit and magnify grievances but to labour for the improvement of their conditions.

509 Minutes of the EDPHA Advisory Board, 2 August 1944 in LHC Minutes, Vol. 3[2], 1 April 1944 - 30 September 1944. There is no reason to doubt that Boshoff's view was endorsed by the rest of the LHC officials and the two Commissioners. As some of the examples discussed in this section demonstrate, the LHC officials regularly called upon AB members to undertake certain actions or to promote LHC decisions. 510 Ibid. 511 Ibid. 168

In spite of Boshoff's efforts to impress upon the AB members his, and possibly the LHC's views, regarding the role of the AB, the Edendale leaders continued to look at their participation as a step towards self-governance and direct representation. The question of self-governance, as mentioned above, arose when the idea of an LHC was first introduced to Edendale residents. Once the AB was established, its members did not simply abandon their demands. As early as 1947 the EDPHA AB requested the LHC to implement its promise and 'hand over the control and administration’512 of the EDPHA to the residents.

These AB members were aware of the fact that the LHC was in no position to transfer the statutory powers to the AB and the LHC did not transfer control of the EDPHA to the AB. In 1947 Boshoff offered the same argument that he gave three years earlier but this time the LHC conceded and awarded the AB with limited authority. It was granted a twelve month trial period to exercise control over the EDPHA

Commonage.

Specific responsibilities included control over fencing; removal of sand; sale of grass; protection of trees; determine and collecting grazing fees; and oversee the irrigation works. According to the LHC, these tasks and the trial period would serve as a 'practical demonstration by the Commission of its intention to prepare these people for self- government at some future period'.513 In addition, it presented the LHC with an opportunity to put members of the AB to the test regarding their ability to accept and discharge responsibilities of this kind. This twelve month experiment, however, did not see the LHC cede particularly significant authority to the AB. For one, they did not take any real financial risks. Boshoff's communication to this co-Commissioners noted that the LHC would benefit from the 'propaganda value to the Commission, with little, if any, financial loss'.514 As for the tasks handed over to the LHC, these were already responsibilities of the Edendale Trust.515 A few years later, the EDPHA AB made another

512 Memo by J. Boshoff, Commissioner for the LHC, 18 June 1947, LHC Minutes, 1.4.47-30.6.47 Vol. [6](1) 513 Ibid. 514 Ibid. 515 H.Selby Msimang, "History of Edendale," PC 11/1/6 file PC 11/1/6/2; LHC Minutes, Vol. 1, 1 November 1941 - 21 March 1942 169

impassioned plea to the Minister of Native Affairs and it is worth repeating their representations, in full:516

Your thoughtful condescension to meet us, Sir, has raised in us some hope, indefinable though it may be, of the unveiling of the cloud of abject despair which has overshadowed our lives. There were times when we believed that co-operation would in the long run bring about a genuine recognition by the State of our aspirations and natural ambitions. Experience of the disposition of the State towards us has convinced even the unsophisticated of our race that the type of co- operation expected from us must amount to a surrender of our soul and accept to be ruled as mere automatons – we are expected to have no claim to natural promptings as human beings, but to be relegated to a position of perpetual political children for whom the State must think, act and do things for us in any way it pleases.

This letter is in part reminiscent of an earlier time when Africans were both optimistic and despondent.517 Msimang, who wrote the letter on behalf of the AB, noted that Africans expected that the government was committed to provide them with urban self-government. The NPA made this commitment at the inception of the LHC, a mere 10 years earlier. In fact, in 1944 when Boshoff explained the LHC's expectations of the EDPHA AB and the newly introduced AB sub-committees (see below), he said that the involvement of AB members in these committees was 'a test of [their] fitness for self- government' and that the LHC was watching 'very closely'518. Uneducated, or as Msimang said, even the

'unsophisticated' Africans were by now convinced that they would not achieve self-governance and that submission to white rule was the only option. His main evidence for these conclusions came from the fact that African participation in government-sanctioned institutions was not being rewarded. Educated

Africans and those with professional jobs who advocated on behalf of their people by participating in the

ABs and the LHC, as required and instructed [my emphasis] by the NPA, were still infantilized by the state as individuals who could not take care of themselves for Africans were 'perpetual political

516 EDPHA AB, Letter to the Minister of Native Affairs, October 1950, PC 14/1/4/3/4 517 Op. Cit. note, 494 518 Op. Cit. note 524 170

children'519. After almost 10 years of LHC governance, they were even more convinced that their demands for self-governance was slipping away for while their co-operating with the LHC demonstrated both their goodwill and their commitment to develop their own area, the sense of trust was not reciprocated.

Alongside this battle for self-governance, the AB members participated actively in the AB. They interpreted their role as advisors in at least three different ways. On the one hand, they could not avoid undertaking functions that they were asked to do by the LHC and its officials. In this regard, AB members primarily worked with the LHC officials on activities that the latter identified and wanted to implement in the EDPHA. On the other hand, AB members were also pro-active by suggesting activities that they thought the LHC should be working on and more importantly, by holding the LHC officials accountable for their actions.

AB members were often asked to undertake certain activities on behalf of the LHC. One of the most hands-on activities by the AB members was their involvement in the AB sub-committees or

Standing Committees that were introduced in 1944. The first sub-committees that were struck were:520

Finance and Administration with LHC Secretary A.R. Norman as the chairman; Public Health with LHC

MOH Dr. Landau as chairman; Public Works with LHC Engineer W.M. Chrystal as chairman; Transport with E. Holden, AB member representing white residents of EDPHA and the manager of the Tannery at

Edendale as chairman; Irrigation with AB member representing white residents of EDPHA, A.G. Hoch as chairman; and the Social and Recreation sub- committee that was chaired by H. Selby Msimang, the only

519 Ibid. 520 Op. Cit. Note 524 171

African to hold such a position. A sub-committee on water that was also constituted at this same meeting had no chairman and its members were all African AB members.

The one objective of these sub-committees was to allow AB members to gain insight into the problems that the LHC faced. They met separately on the issues that they were tasked with. The Transport sub-committee met with the Transportation Board and representatives of the Bus Owners operating in the

EDPHA regarding the LHC's regulation of transport facilities. The Irrigation sub-committee was responsible for regular inspections of the furrows on the EDPHA Commonage and was asked by the LHC to continue discussions with the Edendale Trust regarding the 'improvement and control of water furrows'521. The Trust had official control over the Commonage and the LHC required their express authority to take over this responsibility. The LHC planned to construct public toilets on plots demarcated by the LHC and Public Works sub-committee was sent to negotiate the lease amount with Mr. Allie, owner of one of these plots.522

The AB members also received requests from the Chairman or the LHC Heads of Departments.

Boshoff reported that the EDPHA Superintendent complained that residents were not paying their dog licenses and asked members of AB to 'assist in the matter and see that dog licences are taken out'.523 The

LHC decided to construct at least four public toilets, one of which was opposite the LHC offices in

Plessislaer. AB member, Mr. du Plooy, proposed an additional public toilet for the area and offered that he would 'arrange to provide a suitable site'.524 The AB members were asked by the MOH to 'assist considerably by encouraging residents to attend the Clinic for vaccinations'525. When L.S. Msimang

521 EDPHA AB Minutes, 2 August 1944, LHC Minutes, Vol. 3 (1), 1 April 1944 - 30 September 1944 522 Ibid. 523 EDPHA AB Minutes,14 June 1944, LHC Minutes, Vol. 3 (1), 1 April 1944 - 30 September 1944 524 Ibid. 525 EDPHA AB Minutes, 2 August 1944 in LHC Minutes, Vol. 3[2], 1 April 1944 - 30 September 1944 172

requested a report on the payment of bicycle licenses, the EDPHA Superintendent suggested that 'much could be done by the members of the Board using their influence with bicycle owners to take out licenses at the Commission's offices instead of from the Corporation'.526

On the basis of these activities, it is easy to conclude that the AB members were co-opted by the

LHC and that they were truly no more than an extension of the LHC. This is a conclusion that would support the criticism in the literature that ABs were not politically beneficial for urban Africans and that the members were 'puppets'. It may provide a more positive picture about the ABs regarding their developmental role, i.e. that they assisted in the improvement of these urban areas by participating in state- sanctioned political institutions. However, if AB members only worked on issues that the LHC asked the AB members to do; one can still conclude that they had a fairly limited impact, even if their contributions resulted in improvements. For this reason, it is critical to examine how the AB members sought to push the boundaries determined by LHC officials.

Individual AB members made interventions asking the LHC to amend their decisions or incorporate new issues. By their own admission, the LHC conceded that between 1942 and 1944 'the great majority' of the AB's representations were approved and 'in some instances, the Commission has had to seek added powers in order to give effect to these recommendations'.527 As examples, Boshoff, who shared this information, mentioned the establishment of a milk depot, supply of firewood and vegetables, provision of clean water and the construction of roads. In addition, Boshoff mentioned that due to the increase in health services, the LHC planned to build a Health Centre. The AB approved the establishment of the Edendale Benevolent Society in June 1994.528 This was an initiative that H. Selby

Msimang proposed and coordinated. AB member Holden, who was also the manager of the Tannery, pledged a contribution to this Society. (See above) The AB members requested on several occasions that

526 EDPHA AB Minutes, 1 November 1944 527 Op. Cit. note 524 528 EDPHA AB Minutes,14 June 1944, LHC Minutes, Vol. 3 (1), 1 April 1944 - 30 September 1944 173

the LHC find additional funding to assist people to build houses and the LHC responded positively. At the end of June of 1944 it began the process by putting in place a regulatory framework that would govern a scheme of lending money to residents to assist them in purchasing homes.529 The Finance and

Administration sub-committee convinced the LHC to amend their capital expenditure budget for the year

1 July 1944 - 31 June 1945 to allow for the construction of a Social Centre that would include a hall, committee or debating room, library, kitchen and indoor game hall.530 There are indicators that the LHC built a hall and a library. Jayshree recalled in her interview visiting the LHC Library in Plessislaer.531 The use of the public hall in Plessislaer was raised by the AB when they requested that the LHC 'define its policy with regard to the management and control of the new public hall at Plessislaer'532. They were concerned that the LHC would lease the premises for 'fixed periods as a cinema or other public entertainment'533. According to the LHC, they wanted the hall to remain available to residents for

'organized functions sponsored for social work'.534

Not all of these recommendations or requests were implemented by the LHC. J.P. Ntsiba suggested that the LHC construct queuing stations, shelters and public latrines at bus terminus.535 These were already issues that the LHC identified for action and Ntsiba's requests were noted for integration into the LHC plan. Mdhladhla requested that the LHC posts road signs near schools that are situated close to main roads. The objective was to regulate traffic and prevent 'inevitable accidents that may occur as a result of reckless driving'.536 This was noted but not implemented. The AB also encouraged the LHC to

529 LHC Memorandum, 30 June 1944, LHC Minutes, Vol. 3 (1), 1 April 1944 - 30 September 1944 530 13 September 1944 531 Op. Cit. note 463 532 EDPHA AB Minutes, 2 April 1952, LHC Minutes, Vol. 11 (1), 1 April 1952 - 30 September 1952 533 Ibid. 534 Ibid. 535 EDPHA AB Minutes,22 July 1944, LHC Minutes, Vol. 3 (1), 1 April 1944 - 30 September 1944 536 Ibid. 174

consider the creation of a Department of Social Work, separate from the Department of Health and based this recommendation on the range of issues that required attention.

They listed the following issues: child welfare, delinquency, juvenile unemployment, and illegitimacy.537 The LHC never opened a Department of Social Work and the LHC DOH continued to deal with these issues as well as supervising the Social Workers. There were also AB members who used this LHC/AB process to advance their agendas or protect their own interests. AB members Mazibuko and

Msimang proposed the establishment of a Labour Bureau of Exchange so as to register those looking for work and to provide a resource to employers. While this seems like a noble ideal, Msimang's comments in support of Mazibuko's suggestions revealed a level of conservatism. He said that such a register would also identify those residents who, in his mind, refused to work and that they could then be 'appropriately dealt with by the Commission under the law'538.

A far more important intervention by the AB members was their monitoring and advocacy role.

Some of these did not have much effect as it comprised raising questions after the fact while others were fairly significant. The LHC Secretary prepared a Draft Ordinance that included provisions affecting the

ABs, for the Provincial Law Advisor and reported this at the AB meeting.539 AB member E.O. Msimang

'stressed the point that the AB was concerned with the principle of consultation and claimed that the draft

Ordinance should have been submitted to the AB at the first available opportunity' even if the LHC

Secretary reported that he consulted the minutes of previous meetings in order to inform the Ordinance. In this instance, the LHC Secretary had already completed the task however; E.O Msimang did not let the opportunity pass to draw attention to the role of the AB, or rather, the AB members' understanding of their role. Bishoon asked for clarification about 'rumors' that the Umsunduzi river water was 'unsafe for

537 Op. Cit. Note 539 538 Op. Cit. note 545 539 Op. Cit. note 529 175

human consumption'.540 MOH Landau explained the situation regarding the polluted water and that the residents should be advised to boil their water. He added that the LHC was putting together a plan for a water purification system and that he would provide the AB with an update once this system was implemented. L.B. Msimang raised the issue that the notices for overdue rates issued by LHC Plessislaer office were delivered too close to the final payment date, which caused 'real hardship'.541 In addition, he noted that residents were not familiar with the regulations and procedures, especially those related to lodging complaints. To address this problem, L.B. Msimang suggested that the LHC appoint an investigator to assist residents with advice and with the lodging of appeals against the LHC decisions.542

Following this complaint, the LHC changed the procedures regarding late notices so that these were issued well in advance of the final due date.

Mazibuko asked for an explanation as to why the Assistant Superintendent's salary came from two different votes in the budget.543 Boshoff, as chairman, explained that the official in question conducted work for two different departments, i.e. Health and Engineering. This led Mazibuko to further enquire into the qualifications of the Building Inspector. The meeting was told that this person was 'a qualified builder' to which Mazibuko asked if 'an African equally qualified would be so appointed and on the same scale'.544 Someone in Mazibuko's position must have known that there was no equal pay for equal work at this time in South Africa and it would have been a legal impossibility for the LHC to employ an African at the same wage as a white worker. This intervention again, could not affect real change, it is an indication, I argue, of ways in which Africans pushed broader political questions onto the

LHC agenda. These kinds of interventions, in my view, can also be seen as African political leaders testing the (liberal) boundaries of the LHC.

540 Ibid. 541 Op. Cit. note 536 542 Ibid. 543 Ibid. 544 EDPHA AB Minutes, 13 September 1944, LHC Minutes, Vol. 3 (1), 1 April 1944 - 30 September 1944 176

When the LHC officials failed to circulate the financial information before an AB meeting in

1946, L.B. Msimang expressed regret at this. He added, though, that this particular oversight was part of a pattern for this kind of information had never been brought before the Board. As a result of this intervention, these documents were circulated to AB members before the next AB meeting.

During 1947, the AB condemned what they termed the 'discriminatory practices' of the PMB City health department involving medical examinations of domestic workers from EDPHA who worked in the city and requested that the LHC intervene to both stop these practices and set up alternatives. The AB

'strongly protests against the discrimination of African women in a matter of public health'.545 These women were being screened for infectious diseases, including venereal diseases, as part of their entry into the city to work. As part of their proposal, the AB was of the opinion however, that these medical examinations should form part of a 'general scheme for promotion of good health and prevention of infectious diseases'546 as opposed to singling out these women and specific diseases. They also requested that as residents of the EDPHA, a medical certificate by the MOH based in the EDPHA should be acceptable to the City of PMB and therefore that the LHC 'make strong representations'547 in that regard.

In less than a month after the AB raised this issue, Seymour attempted to clarify this issue.548

Firstly, the medical examinations were voluntarily and that the scope extended beyond testing for VD. In addition, Seymour endorsed the notion of routine medical examinations as early detection of disease was one of the best interventions to fight against diseases such as VD and TB but also non-communicable

545 Ibid. 546 Ibid. 547 Ibid. 548 Dr. Seymour's response to Minutes of the EDPHA Advisory Board, 15 July 1947. LHC Minutes, 1.4.47- 30.6.47, Vol. [6](1) 177

diseases like cancer.549 In this regard, the MOH and the AB were in agreement as both recognized the importance of prevention given that the AB's complaint specifically suggested that the PMB practice should be changed to a more generalized program of health promotion and prevention. The AB, however, considered this issue beyond the narrow confines of health by also looking at the broader political implications of demanding that African domestic workers carry health certificates. This concern expressed here resonates with the connotation of being labeled diseased in particular, a sexually transmitted disease. I discussed the implications of the label of a 'public health area'. (See above)

Edendale leaders, such as L.B. Msimang did not deny the presence of health problems however, it appears that the problem was with who framed the message and in which forums. Long before the LHC was even established, for example, this Msimang wrote a letter to the media wherein he gave notice of a public meeting to discuss the levels of crime and slum conditions in Edendale. (see Chapter Three). However, once the LHC was installed, this became a more sensitive issue for these leaders. They contested the medical examinations of the women from the EDPHA. A few months later, when the NPA wanted to build a temporary hospital in the Edendale area, this same L.B. Msimang, 'questioned the reasons for opening a temporary hospital … in view of the contention that Edendale was infested with syphilis and other infectious diseases'.550 When he complained about the 'slum conditions' during the 1930s, he was able to identify external conditions that could easily be blamed on the illegal tenants [my emphasis] and presumably, the lack of government intervention especially as this was prior to the introduction of the

LHC. However, he took issue with the connotation that resulted from the construction of a temporary hospital and the notion that all of Edendale was 'infested' with disease and not any disease but specifically a venereal disease.

549 Ibid. 550 Minutes of the EDPHA Advisory Board, 1 November 1944, LHC Minutes, Vol. 3(1), 1.4.44-30.9.44 178

In June 1947 Selby Msimang, by now Secretary of the Advisory Board, wrote a detailed letter to the LHC complaining that the AB members felt that their recommendations were being ignored by the

LHC. Selby Msimang wrote that 'the Board expressed much concern over the amount of its recommendation which appear not to have been given consideration by the Commission'.551 This letter listed four issues on which the AB made concrete recommendations a few months ago but, to which the

LHC was yet to respond. One of the issues raised involved the Café De-Move-On. According to

Msimang, the AB meeting of 20 November 1946 recommended that the LHC inform the owner of the café should shut down because it occupied the premises illegally.

The LHC agreed with the AB recommendation for it confirmed in March 1947 that an eviction notice was issued to the owner of the café, George Naidoo. However, Msimang complained, in June

1947, the café was still operating. The delay in LHC action is particularly puzzling because its own records indicate that as early as 1943; the LHC identified a number of problems with this café.’552 Firstly, the Rural Licensing Board issued and continued to renew the licence of this establishment without consulting the LHC. The EDPHA Superintendent and the MOH concurred at the time that the conditions under which the café operated was 'very unsatisfactory'553. Secondly, the café operated from a caravan that was parked on a gravel area at the bus terminus and was constantly covered in a cloud of dust.

Further, bus and taxi drivers as well as passengers were 'always hanging around the caravan and were seen lying stretched out, boots and all on top of the counter from which food is served'554. Finally, and to the horror of the MOH, tea and coffee cups 'often serve as shaving mugs and water for washing eating utensils'555 was drawn from a stream. According to Msimang and his fellow AB members then, their

551 LHC Minutes, 1.4.47-30.6.47, Vol. [6](1) 552 LHC Minutes, 3 March 1943, Vol. 1, 1 November 1941-31 March 1943 553 Ibid. 554 Ibid. 555 Ibid. 179

intervention in 1946 requesting that the Café De-Move-On be closed came long after the LHC identified health concerns and yet almost one year after their initial request, the café was still operating.

The crux of the EDPHA AB's complaint and allegations was that it was being ignored in the governance process for either their recommendations were not being attended to or, they were not being informed of the process by which their complaints and recommendations were being addressed. For

Msimang, who also served on the NRC, there was little distinction between the way in which national government departments treated the NRC and how the LHC related to the EDPHA AB. The AB members, much like those on the NRC felt ignored or that their advice was being dismissed.

In 1957 the AB addressed the loss of occupational rights of widows in the Ashdown area. The crux of the matter was the demand for housing and the cultural mourning period required for widows.

According to the LHC, 'there would be no justification for [a widow without dependents] to remain a permit-holder and thus herself occupy a house intended for a family'.556567 Ashdown was bought as part of the LHC's plan to re-accommodate residents from all areas of Edendale so as to phase out 'temporary dwellings' and slum housing. The need for housing families trumped a situation where an individual occupied a dwelling suitable for housing a family. The intention, argued Donaldson, was not to evict widows but to meet the housing needs. Widows in these situations were given a lodger's licence and provided with a room in a house.

The AB and the LHC took different positions on this issue. According to the former, Native

Customs demanded that the widow remain in the house she shared with her deceased husband for one

556 Memo: Loss of Occupational Rights by Widows: Ashdown Native Location', LHC Secretary, 3 February 1958, LHC Annexures to Minutes 1 January 1958-31 March 1958, Vol16[2](b) 180

year after this death. The LHC argued that this prevented the effective implementation of its housing policy, especially if it was prevented from rehousing the widow. It further argued that its position was not restricted to Africans. The AB definitely did not succeed in convincing the LHC to change its mind.

At work was not only the health and welfare concern of the LHB but also its imposition of an approach to customs that was far-reaching. During the course of this dispute, the EDPHA Superintendent was disparaging about EDPHA residents' claiming rights to cultural practices. It is useful to quote him at length: 557

It has been the experience of the Location Superintendent that Native Law and Custom relating to the observance of the period of mourning is not rigidly observed in Ashdown. Native law is flouted and the majority of the inhabitants of the Location have become de- tribalised Bantu. The Location must have regulations for its control and management and their very design precludes the rigid practice of Native

Laws and Customs. If any of the residents wish to adhere to the strict tribal control and to the code of conduct and discipline laid down by such tribal control, then I feel that they should not be accommodated in Ashdown but seek a kraal in the Native Reserves.

The LHC Secretary supported the Ashdown Superintendent's rejection of the AB's argument in favour of African customs. While he, Donaldson, tried to include additional factors such as demand for housing, alternative accommodation for widows, and the fact that LHC housing policy did not require any amendments; it is clear that the older distinction between the urban, civilized and detribalized African as opposed to the rural, tribal African re-emerged after 1948 to the extent that it permeated the LHC.

Perhaps this notion never became dormant however; I found no evidence of this language in the earlier

557 Ibid. 181

records of the LHC. What did appear was when the EDPHA AB questioned the LHC's use of the term

'Bantu' as opposed to 'African'; it argued that the LHC was merely employing the language of the national government and therefore, for purposes of consistency.

In 1958 Mr. Gcabashe challenged the LHC's relaxation of its housing policy. As mentioned above, while clearing up slum conditions included the prohibition of new wattle-and-daub buildings, the

LHC was forced to allow people to use this material when replacing existing, condemned ones. Gbabashe

‘questioned the wisdom of supporting and encouraging' the construction of wattle-and-daub buildings which he considered was a 'retrograde step’.558 It should be noted that these dwellings were LHC- approved building materials and houses. For the secretary then pointed out that ‘the LHC had never accepted as a principle the erection of inferior-type structures, but urged that until adequate provision were made to facilitate the obtainment by the inhabitants of building materials or building loans no restrictions on the erection of inferior-type buildings should be imposed’.

These examples are not conclusive and certainly require closer examination especially if one were to assess the effectiveness of the ABs. They are, however, illustrative of how AB members advocated from within the system on issues that fell within the mandate of the LHC and on issues that may have been outside of the scope of the LHC but were a concern for the AB members and residents of the EDPHA. In addition, the AB focused equally on issues that the LHC asked them to do and exercising a monitoring function of LHC decisions or conduct. The focus was predominantly on municipal issues.

There is very little mention of broader political issues in the minutes of the EDPHA AB. Except for the demand of self-governance, the situation with the EDPHA AB was unlike the New Brighton AB where

Gary Baines found that local political leaders used that system as a forum to promote their broader

558 Edendale 24Feb58 p1 IN LHC Annexs to Minutes 1.1.58-31.3.58, Vol16[2](b) 182

political goals. A number of AB representatives also became 'major political brokers' in New Brighton and as 'long-serving' NBAB members, they were 'men respected by their own people who had rendered very valuable service to the community'.559 Elected members, who were also communist Party supporters made political speeches at Board meetings and used the Board to convene public meetings only to address broader political questions. Baines' time period included only four years into the apartheid era and therefore we do not know whether the New Brighton political activists were able to continue this practice.

What this demonstrates, though, is that the EDPHA Advisory Board members, like those in New

Brighton, were able to use a state-appointed governance system with limited scope and no legislative authority to advance their own demands, which pertained to broad political issues in New Brighton and local, developmental issues, in the EDPHA. The residents of the latter were able to use their Advisory

Board well into the 1950s.

The LHC structured itself in such a way that its internal administration was its main resource and the PHAs the sites where it conducted its work. The above discussion on the ABs demonstrates that the

LHC conceived of the EDPHA AB to further its own goals. The AB members were tasked with responsibilities aimed at implementing the LHC's functions or, managing the expectations of the residents. In some instances, however, these AB members pushed back and held the LHC accountable or forced it to incorporate new issues that the AB itself or residents prioritised. Some of the AB members were not merely men of straw or 'puppets', as the literature suggests. F. J. Mazibuko, L.B. Msimang and

E.O. Msimang were vocal and persistent critics of the LHC while members of the EDPHA AB. In 1946,

Mazibuko became deputy Chairman of the AB indicating that these men did not give up on the LHC.

George Mtimkulu worked within the AB and from the outside to push the LHC into directions he thought

559 Op. Cit. note 93, p.85 183

it needed to go.560 Mtimkulu alleged that the LHC had 'singled itself out to oppose trading licenses at

Edendale'.561 Again in 1952, Mtimkulu angered the AB members when he communicated directly with the Engineer regarding electrification problems in the EDPHA, instead of channeling his complaints via the AB, as the latter expected. Another respected leaders in Edendale was Selby Msimang. He was active in resistance organizations such as the ANC. Selby Msimang was also one of the Edendale leaders who initially opposed to the introduction of the LHC, but once the latter was established, he became an AB member. In 1944 he produced a document wherein he explored the notion of 'industrial democracy' could

'save' the people of Edendale.562

These leaders did, however, participate actively in the LHC structures in order to assist in the development of the EDPHA. In spite of this collective pool of African leadership and resources, the LHC was still constrained by the political and legal environment in which it worked.

Negotiating Apartheid

The Thornton Committee confirmed that urbanization placed service-delivery demands on urban local authorities. What it could not predict was the rapid urbanization during and after World War Two.

Increasingly, people evaded the influx control measures as much as municipalities elected not to enforce these regulations.563 The erosion of pre-1948 racial boundaries, especially in the urban areas, became a lightning rod for apartheid ideology, which in turn shaped urban apartheid measures. This presented the

LHC with a new set of challenges.

560 EDPHA AB Minutes, 1 November 1944, LHC Minutes 561 Ibid. 562 DC2811, 1944 563 William Beinart, Twentieth Century South Africa. 184

Between 1948 and 1959 the NP government transformed the legislative framework by adopting about twenty new laws and amending existing ones in order to implement and give expression to their apartheid ideology. (Table 12) One of the first measures adopted addressed the question of racial purity.

The Prohibition of Mixed Marriages Act and the 1927 Immorality Amendment Act, as amended, banned inter- racial sexual relationships. This was followed in 1950 by the Population Registration Act resulting in the classification of the population into four main categories, i.e. white, coloured, Indian and African.

While the racial classification of the population facilitated the implementation of the laws prohibiting inter-racial relationship, it became one of the central building blocks of Grand Apartheid.564 Further consolidation of apartheid included a range of laws aimed at exercising deliberate and stringent control over social relations and activities: Suppression of Communism Act (1950); the Native Building Workers

Act (1951); Public Safety and the Bantu Education Acts (1953); and in 1956 the Riotous Assemblies Act; the Industrial Conciliation Act; and the Natives (Prohibition of Interdicts) Act.

564 Op. Cit. note 94 185

Table 8: Apartheid legislation with an urban impact565

Date Law 1950 No.21, Immorality Amendment Act No. 30, Population Registration Act No. 41, Group Areas Act 1951 No. 46, Separate Representation of Voters Act No. 68, Bantu Authorities Act Suppression of Communism Amendment Act Prevention of Illegal Squatting Act 1952 Native Services Levy Act Native Urban Areas Amendment Act No. 54, Native Laws Amendment Act No. 67, Native Abolition of Passes & Coordination of Documents Act 1953 No. 49, Reservation of Separate Amenities Act 1954 Natives Resettlement Act Native Urban Areas Consolidation Act 1955 Group Areas Development Act Native Urban Areas Amendment Act 1956 Separate Representation of Voters Amendment Act Native Urban Areas Amendment Act No. 42, Native Administration Amendment Act 1957 No. 77, Native Urban Areas Amendment Act

Another critical component of Grand Apartheid was the administration of black people. This involved a more concerted effort at the demarcation and occupation of the urban and rural landscape and controlling the lives and movements of people. The main goal was to bring into fruition the idea of separation of the race groups. As a result the Bantu Investment Corporation and the Promotion of Bantu

Self-government Acts, both in 1959, began to lay the ground work for independent African states comprising different South African ethnic groups within the boundaries of SA. Some of the apartheid laws affected the operation of the LHC in a number of ways, in negative but also unexpectedly, positive ways.

565 http://www.nelsonmandela.org/omalley/index.php/site/q/03lv01538/04lv01828/05lv01829/06lv01985.htm. 186

The LHC's survival during the consolidation of apartheid is one of the first developments worth noting. In contrast to the social medicine experiment and the NHSC recommendations, the LHC continued to expand its number of PHAs and range of services it provided in those areas. It had been in existence for less than a decade when the NP came to power in 1948 but was well on its way to extending its control over the urban areas of Natal. As the NP government began to 'starve the Health Centres to death'566, the NPA and the PMB Municipality encouraged and at times facilitated, the expansion of the

LHC's authority to include more peri-urban as well as rural areas. In 1949 the PMB Borough suggested to the NPA that it should allow the LHC to develop along the lines of the PUAHB in the TVL. The NPA was already benefitting from the work of the LHC and would stand to gain more if the latter moved into governing rural areas. An exponential expansion of the LHC could increase the number of people receiving health and welfare services and therefore increase the opportunity for disease prevention. As for the motivations of the PMB Borough, the LHC had already taken over most of the areas within its 'black belt' even if only by incorporating those areas and thus, relieving the Borough of a decision that would put those areas under its control.

The LHC was not averse to these proposals. Its expansionist aspirations were evident from the very beginning for as soon as it took control of Edendale and Clermont, it began to expand. By 1946, it organized itself along three regions. In September 1951 the LHC gave its Secretary, Donaldson, permission to visit municipalities in the TVL and Cape Provinces to determine which model would suit further LHC expansion. The LHC officials were particularly impressed with the work and organization structure of the Cape Divisional Councils. The latter operated in both urban and rural areas and was credited by the Thornton Committee as one of the main reasons why the urban public health crises in the

Cape was not as bad as in Natal or the TVL. Donaldson visited the Cape and Port Elizabeth Divisional

566 De Beer, op. cit. note. 187

councils as well as the Cape Town Municipality.567 It is more than likely that national government decisions for black urban areas and rural reserves overtook any plans for the LHC that were being contemplated by its officials. As noted above, 1951 saw the introduction of the Separation of Voters' Act, further entrenching the second-class status of black people with regard to civil and political rights. In addition, the Bantu Authorities Act of that same year, provided for the establishment of local authorities for black areas. In addition, the government introduced further restrictions on urban Africans and governance of black urban areas with the amendments to the Native Administration Act, 1956, and the

Native Urban Areas Act, 1956 and 1957.

During the first decade of apartheid, however, the LHC found that there were aspects of the urban apartheid laws that could assist it in implementing its mandate. Some of the provisions of the GAA were used to establish new PHAs or expand existing ones. According to the GAA enacted in 1950, certain areas were set aside for specific race groups and consequently, the LHC had to make an application to gain access to white owned land in order to provide services to areas occupied by Africans on adjacent properties. The 1952 amendment of the GAA, however provided Local Authorities, including the LHC, automatic access to properties for purposes of service delivery thus eliminating an onerous administrative procedure.568 In a memo of 30 April 1952 the LHC noted that these specific (GAA) measures would constitute a 'net benefit' for the LHC as it would save them time. 569 The problem of access was one that the LHC faced early on largely because some of the 'black spots' that it incorporated were situated

567 The Cape Divisional Council and its 'local areas' operated in a similar way as the LHC. 568 LHC, Annexures to Minutes, 1 April 1952-31 March 1953, Vol. 11 569 Ibid. 188

amongst white-owned land and in order to gain access or provide services to those PHAs, it required permission to use white-owned land.570

In addition to such obvious [my emphasis] advantages inherent in the GAA provisions, the LHC also challenged the operation of some of those provisions. In June 1954, Col. W.F. Short, Acting

Commissioner, participated in public hearings organized by the Land Tenure Advisory Board.571 Short suggested that the land relocation process should not only award ownership in alternative land to those who were moved from land that they owned but that all Africans should be afforded freehold title once they were moved.572 This was a bold proposal on behalf of the LHC. Short's proposal demonstrated the

LHC's commitment to its public health agenda. The success of disease prevention related to housing and sanitation, depended upon the availability of land. Short's proposal was also contrary to the ideas about

Africans and urban settlement among Afrikaner ideologues before 1948 and during the early years of NP rule.573

According to Evans, the Sauer report 'provided an early clue’574 of Apartheid policy of the 1950s.

The LHC officials however, who were committed to and had worked in those urban areas for more than a decade knew what kind of institutional mechanisms would ensure an effective and sustainable urban policy that emphasized public health goals.

570 Dr. Landau, MOH, and Mr. King, LHC Chief Superintendent, Re: The Circumstances which would lead to a recommendation that an existing peri-urban area to be incorporated into an adjacent urban authority area, 1 July 1944 in LHC Minutes, 1 April 1944-30 September 1944, Vol. [3](1) 571 MOH Memo: Group Aras Act: Public Hearing of Evidence by the Land Tenure Advisory Board', 5 June 1954, LHC Minutes, 1 April 1954 - 30 June 1954, Vol. 13 [1](a) 572 Ibid. 573 Nigel Worden, The Making of Modern South Africa: Conquest, Apartheid, and Democracy. 2nd Ed., (Malden, Mass.: Blackwell, 1995); Ivan Evans, Bureaucracy and Race. (Berkeley: University of California Press, 1997) 574 Ibid., Evans, Bureaucracy and Race, p. 61 189

Regarding the EDPHA Industrial zone, Short questioned the Land Tenure Advisory Board's plans and instead recommended an expansion of the industrial area and that it should be 'unzoned'.575 He based this recommendation on the LHC's position of 'taking your industries to your labour and not the other way about' and given the 'large Native labour force in the Edendale area'.576 His proposals regarding the industrial development, however, demonstrate the limitations of his, and the LHC's radicalism. [my emphasis] The principle of taking industry to the workforce appears to be advocating on behalf of the residents of the EDPHA however, it was very much in line with government policy at the time, and he recognized this when he said that such a decision would meet with 'Governmental policy of creating a buffer between racial groups'.577

While the LHC found that some of the provisions of the GAA useful, others proved to be more problematic than beneficial. The PRA had an immediate effect of transforming the LHC reporting systems, including the racial classification of individuals in all its reports and documents. The introduction of race-based reporting is evident in the Engineer's reports, concerning building plan applications.578 Prior to 1948, these reports provided personal details of the applicant and descriptive details of the building in question: name of applicant, description of property, type of building, number of rooms, type of construction and estimated cost. From 1950 onwards, these reports included an additional item and that was the applicant's race. (Table 13) The inclusion of the race of the applicant demonstrated at once compliance with the law but also drew the LHC into its surveillance system when records were used to monitor the racial composition of different areas.579

575 Ibid. 576 Ibid. 577 Ibid. 578 Engineer's Report, 22 November 1950, LHC Minutes, 1.10.50-31.12.50, Vol. 9[2](a) 579 Deborah Posel, "What's in a name? Racial categorisations under apartheid and their afterlife," at http://www.ascleiden.nl/pdf/paper20032003.pdf (2 December 2014) 190

Table 9: Race in LHC Building Regulations, c.1950580

Plan No. Applicant Race Description of Type No. of Type of Est. cost

property rooms construction581 164/50 W. Msimang N Sub 2 Blk M B4 2 B Brick £350

174/50 Sutherland A SubGeorgetown 1 of C of 26 School 3 " £2100

106/50 duG.A Plooy School Ltc E RemPlessislaer A of 23 of Factory - " £900

27-28 188/50 L. Mahomed A Sub 1 of M Add. 1 " £450 Plessislaer Georgetown

In addition, the PRA and the GAA became the official authority regarding the occupation and ownership of land. Those laws replaced the regulations applied by the LHC and in general, affected the way in which the LHC could fulfill its mandate. Prior to 1948 the main focus of the LHC regarding housing was to ensure that there was no overcrowding, to work towards the elimination of informal-type housing or shacks, and to aim to provide residents waiting for a house, with suitable accommodation.

Race only became a determining factor for the LHC in places, like the EDPHA, where land was set aside specifically for African ownership. After 1948, the LHC's procedures now incorporated national government forms and regulations. In September 195i the Native Commissioner for Pietermaritzburg sought the LHC's views in response to a Mr. Kothe's request to transfer a piece of land in the Edendale area.582 The Edendale Area Secretary replied to the Commissioner stating that the land was indeed vacant and that it was situated in 'an area where the owners are predominantly Africans'. He advised the

Commissioner not to approve the sale and transfer of the land to Kothe. Even though Kothe argued that

580 Ibid. 581 In the report for Clermont for November 1950, the types of houses listed were wattle and daub but the rest of the information, including race, remained the same. 582 Local Health Commission Minutes, 30 September 1951, Vol. 10 (1) [b], 1 July 1951 to 30 September 1951 191

he wanted the land to house his employees, the LHC was not persuaded by this argument because the land was situated within a released area where new white and Indian ownership was prohibited. He stated that there 'would appear to be no good reason why this policy should be changed in the present circumstances'.

This decision was taken in terms of the existing law but it also demonstrates the LHC's commitment to the protection of the rights and interests of Africans for the Secretary continued by stating that the LHC would not oppose the transfer of land from Africans to other races if Africans would benefit from that transfer, for example, commercial enterprise that could create employment. In Kothe's case, the EDPHA

Secretary found that there would be no direct gain for 'Africans as a whole'. This case, however, raises the question about the balance of interest. Why did the EDPHA Secretary afford more weight to the interests of the Edendale community than the need to house workers, also Africans? It seems that the determining factor was that the land would end in white ownership, which trumped the LHC's commitment to housing those in need of accommodation. In Joseph Pratt's case, the LHC was happy to transfer land from 'a

Coloured man', Pratt, to M.H. Moosa, 'registered Indian'. In line with the provisions of the GAA. Pratt's application to the LHC included a completed application form (below), a description of the property

(including boundaries and appropriate local authority) and the owner's reasons for selling the property

Pratt wrote to the LHC seeking permission to sell his house to Moosa as, he said, he was getting older and physically unable to maintain the properties in Edendale. Moosa, already resident in Edendale, had presented Pratt with a 'firm offer'583. The National Department of Planning however, overruled the LHC and used the GAA to prevent the sale.

583 Local Health Commission, Vol. 10 (1) [b], 1 July 1951 to 30 September 1951 192

Image 5: Impact of Group Areas Act on Property Development and Occupation, Edendale

193

The LHC enjoyed successes but were also challenged both by the residents and by the national government's urban apartheid measures. In the first part of this chapter I tried to demonstrate that at least up to 1959, the LHC actively engaged with the residents of the PHAs. In addition, it faced serious challenges from the national government's racial policies especially after 1948. The successful implementation of segregation depended heavily on local authorities and the LHC's efforts to meet public health needs on the ground were not always in line with the goals of segregation. At other times, however, the LHC used those measures to advance their own agenda. Both these perspectives, seemingly in opposition, confirm the historiography regarding the fact that there was no clear blue print for apartheid.

These perspectives also confirm the liberal narrative, especially purported by David Welch, that white liberals, with and without the support of an official political party, sought to intervene on behalf of

Africans and protect them from the full force of racism. In the same way that Thornton and the UDPH spoke for urban black people regarding the way forward for black urban areas, the LHC continued to speak for and on behalf of some black people in a frequently paternalistic way that alienated many.

Conclusion

While the LHC made a positive contribution to the development of the EDPHA, there were also times when it faced obstacles. The lasting memorials honoring some of the LHC commissioners are some indication of how some of the resident of the EPHA valued these officials and the work of the LHC. In this chapter I examined some of the political implications of the LHC's work as well as its role as the local authority. I demonstrated that at an institutional level, the LHC both frustrated and postponed the demands of Africans for self-government. A number of residents and leadership organizations tried to intervene so as to make sure that they were not replaced by the LHC. Their efforts were in vain in 1940 but they never gave up on their demands. Ordinary residents also engaged the LHC by pushing their own demands onto the LHC agenda. The right to occupy a shack was a significant victory for residents who

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contested the LHC’s decisions. In this chapter I also tried to illustrate how public health bureaucrats, faced with the barrage of urban apartheid measures tried to work with and against those regulations. The implementation of the apartheid laws were a lot more complicated and as Posel and others have argued, its ideologues were forced to adapt their ideas with time. The work of the Advisory Boards was particularly interesting for their developmental role is one that certainly requires further research.

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Chapter 6: Conclusion

Effective environmental services are crucial to ensure the prevention of unhygienic conditions, the promotion of optimum health, protection of the environment, and sustainable industry.584 According to Mäki , the lack of personal and environmental health services are such pressing and immediate needs that do not often inspire historical research. However, health and especially environmental health services including sanitation services 'in a historical context can provide new ideas for dealing with contemporary problems caused by increasing demands due to rising expectations of living standards and growing populations'.585 The few case studies by Phillips, Maynard, Jeeves and Parnell discussed in chapters one and two, attest to this. In addition, there are very few contributions in the history of medicine and public health that focus on the role of local authorities, or connecting the role of local authorities to disease prevention and/or maintenance of optimum health status of urban residents. My research on the LHC is a contribution to this body of literature.

Chapter Two is a survey of the literature focusing primarily on issues of public health and the administration of black urban areas. The former is not a new topic in the history of medicine and it is evident from the literature that there are multiple approaches to and practices of public health.

Conversely, there is very little research regarding local governments as public health institutions. The dominant framework adopted by historians including historical geographers, is a political governance approach. Studies on SOWETO, Alexandra, New Brighton, Langa and Ndabeni, for example, discuss the political origins of these townships; the governance structures prescribed before and during apartheid, i.e. the ABs. A theme that runs through these studies is the failure of these governance structures. This history is primarily critical of the way in which the governments of the day administered the black urban areas.

584 Mäki, Water, Sanitation and Health, Op. Cit. note 76, p.2 585 Ibid. 196

Historical research that brought the public health functions and local government institutions into one analytical frame are the contributions by Howard Phillips (Bloemfontein), Susan Parnell (Johannesburg),

Hari Mäki (Cape Town, Durban, Grahamstown and Pretoria) and Julie Dyer (Pietermaritzburg) brought the two research focus areas into one analytical frame. These authors examined some of the institutional mechanisms adopted by local authorities in order to deal with the health and welfare issues of the urban poor and black people within as well as on their boundaries. My examination of the LHC was influenced by these authors and as a result, I looked at the functions and institutional arrangements of the LHC as a form of local government. An analysis of this nature does not ignore the political nature of health and welfare but rather, it aims to move beyond the partisan approach to these issues. Further, the case studies that adopted this approach did not ignore the impact of race or racial discrimination on health services but focused on the function of the bureaucrats and officials at different levels of government who influenced health policy in relation to Africans. It is this emerging historiography that influenced my approach to the

LHC and one which I aimed to expand.

The role of the public health officials of the UDPH in framing the urban crises is the subject of

Chapter Three. I looked at how their professional backgrounds influenced their commitment to a specific approach to public health, i.e. one that attributed equal importance to personal and environmental health aspects and an approach that aimed to prioritize prevention of disease above racial politics for as long as they could. An important development was the UDPH-appointed Thornton Committee whose report served as the blue print for the LHC in Natal and the PUAHB in the TVL. I further argued that the push for change in the organization of health care did not only come from within the UDPH but also among physicians in private practice. The context within which these ideas and programmes concerning public health emerged during the latter part of the 1930s was a manifestation of liberal values attributed by

Dubow and Jeeves to the 1940s only. To the contrary, the 'liberal interregnum', I argued, commenced as early as 1938. The UDPH launched its nutrition survey during that year and the Thornton Committee also

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began its work in 1938. The Karks, who went on to establish the social medicine experiment in 1940, participated in the nutrition survey and Thornton Committee's recommendations were implemented in

1939 and 1940 when the LHC and the PUAHB were established. This context, the kind of work of the

UDPH and the public health biases of the UDPH officials combined led me to conclude that the LHC had its roots in white liberal health activism.

Chapter Four is a description of the LHC, its administrative departments, senior staff members and its work in the PHAs. Its health department, with the MOH at its head, was probably the most powerful department in the LHC as many of the decisions of the LHC were based on recommendations by the MOH. Even some of the responsibilities of the Engineering department were informed by the

MOH's decisions. This was at least the case up to 1959, the end of my time period, and is, in my opinion, an clear indication of the centrality of public health in the LHC.

In Chapter Five I discussed some of the political implications that faced the LHC and more importantly, the leaders of Edendale. In this chapter I relied primarily on the work of the LHC in the

EDPHA. While the LHC was established as a special form of local government for black urban areas and organized groups as well as individual residents agreed with the need for governance and, health and welfare services; the LHC continuously faced push-back from residents. Firstly, individually or collectively, residents in the PHAs either challenged the LHC decisions or demanded that it attend to their own issues instead of focusing only on their predetermined plans. Secondly, while the political leadership in the EDPHA came to accept the public health mandate of the LHC, they did not abandon their demands for self-governance and direct representation. The EDPHA AB also made an effort to hold the LHC accountable for their actions in spite of the fact that the LHC and the AB had different interpretations of the latter's role. A third and final issue in Chapter Five was the challenges faced by the LHC once the NP

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government began its consolidation of apartheid, especially the urban apartheid measures. Before 1960, the LHC made selective use of the apartheid regulations.

During the course of planning and writing this dissertation I identified a number of issues and research questions that I did not include. A detailed assessment of the work of the LHC in the PHAs, at least the two largest ones, is an area that should be undertaken. This should include a comparison of the different governance institutions of black urban areas across the country as this will provide a more accurate picture of the impact of the LHC. My institutional history that explains the nature of the LHC and explained the range of services it provided, is a useful foundation for an enquiry into the development role of the LHC compared to the work of the PUAHB and those of white municipalities in the black urban areas. This dissertation did not include a gender analysis of the LHC. As stated in Chapter One, this is a topic included in the historiography, a closer evaluation of the work of the LHC should include a gender analysis of its work and the responses to the LHC by the PHA residents.

Two further issues that I omitted as a result of my time line is the changes in the LHC under

Grand Apartheid and comparing this with its earlier years. Related to this is the long-term impact of the

LHC and its legacy, as well as a more comprehensive oral history that focuses on the LHC more specifically and can include those officials or staff members who worked for the LHC. The second issue relates to the role of the EDPHA AB between 1960 and 1974, especially as violent opposition to apartheid intensified.

There are a number of additional but equally important questions that arose during the course of my research on the LHC as an institution. What are the implications of constituting a local government based on Public Health legislation and with a public health mandate? How can such an institution be

199

structured and more importantly, how would it avoid depoliticizing health and welfare? This last question is especially important as it takes into account Diane Wylie's criticism of the technocratic approach and professional arrogance that, in her opinion, permeated the work on public health officials during the

1930s and 1940s.586 In addition, such a question will have to address James Ferguson's thesis about the unintended consequences of development.587 The UDPH officials and those in the LHC were not oblivious to economic conditions that contributed to the deteriorating health and welfare conditions in

Natal. The LHC was also acutely aware of the racial politics that dominated the South African social landscape. In 1943, three years after it came into existence and two years after it took control of Edendale, its officials acknowledged that the problem of Edendale was largely an economic one. Thornton himself had to work around the existing laws regarding governance when his committee recommended the establishment of the LHC. This meant that the LHC owed its very existence to the racially-based laws that not only deprived black people from urban self-governance or representation on existing local authorities but, the lack of political and economic rights stripped black people from asserting any political authority over any governance institution. The finer questions of race and the LHC can only emerge with oral interviews of both LHC officials and residents and with an investigation into the LHC up to 1974.

The experience of the people who lived in the PHAs and their perceptions of the LHC is another important research area. The residents had first-hand experience of the LHC and some of their voices may well be absent from the historical record. The Sinomlando Oral History Project began this work with their oral history of Edendale. Some of the interviewees referred to the LHC but because Sinomlando's primary focus was not the LHC, this is still an unexplored question.

The significance of this doctoral research lies in the uniqueness of the LHC. These additional research questions and themes can both enhance the historiography of public health and local governance

586 Op. Cit. Note 13 587 Op. Cit. Note 15 200

and pose new questions regarding post-1994 service delivery to residents, government officials and civil servants.

I began this dissertation and the research project by observing the ways in which personal and environmental health services were turned into party-politics as opposed to non-partisan political issues.

While I did not specifically address these post-1994 service delivery problems, the questions related to institutional capacity and expertise; institutional arrangements; and perhaps more importantly, the public health foundation of local governance, are themes that, were evident in 2010.

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