Healing Traditions: African Medicine, Cultural Exchange, and Competition in South Africa, 1820-1948.

Clark, Patricia G.

Healing Traditions: African Medicine, Cultural Exchange, and Competition in South Africa, 1820-1948, by Karen E. Flint. New African Histories series. Athens, Ohio, Ohio University Press, co-published with University of KwaZulu-Natal Press, 2008. xiv, 274 pp. $55.00 US (cloth), $26.95 US (paper).

Since the appearance of Eric Hobsbawm and Terence Ranger's The Invention of Tradition in the 1980s, historians have investigated cultural customs and rituals as historically constructed practices. In particular, historians of Africa analyze the concept of tradition as used by Europeans to justify colonial rule. Here, Karen E. Flint examines the idea of "tradition" in medicine as practiced in Zululand and Natal, South Africa, in the nineteenth and early twentieth centuries. Using the lenses of cultural interaction and competition, Flint outlines the historical nature of African therapeutics, or what is now termed "traditional" African medicine.

According to Flint, cultural exchange and interaction shaped African therapeutics. In the 1800s, this exchange took place between Africans in the Zulu kingdom and white traders and missionaries, as well as among other African ethnic groups. The first two chapters of the book examine healing practices in the Zulu kingdom during its heyday from 1820-1879. As the Zulu kingdom rose, Zulu-speaking inyangas (herbalists) and isangomas (diviners) encountered new diseases brought by colonialism, as well as new methods of healing. African therapeutic practices included not only pharmacological approaches (some similar to allopathic Western medical practices), but also appeals to ancestors and the "smelling out" of witches. Inyangas and isangomas healed not only the individual body, but also the body politic. In the Zulu kingdom, healers helped maintain the health of the king and thereby the kingdom.

The third chapter focuses on changes in white reactions to indigenous healers and concepts of healing in the nineteenth century. In the early 1800s cultural exchange between Africans and Europeans was evident. Some whites in Natal such as settler Henry Francis Fynn utilized African muthi (medicine) in combination with European remedies to heal Africans and whites alike. By the mid-1800s, however, African healers were perceived as competition to missionaries and destabilizing to white rule. In the 1860s, colonial legislation criminalized African healers and rainmakers, forbidding them to employ their expertise. Even so, in 1891 the legislature made the decision (unique in South Africa) to grant official recognition through licensure to African midwives and herbalists, but not diviners. This acknowledgment of African healers whose practices more closely approximated those of Western medical practitioners demonstrated the government's admission of the need to provide health care to Africans, as well as its desire to maintain nominal control over medical provision in the colony.

By the early to mid-1900s, healing the body politic was no longer possible. South Africa was increasingly urbanized, Africans were crowded into "native reserves," and migrant labor spread disease across local and regional boundaries. In this environment, competition became crucial in shaping African medicine.

In an intriguing chapter entitled "Competition, Race and Professionalization: African Healers and White Medical Practitioners, 1891-1948," Flint delineates the contested nature of the relationship between African and white medical practitioners in the first half of the twentieth century. The South African Medical, Dental, and Pharmacy Act, passed in 1928, limited medical practice to practitioners recognized by the South African Medical Association, effectively undermining African health care workers. In response, African healers set up their own professional associations, the African Native Doctors' Association in 1928 and the Natal Native Medical Association in 1931. Although these organizations sought to confer legitimacy on African healers, they were not officially recognized by the government. Nonetheless, by professionalizing and claiming authority over a body of expert knowledge, these healers helped to define African therapeutics.

The relationship between African and Indian medical providers in Natal, however, was one of cultural exchange, not contestation, as Flint describes in chapter five. Indians began to arrive in South Africa as indentured sugar plantation workers in the 1860s, and brought their Hindu, Muslim, and Ayurvedic healing practices with them. Indian herbalists and muthi shop owners emerged to serve the health care needs of the growing Indian community. These health care providers interacted with Africans and the local environment, learning about indigenous herbs and incorporating this knowledge to treat African as well as Indian patients.

The book concludes with an epilogue that notes the contemporary relevance of the social history of medicine to current South African health issues such as bioprospecting, HIV/AIDS, and the licensing of "traditional" healers.

In building on the works of previous historians and anthropologists of African medicine such as Megan Vaughan and John Janzen, Flint's work serves as a model for social and cultural history of medicine that is attentive to the vagaries of available sources. Flint draws on oral histories, government archives, and professional journals of the period, discussing thoroughly the challenges of writing a history of African health care utilizing sources written by Europeans.

Flint's work is of interest not only to historians of medicine, but also social-cultural historians working with topics as varied as witchcraft and professionalization. Flint does assume, however, that the reader is familiar with South African history. Some of the events described could have been put into context for the nonspecialist: for example, in the early twentieth century South Africa's increasingly segregated society spawned the formation of many racially defined professional organizations. African teachers and nurses, not just healers, formed their own professional groups. Taken as a whole, the work demonstrates that the syncretic nature of the current South African medical environment results from almost 200 years of dynamic cultural exchange and competition.

Patricia G. Clark

Westminster College