The "Healthy Reserve" and the "Dressed Native": Discourses on Black Health and the Language of Legitimation in South Africa Author(s): Randall M. Packard Source: American Ethnologist, Vol. 16, No. 4, (Nov., 1989), pp. 686-703 Published by: Blackwell Publishing on behalf of the American Anthropological Association Stable URL: http://www.jstor.org/stable/645116 Accessed: 10/05/2008 07:35 Your use of the JSTOR archive indicates your acceptance of JSTOR's Terms and Conditions of Use, available at http://www.jstor.org/page/info/about/policies/terms.jsp. JSTOR's Terms and Conditions of Use provides, in part, that unless you have obtained prior permission, you may not download an entire issue of a journal or multiple copies of articles, and you may use content in the JSTOR archive only for your personal, non-commercial use. Please contact the publisher regarding any further use of this work. Publisher contact information may be obtained at http://www.jstor.org/action/showPublisher?publisherCode=black. Each copy of any part of a JSTOR transmission must contain the same copyright notice that appears on the screen or printed page of such transmission.

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the "healthyreserve" and the "dressed native": discourses on black health and the language of legitimationin South Africa RANDALLM. PACKARD-Tufts University

Since the discovery of gold and diamonds at the end of the 19th century the central characteristic of capitalist development in South Africa has been the emergence and development of a system of migrant labor. The reliance of capitalist enterprises on the use of migrant labor evolved initially in response to the resilience of precapitalist social formations, and peasant resistance to proletarianization. Given, on the one hand, low wages and unhealthy working conditions, and on the other, opportunities to earn income through the sale of crops and cattle, Africanspreferredto limit their involvement in wage employment to short periods of time. The viability of the rural economy thus served as an impediment to the free flow of labor to the mines. As the demand for labor grew, mine owners as well as other capitalist interests argued for the implementation of legislation that would reduce the opportunity costs of African labor. Thiswas achieved through a series of policies, culminating in the 1913 Native LandAct, which greatly reduced African access to the means of production and represented a serious blow to the Africans' ruralbase. At the same time, however, the owners of industry realized that such policies, if carried to their logical conclusion, would virtually eliminate the African farmers' ruralbase, making African workers totally reliant on wage income. This would place responsibility for the reproduction of labor squarely on the shoulders of capital. The owners of industry,therefore, argued for the maintenance of African reserves that would provide an economic base for the families of industrialworkers, as well as a place to which workers could retireonce they were deemed to be no longer productive. In effect, the owners of industry attempted to both destroy and preserve the viability of African ruralproduction in order to generate profits (Marksand Rathbone 1982; Bundy 1979; Beinart 1982; Jeeves 1985). In actual practice, capital, supported by the state, proved much more efficient in undermining African ruralproduction than in preserving it. The rising demand for industrial labor, com-

The need of industrial capital to generate a supply of cheap African labor led to policies which both undermined and preserved the rural support base of African farmers.The encouragement of an educated class of African workers, essential for the maturationof industrialdevelopment, was accompanied by restrictions in social and economic mobility that maintained the social dominance of whites. These conflicting strategies have produced impoverishment among both urban and rural African populations. Yet these conditions have been effaced by the construction of powerful stereotypes or myths about African urban and rural life, myths that have preserved the ideal of a healthy labor reserve, while explaining the African worker's lack of social and economic advancement in terms of their own maladjustment to industrial civilization. This paper examines the role of medical authorities in valorizing and contributing to the longevity of these myths in the face of contradictoryevidence and alternative constructions of African ruraland urban life. [SouthAfrica, myths, medical ideas, legitimation]

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bined with the ecological consequences created by the growth of human and animal populations within inadequate reserve areas, and low wage industrialpolicies, seriously undermined the income earning capacity of Africanfarmers.Widespread impoverishment, malnutritionand disease were reported in some areas by World War I and within most reserves by the late 1930s, with conditions being most severe in the Ciskei and Transkei areas of the eastern Cape. By World War II,the disastrous conditions existing in the reserve areas of South Africa produced a massive movement of Africans to the cities. The adverse consequences of deteriorating conditions in the reserves led to efforts at rural reconstruction after the war. Yet these efforts went hand in hand with the forced movement of urban Africans into the increasingly crowded rural reserves, under the Nationalists' policy of separate development, and represented a continuation of the contradictory policies that had shaped African ruraldevelopment before the war. The result was an acceleration of impoverishment among the vast majorityof African families living in the reserves. Despite the deterioration in rural conditions and the growing impoverishment of African worker families living in the reserves, many white authorities in industry and in the state discussed the reserves in a language that reflected an idealized vision of what a reserve should be-a viable support base for the African worker's family-rather than what they had becomeruralslums. In effect, what capital and the state failed to produce through effective rural development policies, they constructed in the language they employed to describe African rural life. This extraordinaryevocation of a healthy rural life, in the face of the stark reality of rural impoverishmentand disease, represented not only a massive act of denial, but more important, a means of legitimating policy choices that served specific sets of social and economic interests within white society, at the continued expense of African workers and their families. They became part of what Deborah Posel refers to as the "language of legitimization" (Posel 1987). The "myth of the healthy reserve" ultimately served to legitimize the Nationalist Government's policy of separate development, which had at its heart the vision of Africans developing along separate lines within their rural reserves/bantustans/nation states. It thus became part of the Nationalists' attempt to "legitimate the illegitimate" (Greenberg 1987). Not all whites accepted the idealized vision of African rurallife embedded in the myth of the healthy reserve. Infact, by the 1930s a growing number of progressive academics, missionaries and physicians, who were becoming critical of the labor reserve economy, depicted the reserves as exactly what they were becoming-impoverished labor reserves. Despite these alternative constructions of African rural life, the myth of the healthy reserve persisted not only in the statements of government officials and representatives of industry, but also in the language of some of those who were critical of the labor reserve economy. So powerful was the myth of the healthy reserve by this period, that even those who were conscious of actual rural conditions would occasionally make statements that embodied this powerful stereotype, and in doing so unintentionally contribute to its persistence. The other side of the myth of the "healthy reserve," was the myth of the "dressed native." The myth of the "dressed native" placed responsibility for the apparent physical and moral failings of urban Africans, reflected in high morbidity rates, alcoholism, family separations and crime, on African inexperience with the conditions of urban industrial life and their difficult transitionfrom a ruralto an urbanexistence. Formany white South Africans, the Africans'wearing of European-styleclothing, which was often of inferiorquality and worn in what appeared to be an indifferentmanner, symbolized this difficult social and cultural adjustment. The image of the dressed native, like that of the healthy reserve, was the product of a fundamental contradiction in the development of racial capitalism in South Africa. On the one hand, emerging commercial and industrial interests in the urban centers of country, like those elsewhere in colonial Africa, benefited from the development of a class of educated black workers. Yet the presence of a growing population of Westernized Africans threatened the so-

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cial dominance of whites, as well as the specific economic interestsof white workers and farmers. This led to social and economic policies that denied the existence of a permanent class of urbanworkers and made no provision for its well being or social reproduction. The result was massive impoverishment, overcrowding and disease among urban African workers and their families. The image of the dressed native effaced the effects of this contradiction by placing responsibility for the conditions it produced on the African workers themselves. At the same time it gave voice to the ambivalence with which the Westernizing African was viewed within the colonial world. For some, and especially many conservative white farmers and workers, the image of the dressed native served as proof that Africans were ill-suited to the ways of Western civilization and should be discouraged from attempting the transition from their natural rural existence. Within the context of the Nationalist policy of apartheid, the myth of the dressed native, like the myth of the healthy reserve, legitimized the policy of separate development on the grounds thatAfricansdid not function well within an urbanenvironment. Forothers, including the evangelical missionaries (see Comaroff this volume), liberal academics and politicians, the image of the dressed native spoke to the need to educate and in other ways further the social and economic advancement of Africans. Despite these differences in interpretation, however, both liberal and conservative whites came to regardthe social problems experienced by Africansentering colonial society as being, in one way or another, a product of the Africans' maladjustment to the ways of Western civilization. Even active critics of urban policies in the late 1930s and 1940s can be seen to have employed language that reflected this assumption. The image of the dressed native, therefore, was a powerful trope that came to permeate the thinking of even those who were committed to African social and economic advancement. This article begins to explore how these powerful images or tropes became embedded in discourses on Africandevelopment within white South Africa and why they were able to persist in the face of massive evidence that challenged their validity and alternative constructions of African urban and rural life. At a more general level, the article is about the process by which images of the colonial world were constructed by the colonizers and how these constructions both shaped and legitimated colonial policies. Likethe contributions of Cooper and Stoler, the article argues that processes of cultural construction did not evolve in a vacuum but were shaped by changing patterns of capitalist production and shifts in the demand and nature of labor supplies within colonial economies. The article is therefore about the political economy of meaning. Tracing the history of the myths of the "healthy reserve" and the "dressed native" is by no means a simple task. Forthey were pervasive and can be identified within a number of parallel discourses on Africanculture and society. Thus one can find elements in both myths within the writings and discussions of urban planners, labor recruiters, mining officials, district commissioners, and missionaries. One can also find them reflected in the writings of white South African novelists (Paton's Cry the Beloved Country, being perhaps the most well-known example), journalistsand academics. These various discourses may, in fact, be seen as reflections of a single discourse if, as Foucault (1972:28-29) suggests, one suspends accepted unities.' It is equally clear that the image of a blissful rural life contrasted with that of a difficult and unhealthy adjustment to an urban industrialexistence was by no means unique to white South Africans,but had wide currency in Europeand America during the 18th and 19th centuries and can be found also in other colonial settings. One finds a similar image in the language medical authoritiesemployed in discussing the susceptibility of young men and women from the country districts of England and Ireland to tuberculosis within the industrial slums of London and Manchester (Dubos 1953), and in discussions of early childhood diseases in 18th-century France (Morel 1980). It can also be found in the somewhat dubious claim made by medical

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authorities in the United States earlier in this century that African-American susceptibility to disease and alcoholism was a product of rapid transition from the "country life of the plantation" to the harsh realities of northern industrialcities (Torchia 1977). To the extent that South African whites were part of this wider intellectual and cultural tradition, these more distant images may well have influenced their local development. Where these ideas originated, how they spread, and what were the contact points at which the ideas of one discourse fed into and influenced parallel discussions of African development is extremely difficult to define. To do so would require a comparative analysis of texts from a range of cultures, disciplines and time periods that is clearly beyond the scope of the present article.2 Instead, I will trace one thread of this development-that revealed in the writings and discussions of white medical authorities in South Africa. I have chosen to trace the development of these myths within South Africa'sWestern medical community for two reasons. First,as a case study the history of medical thinking about Africans permits us to explore in detail processes that may have shaped the broader history of these two images. Second, while medical professionals were clearly not responsible for the origins of these myths and were themselves influenced by the ideas of others, the medical profession did play an important role in valorizing the myths and thus in ensuring their pervasiveness and longevity. This is because much of the discussion about the position of Africans within South Africansociety revolved around problems of health. Forexample, as Swanson and others have demonstrated, discussion of the status of urban Africans by municipal councillors, employers of labor and the Native Affairs Department, was dominated by issues of African health (Swanson 1977). Indeed, African health problems became the central justification for implementing a system of urban segregation. Similarly, as we will see, health issues were a key element in the mining industry's efforts to justify their highly exploitative labor policies up through World World II. Finally, it must be recognized that the opinions of medical professionals in South Africa,as in the West, were given a great deal of credibility by the general public. This was due in partto their advanced level of learning. Few white South Africans were as well educated as the medical profession. Yet it may also have been related to the nature of doctor-patient relationships, which were characterized by a high degree of confidence, deference and dependency on the partof the patient. These attitudes may have influenced popular views of the medical profession and legitimated their ideas. Forall these reasons, white medical authorities had considerable influence on the development of popular thinking among whites about the status of Africans in South African society and in the development and persistence of the dual stereotypes of the healthy reserve and the dressed native. While one could trace the evolution of the myth of the healthy reserve and primitive native back into the 18th century, this article will concentrate on their development within medical circles during this century and focus particularlyon two periods: from 1912 to 1932 and from 1938 to 1948. It was during these two periods that the validity of both myths was challenged by alternativevisions and realities. Understanding why this challenge failed to undermine completely the popularity of the "medical" myths helps explain their longevity.

industrialization, disease and the "dressed native" The discovery of minerals in South Africa at the end of the 19th century was followed by a rapid growth of urban and industrial centers. Between 1891 and 1911, the urban population of South Africa increased by 200 percent. Much of this increase was caused by the introduction of thousands of unskilled African workers. By 1890 nearly 20,000 Africans worked in the diamond mines in Kimberley, and by the turn of the century there were over 100,000 Africans working on the Rand. The mineral revolution also stimulated the growth of the commercial ports and towns.

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This rapid urbanization was accompanied by a myriad of health problems. African workers sufferedfrom a range of infections including pneumonia, dysentery, tuberculosis, and typhoid as well as nutritionalproblems including scurvy. The health costs of urbanization and industrial work did not go unnoticed among white health authorities and employers of labor, if only because they threatened the security of labor supplies and the health of whites. There was little consensus, however, about either the causes of African ill health or about the best ways to deal with the problem. Debate over the causes of African ill health, in fact, dominated discussions of public health in the urban centers of South Africa through the 1940s. While the debate involved a number of health problems, it centered increasingly on tuberculosis, the major cause of African morbidity and mortalityin the urban and industrialcenters of South Africa during the firsttwo decades of the century. The primacy of tuberculosis in public health debates also reflected the disparate pathological experiences of Africansand whites. Of all the diseases that affected both Africansand whites in South Africa, tuberculosis appeared to contemporary observers to illustrate most clearly the existence of racial differences in susceptibility to disease. While tuberculosis often took a slow chronic course among whites, it frequently appeared as an acute progressive disease, with a high mortality rate, among Africans. This marked difference made TB a focus of the debate over the causes of African ill health. A number of explanations for Africansusceptibility to TB coexisted at this time. Broadly,from the end of the 19th through the firstdecade of this century, Western medical models of TBwere in a state of flux. The hereditary paradigm, popular in the 19th century, now competed with Koch's germ theories. On the question of racial susceptibility there was no established medical explanation and a number of theories coexisted (Torchia 1977). Within South Africa, however, a dominant explanation based on a cultural or behavioral model emerged in the early years of this century. This model posited that African susceptibility to TB was a product of incomplete and inadequate adjustment to the conditions of urban life and a general adoption of European patterns of dress and behavior, symbolized by the wearing of Europeanclothes, to which Africans were unaccustomed. For example, the South African Native Affairs Commission Report of 19031905 notes: Europeanclothingwhich is comingmoreand moreintogeneraluse has not been an unmixedblessing. Ithas promotedpublicdecency, but,not beingadoptedin itsentirety,and beingnecessarilyof inferior material,it has not provedequallyconduciveto the promotionof health.Theuse of cottonshirtsby the menandthe habitof allowingwet clothingto dryon the personhavebeen particularly harmful. . . and a markedincreasein consumption,pleurisy,inflammation of the lungsand rheumatismhave been the result.Europeanclothes, too, requiremuch morefrequentcleansingthantheirancestralgarb,a fact is not sufficientlyrealizedby the Nativeswho havepartiallyadoptedourstyleof which,unfortunately, dress;but the hardschool of experiencewill teach themas it has taughtus to use greatercare in these matters.Theevils are not inseparablefromEuropeandress,but arisefroman imperfectunderstanding of the lawsof health[emphasisadded].3 This theory was based in part on empirical facts. EarlyChristianconverts and other Africans who adopted Western lifestyles were among the first to feel the squeeze of poverty and suffer from the effect of TB. Early medical reports note particularly high TB mortality rates among mission Africans. By contrast, Africans living in the ruralareas appeared to have, and at least prior to 1890 probably did have, lower TB rates and generally healthier lives. It should be noted, however, that few white medical authorities had much opportunity to view these conditions firsthand and much of the faith in the health of African rural life stemmed from a romanticized vision of this existence inherited from 18th-century writers in both South Africaand England.The view that "dressed natives" were more susceptible to TB was, in fact, a logical extension of earlier medical opinion, which ascribed the relative absence of tuberculosis among Africans during the 18th and early 19th centuries to their lack of exposure to the unhealthful habits of European life (Packard 1987:193-194).

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Following this reasoning of the causes of black ill health, white medical authorities concluded that African health problems could best be solved through education and acclimatization to urban life. Africans had simply to be taught about the dangers of overcrowded housing, sanitation and unhealthy diets, as if they chose to live in these conditions out of perversityrather than from economic necessity. While these conclusions in effect blamed the victim, they at least acknowledged the possibility of amelioration. Medical authorities recognized, however, that acclimatization would not be a rapid process. In the meantime, it was necessary to enforce measures to protect the native from himself, as well as to protect white society from the adverse health conditions that were a product of the African's lack of experience with urban industrial life. This led to the passage of public health acts and slum clearance measures designed to place Africans in controlled "native locations" removed from the centers of urban white settlement. This move toward urban segregation began in the firstdecade of this century and, as Maynard Swanson has shown, was stimulated as much by a desire to control the mobility of African labor as by health concerns. Nonetheless, the language employed to enforce segregation furtherhighlighted and reinforced the vision of Africansas primitive natives who were ill-prepared for urban life (Swanson 1977:400). While explanations for African susceptibility to TB at the turn of the century can be explained by the existence of a romanticized view of traditional African life reinforced by an empirical observation that "Westernizing" Africans were less healthy than their rural counterparts, we need to ask why the images of the healthy reserve and the dressed native persisted in the face of both a rapid deterioration in rural conditions and the emergence of a permanently settled Africanworking class following World War I. Why did the images persist in the face of growing empirical evidence that they did not reflect reality?Why also did the alternative constructions of African life embodied in the ideas of evangelical missionaries, progressive physicians and others fail to capture the thinking of medical authorities at this time? It is at this point that the role of mine medical officers and the interests of the mining industry appear to have had an impact on medical thinking in South Africa.

tubercularization, migrant labor and the myth of the "healthy reserve" During the second decade of this century, attitudes toward the causes of Africans' ill health began to change. In place of behavioral or cultural model, one increasingly finds white medical authorities speaking of physiological susceptibility. This took several forms, yet basically argued that African inexperience with diseases common in Europeproduced a physiological susceptibility. To use the language of the time, Africans lacked a "herd immunity" to particular diseases, such as TB, and were thus particularlysusceptible. This model not only presented a differentexplanation for African ill health, it also presented a different solution. In contrast to earlier explanations, education and acclimatization were of little use. Resistance would be gained only through a process of natural selection or through repeated exposure to these diseases. In the context of TB, medical authorities talked of "tubercularization," a process of repeated exposure to TB bacilli under conditions that permitted infected individuals to cope effectively with their infections. Over time this would lead to an acquired immunity, which would be passed on to subsequent generations. These ideas, not unique to South Africa, emerged within the wider Western medical community. However, as I have indicated elsewhere, they arose earlier in South Africa, predating their popularity in Europeand the United States by nearly a decade (Packard1987, 1989). They were first enunciated in South Africa by medical officers working in the employ of the gold mining industry,where TB was a major problem, and in association with changes in the nature of the mines' work force and recruitment practices. In essence, the physiological explanation for African susceptibility to TB was more compatible with the mines' growing dependence on a system of migrant labor than was the earlier

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paradigm. The logic of the earlier paradigm had led medical men to argue for labor stabilization, which would contribute to acclimatization. The mines' growing preference for a migrant laborforce now dictated against labor stabilization. The logic of the physiological model could thus be used to rationalize the use of migrant labor; for it was argued that Africans had a racial susceptibility to TB, and that their exposure to the conditions of mining life must be limited to permittubercularizationto occur. Ifworkers stayed in the mines too long they would succumb to their infections; if they returnedto their ruralhomes between exposures they would be able to cope with their infections and develop resistance. Medical men, whose economic interests were tied to those of the mining industry,found it expedient to adopt the new paradigm.4 These attitudes were clearly stated in the Report of the Tuberculosis Commission in 1914. Thus, in response to recommendations that the mines should stabilize their African work force, representativesof the mining industryargued: Underpresentconditionsa largeportionof minenativesreturnperiodicallyto theirkraalsafterfrom12 to 18 monthsof workon the mines.If,however,the wives andfamiliesof such nativeswere broughtto the Rand,the nativewould have less inducementto leavework,andoftenno hometo go to. He would effectof longrestswhichhe now periodicallyenjoys,andwhichwe consequentlylose the recuperative believeto be invaluable.While,therefore,we do notdoubtthathis morbidityand mortalityfrompneumoniawould be materiallydecreasedby familylife in a locationhut,we thinkthereis reasonto fear, thatone effectof continuedmine workwithoutthe interventionof the presentlong periodsof restand changewouldbe a markedincreasein tuberculosis[emphasisadded].5 The advantages of the rest periods provided by a system of migrant labor were stressed again elsewhere in the report: Owingto the shortnessof the periodof exposureto the adverseconditionsof laborcentres,and to the effectof a returnto the freeand lazy life of the kraal,any evil effectof such conditionsis recuperative verymuchmitigatedin the case of the native.6 Preventingthe spread of tuberculosis became a medical rationale for the use of migrantlabor. More importantly,the arguments of the mining industryclearly embodied and reinforced both the myth of the "healthy reserve" and the "dressed native." The mine medical officers continued to project the image of a healthy reserve up through the 1940s despite growing evidence that the reserves were no longer healthy. Thus they noted that the most effective way to treat mineworkers who became ill and unable to function was to repatriatethem as soon as possible so that they could regain their health in their own surroundings. They maintained this line of argument even when there were indications that it had little basis in fact. Studies that traced Africans who were repatriatedwith TB found that a high percentage of them died within the first year after returninghome. A study in the late 1920s indicated that 60 percent were dead within two years.7 It is clear, moreover, that mine medical officers employed the myth of the healthy reserve when it served their purposes, and yet were quick to point to the harsh realities of life in the reserves when it did not. For example, the officers repeatedly denied that tuberculosis was an industrialdisease associated with mining, arguing instead that it was brought to the mines from the reserves by African workers. Similarly, they claimed that scurvy, a fatal disease during the early years of the industry and a serious health problem through the twenties and thirties, resulted from food scarcities in the ruralareas from which the Africanworkers came. In short, the healthy reserve was not so healthy when it served the purposes of the mining industry. The extent of this doubletalk is highlighted by the conflict between the medical officers' explanation for scurvy in the mines and their policy of repatriatingmineworkers with scurvy, justified on the grounds that the workers would have a better chance to recover in the healthy environment of the reserve (Packard 1989)! The opinions of mine medical officers concerning Africans had considerable influence on the thinking of other members of the South African medical community at this time because mine doctors were viewed as having extensive experience in working with Africans. This influence insured that both the physiological explanation of African susceptibility to TB and the

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myth of the health reserves it contained, gained wide acceptance. This popularity was further reinforced by the publication of the Report of the Tuberculosis Research Committee in 1932, a committee funded jointly by the Union Government and the Chamber of Mines, but dominated by mine medical officers. In addition, it had as its ExpertAdvisor, Sir Lyle Cummins who was a staunch supporter of the physiological paradigm. Thus in the writings of medical men and women throughout the 1930s one can find repeated references to the myth of the healthy reserve. The popularity of the myth among medical professionals was of course related to the pervasiveness of the image upon which it was based within white South African society. The very fact that romantic ideas about African rural life were held by white South Africa created a receptive audience within the medical profession for theories that incorporated this image. These medical theories in turn helped galvanize popular acceptance of the myth by lending it further "scientific" legitimacy. In much the same way, Charles Darwin's Origins of the Species was both a product of scientific racism and a galvanizing force in its development (Curtin 1964:363-364). What is remarkable about these references to the healthfulness of the reserves is that they coexisted with reports that delineated, in considerable detail, the deteriorating conditions in the Africanreserves during this period. Infairness, full recognition of the plight of ruralAfricans was not brought home to the wider white medical community until the 1940s when conditions reached a point at which survival in the reserves became a day-to-day struggle and thousands of Africans began pouring into the cities in search of employment. Moreover it was not until 1942 that the most damning indictment of conditions in the reserves was made public. This was the reportof F. W. Fox and Douglas Back on agriculturaland nutritionalconditions in the Transkeiand Ciskei (Fox and Back 1938). The study was commissioned in the mid-thirties by the Chamber of Mines, which was becoming alarmed at the deteriorating condition of mine labor coming from these areas. The report contained detailed evidence of the immiseration of thousands of reserve families, widespread malnutritionand disease. The reportalso placed partial responsibility at the door of the Chamber, arguing that the Chamber's low-wage policies and disregard for the health of mineworker families had contributed to conditions in the reserves. The Chamber predictably locked up all copies of the report, and its findings were not made public until the authors themselves provided a copy to LordHailey for his study of social and economic conditions in the BritishEmpire.8

the new environmentalism

and the myths of the healthy reserve and dressed native

The Second World War was accompanied by major transformations in the South African economy. These changes led to the emergence of a new paradigm for African susceptibility to TB. The new paradigm placed responsibility for African susceptibility much more squarely on the adverse conditions under which Africans lived and worked, particularlyin the urban areas, and represented a major challenge to the stereotypes of the healthy reserve and the primitive native. In the end, however, this new thinking failed to erase these images from medical discourse on African health, allowing them to persist into the fifties and sixties where they found new life in the racial ideology of the Nationalist period. The war accelerated an expansion of secondary industry in South Africa, which had begun in the late thirties. By 1943, manufacturing had surpassed mining in its contribution to GNP, greatly increasing the demand for African labor in the growing urban industrial centers. This demand paralleled deteriorating conditions in the ruralareas, accentuated in 1942-43 by severe drought. As noted above, thousands of African workers and their families flooded into the urbancenters during this period. To facilitate this movement and specifically to provide indus-

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try with labor, the government relaxed influx control laws, suspending them completely in 1942-43. While industrialcapital and the state encouraged the movement of Africansto urban centers, they were unwilling to provide adequate housing for them. Municipal councils, responding to the concerns of white rate-payerswho saw the influx of Africans as a threat to their own economic interests, also failed to allocate resources for housing. As a result, a housing crisis developed and slumlike squatters' camps sprang up around all the major urban centers. In addition, wartime inflation kept the cost of living above wage levels, contributing furtherto housing problems for the poor and to widespread malnutrition. These conditions provided an ideal breeding ground for TB, which exploded among urban Africans. TB mortality rates again reached pre-World War I levels (Packard 1989). Urban medical authorities were not unaware of the connection between the conditions of urban life and the epidemic of TB. As a result, discussion of African susceptibility to TB came to focus increasingly on urban conditions and to move away from the physiological model.

the rise of environmentalism

and the myth of the healthy reserve

In 1948 B. A. Dormer published an article in the South African Medical Journal that was modestly titled "A Case of Tuberculosis." The article began innocently enough with a clinical presentationof the case history of a marriedAfrican man, identified simply as A.N. who, at age 24, was admitted to Springfield Hospital, where he died three weeks later. The man was found to be suffering from pulmonary TB, tuberculous enteritis and possibly tuberculosis of the kidney, complicated by secondary syphilis, amoebic dysentery, ascariasis, hookworm, and secondary anemia. Afterdescribing the clinical evidence, diagnosis, treatment, and post-mortem findings, Dormer posed a question. What was the primarycause of death? He then proceeded to describe the man's "past history." The tale is of a young man brought up in an open air, healthy ruralenvironment who at age 22 came to Durban in search of work to pay his taxes. He found employment with a contractor, which involved hard labor with a pick and shovel for nine hours a day. The man lived in an overcrowded shack in Cato Manor with four other men, one of whom died of TB prior to A.N.'s death. The shack lacked proper sanitation, facilitating the spread of parasitic infections. His food in the city consisted of bread or mealie meal, and Africantea with sugar. About once a month he managed to obtain about a half pound of meat offal. Aftera few months of life in Durban, the patient met and liked a young native prostitute, and from her he contracted his syphilis (Dormer 1948:84-85). Expandingthe scope of his initial diagnosis on the basis of this history, Dormer asked, "What killed him?" and proceeded to provide what he termed "a social diagnosis": Surelynot syphilisor tuberculosis,or amoebicdysentery.Ifhe hadcontinuedto live in the countryhe would neverhave contractedany of these bacterialinfections.Theorganismand the disease patterns economicneed, Westerncivilization-call werejustthe resultsof somethingfarmorepotent.Industry, it whatyou will, it is to-day'ssocial systemwhich was responsibleforthe deathof our patient,as it is fora deathratefromtuberculosisof 900 per 100,000 of industrialnativesin SouthAfricato-day-perhaps the highestdeathratein the world(Dormer1948:85). Dormer'sstory of A.N. representsan emotional example of a growing tendency among Western-trainedmedical authorities in South Africa to see tuberculosis among blacks as a product of the adverse social and economic conditions under which Africans were forced to live in the rapidlyexpanding industrialeconomy of South Africa. The new environmentalism of the 1940s, like earlier etiologies, reflected and was part of a broaderdiscourse on the status of Africans within South African society. Itechoed the reformist language of the Fagan (Native Laws)and Gluckman (National Health Service) Commission Reports as well as to some degree that of the earlier Native Economic Commission, in accepting the permanence of African urban settlement and the need to develop social and economic

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policies that reflected this reality. Like these other initiatives, the new environmentalist discourse on African health coincided with the interests of manufacturingcapital, which had the ear of the ruling United Party.These interests saw both the inevitability of African urbanization and the social and political dangers that uncontrolled settlements were creating. Yet, the new etiology of African TB also shared with these other products of liberal capitalism discordant themes that undercut the full force of its reformist language and represented an intellectual connection to the racial discourse of the twenties and thirties. Like Fagan and Gluckman, the new discourse on AfricanTB recognized the realityof Africanurbanization without challenging the underlying political economy that was shaping this process. As a result, the new environmentalism retained and reinforced the dual stereotypes of ruraland urban African life that had markedearlier paradigms. The growing emphasis on housing, diet and working conditions that punctuated discussions of African susceptibility to TB in the forties was not totally new to white medical officers concerned with urban health problems. A few municipal medical officers like P. W. Laidlerof East London had frequently decried the horrendous housing and dietary conditions experienced by urban Africans. Moreover, physicians like Neil MacVicar, George Gale and Peter Allan, experienced in working with Africans in the ruralareas of South Africa, were arguing in the midthirtiesthat African susceptibility to TB was not inherent in their physiology, but resulted from the harsh conditions under which they lived and worked in industrial areas. What changed in the late thirties and forties was the extent to which these views came to be accepted in mainstream medical thought in urban as well as rural areas, becoming the dominant etiological paradigm.The acceptance of the environmental model was in no small measure enhanced by the appointment of Gale as Secretary for Health, and Allan as Secretaryfor Public Health. The shift to an environmental paradigm within mainstream medical opinion can be seen in the statements of government medical authorities from the late 1930s onwards. For example, in a memo to the Ministerof Health, the Secretary of Health in 1938 stated that: Nutritionand housingstandout prominentlyfromthis social backgroundas factorsfavouringtuberculosis.... No singleenterprisewoulddo so muchforthe eradicationof tuberculosis,andforthe public welfaregenerally,as the provisionof adequatedwellingsforthe poorerclassesat rentalstheycan afford.9 Similarly,a Conference of Municipal, Provincial and Union Health authorities on tuberculosis in 1939 resolved that: Thisconferencebeingconsciousof the gravityof the tuberculosissituationin thiscountryis of the opinion (a) thatthe chief cause is to be found in the depressedsocial and economic conditionsof large sectionsof the populationresultingin undernourishment, overcrowdingand otherfactorspromoting tuberculosis.10 The conference reportalso noted that "Underlying factors of the problem are largely social and economic, with a wage rate insufficient to enable poorer families to maintain a proper standard of nutrition." Both statements not only stress the importance of environmental factors but, in their references to "poorer classes" and "large sections of the population," implicitly reject the importance of racial differences in favor of social and economic ones. While there was little doubt that most of the poor were blacks, the changing pathology of the disease and the realization that poor whites during the depression shared a susceptibility to TB led medical authorities to underplay the importance of race. The rejection of racial susceptibility was made more explicit in a major article on TB by Drs. Dormer, Frielanderand Wiles, of King George V Hospital for Tuberculosis in Durban. The authors noted that it was generally accepted that "primitive races" are more susceptible to tuberculosis than so-called civilized people. This ascription did not, however, square with evidence of high infection rates and yet low rates of active disease among Africans living in the reserves. They concluded that "Race is not a factor per se," and that TB in the progressive form

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occurred primarilyunder conditions of physical stress and malnutritionassociated with industrialemployment (Dormer, Frielanderand Wiles 1943:76). While environmental explanations for African susceptibility to TB gained prominence in the late thirtiesand forties, their influence was not felt in all medical circles. This variation reflects the extent to which these ideas tended to reflect specific sets of economic and political interests within South Africa. Environmental explanations were particularly popular among two groups of physicians: those who worked in the reserves, and those who worked in the rapidly expanding centers of manufacturing.The former group had had the opportunity to see the difference between the disease experience of Africans living in a ruralsetting, where the disease took a chronic course, and those who returnednear death from the towns. They also saw the growing deterioration of the reserves and how this was adversely affecting the overall health and nutritionof Africans.11 Formedical authorities working in the growing manufacturingcenters, the rising toll of African tuberculardeaths forced them also to come to grips with the failure of earlier explanations and the role played by the appalling conditions under which Africans lived. The environmentalist arguments, however, carried less weight among mine medical officers. While the published statements of mine medical officers recognized the importance of social and economic factors, they continued to stress the importance of the African's lack of physiological resistance to disease.'2 The continued acceptance of racial etiologies among mine medical officers in the forties must be viewed within the context of the mines continued, even growing, dependence on migratory labor. As Yudelman and Jeeves note, the mines' heavy investment in establishing a northernrecruiting system and the vista of unlimited tropical labor resources, "made it more difficultfor Chamberof Mines executives to consider seriously alternativesto its low wage labor policies based on maximum utilization of transitory,unskilled labor" (1986:112). It must also be viewed in the context of the debate in wider government and public circles over the costs and benefits of migrant labor on both the migrants and their families. This debate was central to the inquiries of the Fagan Commission. In testimony before the commission, representatives of the chamber presented the expert opinion of Sir Lyle Cummins, citing his 1946 study of Empireand Colonial Tuberculosis. The study concluded that tuberculosis among "Native people" was not primarilythe result of industrialconditions. Rather,it was the result of "the sudden settlement of large numbers of primitive people, highly susceptible and highly sensitive to tuberculosis infection, in closer and more sustained contact with European communities and living under industrial conditions would lead to a greaterexacerbation of acute tuberculosis among them.'3 The Chamber argued further,through its representative, Dr. Orenstein, that the establishment of a permanent work force would heighten the risk of African workers developing silicosis and TB, while retaining the current intermittentlabor force reduced the risk of these diseases. At the same time, before the Mine Wage Commission the chamber presented the view that the African worker's "position as peasant farmerand stock holder" guaranteed the support of his family and assured him of a "prolonged holiday at home" between contracts (Bundy 1979:225). Ineffect, the mining industryresurrectedarguments they had made before the 1914 TB Commission in favor of preserving the migrant labor system. In the political context of the 1940s any recognition of the prominence of environmental factors over racial susceptibilities would clearly undermine the force of the mines' arguments for the maintenance of this system. More importantly,the mine managers again employed the image of the healthy reserve to make their case. Conversely, opponents of the use of migrant labor, men like Sydney Karkand George Gale, supported their case for the stabilization of urban workers by presenting images of the reserves as impoverished ruralslums, thereby undercutting the industry'sclaims about the role of the reserves in the reproduction of labor. The various commissions of the 1940s can be seen as sites of struggle between opposing white constructions of African experience.'4

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Yet even among those who sought to stress the importance of environmental factors, one can hear elements of earlier paradigms and specifically the dual stereotypes of a "healthy reserve" and the "dressed native." In other words, the advocates of an environmental paradigm presented their arguments within the idiom of earlier models. This continuity can be seen clearly in B. A. Dormer's story of A.N., and in his 1948 article "Tuberculosis in South Africa." In the latter, Dormer, perhaps the foremost advocate of an environmental paradigm and, as the Union Government's first Tuberculosis Officer, a leader in the development of attitudes and policies toward African TB writes: Intrulyruralareas(sometribalreserves)the Bantulivesa pastoralexistenceof blissfulease. Thereis the social life of the Kraal,the sittingat ease in the sun, the Springploughing,the reaping,the celebration of the harvest,all the simpleandcomparativelyslothfulexistenceof the primitive.... Whenthe Bantu go to live in the townsthe picturechangesrapidly... the Africanmanmovesfromthe 14thto the 20th Centuryin a matterof days. His environmentis suddenlychangedand he movesfroma life of ease to heavysustainedphysicalworkforeighthoursa day, withthe addedeffortof gettingto andfromwork, oftena walkof eightmilesor morea day.Theincidenceof tuberculosisrisesrapidlyin such urbanareas and the type of the disease is a soft exudativerapidlyadvancinglethaltype of tuberculosis[Dormer 1948a:65]. The same line of argument was presented by Dr. Allan in the 1943 Report of the Secretary of Public Health: Withincreasedindustrialdevelopment,wherethe Nativecomes in contactwith new surroundings and modeof life, it is inevitablethatmanywill developtuberculosisin an activeform[emphasisadded].15 The environmentalists were also fond of citing the experience of American blacks as proof that it was not race but urbanization that caused the high incidence of TB among Africans. This line of argument also reinforced the image of the Africans' difficult transition to industrial society. The annual report for 1939, of the Medical Officer of Health for Johannesburg, for example, stated: If it is claimedthatall or most nativetuberculosisis based on a racialsusceptibility,then it mustbe remembered thatas slaves,the negroesof USAliveda countrylifeandknewnottuberculosis.Itwas the urbanization thatfollowedfreedom,dissipationandexcess, thatwas followedby tuberculosis.16 The new environmental discourse thus contained an image of a bucolic rural lifestyle that contrasted sharply with the African's difficulty in adjusting to the harsh world of industrial society. Despite their emphasis on the environmental conditions under which Africans were forced to live, and their condemnation of overcrowding and malnutrition, the environmental paradigm implied that the impact of harsh industrialconditions on the health of Africans was, in some measure, the result of their inexperience with these conditions, thus reinforcing the myth of the "dressed native". The argument implied that the Africanwas better off in his or her ruralsetting. Thus, far from destroying the myths of the healthy reserve and dressed native, the environmentalists' arguments contributed to their longevity. It must be said in qualification that the writings of the environmentalists during this period show varying degrees of acceptance of the language of the healthy reserve and the dressed native. Drs. George Gale and Sydney Kark,with experience in ruralareas, for example, were much less prone to adopt images of the healthy reserve and less apt to attributeAfrican susceptibility to inexperience with industrial life. On the other hand, Dr. Peter Allan and B. A. Dormer, who also had extensive ruralexperience did invoke this language. While they may have over-romanticized African rural life in order to reject earlier notions of racial susceptibility by drawing attention to the different experiences of Africans in ruraland urban surroundings, their efforts nonetheless reinforced the myths of the healthy reserve and the dressed native. At the same time, one is forced to ask whether these tropes were not so firmlyembedded in the consciousness of South Africanwhites that, despite their good intentions, they found it difficult to break completely from this view. Whatever the reason, the myth of the healthy reserve and the correlate that African ill health was a product of their historical inexperience or "primitiveness" became intertwined with the

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language of environmental reform. In doing so it provided an intellectual justification for inaction. For those who opposed the stabilization of labor and the costs that this would entail, the logic of the argument that Africans were paying the price of industrializationwas that these costs were somehow inevitable, and while the costs could be reduced they could not be eliminated. This line of argument was adopted by representatives of the mining industry, invoking their earlier arguments about the healthy reserves, as seen in the following statement by the Chief Medical Officer for the WitwatersrandNative LabourAssociation: Thisthenis possiblythe pricethe Bantuhasto payforthe changefromhistraditionallazytriballifeand easy habits,fromruralagricultural occupationsto industriallaborwith sustainedphysicaleffort:from livingroomto crowdedcompoundsand locationswherehe hasto adjusthis hours,his modeof lifeand livingconditions.No doubtthe nativewho remainsin his kraalor village, leadingan easy life, surhas less and milder roundedby wine andwomen,or love and beerif you like,and no maladjustments, tuberculosisthanhis compatriotswho laborin the minesor in industry[Retief1947:25]. The inevitability of such health costs involved in the transition to an industrial life was used also by manufacturerswho saw the equation of industrialization with increased incidence of TB among African workers as an attack on industrialdevelopment.17 Ultimately the arguments about the health of the rural reserves and the health costs of the transition to industrial life would find a comfortable home in the Nationalist's arguments for separate development and a returnto the Stallardistview of the 1920s and 1930s that Africans were to be treated as temporary sojourners in white industrial areas. This explanation reinforced beliefs in the moral correctness of racial segregation, for it implied that while the African was able to cope with TB in his ruralsetting, he was fundamentally unable to do so when he entered the world of the whites. In this way the environmentalists' discourse on the causes of Africanill health represented not only a link to the past but a bridge to futurediscussions. While the intent of the environmentalists may have been very different from that of their successors, their language reflected a common intellectual heritage and provided "apartheid medicine" with intellectual legitimacy. Put another way, by failing to effectively challenge the historical assumptions which underpinned the racist paradigms of their predecessors, the environmentalist enabled the designers of Nationalist social policies to legitimize their renewed efforts at sanitarysegregation on a grand scale.

the postwar legacy The Nationalist victory in 1948 insured the longevity of the myths of the healthy reserve and the dressed native. For the new health ministers, secretaries and government medical officers who took up positions of authoritywithin the Nationalist government, the myths of the healthy reserve and the dressed native were accepted realities. Conversely, with the coming to power of the Nationalists, the voices of critics such as Gale and Karkwere gradually silenced. Both men eventually chose to leave South Africa. Although the discovery of effective chemotherapies in the form of streptomycin and INH, which provided a cure for TB, directed attention away from the problem of causes of black susceptibility, one can still hear the familiar evocation of an idealized rural life and the litany of the African's difficult adjustment to urban life in the statements of medical authorities. This view is present in discussion of the failure of Africans to achieve a cure with anti-tubercular drugs and their tendency to "default." Patient defaulting is a common problem in ThirdWorld TBcontrol programs.The term "defaulter"of course puts responsibility for treatmentfailure on the shoulders of the patient, whereas in reality it is often the political and economic context within which treatment occurs that is responsible. This was particularlytrue in South Africa, where Africanswith TB would lose their jobs and then might be arrested on their way to treatment for not having their passes properly endorsed by an employer; where forced relocations disrupted treatment and where, above all else, poverty prevented Africans from staying out of

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employment. Yet the Africanswho failed to complete their treatments were stigmatized. Moreover, explanations for their failure to complete treatment incorporated the stereotype of the dressed native ignorant of the basic rules of health and sanitation. The Chief Medical Adviser of TEBA(the central labor recruiting bureau for the mines) referringto the refusal of African workers to remain on the mines to receive treatments, observed: I havespokento them.Theydon'tcaretwo hoots. Ifyou say "youwill die if you go home,"it does not meana thing.Theyarepreparedto die at home. Ifyou sayto them,"Thinkaboutyourchildren,you are goingto infectthem"-all the reasonsthatwould keep a Europeanin the hospital.Theyjust laughat you. Ifthe wife gets it, he has got two more,if those get it, it is bad luck.18 This sentiment, shared by other mine medical officers, was used as a primaryjustification for not providing more long-term treatment. As the Chief Medical Adviser of TEBAeventually learned, the main reason that Africanworkers refused treatment was that they were not paid during their treatment and could not afford to be unemployed for the six to nine months that treatmentwould take. In the 1970s, when the CMAvisited the ruralareas he was asked again and again in response to questions about getting treatment "Who will feed my family while I am in the hospital?"'9 Interestingly, DeBeers diamond mines, which did pay workers under treatment, had much greater success in getting workers to accept treatment. The mining industry also continued to argue that quick repatriation was beneficial to the health of the Africanworker, thus perpetuating the myth of the healthy reserve. In a letter to the Government Secretary of Swaziland, the General Manager of the Native Recruiting Corporation stated, "The policy of repatriationhas been stated on good authority to have a beneficial effect on the course of the disease, in that the open-air life of the rural native is the condition of choice."20 Outside the mining industry,one finds the two myths embedded in the writings of other medical authorities, occasionally in rathercontradictory fashion. Forexample, in an article describing the results of a TB survey conducted in the northeast Transvaal in the mid-1950s, Dr. J. Schneider wrote, "At Nchabaleng in Sekukuniland (LynchburgDistrict)soil erosion was so far advanced that the whole area resembled a semi-desert. The Native Commissioner of the area wrote in his Annual Report (September 1952), 'Fountains and even wells are drying up and active steps will have to be taken to prevent the district from becoming a desert' " (Schneider 1954:690). Five pages later, however, in describing the consequences that befall blacks who moved from these areas to the cities we find the following description, "A drastic change ensues, from a peaceful pastoral existence to one associated with arduous work, fatigue, poor nutritionand overcrowding in slum, or shack locations." Later,in describing the spread of TB from urban to rural areas he writes, "Those black males who do not succumb to the disease may take it back with them to their peaceful ruralhome" (Schneider 1954:695). In a similar fashion, the head of the state-run Tuberculosis Research Institute, in the face of abundant evidence that economic conditions in the bantustans were deteriorating, stated in 1982 that black TB notifications in South Africa had declined dramatically over the previous 20 years and that this decline had occurred in large measure because of improved living conditions in the ruralareas. In reality, much of the decline in notifications is due to a drop off in case finding efforts combined with the removal of millions of poor blacks to rural dumping grounds where their TB cases often go unreported (Packard 1989:292-307). It is importantto note that not all white South African medical authorities employ such images of the healthy reserves or the dressed native. In fact, a growing body of progressive physicians has been extremely critical of both urban and ruralconditions. The point, however, is thatdespite these critiques, the myths have become embedded in the language of legitimization employed by the mining industryand the South African State and continue to be used by them to rationalize their policies of economic and political development in South Africa. They have, in effect, become partof a realitythat shapes the way many white authorities think about blacks

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in South Africa. Earliergenerations of medical professionals certainly contributed to the constructionof this reality. The degree to which the Nationalist Government has taken up the myth of the healthy reserve can be seen in the following statement made in 1983 by the head of the South African Government's Human Sciences Research Council, an organization charged with collecting scientific data on conditions within the bantustans to find ways of increasing their capacity to absorb an ever increasing number of blacks displaced from white South Africa: Ido not havemuchexperienceof the EasternCape.Butin Natalandthe Bushveldareas,mothernature is wonderful.Itis now nearlythe Marulaseasonandeven in a droughtyearnaturelooksafteritschildren at this time. Thenthereare othertypes of fruitlike the maroq,a type of bean and then thereare the Mopeniworms.TheBushveldis richfroma nutritionalpointof view [quotedin Zwille 1984:30]. At the time that this statement was made much of Southern Africa was suffering from an extended drought, and a World Health Organization reporton apartheid and health reported that three black children died from malnutrition in the ruralareas of South Africaevery hour (WHO 1982:142).

conclusion The images of a healthy and peaceful ruralAfrican life and its counterpart, the maladjusted, "detribalized" urban African, were not unique to whites in South Africa, but can be found throughout colonial Africa. As in South Africa, these stereotypes appear to have been evoked to foster specific sets of political and economic interests in the rest of colonial Africa and were partof the language of legitimation. Politically, they served the needs of colonial administrators whose system of political control was built largely on a pattern of indirect rule. Africans who strayedfrom their ruralsurroundingswere viewed as leaving the locus of political control. The movement of Africans out of the rural setting was also viewed as a threat to economic development where production was centered on peasant grown cash crops. Colonial officials in such areas developed an acute interest in restrictingAfrican mobility. The Belgians seem to have had a particularmania for immobilizing African farmers in cash cropping areas, developing precise calculations to determine the percentage of men who could be away from a village at any one time before social and economic disintegration set in. In labor reserve areas such as Kenya and Zimbabwe there was the same concern for maintaining a ruralbase as well as for discouraging the complete proletarianizationthat evolved in South Africa. Also, as in South Africa, colonial medical officials appear to have played an important role in fostering the development of these stereotypes. Take, for example, the following statement by the director of medical services for Kenya, written just before independence, which portrays the urbanAfrican as maladjusted to the ways of civilized society: TheAfricanin his ruralsettingis strictlyboundby tribalpatternsof behavior,beliefsandcustoms.He is an integralpartof his communityand his thinkingtendsto be communal. . . withthe transpositionto the townshe forsakesthe communallifeforan individualisticlife, unsupportedby tribalrulesand regulations.... Furthermore, he is abandoningingrainedcenturiesof agricultural andpastoraltraditionand learningthe technicalskillsof an industrialworldquitestrangeto him [Fendell1963:78]. Similarly,Maryinez Lyonshas recently shown how the medical explanations for the outbreak of sleeping sickness in northeasternZaire reflected a generalized concern about the dangers of Africanmobility as much as a specific concern about the origins of the disease (Lyons 1988). The wider occurrence of these images within colonial discourses on African development raises a number of questions. How have these images or stereotypes evolved within different social, political and economic contexts? Do they take different forms or trajectories in Francophone countries? Does the existence of a labor reserve economy, such as that which existed in South Africa, Kenya, and Zimbabwe, shape their evolution in ways which are distinct from their evolution in cash cropping areas? To what extent have these images persisted into the

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post-colonial era to become part of "new" discourses on development? Clearly there were echoes of the healthy reserve and the dressed native in the language employed by economists and political scientists to discuss African development within the "modernization" paradigm during the fifties and sixties. In this respect has the continued dominance of "settler" interests in South Africa caused the images to take different forms, or to be used to serve different interests, than in postcolonial Africa?There is some indication that the image of the healthy reserve has taken on negative connotations within postcolonial Africa, becoming seen as an impediment to "development"; whereas in South Africa the healthy reserve remains a positive image in the context of the Nationalist's policy of separate development. Are these images limited to colonial Africa or do they occur elsewhere in the colonial world? If so, can they, as suggested in the introduction, be traced to an earlier language of legitimation which evolved in association with the early expansion of industrialcapitalism in Europe and America? Answering these and other questions will help us to understand better the use of language in shaping perceptions and realities within the colonial world and to define more clearly both the origins of this language and its association with particular patterns of political and economic development.

notes Theresearchuponwhich this paperis basedwas supportedby a post-doctoralfelAcknowledgments. lowshipfromthe SocialScience ResearchCouncil,as well as by grantsfromthe Councilforthe Internaof Education.Analysisof the datawas supportedby grants tionalExchangeof Scholarsandthe Department fromthe NationalEndowmentforthe Humanitiesand the NationalLibrary of Medicine.I wish to thank each of these institutionsand agenciesfortheirsupport. 'Foucaultarguesthat by suspendingwhat appearto be naturalor universalgroupings,one is able to describeotherunitiesthattie togetherdisparatetextsand to see how the textscoexist: "theirsuccession, theirmutualfunctioning,theirreciprocaldetermination, and theirindependentor correlativetransformation."Thissuspensionpermitsone to appreciate"Relationsbetweenstatements(even if the authoris unawareof them;even if the statementsdo not have the same author;even if the authorswere unawareof each other'sexistence);relationsbetweengroupsof statementsthusestablished(evenif the groupsdo not concernthe same,or even adjacent,fields;even if theydo not possessthe sameformallevel;even if they are not the locus of assignableexchanges);relationsbetween statementsand groupsof statementsand eventsof a quitedifferentkind(technical,economic,social, political)." 2Anexampleof thiskindof wide-rangingcomparativeworkcan be seen in SanderGilman'sinnovative studiesof stereotypesof illness,sexualityand race in continentalEurope(1978, 1988). 3TAD,SNA303/3940, 1905. 4Fora moreextensivediscussionof the relationshipbetweenthe miningindustryandtheirmedicalofficerssee Packard1987; Baker,1989. 5Union of South Africa, Report of the Tuberculosis Commission (Cape Town, 1914):212. 6Union of South Africa, Report of the Tuberculosis Commission (Cape Town, 1914): 101.

"Tuberculosis 7TBRC, AmongSouthAfricanNatives,"SouthAfricanInstituteforMedicalResearch,Pro1932. ceedingsNo. 30, Johannesburg, 8"Fox-Back ReportReleased,"Guardian,14 October1943. 9GES998, 401/176, "TBandthe PublicHealthAct,"Memoto the Ministerof Healthfromthe Secretary of Health.23 February1928. 'OGES 998 401/17E,Reporton TuberculosisConference,CapeTown,6-7 February1939. "Commentingon the activitiesof the PolelaHealthUnit,Dr.SidneyKarkwrote, The influenceof social economic factorsis stillfelt in all spheresof the Unit'sactivities.One example of suchan influenceis the disintegration of familylife by the withdrawalof largenumbersof mento the townswiththe inevitablespreadof venerealdisease.A furthereven moreimportantinfluenceis the rapid progressof soil erosion.The devastatingprocessdwarfsall the Unit'seffortsto encourageincreased productionof protectivefoods.Sucharebuttwo factorsbeyondthe powersof a HealthUnitto combat, AD 1715, 9.6.97 no matterhow clearlytheirdetrimentalinfluenceon healthmay be realized[SAIRR, Health:Karkto Editor,RaceRelations,Johannesburg, 28/10/42]. '2Forexample,Dr. FrankRetief,ChiefMedicalOfficerforWNLAconcluded: Inouropinion,as mentionedbefore,the nativeracesaremoresusceptibleto tuberculosisthanthewhite ones and also have a low racialimmunityto this disease.Thisis shown by theirgreatermortalityand

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morbidityrates, greater severity, more extensive caseation, less reparativeprocesses and more tendency to dissemination by lymph and blood stream. It would appear that in the native there is a comparative inability to develop acquired immunity, which in the Europeanso markedly alters the course of the disease, and also the fate of reinfection lesions [Retief 1947:27]. While Retiefacknowledged the importance of the "socio-economic aspect," malnutritionand overcrowding, it is clear that, here as in earlier statements, such concerns were of secondary importance and their relevance was in fact undercut by the overriding racial susceptability of Africans. '3U.G. Reportof the Native Laws Commission, Pretoria, 1948, p. 36. 141tmust also be recognized that mine medical officers during the forties were faced with a rising incidence of TB. Given the improvements in living and working conditions which they believed to have caused a decline in the disease between 1913 and 1935, this rise did not appear to be the product of environmental conditions. The inherent racial susceptibility of Africans was therefore an explanation which appeared empirically correct. In short, for the medical officers themselves, racial susceptibility was not simply a convenient explanation which suited the needs of their employers. 5Cited in Gluckman Commission Report, p.94. '6Annual Report of the Medical Officer of Health, Johannesburg, for the year ending 30 June 1939. p. 11. 7"lndustryand T.B.," The Cape Times, 5 July 1945. 'CMA, Silicosis-TB-Dept. CTE5, 1954, p. 1185. 'gNeil White, "TB as an Occupational Disease," in UCT Medical Council, Consumption in the Landof Plenty-TB in South Africa, Cape Town. 1982. 20SNA3021a, 10 June 1952.

references Beinart,William 1982 The Political Economy of Pondoland. Cambridge: Cambridge University Press. Bundy, Colin 1979 The Rise and Fall of The South African Peasantry. Berkeley: University of California Press. Curtin, P. O. 1964 The Image of Africa. Madison: University of Wisconsin Press. Dormer, B. A. 1948a Tuberculosis in South Africa. Proceedings of the Transvaal Mine Medical Officers Association, 27 (293):63-73. 1948b A Case of Tuberculosis. South African Medical Journal, 27(297):82-88.7. Dormer, B. A., Frielander,J. and Wiles, F. J. 1943 A South AfricanTeam Looksat Tuberculosis. Proceedings of the TransvaalMine Medical Officers Association. 23(257):1-114. Dubos, Jean and Rene 1982 The White Plague. Boston: LittleBrown and Company. Fendell, N. R. E. 1963 Public Health and Urbanization in Africa. Public Health Reports 78, 7:574. Foucault, Michel 1972 The Archaeology of Knowledge. New York: Pantheon Books. Fox, F. W. and Back, D. 1938 A PreliminarySurvey of the Agriculturaland Nutritional Problems of the Ciskei and Transkein Territorieswith Special Reference to Their Bearing on the Recruitingof Labourersfor the Mining Industry.Johannesburg:Chamber of Mines. Greenberg, Stanley 1987 Legitimatingthe Illegitimate. Berkeley: University of California Press. Jeeves, Alan 1985 MigrantLabourin South African's Mining Economy. Kingston:McGill-Queens University Press. Lyons, M. 1988 The "Civilizing Mission," Economic Development and Sleeping Sickness in Northern Belgian Congo, 1900-1930. Paperpresented to Canadian AfricanStudies Association Meetings, Kingston,Ontario. Marks,Shula and Richard Rathbone 1982 Industrializationand Social Change in South Africa. London: Longmans. Morel, Marie France 1980 City and Country in EighteenthCentury Medical Discussions of EarlyChildhood, Medicine and Society in France. Annales. 6:48-65. Packard,Randall 1987 Tuberculosis and the Development of Industrial Health Policy on the Witwatersrand, 19021932. Journalof Southern African Studies. 13(2):187-209.

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1989 White Plague, Black Labor:Tuberculosis and the Political Economy of Health and Disease in South Africa. Berkeley: University of California Press. Posel, Deborah 1987 The Language of Domination, 1978-1983. In The Politics of Race, Class and Nationalism in Twentieth Century South Africa. S. Marksand S. Trapido (eds.). Longmans: London, pp. 419-444. Retief, Frank 1947 Random Notes and Observations on Tuberculosis. Proceedings of the Transvaal Mine Medical Officers Association. 27(295):21-27. Schneider, J. 1954 Tuberculin Testing and Mass Miniature X-Ray Survey of the Northern and Eastern Transvaal. South African Medical Journal28:689-696. Swanson, Maynard 1977 The Sanitation Syndrome: Bubonic Plague and Urban Segregation in the Cape Colony, 19001909. Journalof African History. 18(3):387-410. Torchia, M. 1977 Tuberculosis Among American Negroes: Medical Research on Racial Disease, 1850-1950. Journal of The History of Medicine and Allied Sciences. 32:278-279. World Health Organization 1982 Apartheid and Health. Geneva: WHO. Yudelman, David and Jeeves, Alan 1986 New LaborFrontiersfor Old: African Migrantsto the South AfricaGold Mines, 1920-1985. Journal of Southern African Studies. 13(1):101-124. Zwille, Helen 1984 Political Power and Poverty: An Examination of the Role and Effect of Influx Control in South Africa. Cape Town: Carnegie Conference Paper 83.

submitted 8 March 1989 accepted 26 June 1989 final version received 12 July 1989

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