In 1652 the Dutch East India Company founded a “refreshment station” in Table Bay on the southwestern coast of Africa for its fleets to and from the East Indies. Within a few years, this outpost developed into a fully-fledged settler colony with a “free-burgher” population who made an existence as grain, wine, and livestock farmers in the interior, or engaged in entrepreneurial activities in Cape Town, the largest settlement in the colony. The corollary of this development was the subjugation of the indigenous Khoikhoi and San inhabitants of the region, and the importation and use of a relatively large slave labor force in the agrarian and urban economies. The colony continued to expand throughout the 18th century due to continued immigration from Europe and the rapid growth of the settler population through natural increase. During that century, about one-third of the colony’s population lived in Cape Town, a cosmopolitan harbor city with a large transient, and overwhelmingly male, population which remained connected with both the Atlantic and Indian Ocean worlds. The unique society and culture that developed at the Cape was influenced by both these worlds. Although in many ways, the managerial superstructure of the Cape was similar to that of a Dutch city, the cosmopolitan and diverse nature of its population meant that a variety of identities and cultures co-existed alongside each other and found expression in a variety of public forms.
Disease control and public health have been key aspects of social and political life in sub-Saharan Africa since time immemorial. With variations across space and time, many societies viewed disease as the result of imbalances in persons and societies and combined the use of materia medica from the natural world, spiritual divination, and community healing to redress these imbalances. While early encounters between African and European healing systems were still marked by mutual exchanges and adaptations, the emergence of European germ theory-based biomedicine and the establishment of racialized colonial states in the 19th century increasingly challenged the value of African therapeutic practices for disease control on the continent. Initially, colonial states focused on preserving the health of European soldiers, administrators, and settlers, who were deemed particularly vulnerable to tropical climate and its diseases. Around 1900, however, they started paying more attention to diseases among Africans, whose health and population growth were now deemed crucial for economic development and the legitimacy of colonial rule. Fueled by new insights and techniques provided by tropical medicine, antisleeping sickness campaigns would be among the first major interventions. After World War I, colonial health services expanded their campaigns against epidemic diseases, but also engaged with broader public health approaches that addressed reproductive problems and the social determinants of both disease and health. Colonial states were not the only providers of biomedical healthcare in colonial Africa. Missionary societies and private companies had their own health services, with particular logics, methods, and focuses. And after 1945, international organizations such as the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) increasingly invested in health campaigns in Africa as well. Moreover, Africans actively participated in colonial disease control, most notably as nurses, midwives, and doctors. Nevertheless, Western biomedicine never gained hegemony in colonial Africa. Many Africans tried to avoid or minimize participation in certain campaigns or continued to utilize the services of local healers and diviners, often in combination with particular biomedical approaches. To what extent colonial disease control impacted on disease incidence and demography is still controversially debated.