This is an ambitious but unsatisfying attempt at a grand, complex historical synthesis of South African cultural practice. The book aims to examine ‘the interactions between colonial or “western” medicine, missionary medicine, and indigenous healing’ (p. 27). It has five main sections: the epistemological challenges of this topic; the Cape Province in the nineteenth century; histories of doctors, nurses, missionaries, and indigenous healers; medical pluralism by practitioners and patients; and finally a brief review of challenges faced by the new South African government, including HIV/AIDS policy. In promising an innovative contribution to the crucial and contested history of South African health care, bringing together medical histories across racial and conceptual divides, the reach of Diversity and Division far exceeds its grasp.

A major structural flaw lies in the separation of missionary from ‘Western’ medicine. The section on missionary medicine (based on research in an impressive set of archives) is detailed and fairly comprehensive on Cape missions in the nineteenth century, although the voices of African patients and mission station tenants are conspicuously missing. Missionary medicine was at best an intriguing blend of allopathic treatment and faith healing, and at worst a manipulative and hypocritical exercise. Yet Digby does not integrate her description of these efforts into a political economy of settlement and colonialism, oddly walling off the missionaries in the book's structure as if their ‘civilizing’ efforts were outside the larger colonial paradigm (which is discussed in later chapters). The spiritual elements of missionary healing are not compared to the spiritual elements of indigenous healing, which is curious in a book that promises a new kind of synthesis of the material on medical practices. Rather, Western Christian spirituality is conceptualized as modern religion (even after the passage of 2,000 years), while African spirituality is referred to as ‘witchcraft’.

The central failure of the book lies in its inability to adequately historicize non-Western medical practice in the South African context. This failure poses, yet again, the eternal methodological question of how to write histories of indigenous practices where there are, supposedly, few written sources. Digby is not unaware of this problem; she states that European observers of indigenous medical practices were ‘rarely well-informed’ and that she used ‘alternative strategic approaches’ to mobilize perspectives and data from other sources: evidence from material culture and oral history (p. 27). The book repeatedly asserts that it will avoid stereotypically patronizing approaches that label indigenous cultures as ‘static’ (pp. 278–9). Here, however, the language barrier looms large; reference is made to one interview conducted with the help of an interpreter, and the attendant difficulties (p. 28). The small number of indigenous healers interviewed, presumably in English, seems inadequate to the task. In addition, there are no sources listed in the bibliography in languages other than English and French. Helen Bradford's recent article, which re-situates nineteenth-century South African history based on overlooked Xhosa-language sources, is extremely apposite here.Footnote ¹ There could well be texts in indigenous languages (some of which might even be creative/literary works) that would help us to better understand change and continuity in indigenous medical practices. Other opportunities are also lost: Mamphela Ramphele's tales of her upbringing on a mission station, medical training, political involvement, and the decision to establish a progressive clinic are boiled down to one quotation reflecting on a set of unsanitary local practices (p. 362). If African voices and memories of their medical experiences and interactions had been a priority for the author, she could have drawn on rich material in the autobiographical accounts of people such as Ramphele, Ellen Kuzwayo, Winnie Mandela, Katie Makanya, and others. Without such perspectives, official documents and sources continue to create a one-sided view.

The strongest sections of the book deal with more conventional histories of Western medical practice. The chapters on nursing and on pluralism in medical choice and practice, and the short section on post-1994 policy on traditional healing, are interesting. Later parts of the book on the apartheid period, which have more of a political economy flavor, almost work up some analytical momentum. But even so there is no mention of the extreme medical experimentation of the South African state, such as the army's ‘medical’ treatment of gay soldiers or the complete abdication of medical ethics involved in the Nazi-like exercises of state doctors (such as the cardiologist Wouter Basson, allegedly) involved in poisoning and biological warfare projects aimed at the liberation movements. An account appears of the despicable dereliction of the government doctors who allowed Steve Biko's torture and death to proceed in 1977, but it presents nothing new.

Researchers and students 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.