For more than a century, McCord Hospital, a partly private and partly state-subsidised mission hospital has provided affordable health-care services, as well as work and professional training opportunities for thousands of people in Durban, a city on the east coast of South Africa. This article focuses on one important aspect of the hospital’s longevity and particular character, or ‘organisational culture’: the ethos of a ‘McCord Family’, integral to which were faith and a commitment to service. While recognising that families – including ‘hospital families’ like that at McCord – are contentious social constructs, with deeply embedded hierarchies and inequalities based on race, class and gender, we also consider however how the notion of ‘a McCord family’ was experienced and shared in complex ways. Indeed, during the twentieth century, this ethos was avidly promoted by the hospital’s founders and managers and by a wide variety of employees and trainees. It also extended to people at a far geographical remove from Durban. Moreover, this ethos became so powerful that many patients felt that it shaped their convalescence experience positively. This article considers how this ‘family ethos’ was constructed and what made it so attractive to this hospital’s staff, trainees and patients. Furthermore, we consider what ‘work’ it did for this mission hospital, especially in promoting bonds of multi-racial unity in the contexts of segregation and apartheid society. More broadly, it suggests that critical histories of the ways in which individuals, hospitals, faith and ‘families’ intersect may be of value for the future of hospitals as well as of interest in their past.

This paper examines the representations and emotions associated with disclosure and stigma in Pietermaritzburg, KwaZulu-Natal, seven years after the start of the South African government’s ARV roll-out programme on the basis of in-depth oral history interviews of HIV-positive support group members. It argues that the wider availability of ARV treatment, the ensuing reduced fatality rate and the increased number of people, including men, who receive counselling and testing, may mean that HIV/AIDS is less stigmatised and that disclosure has become easier. This does not mean that stigma has disappeared and that the confusion created by competing world-views and belief systems has dissipated. Yet the situation of extreme denial and ideological confusion observed, for example, by Deborah Posel and her colleagues in 2003 and 2004 in the Mpumalanga province seems to have lessened. The interviews hint at the possibility that people living with HIV may have, more than a decade before, a language to express the emotions and feelings associated with HIV/AIDS. They were also found to be more assertive in matters of gender relations. These new attitudes would make disclosure easier and stigma more likely to recede.

According to traditional forms of act-consequentialism, an action is right if and only if no other action in the given circumstances would have better consequences. It has been argued that this view does not leave us enough freedom to choose between actions which we intuitively think are morally permissible but not required options. In the first half of this article, I will explain why the previous consequentialist responses to this objection are less than satisfactory. I will then attempt to show that agents have more options on consequentialist grounds than the traditional forms of act-consequentialism acknowledged. This is because having a choice between many permissible options can itself have value.

After its formation in 1910 as a self-governing dominion within the British empire, the Union of South Africa followed a combination of English and Roman-Dutch common laws on abortion that decreed the procedure permissible only when necessary to save a woman’s life. The government continued doing so after South Africa withdrew from the Commonwealth and became a republic in 1961. In 1972 a sensational trial took place in the South African Supreme Court that for weeks placed clandestine abortion on the front pages of the country’s newspapers. Two men, one an eminent doctor and the other a self-taught abortionist, were charged with conspiring to perform illegal abortions on twenty-six white teenagers and young unmarried women. The prosecution of Dr Derk Crichton and James Watts occurred while the National Party government was in the process of drafting abortion legislation and was perceived by legal experts as another test of the judiciary’s stance on the common law on abortion. The trial was mainly intended to regulate the medical profession and ensure doctors ceased helping young white women evade their ‘duty’ to procreate within marriage. Ultimately, the event encapsulated a great deal about elites’ attempt to buttress apartheid culture and is significant for, among other reasons, contributing to the production of South Africa’s extremely restrictive Abortion and Sterilisation Act (1975).

Recent scholarship has explored the dynamics between families and colonial lunatic asylums in the late nineteenth century, where families actively participated in the processes of custodial care, committal, treatment and release of their relatives. This paper works in this historical field, but with some methodological and theoretical differences. The Foucauldian study is anchored to a single case and family as an illness narrative that moves cross-referentially between bureaucratic state archival material, psychiatric case records, and intergenerational family-storytelling and family photographs. Following headaches and seizures, Harry Walter Wilbraham was medically boarded from his position as Postmaster in the Cape of Good Hope Colony of South Africa with a ‘permanent disease of the brain’, and was committed to the Grahamstown Asylum in 1910, where he died the following year, aged 40 years. In contrast to writings about colonial asylums that usually describe several patient cases and thematic patterns in archival material over time and place, this study’s genealogical lens examines one white settler male patient’s experiences within mental health care in South Africa between 1908 and 1911. The construction of Harry’s ‘case’ interweaves archival sources and reminiscences inside and outside the asylum, and places it within psychiatric discourse of the time, and family dynamics in the years that followed. Thus, this case study maps the constitution of ‘patient’ and ‘family’ in colonial life, c.1888–1918, and considers the calamity, uncertainty, stigma and silences of mental illness.

This article describes the role of transnational anti-apartheid activism in South Africa, Britain and the United States in generating international moral outrage over the readmission of the Medical Association of South Africa (MASA) to the World Medical Association (WMA), which had taken place in 1981 after it had withdrawn from that body in 1976. It discusses an example of a controversy where an international health organisation (IHO) lost moral authority as a result of being accused of white supremacy and a pro-American engagement in Cold War politics. At the time of its readmission to the WMA, the MASA was controversial because of its failure to strike off its membership roll one of the doctors implicated the death in detention of Black Consciousness leader Steve Biko in 1977. It details how these activists viewed the American Medical Association as having campaigned for the MASA’s readmission. The WMA’s readmission of the MASA cost the former its relationships with the World Health Organisation (WHO) and the British Medical Association – a dispute which continued until South Africa’s democratic transition of 1994. With its focus on transnational activism in relation to the WMA and the effects of activists’ allegations of racism on its internal politics, this article contributes to the literature on the history of IHOs. Ultimately, this controversy shows the deficiency of international medical professional associations as ethical arbitrators of last resort.

According to act-consequentialism the right action is the one that produces the best results as judged from an impersonal perspective. Some claim that this requirement is unreasonably demanding and therefore consequentialism is unacceptable as a moral theory. The article breaks with dominant trends in discussing this so-called Overdemandingness Objection. Instead of focusing on theoretical responses, it empirically investigates whether there exists a widely shared intuition that consequentialist demands are unreasonable. This discussion takes the form of examining what people think about the normative significance of consequentialist requirements. In two experiments, the article finds that although people are sensitive to consequentialist requirements and, on average, find more extreme demands less reasonable, the level of disagreement with consequentialism falls short of qualifying as a widely shared intuition, even when demands are the highest. The article then ends with a general discussion of possible objections to its methods and its findings.

This article examines the rise of an irrigation economy in Hetao along the Yellow River during the nineteenth century, and uses it as a case study to illustrate how the periphery played a major and hitherto overlooked role in the development of the Chinese economy, which confounds the conventional view of a Chinese path of development that replicated smallholder farming. I focus on a group of Han entrepreneurs known as land merchants (dishang) who combined capital and expertise in irrigation development, and introduced a new set of property regime and socio-technical arrangements that fundamentally changed the frontier society. By linking the changes in local society to regional and global processes, this study demonstrates the centrality of the periphery as not only a zone of possibility and experimentation, but more importantly, a “contact zone” that facilitated China's integration into a new global market system.

This article recounts the legal proceedings against those Puritan activists who challenged the government of Charles I in the 1630s. It demonstrates that most of our knowledge of these events has come from the highly colored accounts written by the defendants themselves. Closer examination demonstrates that Leighton, Prynne, Bastwick, Burton, and Lilburne set out to challenge the government, first by writing incendiary tracts about religion and then by refusing to recognize the jurisdiction of the courts into which they were brought. While they saw their causes as cases of conscience, Caroline officials saw them as attacks upon the legal and political system. They were convicted in formal legal proceedings, and while the penalties they received appear barbaric to our sensibilities, they were typical in such cases.

Early modern London burned quantities of dirty coal that were unparalleled anywhere in Europe before industrialization, and the consequent smoky air was a matter of more serious and sustained concern than has been appreciated by either early modern or environmental historians. During the 1620s and 1630s, King Charles I and his government sought to remove smoky industries, above all large brewhouses, from the vicinity of the court in Westminster. This was part of a broader campaign for order and beauty that has been described by other scholars, but a focus on smoke highlights the very partial successes achieved by attempts to reform the real spaces of royal government. The improvement of Westminster's air during Charles's personal rule displays an early modern variety of environmental concern that was expressed through courtly display, hierarchy, distinction, and exclusion.