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During the last quarter of the 19th century 4 new mental hospitals were opened in the Cape Province. These were all formerly gaols or military barracks. In 1922 the first specially designed mental hospital was opened at Queenstown. The development of psychiatry at the Universities of Cape Town and Stellenbosch is described.

The only mental hospital in the Orange Free State is the Oranje Hospital, opened by the Republican government in 1884, after mental patients had been detained in a rented house for a number of years. It has grown into a large institution, housing over 1 600 patients. The professor of psychiatry at the University of the Orange Free State is now the clinical head of the hospital.