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The Municipality of Murraysburg was constituted on 10 March 1860 in terms of Proclamation No 16 of 1860 under provision of Ordinance No 9 of 1836.

In terms of the Local Government Transition Act, 1993 (Act 209 of 1993) the local government bodies in the Murraysburg Forum Area, namely the Municipality of Murraysburg and the Management Committee of Murraysburg, was dissolved and a transitional local council under the name “Municipality of Murraysburg” was established (Province of Western Cape Provincial Gazette Extraordinary No 4885, 21 October 1994, Proclamation No 65, 5 October 1994).

In terms of the Local Government: Municipal Structures Act, 1998 (Act 117 of 1998) the existing Municipality of Murraysburg together with other municipalities was disestablished and the Beaufort West Local Municipality established (Province of Western Cape Provincial Gazette Extraordinary No 5593, 22 September 2000, Provincial Notice No 508, 22 September 2000). The Beaufort West Local Municipality forms part of the larger Central Karoo District Municipality.

In 1855 a municipal sub-committee recommended the erection of a hospital in Port Elizabeth and thus a Provincial Committee for the Management of the Port Elizabeth Provincial Hospital came into being to guide its establishment in November 1855. While the building of the hospital was being undertaken, a temporary hospital was opened on 10 September 1856.

In 1856, Act No 5 for Regulating the Provincial Hospital at Port Elizabeth (CCP 6/2/1/1) was passed, which vested all control of the institution in a Board of Managers.

The completed hospital building was occupied in 1859 and the temporary hospital closed. By 1900 the need for a new hospital was realized and the foundation stone of this hospital was laid in 1912.

In terms of Ordinance No 5 of 1912 (Province of the Cape of Good Hope Official Gazette No 218, 27 January 1912), Hospital Districts were created in Divisional Council areas. Hospital Boards, named after the division or town in which the main hospital was situated, were constituted to control and manage all institutions under and created by them.

The Alexandra Institution for the Feebleminded was opened in 1921. It was situated on what was formerly the Nieuwe Molen Estate.

It was decided to erect a hospital on the site to replace the Old Somerset Hospital, and the foundation stone was laid on I3 January 1906 by HRH the Duke of Connaught. Owing to the delays that seem inevitable in the construction of any public building, it was not until 1914 that the buildings were ready for occupation. By that time, the First World War had broken out, and so it was taken over as a military hospital. After the war, the Government decided to open it as South Africa's first institution for mental defectives. Patients were admitted in July 1921.

The first group came from Valkenberg and the Pretoria Mental Hospital, and by September they numbered 153 (all of whom were white females). By the end of the year, the numbers had increased to 245, of whom 92 were males. It had its share of teething troubles, many of which arose because the buildings had not been constructed to house defectives; for example, the admission of males was considerably delayed because the doors had no locks. Despite such handicaps, the development of the institution progressed well, and the numbers of patients and staff increased rapidly. Owing to ignorance of the scope and purpose of the institution, many unsuitable patients were sent there in the early days and had to be returned to tile hospitals from which they had come.

One of the first developments was the opening of a school for the younger defectives. Specially trained teachers from abroad were engaged, and special emphasis was laid on the development of muscular co-ordination and manual skills, rather than on scholastic attainment. There was an early institution of occupational therapy for both sexes, and this was highly developed over the years. Among the activities available for males were boot making, tailoring, painting, upholstery, woodwork, building, and plumbing. The females did laundry, sew, and fancy-work.

A development from 1947 was that the high-grade defectives now did paid work for outside firms. It began with rug-fringing, but in 1949 patients began to make bags for a tobacco firm; they earned 4 shillings for 1 000 bags.

When the institution was opened in 1921, Dr HC Watson was the first medical superintendent. Dr Watson was succeeded in 1923 by Dr RA Forster, who remained in charge until 1940. In addition to its medical staff, it had several psychologists, and several graduate students in psychology, from the University of Cape Town were doing research and practical work there.