Mind, psychoanalysis and science

This collection of papers, like the previous two publications in the series, covers a wide and eclectic range of topics documenting aspects of the development of western medicine in Australia. Such diversity, in methodology as well as content, is not surprising given the open-ended theme and the fact that the conference at which these papers were presented provided a forum for anyone "interested in the history ofmedicine". While this attracted a fairly representative, Australia-wide selection there is no reference to Aboriginal medicine, and contributions tend to cluster between 1850 and 1950, a period when the plant of British medicine was being assiduously nurtured in an unfamiliar environment. Yet there is little hint of re-rooting difficulties or growth differences. Indeed, the theme notwithstanding, many of the papers are descriptive rather than reflective and, although well informed and often full of interest, generally lack a critical dimension. There are exceptions, but the tendency among medical practitioners, (i.e., most of the 24 contributors) to interpret developments largely within the circumscribed parameters of medicine, and to identify with those who have "laboured in the field" is apparent in the several accounts of clinical entities and the marked preference for biography. Clinical subjects include the relationship between sunstroke and insanity, treatment of head injuries, the nosology of trophoblastic tumours, chronic skin ulcers, changing disease patterns in colonial South Australia, and a careful evaluation of cold bath therapy for typhoid fever. Of the medical personalities (only one is a woman-a nurse), several gained distinction through their war-time efforts or an unorthodox clinical approach, and others represent sectors of the profession. Papers dealing with institutions, issues, and ideas, by and large, push beyond descriptive boundaries to explore the interface of medicine and society. The Adelaide Children's Hospital and the Queen Victoria Homes for Consumptives reflect typical institutional developments, and discussion of a compensation case at the turn of the century demonstrates a growing medical dominance and paternalism, both of which are evident in the article on early nursing training in South Australia. Policies excluding mental and contagious diseases from the Ballarat District Hospital in the last century highlight contemporary attitudes and medical knowledge against a background of political and economic expediency, issues which are also raised in relation to the federal government's occupational health initiatives this century. Only one paper probes-most skilfully-the implications of adapting Western medicine to Australian conditions and, apart from an abstract referring to mortality trends in Australia and other Western countries, comparative evaluation is noticeably absent. Considered as a whole, the volume suggests that medical history in Australia continues to be a parochial discipline, a dilettante's pursuit, largely ignored by academic historians as too specialized or of limited consequence in the broader movements of history. There is, however, an encouraging note: the 'Foreword' informs us that the Australian Society of the History of Medicine, inaugurated in November 1986, seeks to develop "critical standards in the field".