Framing disease: studies in cultural history

The New Zealand essays are less focused and assured than those in the MacLeod-Denoon collection. They are centred on the development of the health professions, hospitals, public health policies and womens' health. There is, unfortunately, no introductory overview of New Zealand as "a healthy country" which might set the various contributions in context. The strongest papers are those by Derek Dow and Linda Bryder. Dr Dow analyses the impact on the charity hospitals of antisepsis and the new procedures and facilities it entailed. One major change was the incursion of middle-class patients to pay-bed wards attracted by the new curative possibilities. Their arrival coincided with the hospital boards' needs to raise extra money for the additional nurses and capital works, not least separate wards for middle-class patients. The old charity-based hospital system was doomed. This complicated process in New Zealand matches developments in the United Kingdom and elsewhere, but Dr Dow's account is a notably clear case study. Dr Bryder's chapter on tuberculosis is authoritative and wide-ranging. Her discussion of sanatoria is particularly informative. But she has been constrained for space: occasionally she mentions issues, such as the Maori interest in 1938 in BCG vaccination and medical opposition to its introduction, without providing the necessary detail or explaining the outcome. Other essays in the volume are under-researched and a couple belong to that wasteful class which list problems for research with no indication that any work is being done. Pertinent issues are casually raised and casually dropped. The author of the essay on the school medical service notes that parents were suspicious of doctors but does not tell us why and in what circumstances. More importantly, given the title of the collection, we are not told about the general condition of the children's health over time, by region, or by race. The paper on women's health provides better information on male ill-health than on the health of females and is generally muddled. The author says that admission rates for mental hospitals were higher for males than for females, echoing the differential rates for general hospitals. This disparity could shed much light on "a healthy country", but the essay has been narrowly conceived and the opportunity missed.