Henry Wellcome. The man, his collection and his legacy

studies, that "illness" as well as "disease" should be understood, and this within a holistic perspective of all the forms of therapy available within the "health care system" of a culture. Yet the empirical research embodied in this book is fascinating and important. Over the better part of a decade, Dr. Kleinman did field-work in Taiwan, investigating, from the point of view of the patient as well as the doctor, the pyramid of medical services available. These ranged upwards (in prestige) from self-medication within the family to shamans (tang-ki's) operating through divination, ch'ien oracles, orthodox Chinese-style medicine, and finally Western medicine, with many intermediary forms (e.g. traditional bone-setters and herbalists). Since Taiwan has no state health service, and permits effective laissez-faire in medical practice and the sale of medicines, each group of doctors had made a niche for itself in treating particular types of patients and conditions, and patients were found to have made shrewd choices as to which kinds of physicians to consult. The sick often visit more than one kind of practitioner e.g. going to a Western doctor for a shot of antibiotics but also to a ch'ien oracle to have their fate explained. Similarly, healers often pass patients on to other kinds of doctors thus shamans, adept at handling "psychosomatic" complaints, will pass tuberculosis cases on to Western physicians. Dr. Kleinman details the cultural contours well. Western doctors' "magic bullet" approach carries high prestige (and is expensive) yet is also expected to work almost instantly and infallibly and thus creates high dissatisfaction when it fails. By contrast, the holistic ritually based therapy of the tang-ki is often adjudged successful amongst the generally poorer people who attend the shrines even when disease symptoms show little improvement. Dr. Kleinman documents these dimensions, using extensive case-studies, against a background of basic health assumptions in Taiwan e.g. that medical interventions ought to be family-based, public affairs, rather than private doctor-patient consultations, or that mental illness is shameful, leading to a "somatization" of mental disturbances. Dr. Kleinman's book opens up major questions concerning the cultural determination of illness, and choice in diagnosis and therapy in a society where a multiplicity of treatments is readily available. His data will prove invaluable in assessing these issues. Roy Porter Wellcome Institute