Story: Primary health care
Page 1 – Early primary health care, mid-19th century
Primary health care is professional health care received in the community, and is usually delivered by a general practitioner (GP), practice or district nurse. It is the first port of call for most people with health issues, who may then be referred to hospital and specialist services by their GP.
A healthy country?
In the mid-19th century life expectancy was higher for Pākehā in New Zealand than for people in Britain. Immigration guides advised doctors to come to New Zealand for the benefit of their own health, but warned them that the population was too healthy to need many more medical practitioners.
However, infectious diseases were still major killers, and Māori had lower immunity to introduced diseases than Europeans did. The Māori population plummeted in the mid-19th century and only started to recover in the 1890s.
Vaccination provided protection from smallpox, but the causes of diseases such as tuberculosis, typhoid, poliomyelitis and diphtheria were poorly understood, and there were no effective medicines to treat them. Divine causes of illness were as likely to be accepted as scientific explanations, by Māori and non-Māori alike.
Jack of all medicines
Cod liver oil was used to treat a range of conditions. Dr de Jongh’s oil, which was advertised in the Otago Daily Times in 1864, was grandly described as ‘the safest, speediest and most effective remedy for consumption, chronic bronchitis, asthma, coughs, rheumatism, general debility, diseases of the skin, rickets, infantile wasting, and all scrofulous affections’.1
For much of the 19th century, primary health care for most people was a combination of folk and patent medicines and the occasional doctor’s visit. The vast majority of doctors were male. Midwifery was undertaken by women whose skills were recognised in the community, as well as by medical practitioners. Women provided informal health care to their families and to other women and children during times of illness. Families also diagnosed and treated themselves. Doctors’ scientific claims were based as much on their educational and social status as their ability to cure. They were primarily called to ease the pain of the dying, and during other crises such as accidents, which were an everyday reality in unsafe workplaces.
The rich used doctors more frequently. Elite doctors treated the wealthy in their own homes, but many doctors were more like pharmacists, making much of their income from dispensing medicines, rather than consultations. Most doctors were general practitioners, even if they worked in hospitals. Some doctors whose income was derived from general practice also had honorary positions in hospitals, where they worked for free.
In June 1890 the Thames Star newspaper printed a joke about homeopathy, based on the fundamental homeopathic principle of like curing like – meaning that substances that cause particular reactions in a healthy person will relieve the same symptoms in a sick person. The joke went:
‘I don’t believe that like cures like.’
‘Can you disprove it?’
‘I can. A piece of my wife’s mind is not good for my peace of mind.’2
Health care was divided into conflicting camps of orthodox medical practitioners and alternative practitioners. In the mid-19th century the orthodox majority competed with a range of different practitioners. Most prominent of these were homeopaths, who were popular because of their gentler treatments. Because medical education was not standarised, alternative practitioners could claim respectable professional qualifications.
Māori health care
Māori continued to use a mixture of natural medicines and spiritual healing, but were increasingly interested in European medicines and health care. In the 1840s missionaries dispensed large amounts of medicines imported from New South Wales, including massive doses of cod liver oil, to Māori.
Medical practitioners in some areas were paid a subsidy by the colonial government to treat Māori free of charge. From 1867 Māori schools were established and children were taught about European principles of healthy living, such as hand washing.
The first Māori were trained in European health care at the beginning of the 20th century, including doctors Māui Pōmare and Peter Buck (Te Rangi Hīroa) and nurse Ākenei Hei. They encouraged hygiene and improved sanitation, and were concerned with transforming community standards rather than individual health needs.