162 BOOKREVIEWS employing Nepalese nurses for immoral purposes (p. 50). The Scalpel and The Kukri is Pitt's second book- to 'complete my narrative'(p. 13)- about his and his family's life in Nepal; it very much follows the same format as A Surgeon in Nepal (London: John Murray, 1970). An epilogue, however, records the drama near the end of British presence in Dharan, when in 1988 a powerful earthquakerocked the region and the hospital became a majorcentre for relief efforts. As in the earlier book, the realistic and detailed illustrations by George Douglas from Darjeeling are a highlight. An extensive glossary also aids the non-medical reader. Although the style is at times abrupt, the book will appeal to readers who would like to know more about medical practice and living in a country such as Nepal or who themselves have lived and worked in similar situations, whether in the 1960s or more recently. 1 smiled in recognition as I readabout the luggage and the tape recorderon the family's arrival in Nepal. SUSAN HEYDON UNIVERSITY OF OTAGO Joseph Melling and Bill Forsythe, The Politics of Madness: The State, Insanity and Society in England, 1845-1914 (London and New York: Routledge, 2006). ISBN10: 0-415-30174-2; ISBN13: 978-0-415-30174-9. Hardback, 278pp. A substantial cache of primary source data from more than one psychiatric institution forms the basis of this study of insanity in England between the 1840s and the beginning of World War I. Placed within a wider historiographical context, the institutional records from the Devon County Pauper Lunatic Asylum at Exminster, records of patient admissions to a smaller, fee-paying institution, Wonford House, and the patient admissions for two borough asylums in Devon, allow Melling and Forsythe to undertake a study of the 'politics' of mental breakdown in the period. Their themes in specific chapters include the administration of lunacy; treatment and care; admissions; community and family; gender and domesticity; patient backgrounds and class; and the patient experience. Health& History • 10/1 • 2008 163 In a final chapter the authors reflect on the 'remaking' of the institutional landscape in the twentieth century. This is an impressive volume, not least because it seeks to address a range of issues in one over-arching narrative of asylums and their social, political and cultural context. The authors introduce the complex debates surrounding the now extensive scholarship in the field of the asylum studies in a compact but detailed argument which situates their study. In seeking to understand the institution's role during the period, they set out to question previous assumptions, both scholarly and general, about a range of issues. In particular,the authors appear concerned to challenge leading scholar in the field, Andrew Scull, whose work is critiqued throughout the book. Here, Melling and Forsythe disagree that institutions imposed 'a hegemonic model of treatment'in specific places, and suggest instead that'the identities of class, gender andethnicity (or race) were negotiated via the rules of the asylum' (p. 6). Australian and New Zealand readers of this book will find much to interest them, and many useful points of comparison with colonial psychiatric institutions in the same period. For instance, no Poor Law operated in the colonies, but as Melling and Forsythe suggest, the English institutions were progressively adopting what might be called a mixed-economy of asylum care over the nineteenth century; some families of inmates of public asylums were able to pay a small amount towards their maintenance, as happened in the colonies. A chapterabout patient 'journeys' to the institutions in Devon also comments on migration, family networks and social change, and allows the authors to examine the demographic data in their extensive sample of cases. A similar approach to colonial patient populations is overdue. How friends and families coped with institutional committal is the subject of another chapter, and it too offers much to the scholarly field in different partsof the world. One of the key shifts in the literature around the histories of institutional committal has been a focus on patients and their 'experiences,' insofaras these can be discovered. Inthis volume, which draws heavily upon statistical methods and provides rich insights into large...
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Oct 25, 2023
J. Pedro Lorente 
