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Alistair and Jack Woodward. Photo/Adrian Malloch/Listener

'That was the way it was': Inside New Zealand's shocking medical history

Eighty years ago, fatty foods were actually thought to be good for you, heavy smoking was the norm and avoiding serious illness was more about good luck than good medicine.

By the time Jack Woodward started high school in 1939, he’d dodged an epidemic of polio and outbreaks of diphtheria and typhoid. He’d beaten scarlet fever, measles, mumps and chicken pox and lost much of his tooth enamel to the slow grind of the foot-powered drill at the dental clinic in the local Plunket rooms in Ōhākune. Of his childhood, he says, “We survived.”

He and his seven siblings had good luck, good genes and a good GP. Dr Jordan delivered the babies, operated on mothers and children and anaesthetised them when the dentist pulled their teeth. The glasses that remedied Woodward’s astigmatism came from the local chemist, as did the grease-like goo “Blackjack” they used to draw out pus and splinters, the antiphlogistine poultices they applied to strains and sprains and the Buckley’s Canadiol Mixture and Baxter’s Lung Preserver for coughs. “Baxter’s was high in alcohol and raspberry and the kids loved it. We used to call it Baxter’s Lung Remover.” They wouldn’t get penicillin until after the war. Woodward reckons he saved all his serious illnesses – polymyalgia in 1992, septicaemia in 2002 and non-Hodgkin lymphoma in 2011 – for an era when there were cures for them.

By the war years, it was already too late for most of his teeth. Fluoridation was 20 years away and in Ōhākune in the 1930s and 40s, they relied on rainwater, anyway. It spelt dental doom when combined with the sugary cakes and biscuits that filled the kitchen tins. “We always had sugar in tea, and I still do. I thought, I’ve been poisoning myself for 90 years, it’s too late to stop.” Pre-war cookbooks even recommended butter in cakes and puddings, and cakes filled with cream, as important dietary sources of vitamins A and D, before Ancel Keys definitively linked saturated fat with cardiovascular disease in 1955

 Smokers’ delight

Mr Relph, driving a dray pulling a two-wheeled cart, delivered the family’s milk each day. “He had a quart and pint dipper and you’d go out and he’d fill your billy can.” By 1940, it was delivered in bottles by Mr Drayton. “The first one to the bottle would get the cream.”

Milk and meat was stored in the safe – a cupboard cut into the wall on the south side of the house with a mesh wall exposed to the outside air – because there wasn’t a fridge. You could cool the temperatures still further with the aid of a wet sack. Woodward’s dad, an electrical engineer, was a two-packet-a-day smoker, as were all his workmates, but he made it to the age of 86, when he died of a heart attack. “We were in smoke all the time – no one thought anything amiss about smokers.”

Other than that, Woodward says, “my family was pretty enlightened. Mum or Dad would be horrified that people might think we lived in relatively unsanitary conditions, but we had weekly baths and often the boys shared the water. That would be looked on with horror now, but that was the way it was.”

Ōhākune had neither a town water supply nor sewage system, and although the family had a septic tank, it often malfunctioned. They used an outdoor privy. The can was emptied weekly by the night-soil contractor who’d arrive with his cart to collect it. “If he didn’t arrive soon enough, Dad had to dig a hole and empty it.”

He remembers their single-storey scrim-lined weatherboard home as “very cold”, even though they didn’t have to pay for the electricity that powered their heater thanks to their dad’s job with the council

Jack Woodward, centre, with his father, Frank, and siblings Alan, left, and Lou. Photo/Woodward family collection/Supplied

Bureaucratic blindness

The year 1939 was notable not only for the outbreak of World War II and the birth of the Listener. The Labour Government had just introduced the Social Security Act 1938, with the intent of enshrining healthcare as a fundamental right of all New Zealanders and removing financial-access barriers to treatment. It was also the last time New Zealand’s health statistics – for non-Māori at least – led the world. As the then Department of Health’s annual report noted in presenting the country’s birth and death rates and disease incidence under “Vital Statistics”, the reported numbers were “Exclusive of Maoris”. This bureaucratic blindness was one of the reasons New Zealand’s (non-Māori) population boasted the lowest mortality in the world for roughly 70 years, until 1940.

The annual reports of that era lay out the government’s health priorities. In 1940’s report, there are seven and a half lines on cancer and six on hydatids. Venereal disease has 22, diphtheria 18, and tuberculosis (TB) commands a page and a half. It was a time, says Woodward’s son, Alistair, a public-health physician and professor of epidemiology and biostatistics at the University of Auckland, when the health system was still focused on infectious disease rather than cancer, even though, for non-Māori, cancer and heart disease had already overtaken infections as the most common causes of death.

“Hydatids were something you were worried about, but we didn’t talk about cancer,” says Jack Woodward. “When I was growing up, people didn’t dare think they might have contracted cancer, because if it was discovered, it was so feared.” Many cancer deaths may have been listed under other causes, says Alistair. “A lot of cases were picked up very late and people died of a combination of things. The death records often talked about consumption – just wasting away.” Diagnosis was usually by sight – large, visible masses with treatment usually restricted to surgery and “brutal” radiotherapy.

Dementia, too, was alluded to but rarely spoken of. “My wife used to talk about her ‘silly old aunts’,” says Woodward. “They were obviously suffering dementia, but it wasn’t talked about. Now it’s a big deal and we know it’s so much more complicated.”

Another big change has been in attitudes towards fathers being involved during the delivery of their children. “When one of my younger siblings was born, I remember going up to the hospital with Dad and he held me up on the road outside so I could look through the window into the room to see my mother and the baby. He could visit, but at what stage he was allowed to hold the baby, I don’t know. It wasn’t something that suited hospital routines.”

When Woodward’s wife, Mary, went into labour with Alistair, their first child, in 1953, “I got a taxi and rushed her to hospital in Christchurch; the nurses came and quickly took her away and told me to go home. Fathers couldn’t be there when they gave birth. You couldn’t hold the baby. If I can point to something that’s changed, it’s the naturalness of having family members present during and after birth.

Alistair, Frank jr, Mary, Matthew, Jack and Rebecca Woodward. Photo/Woodward family collection/Supplied

Shut down

Vaccines for polio and measles weren’t introduced until the 1950s and 60s and immunisation campaigns for diseases such as diphtheria were haphazard at best, apparently led by enthusiastic local doctors rather than the Department of Health at a national level. Says the 1940 annual report, of 1939’s 517 cases of diphtheria and 24 deaths: “Viewed purely as an economic proposition, the wholesale immunisation of young children would seem to be well worthwhile.”

Woodward remembers the polio epidemic of 1937, which killed 39. “It shut down the whole country and movement was restricted. People travelling through the country had to declare themselves to the Health Department and anything that brought people together, where you could transmit the infection, was shut down.” His family escaped both polio and TB, but he and three siblings had scarlet fever, including his little sister, Dorothy, who was kept in isolation at the fever ward at Taihape Hospital for a month. Another sister developed rheumatic fever and still has heart problems as a result. “Strep throats were common, and I just wonder if scarlet fever wasn’t endemic in the community.”

Invisible Māori

In Ōpunake in the 1930s and 40s, the local Māori population was all but invisible to the Woodwards. “There were a significant number of Māori kids in the earlier classes at school, but as you moved up in years, they dropped out and by the time you got to high school, there were only a handful. The families were very deprived. Their living conditions were considerably poorer than Pākehās. Now, at Ōhākune, you talk about the marae and it’s a well-established place. When I was a kid, you talked about the Māori pa, but I don’t think Pākehā kids ever went there. At the movie theatre, the Māori kids and adults would generally congregate at the front downstairs; there wasn’t any rule about it, that’s just what they did.”

Although Pākehā with TB were admitted to sanitoriums, Māori, whose death rate from the disease was estimated to be 10 times higher, were segregated in shanty-like “hutments” in their own communities. Asked if that was the result of racism or choice, Alistair Woodward believes it’s the latter. “In some ways that made sense; at least in the earlier days, being admitted to hospital was a very foreign place. Understandably, it was not somewhere they felt at ease or secure.”

In The Healthy Country – a History of Life and Death in New Zealand (2014), he and his co-author, University of Otago epidemiologist Tony Blakely, say they were prompted to write the book because of the observation that New Zealand non-Māori had the lowest mortality in the world in the early 1900s. The likely reasons included the exclusion (and exploitation) of Māori, a wealth of natural resources locally, health-selection of migrants and the lack of the crowd-and industry-related pressures that stalled Europe’s mortality decline. “The non-Māori population of New Zealand was so far ahead of the rest of the world in the middle of the 19th century that it took everyone else 80 years to catch up. The experience of Māori in New Zealand was different, and illustrates [that] in mortality studies, as in the rest of life, there is no such thing as a free lunch.”

Institutional racism

Crown decisions made decades ago still affect Māori health today, the Waitangi Tribunal’s Health Services and Outcomes Inquiry has heard. In 2018, the Wai 1315 and Wai 2687 claims over Māori health opened at Tūrangawaewae Marae – a significant venue given Princess Te Puea Hērangi’s thwarted attempts to establish a Māori hospital in the Māhinārangi meeting house, built at the marae in 1929. She wanted Māhinārangi to be a Māori environment, observing the rules of tapu, while providing European medical care. Te Puea cared for the sick and dying at the marae during the flu pandemic in late 1918.

Sir Āpirana Ngata helped Te Puea get government money and timber for the building, and his iwi, Ngāti Porou, contributed £1300 to the cost, but health officials refused to allow it to be used as a hospital.

The ramifications of this decision, and many others, continue to affect Māori health, Wai 1315 claimant Lady Tureiti Moxon, managing director of Waikato health provider Te Kōhau Health, told the hearings.

“Currently, Māori live shorter lives by seven years compared with others; Māori are twice as likely to face discrimination in health; Māori are less likely to be referred for diagnostic tests; Māori children are more than two and a half times more likely to have unfilled prescriptions due to cost and more than twice as likely to die from preventable diseases.”

Nine key health advances – 1939-2019

  • Improvements in housing conditions and water supply (1940s and 50s). In 1938, a survey of Māori housing in South Auckland found 80% didn’t have a safe water supply and 60% had no sanitary facilities.
  • Introduction of antibiotics such as penicillin post-World War II, and better infection control in hospitals.
  • Dietary changes – recognition of the heart-disease risks of saturated fat, introduction of frozen fresh vegetables and refrigeration, which reduced the use of salt as a preservative.
  • Medical interventions – statins, blood-thinning and blood-pressure-lowering drugs for heart disease; chemotherapy and immunotherapy for cancer treatment, and oral-rehydration solutions to treat infant diarrhoea.
  • Advances in imaging to diagnose diseases, and organised screening campaigns.
  • Tobacco control, including anti-smoking campaigns, taxation and smoke-free environments, from the late 1960s.
  • Immunisation – vaccines for polio were introduced in the 1950s and measles in the 1960s.
  • Fluoridated water supplies.
  • Oral contraceptives.

Source: Alistair Woodward

This article was first published in the August 10, 2019 issue of the New Zealand Listener.