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The first hospitals in New Zealand catered only for patients in their immediate vicinity. With the creation of hospital districts by the 1885 Act, boards had the responsibility for patients from anywhere within their districts, but they did not graciously accept patients from outside their boundaries. This was because ratepayers of each district financed their own hospital and did not take kindly to paying for patients from 'over the border.' This question of boundaries was a bugbear for many years and militated against overall planning for closer co-operation between, and integration of, hospitals. In 1939 the situation changed with the introduction of hospital benefit payments under the Social Security Act 1938. Up until then patients had to pay for hospital treatment, but the Act thrust this burden on local government (the ratepayer) and central government (the taxpayer). In 1958 hospital income from local rates was abolished and the Government became responsible for all public hospital finance. The base hospital frequently takes patients from Stratford and Hawera for specialised treatment. Throughout the greater part of its long history the hospital in New Plymouth has been a 'closed' hospital; that is to say the medical staff are full-time salaried officers of the board.
However, there have been (and still are) many senior specialists appointed as part-time officers who are also engaged in private practice. Under this system, once a patient has been admitted, his treatment is the responsibility of the medical staff, and although the private doctor can consult specialists and visit his patient, he cannot treat him. Part-time specialists include surgeons, radiologists, ophthalmists, obstetricians, anaesthetists and other ex- perts in various medical disciplines. Senior hospital appointments have generally been chosen from private practitioners. Following Dr P. Wilson's death in 1863, DrT. E. Rawson was appointed 'Provincial Superintendent' and in 1878 his place was taken by Patrick Joseph Felix Valentine O'Neill O'Carroll, who had come to New Plymouth as a young man in charge of the health of the local troops in 1865. He was a colourful figure: 'a sociable extrovert with a truly Irish wit; a skilful surgeon and a physician with a warmly human touch, he deserved the esteem he gained so quickly;" His role was taken over by Dr H. B. Leatham in 1897, who served the hospital and the community for 53 years. As were all his contemporaries, Leatham was a skilled horseman, but in 1902 when he imported the first petrol-driven motor car to Taranaki, this became 'the terror of all the horses for miles around.' But horses held terrors of their own. One of Leatham's contemporaries was Dr T. H. A. Valentine, who for nine years from 1891 was in private practice in the Inglewood area and was also on the hospital's honorary medical staff. He later became Director-General of Health, a position he held until he resigned in 1930. In an obituary tribute in the New Zealand Medical Journal in 1945, a colleague, Dr G. Home (himself a consulting surgeon for many years) wrote: 'Dr Valentine was an excellent horseman, so his qualities of physical vigour, energy and sympathy frequently took him on long and difficult journeys as a bringer of medical and surgical help at the age of 29 a very serious accident befell him-a screwing crush of his leg which damaged the popliteal artery and his limb had to come off at the knee joint. In spite of this he was soon about again with an artificial limb on those long-distance backblock rides of professional service ... ' Valintine retained great affection for Taranaki, and in later years he joked that he had left part of himself in the province: In 1930, at a ceremony in the New Plymouth Hospital to honour Leatham's 50 years' service, he praised his former colleague's skill, and added: 'I am a standing monument to Leatham inasmuch as he, with Dr Christie (another honorary specialist at the hospital) chopped off my leg in this hospital, and I would like to ask Miss Browne (the then matron) what she did with my leg.' Valintine was something of an autocrat, an imperialist, but his efforts in his high office were directed solely towards the improvement of the medical profession. Stories about his unusual methods are legion. Graeme Laurenson, MBE, the architect who designed and supervised the erection of the base hospital, was, as a boy, closely associated with Valintine. He recalls that in 1925, during one of his frequent visits to New Plymouth, the doctor went on horseback to see an old friend near Lepperton. He realised he was due in Wellington that day, but he had missed the only train. He and his secretary, J. Eccles galloped down to the railway line, and Valintine ordered Eccles to stop the train. 'I have no authority,' protested the secretary. 'Use the Health Act, man,' said Valintine. 'This is an emergency.' How Eccles managed to convince the driver to stop in the middle of nowhere is not recorded, but the train DID stop, Valintine and his secretary got aboard and the farmer friend led their two horses away as the train gathered speed. Several New Plymouth doctors have followed in their fathers' footsteps. Dr E. A. Walker, a 28-year-old Scot, was appointed to Dr Leatham in 1899 and later served as superintendent and a consultant at the hospital until his death-on the same day as his friend and colleague, Leatham-on November 17, 1939. Walker's son, George, who had received part of his training in England, took over the practice, which he continued until his death in 1978. George was regarded as the town's 'sporting doctor' and was patron and 'honorary doctor' to many clubs. He was himself a noted gymnast and swimmer, having obtained his blues in these sports at Cambridge. The name Allen is well known among New Plymouth doctors. Dr Sidney Allen was a lecturer and surgeon in Dunedin early this century, and after World War One he specialised in orthopaedic surgery (the war-wounded provided him with plenty of material) and midwifery. After a period in Auckland he came to New Plymouth where he was police and prison surgeon and also brought the hospital records up to date.

He married into the King family, and so was related to Frederic Truby King, founder of the Plunket Society throughout New Zealand, Australia and other countries. As a child Truby was evacuated to Nelson during the 1860s, where he almost died as a result of sickness on the voyage. On his return he joined the staff of the New Plymouth branch of the Bank of New Zealand, where his father was manager, and in 1886 he graduated as a doctor-and the most distinguished student of Edinburgh University. Back in New Zealand he became medical superintendent of the Wellington Hospital and later of the Seacliff Mental Hospital. In 1907 he founded the Royal New Zealand Society for the Health of Women and Children, later renamed the Plunket Society as a tribute to the then Governor's wife, Lady Plunket, who had given the movement strong support. This movement spread and when Sir Truby (he was knighted in 1925) died in 1938 there were six Karitane hospitals in the Dominion, which were largely responsible for reducing infant deaths from about 40 per 1000 live births in 1908 to the present figure of less than seven per 10007. Sir Truby was given a State funeral-the first ever awarded to a private citizen. Sidney Allen's three sons, Peter, Dennis and Chalmers, became specialists in their own fields-'Dr Peter' in radiology and later radio-therapy; 'Dr Dennis' in pathology, and 'Dr'Chalmers' in radiology. On 'Dr Peter's' resignation his son-in-law, Dr Reece Harding, became a radiologist. Peter Allen had much to do with both hospitals and in an interview in the Taranaki Herald in 1978 recalled that 'it was a pity the old Barrett Street hospital had to be abandoned. It had a commanding position; it was relatively small-it had only one floor; everybody was in close contact and indeed it was a very companionable place. On the other hand, the Base Hospital, with its five floors and much larger area, made for fragmentation of inter-relationships which used to exist in Barrett Street. However, the new complex was very satisfactory except for the fact that its modular construction imposed some restrictions on ideal planning. But generally speaking there were few complaints. After all, it's not bricks and mortar which make things go; it's the people inside them.' Peter Allen was himself a patient in 1978 and saw life from the opposite angle he had viewed it during his long medical experience-a hospital bed. He had some pertinent comments: 'I became increasingly aware of the discontinuous nature of attention patients get. Nurses work shifts, as do house surgeons, and the result is that there is an impersonal approach which is in contrast to the old system. But medicine is becoming increasingly complex and I had no criticism of the treatment I received ... it's a specialist world these days.' Dr J. S. (Jimmy) Church, himself the son of a Dunedin doctor, and whose son and grandson were also surgeons in Auckland, came to New Plymouth in 1927 after three years in charge of the Opunake Cottage Hospital. During his long career (he was still in practice in 1980) he regarded himself as a GP although he was a recognised specialist in anaesthesia, being a founder member of the faculty of that discipline at the Australasian College of Surgeons. 'There used to be a snobbishness about specialisation,' he recalled, 'which, thank God, no longer exists. The quip that the specialist knows more and more about less and less and the GP knows less and less about more and more, applies to New Plymouth as it does elsewhere. In 1927 anaesthetists were the boys and the surgeons the bosses. Now we are on equal footing. Specialisation is necessary because the exponential curve of knowledge is increasing faster than the individual human brain can cope. Until the 1930s, ether was the main ingredient in anaesthesia, but since then, as in everything else, more sophisticated and improved methods have been discovered, and the facilities at the base hospital are equal to those in the rest of the country's big hospitals. 'When I came to New Plymouth, Walker and Home were doing a splendid job, but they tended to run the hospital as a closed shop. The only other specialist in the place was Rex Brewster, an ear, nose and throat specialist, who, after much difficulty, was appointed an honorary specialist. John Maxwell Clarke was chosen out of 50 applicants as medical superintendent in 1926 when Walker and Home retired, and under his influence the New Plymouth Hospital became a real medical centre. The North Taranaki Clinical Society was formed, with the town's medical men meeting in the hospital to consult and exchange ideas with hospital staff. Clarke was followed in 1929 by Charles (later Sir Charles) Burns and then Gordon Rich, avery, very sound surgeon, became medical superintendent from 1930 to 1938. He was succeeded by Claude Taylor, a little jovial, rotund sort of chap, who was an extremely able physician. But he wanted to be an administrator and in 1942 he left the hospital for the Health Department (from which he retired in 1979), which is something for which we medical men in New Plymouth have never forgiven him, because, with his departure, we lost a jolly good physician. 'Later came Henry Barrett, who carried on the tradition of good surgery-a very quite, unobtrusive, sound allrounder. He retired in 1949 but remained on the staff as senior surgeon until his retirement in 1964 and his position was taken by Jean Sandel, who had begun her notable career in 1950.' Medical superintendents since then have been Drs L. C. McNickle, B. P. McLaurin and H. Stone and Mr D. H. King. The day before the Napier earthquake in 1931, 'Jimmy' Church's car 'was jumped on by a horse, and I lost the tip of a finger and consequently was hors de combat when the call came for help for that stricken city. But several other New Plymouth doctors went, although,because roads were so severely damaged, it took them several days to get there.