"Care; 100 Years of Hospital Care in Bermuda, by J. Randolf Williams It comes as something of a surprise to learn that when the idea of a hospital was first mooted for Bermuda in 1894, it was envisioned as an establishment that would cater first to the needs of visiting seamen, then to the Island's tourists and lastly, to "deserving'' local residents.

This is just one of the snippets of often fascinating information that surfaces in J. Randolf Williams' book on the first hundred years of hospital care in Bermuda.

Commissioned by the Bermuda Hospitals Board to celebrate the centenary of hospital care, this necessarily large volume traces the growth of an institution that began humbly enough with the eight-bed Cottage Hospital, but expanded to the point where, in 1986, there were some 323 beds, 400 nurses and an operating budget of more than $30 million.

Mr. Williams, who has already written biographies of Sir Henry Tucker and Sir Edward Richards, took on a task that must have been daunting in its mass of detail. Theoretically, perhaps, such a book should have a very limited appeal but, overall, it makes for some interesting reading. As might be expected from an historian whose past studies have been of a political nature, he has tended to concentrate on the social and political ramifications that have loomed so largely (some might say, far too much!) in the growth of the Island's health care service.

For this story also traces Bermuda's social growth in general, especially in the last half of this century. As such, it will make a valuable addition to any student's library. Backed by impressive research which entailed well over 100 interviews with many of the hospitals' key players, Mr. Williams' book is surprisingly readable for the lay, as well as the specialist reader.

Almost inevitably, the story of Bermudianisation has provided the main theme, for as he quotes an unnamed Director of Human Resources, despite some initial hand-wringing and early setbacks, the hospitals (mainly funded by Government but run by a Board of Trustees), has "a considerably better Bermudianisation record than the government does.'' It is difficult to imagine these days, that when the Cottage Hospital decided to train its own nurses back in the early 1900s, only whites were considered.

The eventual moves, during the 1950s, toward the ending of segregation is brought vividly alive as Mr. Williams recounts the experiences of early crusaders against job discrimination. For, despite the fact that the very first case dealt with in the Cottage Hospital was a "coloured'' doctor treating a "coloured'' man with a fractured leg, it would prove a long journey (1958) before Barbara Wade became the first black Bermudian to be appointed as the public ward nurse.

Although nursing has traditionally been the preserve of women, this book also reveals a fascinating insight into a parallel struggle for women's rights.

Rather aptly, Mr. Williams' last interview of the book is with Mrs. Sheila Manderson, who has scored a triple success as the first black, Bermudian female to be appointed (in 1994) as Executive Director.

The other theme that reverberates throughout the book is the endless search for funds. As early as 1902, the Cottage Hospital was petitioning the Legislature for 700 to cover the cost of the isolation ward and to install a new system of water drainage. The tradition of bountiful ladies working hard to supplement the seemingly constant shortage of funds has been a feature of the Island's hospitals from the very beginning (further on, due praise is accorded the Pink Ladies) and culminates in the Care Campaign which, in 1991, under the expert chairmanship of Lady Swan, raised a staggering $5.8 million for a newly renovated Extended Care Unit.

There are some absorbing moments in this book, not least of which is the re-telling of "the Challinor scandal'' of 1969, when this apparently very likeable Administrator was found guilty of fraud and theft of hospital funds, providing Bermuda with the "most talked-about'' trial in many years.

There is also the story of the unionisation of the hospital in 1963 and staff member Dr. Barbara Ball's controversial role in the process. Ever-increasing demands for higher pay among the unionised staff led to a three-week strike in 1974 and a 25-day strike in 1981. And all the while, Mr. Williams chronicles the escalating costs to the public, despite the innovations of the Hospital Insurance Plan (HIP) and the 1977 Hospital Levy, "a tax on the public which is payable to the Government.'' As the author points out, it was an epidemic of smallpox, back in the 1760s, that had prompted the first talk of a hospital "on an island off Bermuda,'' but it was not until 1804 that a tiny hospital facility was established in the hulk of an abandoned ship at Dockyard. This was short-lived but it was the dreaded -- and totally misunderstood -- yellow fever epidemics that finally brought the British Naval and Military Hospitals into being a few years later.

It was Dr. Eldon Harvey whom Bermuda must thank for his determined efforts to establish a "cottage hospital'' which, he estimated, would cost about 100 a year to run.

By 1913, the decision had been made to build a new general hospital on Point Finger Road, named in honour of King Edward VII. Despite the endless, uphill drive to fund its increasingly ambitious projects, the new hospital has flourished until today, as the author points out, the technological equipment is certainly comparable to any institution of a similar size in North America.

Similarly, St. Brendan's Hospital has also been transformed over the years from its horrendous beginnings as the local "lunatic asylum'' to an entirely modern facility. For such a large book, surprisingly little space has been accorded this aspect of Bermuda's hospital service.

This book also chronicles how Bermuda's hospital service gradually turned away from Britain and turned instead to the nearer continent, with eventual accreditation by the Canadian health authorities. In the process, any lingering images of the Florence Nightingale world of matrons and sisters have been firmly erased. Today, there is, instead, a "director of nursing,'' and "unit co-ordinators'' -- to name but a couple of the plethora of politically correct titles that now hold sway. Puzzled patients may be gratified to learn that the latter are what used to be called "ward sisters.'' Name changes or no, and in spite of heroic efforts (and high costs to both government and consumer) in keeping up with the latest technology, Mr.

Williams also deals -- albeit rather briefly and, inevitably, somewhat optimistically -- with the persistent lack of confidence in King Edward VII and St. Brendan's hospitals. A tiny community which decided, somewhat reluctantly, exactly a century ago, that a hospital was a vital commodity if it was to continue to attract increasing numbers of visitors to its shores, is still not apparently entirely won over by the undoubted sophistication of today's operation: many Bermudians, given the option, prefer to go overseas for serious diagnostic and health care. Whether the reasons for this lies with the technological resources, the people who run, or actually work in the hospitals (or a combination of all these things), is not addressed.

On a slightly niggling note, it seems surprising that a book that has been so meticulously researched and extremely well written, has been let down by editors who have muddled along with an irritating mish-mash of American and English spelling.

"Care,'' however, is a masterful achievement for J. Randolf Williams and deserves a place in every Bermuda school library. -- Patricia Calnan Mr. J. Randolf Williams HUMBLE START -- From `Cottage Hospital' to KEMH