This thesis is about how medical knowledge is constructed by staff for patients and their families in a Japanese 'comprehensive care' facility for the treatment of epilepsy (the JEC). The thesis sets out to explain the possible reasons for differences between the number of surgeries of epilepsy performed at the JEC and the number performed in a Canadian institute. I will argue in the thesis that the fundamental difference between the two institutes lies in cross cultural and cross institutional differences in the uses and interpretations of the polysemic phrases 'comprehensive care' and 'quality of life'. They are ideological constructs embedded in a social process of knowledge production. Uncritical acceptance of these institutional objectives has significant ideological consequences in that it (1) justifies the unequal distribution of services, (2) legitimates the treatment program's objectives, and (3) masks the social relations out of which authoritative knowledge about epilepsy at the JEC is produced.

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This thesis does several things. It presents a brief history of epilepsy as a foundation to the story of the early development of the New Castle facility. The location of the village caused considerable competition among the counties desiring the institution; space is devoted to that competition. Attention is also given to the selection of the first superintendent Dr. Walter C. Van Nuys. The major method of treatment of epileptics in the early twentieth century was custodial. This study emphasizes the physical development of the New Castle institution in its early years to show the type of custodial care the patients received.

The objectives of this thesis is to explore different approaches of modelling clustered correlated data in the form of repeated or longitudinal counts data leading to a replicated Poisson process. The specific application is from repeated epileptic seizure time to events data. Two main classes of models will be considered in this thesis. These are the marginal and subject or cluster specific effects models. Under the marginal class of models the generalized estimating equations approach due to Liang and Zeger (1986) is first considered. These models are concerned with population averaged effects as opposed to subject-specific effects which include random subject-specific effects such that multiple or repeated outcomes within a subject or cluster are assumed to be independent conditional on the subject−specific effects. Finally we consider a distinct class of marginal models which include three common variants namely the approach due to Anderson and Gill (1982), Wei et al (1989) and Prentice et al. (1981) / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2010.