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FAMILY HEALTH
355
Reconstruction FAMILY HEALTH
K. E. BARLOW M.R.C.S., D.M.R. THE consulting-room is like a test-tube, in that the observed. means of observation conditions what is has tended to of technique split medical Specialisation knowledge into isolated departments. This has made of the consulting-room a place where certain precisely labelled diseases are sought ; and the reorganisation of medicine which is now envisaged is based on a drive to make this search more effective. Consideration of the biological nature of man has led many to question whether such methods are by themselves sufficient. The patient is part of a home, and his home is part of a society ; home and society are, biologically, part of the organism’s environment. The geneticist knows that the family is the place in which to study the interchanges in which he is interested. The family is not only the channel of heredity : it is also the unit which administers the intimate environment. It provides the cellular activity out of which the tissues of society are built. Whether society recognises this or not, it is clear that its amenities-its farming, its housing, and its many services-all touch at some point upon the life of the family within the home. At many levels medicine has been constrained to consider these environmental factors of the family ; welfare and vocational guidance clinics, industrial medicine, nutritional studies, and the control of water and sewage systems are all concerned with the influence of environment upon the home. Although the home is in its nature unitary and integral, the beginnings of social medicine are still fragmentary and dispersive. If we are ever to understand society as the biological field of the family-which to the biologist is what it must appear-we must have access to a field which can be observed as a whole. In other words, an experimental community is required. When an at Peckham for centre was established experimental observing the leisure activities of a community of families, it provided for the first time the conditions necessary for this type of biological inquiry. Five years sufficed to show the immense promise of the new method thus introduced. It has demonstrated the profound pathological influence of the family’s contemporary urban environment ; moreover, it has shown how biological observation of a still larger group of families can be usefully undertaken. THE COVENTRY VENTURE
Communities in several towns are now organising themselves to take advantage of the Peckham methods. The most advanced of these, which may claim to be the prototype, is at Coventry. It is interesting that the scheme originated among working people who seized enthusiastically the opportunity of fashioning their own social environment. To this end the Family Health Club Housing Society (Coventry) Ltd. was formed in March, 1945, to promote the development of a townlet of 7000 people. The community will have its own farm to supply first-quality protective foods to expectant mothers and young children ; it will provide housing for 2000 families, including flats, a family health club of the Peckham type, shops, pubs, a cinema, and, in coöperation with the local education authority, its own schools. The site which has been secured at Binley, to the east of the city, is unhappily second-rate : it is, however, the only area which the society was able to acquire within ready reach of workplaces. The loan of money for building has been tentatively agreed with a friendly society on advantageous terms. Houses, which will be of mixed types, will be let on weekly rentals. Families
being recruited, and it is a condition of tenancy family shall pay a weekly subscription of 2s. 6d. per family to the family health club, when it is established, and shall attend once a year for health overhaul. Steps have thus been taken to collect a mixed community eager to participate in the experiment, to make the health club self-supporting, and to ensure that it shall be within are now
that the
easy walking distance of all homes. The relationship of the new townlet with local authorities and existing medical and other services is at present being worked out. The housing society has consulted with the medical officers of both the city and the county, as well as with the other officers of the bodies concerned. The town-planning committee of the Coventry City Council has approved the scheme in principle. As at Peckham, no treatment will be given at the health club. Patients will be referred to the local practitioners, whose good will, it seems, is already assured ; the club’s service will be entirely supplementary to that provided under the impending legislation. In public health, the examination.of school-children, infant welfare, and maternity will come within the province of the club, and it is hoped that careful dovetailing will eliminate duplication. The siting of schools will be important
in these
arrangements. Necessary as this description is to an understanding of what is proposed, it must be emphasised that we are concerned with no mere effort at neighbourhood planning. What we seek to promote is a social environment which will be adaptable to family development, just as the intimate environment of the ovum is to its. The purpose of the overhaul is to review the function and development of each family and each member. Observation of leisure-time activity is an indispensable part of this assessment, for only by observing families in society can social competence be judged. Here we are in the territory of health, but disease is relevant to the inquiry for its effect in limiting the range of living. Social health depends upon the budding and development of faculties and skills ; the change in the environment from this budding and development should be such as to favour differentiation and maturity. The quality of the social soil is critical to the growth of the human seed. It is interesting that in some senses the Family Health Club Housing Society is already a community. The tenants who are recruited meet weekly to develop the arrangements for their own social world. Although these arrangements are as yet on paper only, the stimulus of a live environment is beginning to evoke undisclosed talent and skill; a considerable educational achievement may already be claimed.
STUDY OF ETIOLOGY
In terms of medicine, it is clear that experiments of this order promise a shift of emphasis from pathology to etiology. In the consulting-room setiological factors are remote, but when the organism is observed in its environment, they are operating at the time of observation. Now that medicine is being reorganised, is it too much to ask that the aetiology of disease and the establishment of the norms of health shall receive at least some consideration by the medical administrators and the Minister of Health As the whole set-up of medicine is in flux, are there not good grounds for giving an absolute priority to the establishment of the prototype experiments on which these inquiries must be based ? ’
THE N.W. London Blood Supply Depot at Slough and N.E. London Blood Supply Depot at Luton are amalgamating, and from March 11 will operate as the North London Blood Supply Depot, in the charge of Dr. J. V. Shone, at Shaftesbury Avenue, East Barnet, Herts (Tel. : Barnet 0165). Dr. Shone has been in joint charge of the two depots for some months.
Reconstruction FAMILY HEALTH
K. E. BARLOW M.R.C.S., D.M.R. THE consulting-room is like a test-tube, in that the observed. means of observation conditions what is has tended to of technique split medical Specialisation knowledge into isolated departments. This has made of the consulting-room a place where certain precisely labelled diseases are sought ; and the reorganisation of medicine which is now envisaged is based on a drive to make this search more effective. Consideration of the biological nature of man has led many to question whether such methods are by themselves sufficient. The patient is part of a home, and his home is part of a society ; home and society are, biologically, part of the organism’s environment. The geneticist knows that the family is the place in which to study the interchanges in which he is interested. The family is not only the channel of heredity : it is also the unit which administers the intimate environment. It provides the cellular activity out of which the tissues of society are built. Whether society recognises this or not, it is clear that its amenities-its farming, its housing, and its many services-all touch at some point upon the life of the family within the home. At many levels medicine has been constrained to consider these environmental factors of the family ; welfare and vocational guidance clinics, industrial medicine, nutritional studies, and the control of water and sewage systems are all concerned with the influence of environment upon the home. Although the home is in its nature unitary and integral, the beginnings of social medicine are still fragmentary and dispersive. If we are ever to understand society as the biological field of the family-which to the biologist is what it must appear-we must have access to a field which can be observed as a whole. In other words, an experimental community is required. When an at Peckham for centre was established experimental observing the leisure activities of a community of families, it provided for the first time the conditions necessary for this type of biological inquiry. Five years sufficed to show the immense promise of the new method thus introduced. It has demonstrated the profound pathological influence of the family’s contemporary urban environment ; moreover, it has shown how biological observation of a still larger group of families can be usefully undertaken. THE COVENTRY VENTURE
Communities in several towns are now organising themselves to take advantage of the Peckham methods. The most advanced of these, which may claim to be the prototype, is at Coventry. It is interesting that the scheme originated among working people who seized enthusiastically the opportunity of fashioning their own social environment. To this end the Family Health Club Housing Society (Coventry) Ltd. was formed in March, 1945, to promote the development of a townlet of 7000 people. The community will have its own farm to supply first-quality protective foods to expectant mothers and young children ; it will provide housing for 2000 families, including flats, a family health club of the Peckham type, shops, pubs, a cinema, and, in coöperation with the local education authority, its own schools. The site which has been secured at Binley, to the east of the city, is unhappily second-rate : it is, however, the only area which the society was able to acquire within ready reach of workplaces. The loan of money for building has been tentatively agreed with a friendly society on advantageous terms. Houses, which will be of mixed types, will be let on weekly rentals. Families
being recruited, and it is a condition of tenancy family shall pay a weekly subscription of 2s. 6d. per family to the family health club, when it is established, and shall attend once a year for health overhaul. Steps have thus been taken to collect a mixed community eager to participate in the experiment, to make the health club self-supporting, and to ensure that it shall be within are now
that the
easy walking distance of all homes. The relationship of the new townlet with local authorities and existing medical and other services is at present being worked out. The housing society has consulted with the medical officers of both the city and the county, as well as with the other officers of the bodies concerned. The town-planning committee of the Coventry City Council has approved the scheme in principle. As at Peckham, no treatment will be given at the health club. Patients will be referred to the local practitioners, whose good will, it seems, is already assured ; the club’s service will be entirely supplementary to that provided under the impending legislation. In public health, the examination.of school-children, infant welfare, and maternity will come within the province of the club, and it is hoped that careful dovetailing will eliminate duplication. The siting of schools will be important
in these
arrangements. Necessary as this description is to an understanding of what is proposed, it must be emphasised that we are concerned with no mere effort at neighbourhood planning. What we seek to promote is a social environment which will be adaptable to family development, just as the intimate environment of the ovum is to its. The purpose of the overhaul is to review the function and development of each family and each member. Observation of leisure-time activity is an indispensable part of this assessment, for only by observing families in society can social competence be judged. Here we are in the territory of health, but disease is relevant to the inquiry for its effect in limiting the range of living. Social health depends upon the budding and development of faculties and skills ; the change in the environment from this budding and development should be such as to favour differentiation and maturity. The quality of the social soil is critical to the growth of the human seed. It is interesting that in some senses the Family Health Club Housing Society is already a community. The tenants who are recruited meet weekly to develop the arrangements for their own social world. Although these arrangements are as yet on paper only, the stimulus of a live environment is beginning to evoke undisclosed talent and skill; a considerable educational achievement may already be claimed.
STUDY OF ETIOLOGY
In terms of medicine, it is clear that experiments of this order promise a shift of emphasis from pathology to etiology. In the consulting-room setiological factors are remote, but when the organism is observed in its environment, they are operating at the time of observation. Now that medicine is being reorganised, is it too much to ask that the aetiology of disease and the establishment of the norms of health shall receive at least some consideration by the medical administrators and the Minister of Health As the whole set-up of medicine is in flux, are there not good grounds for giving an absolute priority to the establishment of the prototype experiments on which these inquiries must be based ? ’
THE N.W. London Blood Supply Depot at Slough and N.E. London Blood Supply Depot at Luton are amalgamating, and from March 11 will operate as the North London Blood Supply Depot, in the charge of Dr. J. V. Shone, at Shaftesbury Avenue, East Barnet, Herts (Tel. : Barnet 0165). Dr. Shone has been in joint charge of the two depots for some months.