27 MAY 1938, Page 5

FAMILY HEALTH I N the chaos of the contemporary world there

are some institutions which seem to point to a better and saner future, which make use of knowledge not to destroy but to create, and analyse present evils only to show that they contain their own cure. Among them, rare as they are, must be counted the Pioneer Health Centre at Peckham, and anyone who wishes to learn about its activities should read the interim report on its last two years' work, which has been published under the title of "Biologists in Search of Material."* The Centre's main purpose is to enquire into the conditions of human health, and its work is based on the assumption that health is something different from the absence of disease, and is a social rather than a physiological phenomenon. For this reason, work at the Centre takes the family, not the individual, as its unit. Only complete families may become members and enjoy the services it offers, because the health of pn individual cannot be properly studied apart from the home and family conditions which help to make his total environment. The work carried out at Peckham on these assumptions has already, despite disappointments and difficulties, led to such interesting results that it is too much to say that the future of medical services in this country depends on the adoption of the principles observed by the Centre. Since the disappear- ance of the old-fashioned family doctor, medical services have become a matter of diagnosing and, if possible, curing maladies that have already reached an advanced stage. It ha& become clear, to doctors perhaps more than anyone else, that the organisation of national health services on this basis is both wasteful and inefficient. The Government's "Keep Fit" campaign is itself a recognition that health services in this country are not in themselves sufficient to maintain the vigour and vitality of the race ; but it is at best a clumsy and in- effective method of making up for the deficiencies in the public health services.

It needs no expert eye to recognise their shortcomings. Anyone who walks down the streets of any great industrial city can see by the faces and carriage of passers-by that these are men and women who, though they show few marks of disease or illness, though superficially they may "enjoy good health," have not that physical and mental vitality which are, or should be, within everyone's reach :oday. The "marks of weakness, marks of woe" are everywhere to be seen ; and thus it 'is not surprising to find that among the 500 families, drawn from the prosper- ous district of Peckham, who have been examined at the Centre, symptoms were found of over 250 serious maladies. The Report draws the following conclusion :

*Faber and Faber. .2s.

"The high incidence of maladies of this degree of seriousness in an unselected group of people supposed to be 'healthy 'confirms our previous findings from 1926 to 1929 in the first Centre—that there are many more people with untreated serious maladies waiting for crisis or collapse before they will seek treatment than can be gathered from inspection of the official hospital and panel statistics from which the presence of disease in this country is adjudged." And further, it must be realised that the relation of these "major "to the " minor " maladies is that of r to to.

It is clear that "Keep Fit" measures are no cure for such ailments. The physical fitness of "the would- be boxing and gymnastic champion" mentioned in the Report was in no doubt ; indeed he was so fit that he sustained cheerfully "valvular disease of the heart, nephritis, a blood pressure of 230 and an almost solid albuminuria." Nor again are they a cure for the cases of "devitalisation," one of whose characteristics is a "psychological somnolence deepened, not awakened, by stimulus." And such cases, more common among women than men, are of great social importance because of their effect on child-bearing. "Even the major stimulus of pregnancy does not stir these individuals. Indeed, on the contrary, pregnancy may induce immediate malaise which the individual accepts without comment and may even take pains to disguise." This conclusion should be read in conjunction with another sentence taken from the Report. "It must be remembered that the average prospective mother is unavoidably living in an environment where fear of pregnancy has, by reason of the maternal mortality and morbidity rates of this and other countries, been raised to a maximum." The population experts who so deeply and helplessly deplore the fall in the birth-rate can offer no cure for such fears ; they need the aid of the " biologists " who conceive of the time of pregnancy as that of the mother's and the " family's " greatest vitality, so that within the Centre "mothers previously healthy anticipate an increase in vigour, strength and enjoyment during that period."

It is impossible in any short space to do full justice to all the social implications of the Report ; every serious citizen should read it for himself. But perhaps its general significance can be summarised in two sentences. Firstly, the health, in its true sense, of the community cannot be maintained at a high level merely by the diagnosis and treatment of disease already in an advanced stage. Secondly, it can only be done if men and women are under medical supervision not merely when ill but also when well. Only thus can ailments, small in themselves, yet permanently devitalising, be prevented and cured, and only thus can the health of the enormous majority who have no illness serious enough to demand "a visit to the doctor" be improved. What is required is regular examination, and instruction in the conditions necessary for attaining health ; it is necessary also to research further, as the Centre is doing, into what these conditions are. The fact is that, at present, medical services are still concentrated on looking after the sick and not the healthy ; medical science itself studies disease and not health, as if it were disease that were precious. In recent years a new outlook has developed, and has been immensely advanced by the work at the Centre ; when it has been fully accepted and applied it will be possible to work the revolution in national health that is both necessary and possible.