We have dealt with the necessity and the nature of manifold ‘chances’ in the environment for the study of family function. The mention of swimming bath, gymnasium, dance floor demanding large and obvious areas in a necessarily extensive building, might make it appear that those particular ‘chances’ for physical and social action took first place in the minds of the organisers. This is far from the fact.

Exercise in Peckham

Physical co-ordination is the first and obvious step by which the faculties can be built up, thus equipment for physical activity is there because it is imperative to begin on as primary and simple a basis as possible. But this does not mean that those responsible for planning the Centre are sensible only of physical development.

Fundamental to the design of the experiment and pivotal to the organisation, other and still more important material is assembled in the building for the continuous and spontaneous use of its members. As prominent as the centrally placed swimming pool is the ‘pool of information’ into which members from the first moment of joining are invited to dip.

This pool of information is primarily located in the physiological department, popularly called the “medical department”, where the family overhauls take place. But as the Centre has grown and as staff and members alike have come through practice with a new instrument to know more of its use and possibilities, it has become clear that all action in the building is illuminated by knowledge from this source. Facts which the member-family first meets with in the physiological department are continuously being digested through experience in action throughout the building, added to through contact with the staff in all other departments and confirmed through association with other member-families grown familiar with their meaning and with the use of this source of information. Unlike the casual visitor then, those who dip into this ‘pool’ do not mistake the main drift of what they find in the Centre ; while some in a short four years have come to sense the far-reaching significance of the service.Periodic health overhaul for every individual in the family is a primary condition of membership, and the first examination takes place immediately on joining. But the family do not come to their examination without understanding its purpose and the advantages to be derived from it. Nor, indeed, do they come without first having had the opportunity of meeting the ‘doctors’ who are to examine them.

Examining a baby

What is their first glimpse of this new opportunity ? Usually, before joining, they come to look round the Centre. Sometimes they are brought by friends who are already members. If not, they are introduced by one of the staff to some Centre-member who takes them on a conducted tour of the building. During the course of this tour the physiological department is visited, and the family is introduced to the receptionist. Possibly during this visit various members—men and women—are seen flitting through the department in their conspicuous and attractive examination gowns. Their ease of movement and the absence of apprehension on their faces does not escape the notice of the visitors. Perhaps a family is emerging from one of the consulting rooms where a ‘family consultation’ has just taken place ; perhaps the last few words between the doctors and the family are being said in the passage. Obviously, relations between them are of an easy nature; there is nothing formidable about what goes on in this department. So, fears and alarms, that cling to the anticipation of a “medical” in the minds of many, unconsciously meet their first solvent in this informal tour of inspection.

Enrolment.

The new family think they would like to join, so on leaving the reception room they make an appointment to meet the ‘Doctors’ for an Enrolment Talk. “You will hear from them better than I can tell you what the Centre means”, says their guide, as she shakes hands and leaves them with the receptionist.

The Family Consultation

The day comes for the Enrolment Talk. It is probably a Saturday they have chosen, because the father is free and the mother will have the children clean and tidy for the Saturday evening shopping expedition. Together they come into the consulting room and meet the two ‘doctors’ who later will examine them, and the biologist who is Curator of equipment. Introductions follow and all sit down. After a little preliminary talk, from which the biologists derive a hint as to the disposition of the family as a whole, the talk may proceed :—”The Centre is , here for the use of families like yourselves at a time when it can be of the greatest value to you—that is to say, when you are young and the children are growing up. Everyone wants a full measure of health and a chance of doing all that he is capable of. Perhaps, therefore, the most important thing the Centre offers to its members is the chance of finding out something of what their own capabilities are. So you will find the health overhaul of the family which takes place about once a year, or every eighteen months, of great use in helping you to know where you stand in this respect. The way it is done is for each of you in turn, beginning with the father as head of the family, to come to a laboratory examination. [Besides being head of the family, a position to which formal recognition is due, ‘ the father is also the member of the family most likely in the first instance to fight shy of examination. It is useful, therefore, to make the family overhaul contingent upon his initial compliance. The disinclination to be examined does not result from any lack of courage, but appears to be derived from his or his fellow workers’ experience of medical overhaul in connection with his work, where to the worker the results seem to operate, as often as not, against his general interests rather than for him. But, the first family consultation once over, it is often the father who makes the most use of the opportunities that the health overhaul of the Centre affords the family.] After there has been time to complete the results of the laboratory tests, you then come, one by one, to one or other of us (indicating the man or woman doctor present) for your personal overhaul. When this is all finished you make one further appointment for what we call a ‘Family Consultation’. At this consultation we all meet again here. We then tell you what has been found and—as far as we ourselves know—the meaning of these findings. If anything is wrong, we shall be able to let you know if anything can be done. That will leave you in a position to put it right, if you wish to do so; or, if any question or difficulty arises, through its discussion a solution may be found for it.”

“Meanwhile, any information we may gain during the examination or consultation will be of great use to us because our interest is to study health and find out how best it can be achieved. If our members want to know anything, or are worried about anything, they always come up at any time and ask for an appointment to see either of us. So you must never be afraid that any matter is too trivial to be of interest or importance. [The number of families or individuals who have abused this invitation has been very small.] It is the little things that matter; a chance taken at the right moment, ‘a stitch in time that saves nine’—perhaps in medical matters ninety-nine !”

They all go out. Only after this talk do the family decide whether they will join the Centre or not. If they decide to join, they there and then sit down in the reception room, become enrolled as a member-family, pay their first weekly subscription and proceed to make their individual appointments for laboratory overhaul in the sequence which the family situation demands. If the mother is pregnant, or if there is a young baby, the mother and baby will make the first appointment instead of the father, for at this period they represent the ‘growing point’ of the family and so dominate the situation for family and biologist alike.

Few people not acquainted with the circumstances of the weekly wage-earner realise the significance to him of this method of approach by choice and at his own time. He expects to have to fit himself into other people’s convenience in all that he does. His hours of work are inexorably determined for him, he is not free to arrive an hour earlier and leave an hour earlier as is his master; if he wants a job, or hospital treatment, he must attend at some hour determined by those who have either at their command. If his wife wants to see the child’s teacher or the school doctor, she must attend at some stated time not necessarily convenient to her. Nowhere in fact—except by the private dentist or the hairdresser—is the time and convenience of the weekly wage-earner and his family considered as anything to be respected. Perhaps it is this background rather than any other factor (e.g., ill-will or ignorance on the part of the applicant) which has led to failure of the attempts on the part of the hospitals to introduce an appointment system. Besides the hospital being situated at a relatively great distance from the home, the times available are insufficiently elastic to meet the family’s circumstances. It is useless to hope for appointments to be kept if the only hours offered are ones which clash with other responsibilities the individual recognises. The truth of this seems to be borne out by the fact that in the Centre it is the exception for appointments not to be kept. and if an individual is prevented from coming it is quite unusual for a note or message of apology not to be brought by some member of his family. The reasons are obvious: the Centre is situated within the range of the daily excursion of its members; it is organised primarily for their convenience; the staff are known personally to them, and there is a continuity anticipated in the mutual relationship between the Centre and all its members. The first thing the new family notice, then, is that the Centre does seem to belong to and really is organised for its member-families. That in itself is arresting and to some of its members at first even difficult to believe. In some cases it has happened that the father has hesitated to give his whole-hearted allegiance to the Centre till he has assured himself that there is no ‘snag’ behind so unusual a situation.

The Health Overhaul.

The purpose of health overhaul is not the discovery of sickness in the members of a family — that is merely incidental. The health overhaul is an attempt to estimate the physical efficiency of the family and all its members, and their capability for : —

  1. individual life;
  2. family life;
  3. social life.

What shall we look at first? The body of each individual : build, type, soundness or otherwise of the component parts, the nature of the effluents and the body’s economy. A bench test, in fact, is done of the working machine of each individual. This involves a laboratory examination1 and a complete personal overhaul, which has already been described in detail in “Biologists in Search of Material”.

Blood pressure check

There is no hurry. No presence of, or fear of sickness impels urgency, so that the examination can be carried out in the family’s leisure. The examination department works from 2 till 10 p.m. five days a week. This wide range of hours enables each to choose a time to suit his or her work and convenience. Each goes first to the laboratory for collection of specimens and other laboratory tests by a biochemist. Nearly every one, but particularly the men and the children, enter into this part of the proceedings with lively interest.

On a subsequent day, also at the member’s convenience and by appointment, comes the personal overhaul in the consulting room conducted by the biologist, a man for the men, a woman for the women and all children under seven. For this each individual is asked to strip and is provided with a suitable and clean examination gown.

The examination wraps made of artificial silk are sterilised between each using by the simple procedure of being run through a domestic dry-cleaning machine. The members appreciate the seemliness of this detail of organisation. On two occasions only in four years has any member appeared with even a vest under the examination gown.

The Family Consultation.

When all have been examined and all facts collected, there follows a final appointment, this time for the Family Consultation, in session with the man and woman biologists who have conducted the individual examinations. The procedure is as follows:—When all are seated in the comfort of an informal setting a review is made of the findings collected in the laboratory and at the personal examination of each individual. Beginning with the youngest child, the results of each laboratory test are given, followed by the results of personal overhaul. The significance of these findings wherever possible is translated into lay terms for the family, the object being that they should themselves understand their meaning. It is the family as a whole which receives this information.

The youngest child finished, it goes out and the next child comes under review. So the consultation proceeds till all the children are gone and the mother and father alone remain with the biologists.By this time the parents1 interest will have heightened and usually they will have drawn closely together. A difficult partner may already have begun to thaw out, for after so much information has been forthcoming there is much to discuss about the children,—the meaning of the findings for each child, for the other children, and for the family as a whole. There are now questions the parents wish to ask. and remarks the biologists wish to make in the children’s absence. Over the discussion of these subjects, now of mutual interest to family and biologists alike, confidence grows, so that by the time the husband’s turn comes any misgiving or shyness he may have had about the review of his own overhaul has vanished. The findings of his examination now follow in the presence of his wife. He is deeply interested. Last of all the review of the wife’s overhaul with its lay interpretation completes the family picture. She too seems somehow to gain in dignity through this discussion; her place and importance to the family is confirmed by the procedure.

Then follow any questions and comments that either doctor or member has to make. By this time, foregone intentions, almost forgotten hopes lying deep in the family consciousness have risen to the surface and somehow seem to take on a new potency in the face of the facts that have led to their unfolding. The meaning of the Centre with its exceptional chances for the whole family dawns clearer to both parents as they see it bringing their aspirations once more into the realm of practical possibility. This is often a very moving moment.

Also there may have come to the surface long buried fears, anxieties, dread unspoken yet ever active in the minds and lives of one or both parents. All these anxieties, too, take on a new aspect in frank discussion of the facts that led to their uncovering. A sense of relief follows either the possibility of doing something about them, or facing the inevitable with full knowledge as well as with the assurance that nothing undisclosed now lurks in the family situation. Example after example of these two types,— unfulfilled aspiration, or secret and unexpressed anxiety, could be given were they not to overburden the text. The effect of the family consultation for the parents is like that of watering the parched soil in which a wilting plant has been struggling to grow!

Through this medium of a family consultation following the periodic health overhaul, the biologist and the family looking at the facts together find that they have been moving towards some common basis of language and understanding. Experience, facts and knowledge shared—this is the beginning of a relationship that is to grow and to deepen in the continuous use of the club and of all its activities. The parents begin to understand some seemingly unusual features of the service that have struck them as peculiar. For instance, they may catch the sense of health as being not the mere absence of disease, but that which concerns their action and their growth; not something which can be ‘given’ but something they, themselves, must take. They may comment upon the fact that there are no rules as to what they shall do in the Club, and begin to understand why, in an organisation concerned with health, they are left free to choose and to act for themselves; why there are no professional organisers or instructors as there are in holiday camps and most other clubs;—only the materials with which to plan things for themselves and build up their own activities. To others it becomes clear why all the facilities of the Club, though each subject to small payments by the adults over and above the family subscription, are nevertheless free to all children. They are the members of the family for whose growth and development the need for equipment of all kinds is greatest.

But the family consultation is not yet over. If the parents are old and their children grown up and married, much time is usually spent in hearing of their doings and of the parents’ hopes and anxieties for them. But if the parents are still young, and if they have young children, some insight is given into the significance of parenthood for them all. In this case the consultation will go forward somewhat on these lines.

“From many different sources Science is beginning to piece together facts that have a bearing upon parenthood. Some of these will interest you. At marriage you both entered on a new stage of development, in which instead of going along on your own individual ways you joined forces and became one—a unity. From the moment of courting you began to act on each other, changing yourselves and changing each other. This was not merely in little ways of give and take, in which you adjusted your tastes and habits; it goes much deeper than that, for changes actually began to occur in your bodies, so that the physical constitution of each of you was modified and you became more and more attuned to each other. The influences which affect such changes are so potent that they do not even need close physical contact to set them off. and when development goes smoothly they are so natural—like many other subtle though profound influences which affect our bodies in the course of life— that they are often taken for granted and overlooked. Pollen of grasses is a good example of how strong but subtle the things that affect us can be. A healthy individual enjoys walking through a hay field, not realising that he is in fact ‘digesting’ what may be a valuable meal of pollen. It is only when function is impaired, when something is wrong and the person cannot ‘digest’ that pollen, that he rejects the experience and gets hay fever. Only then does he become aware of the high potency of the pollen”.

“These changes that take place through proximity and even through casual contacts, are, of course, deepened with the intimacy of marriage. Indeed, some people change so much at this time that, for instance, they find themselves making an entirely new set of friends; their old friends do not seem ‘quite the same’. But if that was your experience you will probably see, if you look carefully, that what really happened was that you changed; not your previous friends”.

“It is important, therefore, that when folk are courting and when they are newly married they should have as many channels as possible open to them for making new friends to meet the measure of their development and growth at this time. That is one of the reasons for the way the Centre is planned, with its chances for meeting many people and for families to do things together. Here a young family can mix with some hundreds of other families. Out of these they will inevitably make many acquaintances, from among whom they will be able mutually and naturally to select one or two intimate friends whose friendship as it deepens will enrich the home husband and wife are building together”.

“These profound changes that we have been speaking of, which begin in courtship and early marriage, reach their height in pregnancy. During this period the woman’s body changes its constitution. Her tissues become fluid and softened so that, for instance, in some you can almost bend the bones under the finger. All the tissues undergo this change,—liver, bones, hair, eyes, brain—all are flooded with the circulatory fluids of the body so that their essence seeps out and is carried round in the blood to the womb where the growing child can draw upon it for its nourishment and growth. So the child is made not out of the food that the woman eats but out of the very essence of her body. It is tinctured with its mother’s own ‘specificity’—as we call it”.

“This process is carried still further through lactation. Only after this is over does her body as it were ‘harden’ again, but now into a different form for she has become a mature woman. By and through what has happened she herself has developed and has changed”.

“But the strangest part is that by this process which has gone on in her body during pregnancy she has changed the man too. We do not yet know how this is brought about in human beings, but we already know much about it in some of the lower animals”. At this juncture, according to the comprehension and interest the family evince, the point is illustrated by some example found in nature, such as that of the nesting doves given earlier in this book.

“So it makes a real difference to both husband and wife that they should be together while the wife is carrying and feeding her baby. Probably the old wives were not so far wrong when they said the milk could be ‘soured’ by untoward events and disruption of the home during these important and subtle periods of development for the pair. It is in the light of such facts being gathered by the scientist that we begin to see that the child is not just a delightful and special sort of luxury which a young couple may or may not be able to afford. It is Nature’s means by which both man and woman reach their own maturity. In healthy parents each successive pregnancy will hold some possibility for changing and maturing both of them”.

“It is true that increasing development and maturity does not always result from pregnancy. That does not necessarily mean that the pair are not capable of such change but that the necessary circumstances for the changes to occur, are for some reason or other not favourable”.

“Now it is clear that if pregnancy is so important a time in family development, both parents must be in their fullest health when conception occurs. Only in this way can they get the best out of it and through it reach a fuller measure of health. Indeed, any physical weakness or deficiency, perhaps not noticeable at other times, can rise into prominence during the great activity of pregnancy, and the pregnancy thus lead to an undoing rather than a building up of the life of the whole family. So, in order to be sure that you are as fit as you can be when conception occurs, it is very necessary to put everything right beforehand, and to make up any deficiencies that you may know of. This sometimes takes a little time. You may therefore find that you need advice on the control of conception. There are very few methods that are relatively safe and not harmful, and if you do need any help or advice on this subject you have merely to ask the receptionist for a ‘special appointment’. The matter can then be discussed with one or other of the doctors, who will advise you as the circumstances demand”. In this way, advice on the control of conception is available to all parents on joining the Centre, taking its place as a measure related to the health of the family.

The consultation ends by letting the family know that provision is also made for pregnancy. “As pregnancy is such an important time for the parents and for the coming child, the Centre also makes full provision for the maintenance of the health of the expectant mother from the time of conception throughout the whole pregnancy. Special arrangements for delivery are also available for all families who already enjoy a full measure of health.

The interest with which this talk is received is one of the most encouraging features of our method of approach to the family. The impersonality of the situation has already been achieved by the objective discussion of the findings of the overhauls; shyness has evaporated, and reticence been swept away. It is one of the most usual occurrences for one or other, if not both partners again to contribute some personal experience in support of what they have just heard. For instance one will remark—”Perhaps that explains why old married people so often come to grow alike”, or—”That happened to us with our friends and quite worried us because we thought we were fickle, and that it was in some way our fault that we lost sight of them when we married!” Or again the man may instance some ache or pain that he always suffers during the pregnancy, one having stated that he knew which day the confinement was going to take place because though not given to vomiting he always had an attack on that day! We do not give these examples as evidence of the facts in question, but only as an illustration of the interest with which the subject arouses and the quality of comprehension with which it is met.

The family consultation, then, is a means of giving to the family and all its individuals the facts that can be gathered from the health overhaul, and of passing such facts through the family mill for digestion. This form of consultation affords a mechanism open to the use of the biologist at all the crucial phases of family development; for instance, after the announcement of conception, after the birth of the baby, at the time for each weaning as it occurs—breast weaning, skirt-weaning of the child from dependence to the state of independent mobility—-and so on right up to the time of puberty when the child begins to extend the home circle far into the greater world. The family consultation is a mechanism available also at the behest of the family at any time a difficulty or question may arise in their minds.They are free to ask for one whenever they wish to do so. Once the first family consultation is over, families find no difficulty about a second dip into this ‘pool of information’. They come with a certain anticipation to subsequent overhauls, each of which seems to pick up where the last left off, and goes on toembrace the new circumstances that in the interim have arisen in the family and the new developments in its individual members. As the children grow up the circumstances of their schooling are discussed; or, well in advance, the choice of a career is considered so that the family can prepare for any financial call that might, if left to the last minute, stand in the way of the child’s chances.The biologist being in possession of knowledge of the constitution, tendencies, and often capabilities of each child and of both parents through the periodic health overhaul and from continuous observation of their actions in the Centre, is in a strong position to help the parents to make a wise decision as to future careers for their children. Discussion at the family consultation often helps to dissolve any prejudice which might lead either parent through ignorance to impede the child’s development.

That all the examinations and consultations, following the traditions of clinical medicine, are kept strictly personal and confidential and are carried on without any sense of hurry goes without saying. Trouble is taken from the first moment of joining to engender between staff and members all the amenities of social contact, and by prompt and careful attention to all details to make it clear that the Centre is there primarily for the use of the members. This attitude is quickly appreciated, and almost universally understood by the members and responded to by confidence placed in the staff and workers. Without this lively response the Centre would lose much of its value to members and to biologist alike.It must be remembered that more than half the difficulty of establishing contact with people moving in different circles from ones own, lies in the absence of a common basis of experience. This difficulty is naturally greater where those approaching each other are separated linguistically by forms of expression as divergent, for example, as that of the scientific worker accustomed to speaking in technical terms, and that of the man in the street who ‘feels’ his way through life and has comparatively little need to express himself in any but intuitive gesture. Mutual action leads to. and must take place before there can be mutual confidence and understanding. But. equally important, unless that mutual action has concurrently presented the less articulate participants with language with which to speak of their common experience, the absence of language will still bar fruitful communication.

The choice of our particular populace has been a happy one in that the members are characterised by a directness and simplicity that enables them, as the experiment proceeds, to pick up language to describe what is within their experience, while remaining quite unresponsive to ideas outside their own ambit. There is therefore no danger in this setting, as there would be among intellectuals, of their adopting ideas which have no counterpart either in their experience or in their capacity to experience. This is a point of very great importance, where observations are to be made, an educational programme is envisaged or a technique of homoculture is contemplated.

The very first family consultation then, gives the family a point of reference in words and facts which will grow in value with the recurring contacts arising out of continuous membership with its regularly repeated overhauls and consultations, and continuous association both with staff and members in the use of the club. Each or any of these various contacts in turn may prove to be a peg the observer finds upon which to hang still other facts as they become pertinent.From what has been said the reader will begin to see how, from this pool of information in the physiological department, a. continuous trickle of pertinent facts flows throughout the whole Centre organisation, tending—like any fluid—to spread gradually over the whole field. In doing so it finds its own level in each situation where it lodges. In this way member-families are always spontaneously gathering knowledge through their associations in the Centre. Thus, facts acquire their meaning in virtue of their topicality; available at all times in the physiological department and demonstrated in action in the life of the Centre and its members, they rise into prominence for each family as it acquires the ability to act upon them. The source of information is always there, but, like the swimming bath, it increases in significance with the use that each family can make of it.

Most important of all, the family consultation illustrates the fundamental technique which the biologist must follow in all contacts, whether it be in the presentation of facts, or in the provision of instruments of any kind in the immediate environment. The presentation must not be directed to one or other individual, but to the family as a whole. Here in the family consultation we have a setting in which this can take place with naturalness and suitability. [When the children of a family are grown up the results of their overhauls are discussed with them individually at the end of their own overhaul, and they are not required to attend the family consultation unless they wish to do so.]

It will be seen from this commentary that the biologist does indeed attempt, and in a great measure achieve, the position postulated as necessary for the experiment, namely that of being in mutual relationship with the members—giving back to them in terms of facts and knowledge an equivalent for what he takes .from them for his own studies. Only if, through mutual action in a topical approach to each family he can induce a process of continuous development, can he hope to gather repeated harvests in his chosen field of study—that of human function.

2 Comments

  1. Eric Walker says:

    Viewers might be interested in this DVD.
    The Pool of Information
    One of the earliest examples of public health interventions in a community. The Pioneer Health Centre, better known as the Peckham Experiment, was opened Peckham, South East London, in 1935. Run as a family centre, it was an experiment to discover and promote the growth of positive health. 
75 years later it still provides an important model for a healthy society, where the quality of health and vitality is important.
 This is a great education and training resource for family centred and inter-generational public health interventions and based on the hypothesis that ‘health is as infectious as disease’. Director: Jinni Rawlings. 1993. 35 mins. DVD sale price £20, From Concord Media. 22 Hines Road, Ipswich IP3 9BG. The 01473 726 012 sales@concordmedia.org.uk Please visit http://www.concordmedia.org.uk

    1. socadmin says:

      Thank you very much. Please post more!

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