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REVIEWS
THE HUNTERDON MEDICAL CENTER, Ray E.
Trussell, M.D. Cambridge, Massachusets, Harvard University Press, 1955, 236 pp., $3.75.
This is the story of the development of an unusual hospital and health center in a rural county that had no hospital facilities. It is of
interest not only because of what was
achieved, but also how it was done. It is a
demonstration of democratic processes at work
in a county, of citizen initiative and participa-tion with physicians in the development of a medical center, and of a co-operative effort of government and private resources.
Of major significance is the affiliation of the hospital with the New York University-Bellevue Medical Center and the decision to have full time specialists in charge of several of the departments. The relationship of these
salaried specialists, who are also on the faculty at Bellevue, and the general practitioners of the area is one of the most constructive de-velopments of this plan. Of importance also is the rotation of house staff from the Bellevue
Medical Center to the Hunterdon Medical
Center.
Pediatricians will be particularly impressed
with the attention given to children in plan-fling the hospital and in developing the hos-pital’s policies for the children’s services. The
parental participation program is
nepresenta-tive of forward-looking practices in this aspect of child care.
One of the most interesting parts of the book
describes how the views of the citizens of the area were obtained in planning the hospital. Many of the suggestions made illustrate how much better informed citizens have become
regarding health matters. The emphasis on preventive health examinations, mental health,
and the need for understanding the emotional problems of hospitalized children, maternity patients and the aged appeared frequently in the suggestions.
Most of the plans for this center have worked out successfully, with the physicians
as well as the patients benefiting and learning.
One of the local physicians recently expressed
his views of the parent participation program as follows:
I think that is one of the best things you’ve got here . . . the practice of the parents’ being
able to stay. . . . Until now, you know, you went through the same old nigamarole-you
told the parents, “Well, the kids are always better off without their parents and they’ll be
happy after a few hours,” and you knew . . deep in your heart it was a . . .lie. But what could you do about it?
This book is an important addition to the
literature on .rural medical care.
ARTHUR
J.
LEssm, M.D.FAMILY, SocriizATIoN AND INTERACTION PROCESS, by Talcott Parsons and Robert
F. Bales, in collaboration with James Olds, Morris Zelditch, Jr., and Philip E.
Slater. Glencoe, Illinois, The Free Press, 1955, 422 pp., $6.00.
This book is altogether unlike an’ other sociological treatise on the family. There are
two generally recognized types of books on marriage and the family. One, theoretical in
nature, deals with the family as a social
insti-tution. The other deals with the problems of
courtship, marriage and parenthood-more or
less as a manual for youths in contemporary
society. The book at hand does not structure the family as a social institution, but neither is it in any sense a popular, practical manual for the guidance of youth in pursuit of marital bliss!
This book represents, rather, the application
of a theoretical model for social systems and social actions, constructed by Talcott Par-sons of Harvard, to the nuclear family (i.e., father-mother-immediate children) as a pan-human “small group.” The latter term is en-closed in quotation marks because it is used to refer to the focus of considerable experi-mental attention by sociologists in the last
dozen years or so.
This experimental work has discovered that each small group almost inevitably develops
not one but two different types of leadership
as its members interact over a period of time. One type of leader which any group appears to require is the task-oriented, instrumental,
idea-applying and organizing leader. The other type
is the morale-sustaining, integrating, expres-sive leader. The first organizes action and gets things done. The second, who is liked by
BOOK
REVIEWS
535small groups in that it demands these two
types of leaders, and, further, that owing to the nature of their panhuman roles fathers tend
to play the first and mothers the second of
these two types of small-group leaders. It would follow from this principle, if it proves to be sustained by investigations of a more
ex-tensive sort than that presented in this book (a sketchy report on ethnologists’ accounts of 56 human societies), that attempts to create a complete equality of male and female adult
roles in the family would be abortive. This
would indeed be a finding of no trivial
sig-nificance!
The other major thesis of this book is that the development of the child is one which proceeds in terms of a process of “binary fission” of objects as he perceives and
concep-tualizes them. The initial object perceived its ego-undifferentiated-from-mother. As the
in-fant becomes involved in larger social systems,
this becomes first ego-alter, then we-they (in addition to ego-alter), and so on. According to
Parsons, this is the way the self is formed,
on the basis of this differentiating process of
perceiving conjunction and disjunction, which
the symbolic logicians believe to be the basis
for all logic. Parsons reinterprets all of the Freudian stages of the development of the child in terms of this process, devoting a
siza-ble proportion of the book to this translation from biologistic motivation to symbolically communicated role and assignments with their
corollary binary fission of conceptualizations.
As part of the objective basis for the
pro-gressive binary fission there are, in addition to the dichotomy between the instrumental and the expressive roles (as pervasive in this book as are the corresponding ying and yang prin-ciples in Chinese culture!), the power-holding and powerless dimension (the other structural characteristic of the nuclear family), plus the
five antitheses represented in Parsons’ “pattern-variables,” for an explanation of which the reader had better go to one of Parsons’ earlier books, such as Toward a General Theory of
Action. A kind of analogy of this process of
conceptual binary fission is given near the end of the book at hand in the description of the
process by which airplane spotters were trained
to identify flying objects. This “representative anecdote,” as Kenneth Burke would call it, is
vastly illuminating in the verbal fog which the
reader is sure to find in much of the book.
This obscurantistic and pretentious language
is unfortunate in writers whose ideas are as
imaginative and provocative as are those of Talcott Parsons and his associates. In the main
the language of contemporary sociologists is no
more needlessly “special” than that of any
other scientific discipline at this stage of
de-velopment. To the nonsociological readers of this or any other book by Parsons and his
associates the present reviewer can only say that the language-even that of his collabora-tors!-is Professor Parsons’ own-quite outside the mainstream of sociological communication.
However imaginative the two main ideas of
this book are, one cannot help having reserva-tions about them at the very outset. The critics of the literature on small groups interac-tion have pointed out that so far such literature
reflects an overwhelming attention to the form
of the interaction and virtually no attention to its content. One wonders whether the two can
be successfully studied so very independently
of one another. If they cannot then it must
be premature to say that all small groups must have two kinds of leaders, and even more so to
hypothesize that a “normal” family will have
a male instrumental leader and a female
ex-pressive leader. And interesting as the
proposi-tion about the development of self through binary fission of conceptualization may be, it would seem that this process and the dichotomies on which it is alleged to rest are
drastic oversimplifications of the meaning of
meaning, however true it may be that they form the basis on which meaning begins to emerge. In fact both of the major theses are so
remote from the content of meaning involved
in the communicative process that one is left
with the feeling that Parsons et a!. are
at-tempting to describe the social processes of the family through the use of subsocial principles.
The authors’ arguments on these matters would have been more convincing had they been accompanied by specific cases of family interaction and specific life histories of
in-fants and children. Instead one has here only
the starkest of schematizations almost entirely
deductively arrived at.
The sociologist, but perhaps not the
pediatni-cian, will feel that Parsons and his collaborators
have taken Freud’s stages of infant develop-ment too much at their face value. They treat them with the respect which sociologists are
536 BOOK REVIEWS tested generalizations, whereas Freudian
theory is not only untested in any rigorous, scientific sense, but, in its present form, basi-cally untestable. The sociologist, but again
perhaps not the pediatrician, will, on the other
hand, find greatly stimulating the authors’
treatment of motivation as a function of social
roles, rather than as of biological motors.
Despite many negative views expressed in
this review, this work deserves attention both
for its pioneering attempt to relate small groups research and the development of the theory of the family as a social system, and for its at-tempt to interpret personality development as
cumulative role-playing in ever-more-complex
social systems rather than on the basis of the
unfolding of biological needs.
MANFORD H. KUHN, PH.D.
MEcHANISMS OF CONGENITAL MALFORMA-TIONS. Proceedings of the Second
Sci-entific Conference of the Association for the Aid of Crippled Children (1954), edited by Harold Wolff. New York, Association for the Aid of Crippled Children, 1955, 137 pp., $3.00.
For many ears the Association for the Aid
of Crippled Children has supported teratologic research in many ways. Among the activities of the Association scientific conferences and publication of their proceedings play an im-portant role. In the present volume one will find brief summaries of papers presented at a conference in 1954 and abstracts of the dis-cussions contributed by the participants. Part
I dealing with physical, chemical and socio-logical aspects of the fetal environment
con-tains an interesting report by
J.
Walker ofAberdeen, Scotland, on the effects of ob-stetnical, physical and environmental factors on the incidence of stillbirths, neonatal deaths and prematunit. A striking correlation was
found between the incidence of deformities and the social class of the mother. Premature babies, gross fetal deformities and obstetrical deaths were encountered much more com-monlv in women of the lower social groups. Interesting observations of anomalies found in early embryos were reported by A. T. Hertig. Part II is devoted to the question of placental
impermeability to proteins and lipoids and dis-cussion of the transfer of antibodies from the mother to the young. Part III deals with nor-mal and abnormal functions of the fetus with
special reference to the blood-brain barrier,
the fetal adrenals, and fetal respiration. The re-sistance of the blood-brain barrier to many sub-stances may be different in the young, growing organism from that of the adult. The peculiari-ties of the human fetal adrenals are briefly dis-cussed. Several pages deal with fetal and ma-ternal hemoglobmns, their oxygen dissociation
curves in different species, disappearance of fetal hemoglobin in the neonatal period and the
transition of iron to the fetus. The role of
vitamin E in erythrocvte hemolvsis of
pre-mature and full-term infants is considered. The final chapter deals with respiratory pat-terns, roentgen cinematography of neonatal
respiration and fetal blood gases.
The treatment of so many topcs of fetal physiology and pathology left little room for
the discussion of mechanisms of congenital malformations, the alleged main purpose of
the conference. Consequently, some of the
statements dealing with controversial
ques-tions of etiology and pathogenesis of
con-genital malformations are too brief amid sound dogmatic. The book can be recommended to
those who wish information on current studies
of fetal amid neonatal physiology.
J
OSEF WARKANY, M.D.PREMATURE INFANTS, 2nd Edition, Ethel C.
Dunham. New York, Hoeber-Harper,
1955, 459 pp., $8.00.
Considerably expanded and improved from
the paper-bound first edition issued by the
Children’s Bureau in 1948 under the same title (Publication #325), the major strength of this edition again lies in its excellent
bibli-ographv. From this has been extracted a tre-mendous amount of useful informatfon, well organized, and easily accessible tlirmigh an excellent index. Though the volume is cer-tamnly not in any sense a textl)ook, it reflects
a large experience and acquaintance of the author and her staff not only with the litera-ture pertaining to premature infants, but with care programs and personnel responsible for the remarkable strides that have been made in
this field during recent times.
Of particular interest, perhaps because it
best reflects the interests amid experience of the author, is the third section of the book, dealing with public health considerations.
