871

limitations of partial integration and must now examinethe feasibility of complete integration.A New HospitalThere should be no difficulties where a hospital is

designed for a new site, as it usually is in developingcountries and sometimes is in technically advancedcountries. It is then only necessary to ensure that thesite is in a good position, and large enough to meet all thehospital needs of a roughly defined population. No

difficulty need arise from the circumstance that all unitscannot be constructed at once (because of insufficientfinance, or continued use of segregated hospitals) if a planis made which allows for the later transfer of other

hospitals to the common site (usually when the segre-gated hospitals have to be substantially extended or

replaced).A General-hospital SiteA general hospital which is reasonably sited and has or

can acquire sufficient adjacent land can also accommodatethe comprehensive scheme. Again, it may not often bepossible to transfer psychiatric, geriatric, and-where theyare separate-obstetric and paediatric units rapidly to thegeneral hospital site. But retention of the land and a far-sighted plan would in time make this possible.Other Hospital SitesWhere general hospital sites are inadequate, as they often

are, the use of others-usually those of mental and feverhospitals-should be examined. In some major cities ofdeveloped countries, mental hospitals have the only siteswhich, on grounds of size and position, can be compre-hensively developed. They should unhesitatingly be usedfor that purpose.Experience in Birmingham suggests that suitable sites

can often be found even in closely built urban areas.Birmingham has at least four sites each capable of accom-modating all the hospital services needed by 200,000-250,000 people. One is the site of the teaching hospital; asecond already has general, mental, and chronic hospitals;a third is the site of a fever hospital; and the fourth is aspacious mental hospital site. Not all cities may be so

fortunate; but the number of suitable sites will not beknown until their identification is recognised to a vital firststep towards a satisfactory hospital plan.

CONCLUSIONS

It is by a phased transfer of all hospitals to well-chosencommon sites that complete integration can be achieved.Clearly this transfer will take time, and not only because ofrestrictions on finance. Many separate obstetric, paediatric,and even mental and chronic hospitals are still serviceable,and cannot be allowed to decline for lack of essentialmaintenance. But the policy should be not to reinvest inthem when substantial developments are needed, and thenumber of digits in the estimate might be used as a roughguide to the advisability of a further commitment. Anadministration should think very carefully before invest-ing sums with six digits in what posterity will almostcertainly judge to be the wrong place.The district general hospital can be seriously criticised

because it does not apply a yardstick of this type in orderto guide new developments along the lines of long-termadvantages. There can be no reasonable objection tocontinued use, mainly for economic reasons, of manyhospitals of the wrong type or in the wrong place. Butthat we should perpetuate the difficulties, both for our-selves and our successors, by policies which are incon-

sistent with comprehensive development is inexcusable.

Regrettable features of contemporary planning includeconstruction or re-establishment of segregated psychiatricand geriatric units; long-term plans for major hospitalson sites which are too small, or badly located; andacceptance of plans which are unbalanced in respect ofboth the use of sites and the relation between sites.These features are attributable to the concept of the

district general hospital. By unifying acute services itoffers a considerable advance from the disorganised hos-pitals of the past; but by countenancing the continueddispersal of psychiatric and geriatric services it threatensto carry some of their disadvantages into the future.Partial integration of these services is not a step in thedirection of complete integration. It is an endorsementof the principle of segregation which has plagued hos-pitals for two centuries.

Occasional Book

BRITISH CRIME IS BETTER

American sociologists explain much of their juvenile crimeby the subcultural theories of Cohen and Cloward and Ohlin 2who believe that boys who are prevented by social disadvantagesfrom sharing fully in the American dream of material affluencebecome so frustrated that they rebel against respectable society.English sociologists, on the other hand, believe that a great dealof child delinquency arises more or less naturally from the basicconcerns and social traditions of lower-class culture. Studiesin such diverse parts of the country as Liverpool,3 Croydon 4and Radby all show that lower-class youngsters here have nounrealistic expectations of rising socially or achieving an

impossibly high standard of living; hence they are less frus-trated than their American peers. This divergence of viewbetween American and English criminologists awaited resolu-tion, and Dr. Downes has now provided this by his carefulstudy 6 of juvenile crime in the two London boroughs ofStepney and Poplar. Based on an analysis of crimes known tothe police in 1960, it is supported by much informal observa-tion and unstructured interviewing. His main findings showthat the orthodox English theories still hold good. Most of theLondon delinquents were not reacting consciously againststatus frustration, and Downes found few signs of organisedgang life on the American pattern, while physical violence wasrarer than in America. All this is encouraging and confirms thesubstantial structural differences between English and Americansociety. In more traditionally minded Britain there are forcesmaking for comparative stability which, though they some-times work against desirable social change, also safeguard usfrom dangerous excesses. One is limited personal aspiration:another is a deep-seated respect for authority, law, and order.But Downes stresses that it is chiefly the lack of organised adultcrime as an alternative avenue to success that has so far

prevented us from reproducing the frighteningly high juvenilecrime-rates of the United States. Unless adult crime becomesmore organised and more successful (and there are unfor-tunately a few indications that this may indeed be happening),we need not fear any great expansion of juvenile delinquency.The lesson of his thesis is that we ought to spend a great dealmore money and thought on making our police force moreeffective, and in finding socially acceptable outlets for theenergies of footloose urban youths, who all too often drift intodelinquency for want of something better to do and someoneto care for them and about them.1. Cohen, A., Cloward, K. Delinquent Boys. London, 1955.2. Ohlin, L. Delinquency and Opportunity. London, 1961.3. Mays, J. B. Growing Up in the City. Liverpool, 1954.4. Morris, T. P. The Criminal Area. London, 1957.5. Jephcott, P., Carter, M. Social Background of Delinquency. Private

circulation, 1954.6. The Delinquent Solution. By DAVID M. DOWNES, PH.D., assistant

lecturer in social administration, London School of Economics.London: Routledge & Kegan Paul. 1966. Pp. 284. 42s.