Family Registration

FAMILY REGISTRATION, forms of medical records kept in medical institutions that have the character of district records and serve a specific territory. The method of family records for incoming patients originated in the early 1880s in rural districts of the former Kremenchug uyezd. From there (1887) it spread to the Moscow gubernia (IX Governor's Congress of Physicians), where it aroused great interest among district physicians. Experiments in its application led to the improvement of record forms and their widespread dissemination in rural and partly urban districts of the gubernia, including by the beginning of the 20th century. Family registration was included here among the obligatory forms and became part of the "Registration Rules." From there it spread to other zemstvo gubernias. It represents one of the links in the general system of records serving sanitary-statistical research purposes. One of the basic elements of these investigations is the determination of overall morbidity, the material for which consists of cards that are sent from the district to a statistical center (gubernia sanitary bureau), where they are processed. However, a treatment-sanitary institution cannot be satisfied with the general definitions given by morbidity statistics. It has a need to approach the individual more closely, to study the peculiarities of his organism; it has a need to record clinical observations made on patients, which, upon subsequent visits, make it easier to analyze and correctly evaluate pathological processes occurring in the organism. The form in which data on the patient is collected is the individual card. It contains general information about the patient (surname, name, patronymic, age, marital status, occupation, etc.), anamnestic data (heredity, past diseases, etc.), and clinical data (status praesens, diagnosis, course of disease, treatment, etc.). Where a clinic serves a population with a changing composition due to migratory influences (urban industrial centers), this card acquires exclusively individual significance. In such cases, cards are stored in the clinic either alphabetically or by number. Each patient receives his own number; however, due to the possibility of patients forgetting their number upon subsequent visits to the clinic, an alphabetical card is also introduced, in which the patient's surname, name, patronymic, and number are noted. Where a clinic deals with a settled population connected with that clinic, the individual cards of members of the same family are combined in the so-called family cover or family envelope. In addition to external connection, the cover or envelope serves for a series of records giving a characterization of the patient's family. Besides general identifying data (surname, name, patronymic of the head of the family, address, etc.), the cover contains a list of the family's composition with indication of age, relationship to the head of the family, and profession. The list of family members is compiled either by preliminary census (under modern conditions, health cells may be used for this) or by questioning patients or persons accompanying them upon first or subsequent visits from that family. In relation to each family member, data from their individual cards regarding observed diseases of syphilis, tuberculosis, and other chronic infections (malaria, trachoma, etc.), mental diseases, and severe neuroses, malignant neoplasms (cancer, sarcoma), and data on alcoholism and other drug addictions are also entered on the cover. These data are combined on the cover in the form of tabs or diagrams and aim to present in an easily comprehensible form a picture of the family's pathology. In the preventive direction of Soviet medicine, a preventive physician also needs data concerning the living conditions of the family. Collected by one means or another (by the physician himself or by a nurse-observer), they can also be entered on the family cover, provided it is suitably constructed. Family covers (envelopes, folders, etc.) with individual cards inserted in them are selected and stored by settlements or, when serving large populated areas, by streets, houses, and apartments. In these cases, family registration receives the name of territorial-family registration. In essence, this does not change the matter. Streets are separated from each other by dividers, and houses are arranged by numbers, just as apartments are within each house. Family registration represents a system in which all data concerning the patient and the processing of his data by the treatment institution are collected in a single document. This eliminates the need to maintain various journals and simplifies finding information about the patient. In addition to its clinical significance, family registration acquires great importance in the study of the sanitary condition of the population served by the district. It makes it possible to move from the study of overall morbidity to the study of morbidity among family members or among individual groups of the population united territorially or by some other characteristic. It makes it possible to approach the resolution of the question of the dynamics of morbidity, i.e., to determine the morbidity of selected individuals, families, or individual groups of the population over a certain period of time, and to resolve a number of other questions concerning the pathology of the family and individual groups of the population. The resolution of these questions promises great prospects in the study of social pathology; unfortunately, until now the methodology of statistical processing of materials on family registration has not yet received its clear resolution, apart from isolated attempts to develop limited topics (the development of syphilis, tuberculosis, etc., among the population of the district). But the thought of sanitary statisticians is working in this direction, and it must be assumed that the preventive direction of Soviet medicine, which requires answers to questions about the connection of pathology with everyday life, will serve as a stimulus for resolving methodological questions in the near future. In those treatment institutions where specialization of aid places them in the position of polyclinics, the collected clinical material becomes very extensive. The unification of all specialties in one form makes its use difficult and does not allow clinicians to subject the observations they make to scientific development. In such cases, the individual card receives further development and, by being divided, turns into an individual journal, which has a synthetic sheet (card) into which the most essential data from the observations of specialists are transferred (date of disease detection, diagnosis, methods of applied treatment, outcome), and a series of sheets (cards) for individual specialties. When using such a journal, each specialist, besides his own card, also has before him a synthetic card, from which he learns about all clinical observations made on the patient. If necessary, he can familiarize himself with more detailed records of other specialists by their sheets, which are present in the individual journal. The completion of the family registration system is the sanitary journal, which can be regarded as an individual journal supplemented by data from special examination and data of a domestic nature. This latter form receives wide dissemination in the USSR in the circle of work on dispensarization. In the system of a single dispensary, which essentially comes down to the fact that in studying the social health of the population and in conducting treatment-preventive measures, the influence of both labor and everyday life is to be taken into account, family registration is a necessary element. The individual card of a single dispensary is a sanitary journal. Individual cards are inserted with sheets for specialists having the significance of case histories. All individual cards with inserted sheets are united in an envelope containing general data of a domestic nature and partly anamnestic nature (heredity, diseases by certain forms of diseases - syphilis, tuberculosis, etc.) concerning the whole family.