1368

able. Many ways of solving them have been suggested, 6but all that seems to be generally agreed is that nationalinvestment in the maternity services is needed if presentstandards are even to be maintained. The provision andstaffing of enough hospital beds for virtually all confine-ments is scarcely practicable. Neither is it the only solu-tion. Adoption of the short-stay principle would do muchto ease the strain on existing accommodation; and improve-ment of the domiciliary service could ensure that what hasto be is the best of its kind. Investment in a skilled

domiciliary service should commend itself to the planners,for such a service could be readily adapted to changingcircumstances. (The 1962 estimates of birth-rate trendsare projections of the current rates; but these could fallagain, just as they rose after 1955.) Moreover, a first-classdomiciliary maternity service would help to stem the lossof practising midwives, many of whom at present find noacceptable alternative to working under hospital conditions(which they regard as intolerable) and leave active practicealtogether. Providing more beds is the most tangible andimpressive way of expanding medical services but notalways the most expedient. The domiciliary midwiferyservice cries out for improvements which are not glamour-ous-better organisation and more good will-besides, ofcourse, more money.

CHRONIC INTOXICATION WITH SEDATIVES

THE problem of dependency on hypnotics and sedativeshas been repeatedly discussed in foreign medical jour-nals 7 8; and Australian psychiatrists 9 10 conclude that atleast in that part of the world addiction to, and chronicintoxication with, such drugs may be much more commonthan is generally suspected. Thus, Bartholomew 3 foundwithin six months no less than 38 cases of intoxicationwith the non-barbiturate hypnotic glutethimide in a

selected population which included alcoholics, psycho-paths, neurotics, and immature and inadequate indivi-duals. Of these people the majority had also taken otherdrugs, such as carbromal preparations, barbiturates, andtranquillisers. Similarly James 10 found that, of 130women admitted in twelve months in 1960-61 to an acute

psychiatric ward in Western Australia, 15 (12%) had formonths or years been habitually consuming grosslyexcessive doses of barbiturates, bromureides, or glutethi-mide. These " undoubtedly addicted " patients were alladmitted in a state of chronic intoxication-a conditionwhich had remained unrecognised in 8 of them while theyhad been treated elsewhere for symptoms ascribed tovarious psychiatric disorders.

Before becoming addicted, most of these patients hadshown neurotic personality traits: long-standing insomniahad been an almost invariable complaint. Bartholomewand James suggest that chronic intoxication with suchdrugs ’ is responsible for many, sometimes atypical,psychiatric clinical pictures which remain undiagnosed.Drug addicts as a rule do not divulge their taking ofdrugs; and James suggests that " there is little doubt thatthe alarming prevalence of addiction to sedative drugs isnot widely realised".How far do such findings apply over here ? In contrast

to Australia, bromureides and glutethimide are obtainable5. Galloway, J. F. ibid. 1962, i, 1287.6. Duncan, A. S. ibid. Oct. 13, 1962, p. 733.7. Halbach, H. J. Thër. franç. 1960, p. 139.8. Wikler, A. in Practice of Medicine; vol. 8, p. 51. Hagerstown, Md.,

1962.9. Bartholomew, A. A. Med. J. Aust. 1961, ii, 51.

10. James, P. I. ibid. 1962, ii, 277.

on prescription only. But the Interdepartmental Com-mittee on Drug Addiction 11 in 1961 found that barbi-turates, other sedatives, and hypnotics account for about10% of National Health Service prescriptions by generalpractitioners; this figure is apparently compounded of6-7% for barbiturates and 2-5-3% for non-barbiturates.12The Interdepartmental Committee found that there hadbeen a substantial increase in the use of potentially habit-forming drugs affecting the central nervous system. Theuse of tranquillisers was also believed to have increased;meprobamate-the only tranquilliser which so far has beenshown to be addiction-producing 8-in 1961 accounted,with 870,000 prescriptions, for 15% of tranquilliserprescriptions.13 The consumption of glutethimide-introduced to the U.K. in 1955-has increased rapidly toits present level of 12 million doses annually."That cases of dependency similar to those mentioned

by the Australian workers occur in this country is shownby occasional reports, such as those on addiction or

habituation to barbiturates,12 ls-1’ carbromal prepara-tions,18-20 glutethimide,21-22 and meprobamate .21 In viewof the popularity of such drugs the warnings of theAustralian psychiatrists should be heeded in this country.Chronic intoxication, especially among the unstable, mayindeed be commoner than is suspected.

HOSPITAL WAITING-LISTS

A REPORT on hospital waiting-lists in Cardiff 24 containedsome valuable recommendations on how such lists couldbe made less misleading. But, besides knowing how manypatients really require admission to hospital, we need,even more, to know the causes of imbalance between thesupply and demand for beds. An attempt to look intothese causes is at present being made in the area servedby the Newcastle regional and teaching hospitals, whicha year ago had 23,167 names on their waiting-lists-over20% of these having been there for more than twelvemonths. The inquiry is financed by the Nuffield ProvincialHospitals Trust, and present investigations are directedtowards the gynxcological waiting-list. A prospectivestudy is being made of the waiting-list and total inpatientturnover during six months, and at the same time thegynaecological inpatient facilities of the area are beingexamined, particularly as regards numbers and distributionof staff and beds. A sample of patients admitted from thewaiting-lists are being interviewed, and methods of main-taining waiting-lists and reviewing them are being con-sidered. The research team is mainly seeking causes of longwaiting periods for admission, and means by which theymay be prevented.

Dr. G. R. HARGREAVES, professor of psychiatry in theUniversity of Leeds, died in London on December 17 at theage of 54.

11. Drug Addiction; Interdepartmental Committee report. H.M. StationeryOffice, 1961. See Lancet, 1961, i, 1153.

12. Glatt, M. M. Bull. Narcotics, 1962, 14, 19.13. Lancet, Dec. 1, 1962, p. 1176.14. Brit. med. J. Sept. 8, 1962, p. 670.15. Willcox, W. Lancet, 1934, i, 370.16. Hunter, R. A., Greenberg, H. P. ibid. 1954, ii, 58.17. Brooke, E. M. ibid. 1956, i, 150.18. Saeger, C. F., Foster, A. R. Brit. med. J. 1958, ii, 950.19. Copas, D. E., Kay, W. W., Longman, V. H. Lancet, 1959, i, 703.20. Glatt, M. M. ibid. 1959, i, 887.21. Glatt, M. M. Brit. med. J. 1958, ii, 1100.22. Fry, A. ibid. Sept. 8, 1962, p. 673.23. Glatt, M. M. ibid. 1959, i, 587.24. Grundy, F., Hitchens, R. A. N., Lewis-Faning, E. A Study of Hospital

Waiting Lists in Cardiff (1953-54). A report prepared for the boardof governors of the United Cardiff Hospitals.