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HOSPITAL WAITING-LISTS
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able. Many ways of solving them have been suggested,6 but all that seems to be generally agreed is that national investment in the maternity services is needed if present standards are even to be maintained. The provision and staffing of enough hospital beds for virtually all confinements is scarcely practicable. Neither is it the only solution. Adoption of the short-stay principle would do much to ease the strain on existing accommodation; and improvement of the domiciliary service could ensure that what has to 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 changing circumstances. (The 1962 estimates of birth-rate trends are projections of the current rates; but these could fall again, just as they rose after 1955.) Moreover, a first-class domiciliary maternity service would help to stem the loss of practising midwives, many of whom at present find no acceptable alternative to working under hospital conditions (which they regard as intolerable) and leave active practice altogether. Providing more beds is the most tangible and impressive way of expanding medical services but not always the most expedient. The domiciliary midwifery service cries out for improvements which are not glamourous-better organisation and more good will-besides, of course, more money.
prescription only. But the Interdepartmental Committee on Drug Addiction 11 in 1961 found that barbiturates, other sedatives, and hypnotics account for about 10% of National Health Service prescriptions by general practitioners; this figure is apparently compounded of 6-7% for barbiturates and 2-5-3% for non-barbiturates.12 The Interdepartmental Committee found that there had been a substantial increase in the use of potentially habitforming drugs affecting the central nervous system. The use of tranquillisers was also believed to have increased; meprobamate-the only tranquilliser which so far has been shown to be addiction-producing 8-in 1961 accounted, with 870,000 prescriptions, for 15% of tranquilliser prescriptions.13 The consumption of glutethimideintroduced to the U.K. in 1955-has increased rapidly to its present level of 12 million doses annually." That cases of dependency similar to those mentioned by the Australian workers occur in this country is shown by occasional reports, such as those on addiction or habituation to barbiturates,12 ls-1’ carbromal preparations,18-20 glutethimide,21-22 and meprobamate .21 In view of the popularity of such drugs the warnings of the Australian psychiatrists should be heeded in this country. Chronic intoxication, especially among the unstable, may indeed be commoner than is suspected. on
CHRONIC INTOXICATION WITH SEDATIVES
THE problem of dependency on hypnotics and sedatives has been repeatedly discussed in foreign medical journals7 8; and Australian psychiatrists9 10 conclude that at least in that part of the world addiction to, and chronic intoxication with, such drugs may be much more common than is generally suspected. Thus, Bartholomew3 found within six months no less than 38 cases of intoxication with the non-barbiturate hypnotic glutethimide in a selected population which included alcoholics, psychopaths, neurotics, and immature and inadequate individuals. Of these people the majority had also taken other drugs, such as carbromal preparations, barbiturates, and tranquillisers. Similarly James 10 found that, of 130 women admitted in twelve months in 1960-61 to an acute psychiatric ward in Western Australia, 15 (12%) had for months or years been habitually consuming grossly excessive doses of barbiturates, bromureides, or glutethimide. These " undoubtedly addicted " patients were all admitted in a state of chronic intoxication-a condition which had remained unrecognised in 8 of them while they had been treated elsewhere for symptoms ascribed to various psychiatric disorders. Before becoming addicted, most of these patients had shown neurotic personality traits: long-standing insomnia had been an almost invariable complaint. Bartholomew and James suggest that chronic intoxication with such drugs ’ is responsible for many, sometimes atypical, psychiatric clinical pictures which remain undiagnosed. Drug addicts as a rule do not divulge their taking of drugs; and James suggests that " there is little doubt that the alarming prevalence of addiction to sedative drugs is not widely realised". How far do such findings apply over here ? In contrast to Australia, bromureides and glutethimide are obtainable 5. 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. 1962. 9. Bartholomew, A. A. Med. J. Aust. 1961, ii, 51. 10. James, P. I. ibid. 1962, ii, 277.
Hagerstown, Md.,
HOSPITAL WAITING-LISTS
A REPORT on hospital waiting-lists in Cardiff 24 contained valuable recommendations on how such lists could be made less misleading. But, besides knowing how many patients really require admission to hospital, we need, even more, to know the causes of imbalance between the supply and demand for beds. An attempt to look into these causes is at present being made in the area served by the Newcastle regional and teaching hospitals, which a year ago had 23,167 names on their waiting-lists-over 20% of these having been there for more than twelve months. The inquiry is financed by the Nuffield Provincial Hospitals Trust, and present investigations are directed towards the gynxcological waiting-list. A prospective study is being made of the waiting-list and total inpatient turnover during six months, and at the same time the gynaecological inpatient facilities of the area are being examined, particularly as regards numbers and distribution of staff and beds. A sample of patients admitted from the waiting-lists are being interviewed, and methods of maintaining waiting-lists and reviewing them are being considered. The research team is mainly seeking causes of long waiting periods for admission, and means by which they may be prevented. some
Dr. G. R. HARGREAVES, professor of psychiatry in the of Leeds, died in London on December 17 at the age of 54.
University
Drug Addiction; Interdepartmental Committee report. H.M. Stationery Office, 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 board of governors of the United Cardiff Hospitals. 11.
able. Many ways of solving them have been suggested,6 but all that seems to be generally agreed is that national investment in the maternity services is needed if present standards are even to be maintained. The provision and staffing of enough hospital beds for virtually all confinements is scarcely practicable. Neither is it the only solution. Adoption of the short-stay principle would do much to ease the strain on existing accommodation; and improvement of the domiciliary service could ensure that what has to 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 changing circumstances. (The 1962 estimates of birth-rate trends are projections of the current rates; but these could fall again, just as they rose after 1955.) Moreover, a first-class domiciliary maternity service would help to stem the loss of practising midwives, many of whom at present find no acceptable alternative to working under hospital conditions (which they regard as intolerable) and leave active practice altogether. Providing more beds is the most tangible and impressive way of expanding medical services but not always the most expedient. The domiciliary midwifery service cries out for improvements which are not glamourous-better organisation and more good will-besides, of course, more money.
prescription only. But the Interdepartmental Committee on Drug Addiction 11 in 1961 found that barbiturates, other sedatives, and hypnotics account for about 10% of National Health Service prescriptions by general practitioners; this figure is apparently compounded of 6-7% for barbiturates and 2-5-3% for non-barbiturates.12 The Interdepartmental Committee found that there had been a substantial increase in the use of potentially habitforming drugs affecting the central nervous system. The use of tranquillisers was also believed to have increased; meprobamate-the only tranquilliser which so far has been shown to be addiction-producing 8-in 1961 accounted, with 870,000 prescriptions, for 15% of tranquilliser prescriptions.13 The consumption of glutethimideintroduced to the U.K. in 1955-has increased rapidly to its present level of 12 million doses annually." That cases of dependency similar to those mentioned by the Australian workers occur in this country is shown by occasional reports, such as those on addiction or habituation to barbiturates,12 ls-1’ carbromal preparations,18-20 glutethimide,21-22 and meprobamate .21 In view of the popularity of such drugs the warnings of the Australian psychiatrists should be heeded in this country. Chronic intoxication, especially among the unstable, may indeed be commoner than is suspected. on
CHRONIC INTOXICATION WITH SEDATIVES
THE problem of dependency on hypnotics and sedatives has been repeatedly discussed in foreign medical journals7 8; and Australian psychiatrists9 10 conclude that at least in that part of the world addiction to, and chronic intoxication with, such drugs may be much more common than is generally suspected. Thus, Bartholomew3 found within six months no less than 38 cases of intoxication with the non-barbiturate hypnotic glutethimide in a selected population which included alcoholics, psychopaths, neurotics, and immature and inadequate individuals. Of these people the majority had also taken other drugs, such as carbromal preparations, barbiturates, and tranquillisers. Similarly James 10 found that, of 130 women admitted in twelve months in 1960-61 to an acute psychiatric ward in Western Australia, 15 (12%) had for months or years been habitually consuming grossly excessive doses of barbiturates, bromureides, or glutethimide. These " undoubtedly addicted " patients were all admitted in a state of chronic intoxication-a condition which had remained unrecognised in 8 of them while they had been treated elsewhere for symptoms ascribed to various psychiatric disorders. Before becoming addicted, most of these patients had shown neurotic personality traits: long-standing insomnia had been an almost invariable complaint. Bartholomew and James suggest that chronic intoxication with such drugs ’ is responsible for many, sometimes atypical, psychiatric clinical pictures which remain undiagnosed. Drug addicts as a rule do not divulge their taking of drugs; and James suggests that " there is little doubt that the alarming prevalence of addiction to sedative drugs is not widely realised". How far do such findings apply over here ? In contrast to Australia, bromureides and glutethimide are obtainable 5. 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. 1962. 9. Bartholomew, A. A. Med. J. Aust. 1961, ii, 51. 10. James, P. I. ibid. 1962, ii, 277.
Hagerstown, Md.,
HOSPITAL WAITING-LISTS
A REPORT on hospital waiting-lists in Cardiff 24 contained valuable recommendations on how such lists could be made less misleading. But, besides knowing how many patients really require admission to hospital, we need, even more, to know the causes of imbalance between the supply and demand for beds. An attempt to look into these causes is at present being made in the area served by the Newcastle regional and teaching hospitals, which a year ago had 23,167 names on their waiting-lists-over 20% of these having been there for more than twelve months. The inquiry is financed by the Nuffield Provincial Hospitals Trust, and present investigations are directed towards the gynxcological waiting-list. A prospective study is being made of the waiting-list and total inpatient turnover during six months, and at the same time the gynaecological inpatient facilities of the area are being examined, particularly as regards numbers and distribution of staff and beds. A sample of patients admitted from the waiting-lists are being interviewed, and methods of maintaining waiting-lists and reviewing them are being considered. The research team is mainly seeking causes of long waiting periods for admission, and means by which they may be prevented. some
Dr. G. R. HARGREAVES, professor of psychiatry in the of Leeds, died in London on December 17 at the age of 54.
University
Drug Addiction; Interdepartmental Committee report. H.M. Stationery Office, 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 board of governors of the United Cardiff Hospitals. 11.