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10. See Lancet, Nov. 30, 1957, p. 1104.11. Smith, C. S. People in Need, and other essays. By C. S. SMITH.

London : Allen & Unwin. Pp. 155. 21s.

should be built into the national agreements them-selves and not left to the discretion of individual

managing bodies who might be tempted to competebetween themselves ... for the limited manpoweravailable in the country ". But the committee’s reallyimportant point was that the example of other largeundertakings should be followed and that ways shouldbe sought for introducing more flexibility " to meetlocal variations ". For our part we have long held thathospital authorities, like other employers, should alsobe able to reward outstanding service. The defectsof the existing points system for the remunerationof administrators have been made sufficiently clear bySir NOEL HALL’s report. 10

Annotations

SOCIAL SERVICES AND THE FAMILY

THE purpose of the Welfare State, according to LordBeveridge in his foreword to Mr. Cyril Smith’s book ofsociological essays,11 is not that " everything that thecitizen could desire " should be provided but rather thata minimum be " guaranteed by the State, without a meanstest, so that every man can safely spend or save for him-self for all that he or his family might desire to havebeyond that minimum ". It is concerned, therefore, notwith providing luxuries but with preventing " primary "poverty. But it is not easy to distinguish between genuinebasic need and socially conditioned desire, for the con-cept of need is constantly changing and is very closelyrelated to changing economic conditions. Moreover,psychological and social influences exert a powerfulinfluence on our general idea of a reasonable minimumstandard of life ; and it becomes harder, as the generalstandard of living rises, to decide what is a luxury andwhat is a necessity. Tobacco and alcohol were once

regarded as extravagances, but many people nowadayswould claim that they are necessities. The NationalAssistance Board allowances do provide for a limitedamount of money to be spent on amusement and recrea-tion over and above that calculated for food, rent, heat,light, and clothing. This more liberal interpretation ofhuman need has given rise to some misunderstandingand to the complaint that today " society is held togetherby the social services ". It is comforting to find, there-fore, that Mr. Smith’s researches in Dulwich lead him tosay that " By and large the family and the neighbour-hood group look after their own problems ", with thesocial services of the Welfare State merely filling thecracks caused by the severer kinds of strain and stress.If this were not so, he points out, we should need agreatly increased and much more costly array of ser-

vices. For this reason, if for no other, we should seek toensure the independence and to increase the effectivenessof the family as the primary social group.The family has indeed (like all worth-while and vital

institutions) changed its role in the face of changing con-ditions. Often critics who bewail what they call thecollapse of family life are merely underlining this fact,and, by lamenting what has been lost or altered, theyignore what has survived and what is novel. Personal

relationship, as an end in itself, and companionship inleisure hours have come increasingly into prominence.The social services have probably gone about as far as iswise towards removing burdens from parents’ shoulders,and the position is likely to be stabilised at least for ageneration or so. There is no denying the paramountcy of

1. Kerbikov, O. V. Lancet, 1955, i, 744.2. Beilin, P. E. S.C.R. Soviet med. Bull. 1957, 4, 1.

the family in emotional development and personalitymaturation. Mother and father love will remain of uniqueimportance in the proper upbringing of children, and it isimpossible to conceive of any public institution whichcould supplant the family in this most vital of all itsresponsibilities. Whoever looks after the child’s teeth orteaches him the three R’s, only the parents can give himthe security born of intimate, loving contact.The function of the social services is to aid all families ;

but obviously some families have more problems thanothers, and fewer resources with which to deal with them.This is not simply a matter of money : there is also morale,the family’s mental and nervous resilience, which islargely attributable to hereditary endowment ; further,the age and sex composition of the family are importantin determining its ability to solve a problem ; and so, too,is numerical strength, for the larger the family group themore hands and pockets available in time of emergency.Today, even though most needs have been met, particularhardship can still be experienced by a few unlucky peoplesuch as old-age pensioners, widows with young children,or wives of chronic invalids. In a time of rapidly risingcosts, these exceptional households often find the gapbetween means and needs widening. It is important thatmonetary allowances and other services should be readilyand easily adjustable for these handicapped families, andthat their misfortune should not be lost sight of amid thegeneral rise in living standards.

Mr. Smith’s book is based on only a hundred and thirtyhouseholds selected at random from the poorer half of theeast ward of the electoral district of Dulwich ; and theinterviews were mostly with housewives. Although itcannot be claimed that this subsection of a London

borough is representative of the whole country, or evenof most working-class areas, the study is important as oneof the first attempts to examine poverty in contemporarysociety, and because it shows the need for a much moregenerously supported research plan. The question of howthe family is faring under present-day conditions meritsmuch further research.

CONDITIONED-REFLEX SLEEP

LONG-CONTINUED narcosis still has a place among thephysical methods of psychiatric treatment. There are

disadvantages in the kind of course that used to be givenin which the patient was submitted to 10-14 days ofsleep interrupted briefly for meals, toilet, and a bareminimum of exercise. Even when the course is muchmodified the amount of sedative and hypnotic drugsrequired to produce long periods of full sleep may haveunwanted side-effects. New techniques are being tried inpsychiatric clinics in the U.S.S.R.A year or two ago Kerbikov described the induction

of electro-sleep by means of a rhythmic current of0-2-0-3 millisecond pulse-duration, frequency 1-20 c.p.s.,and current strength 5-15 mA, applied between electrodeson the frontal and occipital regions. This did not alwaysproduce sleep, but it usually produced sedation. Kerbi-kov claimed good results in mild depressive states. Healso described the use of intravenous alcohol, claiming thatthis was helpful in schizophrenics-especially those show-ing

"

protective inhibition " (perhaps what we would callnegativistic and catatonic states). Beilin 2 has nowdescribed a conditioned-reflex technique for giving sleeptreatment. The technique makes use of all the usualcommon-sense environmental aids to sleep ; then in addi-tion neutral stimuli-olfactory, visual, auditory, andthermal of a soothing and not unpleasant type-are con-ditioned to the effect of some sedative such as sodiumbarbitone. Beilin reports that in one case up to 16 hours’sleep a day was obtained over a period of 9 days with