863

another Fabian tract 13 Prof. R. M. TiTMUSs has

reiterated his view that the better-off third of the

population enjoy fiscal and occupational benefits at theexpense of the welfare services which could offer real

support to those who are " living precariously close tothe margin of poverty ". Mrs. HARVEY agrees with this:indeed in her view it is chiefly the middle classes whohave benefited from some recent developments of thesocial services, notably the National Health Service.In unfair contrast, the poor carry a burden of indirecttaxation which for them is relatively heavier than for thebetter-off. Though widows, old people, and the sick areeligible for benefits, these are modest and the regulationshedging extra earnings and National Assistance are,in Mrs. HARVEY’S view, irksome and often harsh.The most urgent basic need of the poor, she thinks,

is cheap housing. Yet local-authority building fell from200,000 dwellings in 1954 to 113,000 in 1958 (thoughover the same years private building expanded). The

"general need" housing subsidy, abolished in 1956,has never been restored, and she says that we spend alower proportion of our income on housing than allbut three of fifteen other European countries. It is a

commonplace that the home is the centre of family life,and for a family of wavering stability it may make allthe difference between independence and reluctantreliance on the social services. Each of the three

examples we cited above had failed to find reasonableaccommodation, and a section of Mrs. HARVEY’S tractdescribes in detail the misfortunes of a family whichalmost disintegrated, largely from lack of a home of theirown. Though they were given a great deal of expensivehelp from various social services, no authority seemedable to provide them with the house or flat which atmuch less cost would have set them on their feet again."It is one of the salient anomalies of the WelfareState ", she writes, " that despite its insistence on ’ theimportance of the family’, far more services are pro-vided for efficiently sweeping under the carpet theremains of a family after it has disintegrated than forpreventing this disaster. Nor is it generally recognisedthat what is needed to prevent this is far less oftensolemn amateur psychiatry than helpful information andadvice and, sometimes-in an emergency-just plaincash as a loan ". This last sentence expresses Mrs.HARVEY’s dissatisfaction with the manners as well asthe matter of the Welfare State. In her work at acitizens’ advice bureau in a poor district, she has

perhaps tended to meet an undue proportion of thosewho have found its administration bewildering and itshelp grudging. Standing outside the official specialistservices as she does, she has come to regard the pro-fessional social worker with some reserve. Though sherecognises many notable exceptions, she finds amongthem a "terrifying tendency to blame unfortunate

people for their misfortunes " and to expect of themstandards of conformity and virtue " stern beyondbelief ". To those who see the work of the social servicesas a whole such criticism may itself seem unduly13. The Irresponsible Society. 1960. Pp. 20. (2s. 8d., post free, from the

Fabian Society.)

stern; but at a time when the Younghusband report hasset us thinking about the organisation of the social

services, her plea for a reconsideration of their purposeand deployment should not be neglected.

Annotations

APPEAL FROM GREAT ORMOND STREET

THE Institute of Child Health, which was formed in1946 and is associated with the world-famous Hospitalfor Sick Children in Great Ormond Street, London, hasestablished itself not only as a national but also as aninternational centre. Most would agree that such a Meccawithin each specialty is a necessity-for teaching post-graduates at all levels, for coordinating the study ofspecial problems, and, above all, for research. And inthe 1960s even Mecca must be up to date and look tothe future.The Institute has now reached the point where its

resources are exhausted and it can neither accommodateall its would-be students nor properly fulfil its researchprojects. Those who study there can see all types of

disease, and, for comparison, the relatively healthychildren who attend the Province of Natal Welfare Centre.But the amenities for students are meagre, and the

laboratory facilities are badly overcrowded. Such a

situation must obviously be remedied quickly at a timewhen progress in medicine lies so largely in the laboratory.This is perhaps particularly true of pxdiatrics, and ofadvances in the treatment of the sick newborn baby.

Because of the Institute’s insufficient buildings and thegrowing demands made on it as a Commonwealth centre,a new and larger building has become a matter of urgency.A site is available, and plans are already drawn up; butthough these include only provisions for the foreseeablefuture the estimated cost will be t400,000. As part of theBritish Postgraduate Medical Federation, the Institutewould normally look to the University of London forfunds from the allocation made by the University GrantsCommittee. But at present the universities are givingpriority to expansion in technology. and pure science,and the necessary money is unlikely to be given to theInstitute quickly. Accordingly it has launched its ownbuilding appeal, in the hope that those who have benefitedfrom the work of " Great Ormond Street ", either

directly or indirectly, and who believe that its futureshould match its past, will give all the support they can.

Donations may be sent to Sir Hugh Beaver at the Appeal Office,Institute of Child Health, Great Ormond Street, London, W.C.1.

PREVENTION OF SERUM HEPATITIS

SERUM hepatitis is potentially fatal, and every effortmust be made to screen donor blood for the hepatitisvirus. In the absence of specific means of identifying theagent or its antibodies, present screening methods arenecessarily crude. Donors with a previous history ofjaundice are unacceptable, but this does not exclude thesignificant number carrying the virus from a latent oranicteric form of the disease. In order to detect thisgroup of hepatitis carriers, donor blood has been sub-jected to a battery of liver-function tests, but none hasproved effective.l 2

1. Rosenberg, J. N.Y. St. J. Med. 1957, 57, 2522.2. Capps, R. B., Stokes, J., Jr. J. Amer. med. Ass. 1952, 149, 557.