Before proceeding with the subject of this paper, it is my very great privilege to extend to the distinguished members of the Royal Medico-Psychological Association the cordial greetings of my own Chief of Service, Dr. W. Parsons, the Commissioner of the New York State Department of Mental Hygiene, who has long held in high respect his European acquaintances in the field of psychiatry; in particular, those residing in the British Isles. For purpose of clarity it should be explained that the Department of Mental Hygiene is a branch of the State Government, and the Commissioner is charged with the execution of the laws relating to the custody, care and treatment of the insane, mental defectives and epileptics in all public and private licensed institutions.

The patient, C, was a 33-year-old woman who attended hospital complaining of depression, inability to sleep, and weakness of hands and legs. This had been going on for 4 to 5 weeks. She had been suffering from ‘writer's cramp’ five years previously but this had been satisfactorily treated with drugs.

Hypotheses on the relationship of schizophrenia and family variables have changed considerably over the last 15 years: whereas speculations on the causal role of familial interaction for the onset of schizophrenic psychosis previously dominated the field of psychological theorising and psychotherapy (Bateson et al, 1956), it was not possible to confirm these theories empirically. In accordance with the research on Expressed Emotion (EE), a shift in emphasis to the influence of family variables on the further course of the illness has taken place. As a consequence, promising new techniques have been developed for the prevention or postponement of relapse.

The literature on the treatment of sexual frigidity indicates that some success can be obtained by a variety of methods, including psychoanalytic interviews (Abrahams, 1956), insight therapy with physical self-examination (Dawkins and Taylor, 1961; Ellison, 1968), group therapy (Stone and Levine, 1950), desensitization (Lazarus, 1963), and directive advice and counselling (Hastings, 1967; Masters and Johnson, 1970). This investigation aims to look at the different kinds of frigid women and to see if this is related to outcome in treatment.

In a previous paper (Hodges, Jones, Elithorn and Bridges, 1964) we reported on adrenocortical activity in depressed and schizophrenic patients as revealed by plasma cortisol levels before and after electro-convulsive therapy (E.C.T.). Close similarity was found between the two groups except for three depressed patients who appeared to show considerably higher cortisol levels after the treatment than did the remaining subjects. The patients were examined at random different treatments during the whole treatment course and it appeared possible, both that the observed cortisol response to E.C.T. might depend partly on which treatment of the series in a whole course was under examination, and also that the response of the illness to therapy might be a significant factor. It was therefore decided to observe in a number of subjects the response to successive treatments throughout courses of E.C.T.

Previous assessments of nortriptyline (Bennett, 1962; Rose and Leahy, 1964) have suggested that it has useful anti-depressant properties, and a preliminary trial in which the present authors were involved (Rose et al., 1965) found that it compared sufficiently favourably with amitriptyline to merit further controlled study.

We have used a novel technique to assess the transport of cations across the erythrocyte membrane in vivo in unmedicated patients suffering an acute manic illness. The results show that erythrocyte cation transport via the sodium-pump enzyme Na+,K+-ATPase is increased in manic patients compared with healthy controls.

In his Upjohn lecture Professor G. W. Harris (1964) reviewed experiments on the effects of gonadal hormones on the sexual behaviour of animals. He compared sexual behaviour patterns of male rats castrated on the first day of life with those of adult castrates. When fully grown, these day-old castrates were either primed with oestrogen and progesterone and tested for female mating behaviour, or they were given testosterone and tested for male behaviour with receptive females. Thus, Harris was able to demonstrate bisexual behaviour (mediated through hypothalamic-pituitary pathways) with female type activity cycles occurring in male rats. These experiments suggest that gonadal hormones exert a dual effect. During the early phase of development they act inductively, and later in the adult they exert an excitatory action on the central nervous system.

The role of the economist is to evaluate therapeutic options so as to identify both the value of what is given up to provide care (the cost) and the value of what is gained, in terms of improved health status (the benefit). The function of the economic evaluation is to inform choices: these will be determined by clinicians and managers. By informing the choice process, the economic calculus makes decisionmaking more ‘transparent’ and makes those who allocate resources more accountable to their peers, purchasers, and patients.

Atkinson (1971), in his chapter studying the role which coroners and research workers play in defining suicide, noted that by 1927 Hans Rost's bibliography of suicide cited nearly 4,000 works on the subject, while 2,000 further publications were listed by Schneidmann and Farberow between 1927 and 1961. He had personally traced another 300 studies subsequently. In the face of this vast output one hesitates to add yet another paper. However, historical surveys of popular views on suicide have received relatively scant attention, much of the most valuable work being carried out by historians.