SYNOPSIS The brains of 15 retired boxers have been studied and the lives of the men concerned have been investigated in retrospect. A characteristic pattern of cerebral change has been identified which appears not only to be a result of the boxing but also to underlie many features of the punchdrunk syndrome.157 35

The County Borough of Southend-on-Sea is a seaside town with an estimated population of 166,390 in 1965, approximately 24 per cent. of whom were over the age of 60, as compared with 17.8 per cent. of the total population of England and Wales, and 17.7 per cent. of the population of urban areas, outside the conurbations, with populations of 100,000 and over. As in other seaside towns of a similar character, the suicide rate is high: 181 per million population in 1965, as compared with 108 per million in England and Wales, and 120 per million in urban areas outside the conurbations with populations of 100,000 and over (Registrar-General, 1967). Of 237 (46.4 per cent.) consecutive suicides in Southend 111 were over the age of 60 at the time of death.

SYNOPSISUsing statistical methods, the hypothesis that suicide occurs either at the beginning or at the end of a spell of treatment is shown to fit the available data.

The assessment of suicidal intent is one of the most important problems of clinical psychiatry. An earlier study (Robin, Brooke and Freeman-Browne, 1968) has confirmed the high incidence of suicide in admissions diagnosed at first contact as suffering from affective disorders, and found that 8 per cent. male in-patients and 5 per cent. female in-patients so diagnosed committed suicide during a follow-up of 6–11 years. It was also shown that in male patient suicides unemployment at the time of first admission and a previous history of self-poisoning or self-inflicted injury occurred more often than in matched controls, while a history of more than one suicidal attempt was found more often in female suicides than in matched controls. Female suicides were treated less often with E.C.T. than their controls, and more often with tranquillizers.

Robin, Brooke, and Freeman-Browne (1968) reported that during the years 1952-64 an increasing proportion of suicides in the county borough of Suuthend were known to have had contact with the psychiatric services of the town at some time in their lives, often within three months of suicide. Of 92 patients who later committed suicide 72 (78 %) were diagnosed as suffering from affective disorders when first psychiatrically examined, and the great majority (79%) of those with a psychiatric contact) were at some time treated as inpatients. Patients committing suicide had a history of an earlier suicidal attempt more often than other psychiatric patients. Approximately 40% of suicides by patients were from poisoning with drugs, the majority using barbiturates. In view of the fact that psychiatric contacts and particularly admissions were involved, and that drugs were a common method of suicide, it was decided to study the frequency with which patients admitted to psychiatric beds from Southend left drugs at home, the characteristics of such patients, and.the general indications of the drugs involved. Age.-A direct association was found with age for both day and night medication, and roughly twice as many patients over the age of 65 left medicines as those under 25. MethodSex and Civil State.-The same proportion of each sex were found to have left drugs at home. There was a tendency for women to leave more day medication than men, and for men to leave more night sedation than women, but the differences were not statistically significant. A higher proportion of the men as compared with the women were single, and a lower proportion widowers than widows. There were no differences between the single men and women, but a higher proportion of married men than married women were found to have left drugs at home. On the other hand, the individuals with large numbers of bottles were predominantly housewives (five of the seven who left more than three bottles were in this category).Premorbid Personality.-So far as their premorbid personality was concerned, those who were ingenuous or trusting left drugs more often than those who were described as suspicious (Table I)