In a study to investigate how many ex-patients died since 1974 from sudden or violent causes among all the residents in the catchment area of a general hospital psychiatric unit, the identification of the ex-patients was completed with minimum use of the local coroner as a source of names. Since much of the information available from coroners is available elsewhere, and in view of the considerable pressure of work on coroners, it was felt that alternative sources of information should initially be explored. Three alternative sources, available from death registration procedures, are described and the usefulness of the data available from each source discussed.

There is increasing interest in services for younger brain damaged persons (acquired in adult life as a result of trauma or illness). However, there is uncertainty about the type of service needed and to whom the medical responsibility belongs.

[As part of the Cane Hill Hospital Centenary celebrations, the Southern Division of the College held its 1982 Annual General Meeting there last June. Dr Alexander Walk was invited to prepare a paper to mark the occasion. Readers of the Bulletin will know that Dr Walk died in July last year. Poor health had prevented him from giving his paper, though it was read at the meeting.

Psychiatrists who work with the dying met together with other liaison psychiatrists at St Christopher's Hospice in April 1983 for a small two-day conference. We found it both stimulating and supportive to hear about several specialized aspects of our work.

Psychiatry in a land of 7 1/2 million (National Census, August 1982) people with relatively advanced general medical services, but only eight psychiatrists, has great problems. The facilities have been described elsewhere (Murdoch, 1982). Historically poorly related to population needs, and with immense difficulties in serving the rural communities that still comprise over half the population (National Census), Zimbabwe has concentrated its post-independence effort on the development of primary health care in village, district and small town. With a medical school expanding (current intake 80 students per annum) and good central facilities for training and specialist care, primary care in public health and general medical services are developing on a sound basis. In psychiatry, a mere 1200 beds for the country (only 141 in the capital, Harare, which, with dormitory towns, has an ‘official’ population of 1.1 million and serves a further four million in remote rural areas) the training and specialist facilities are sketchy indeed.

Earlier this year the Department of Psychiatry was invited to participate in a Careers Fair at the Medical School, organized by the Postgraduate Dean's Department rather than the BMA. This fair was aimed at medical students and junior doctors, and consisted of poster displays and stands by many different medical specialties. The students attended in huge numbers and in discussions afterwards their representatives commented that it was particularly helpful to realize that careers were available in specialties such as dermatology, venereology and some branches of chemical pathology.

Interest in the process of formulating a psychiatric case continues unabated (Greenberg et al, 1982). We report the findings of a brief survey conducted in an attempt to begin publicizing examiners' expectations in this contentious area.

For that first day, just over a year ago, I had had my grey, slightly pinstriped suit dry-cleaned and bought new shirt, shoe laces and after-shave to emphasize a fresh start. As I drove up to the clinic (somewhat early), I weighed up the pros and cons of the job I had accepted: pros—nice part of the country, relaxed life-style, pleasant people; cons—rather professionally isolated, no university, no in-patient unit (or was this one a pro?).

In the beginning of the 19th century Italy was in the forefront of psychiatric reform. The question as to whether it was Chiarugi (1759–1820) or Pinel (1745–1826) who was the first to unchain patients in mental hospitals has remained unanswered. With the death of Chiarugi, however, the age of enlightenment, which he had heralded, faded and conditions in Italian hospitals reverted to their former state.

Over thirty-five years have elapsed since Dr Joshua Bierer opened the first psychiatric day unit in London in 1946. Following a somewhat tentative start in the early 1950s, day hospitals expanded rapidly during the latter 1950s, ‘60s and into the ‘70s, and are now regarded as an established part of the psychiatric services. However, it is probably a truism that many of the staff working in psychiatry know little more about the philosophy, practice and effectiveness of day care than their colleagues did a generation ago.

Seclusion, locking up patients in isolation, has a long history in psychiatry (Hunter and MacAlpine, 1963). John Conolly (1856), for example, though an advocate of non-restraint, defended the practice: ‘That salutory exclusion of causes of excitement from an already irritated brain, has been so unjustly stigmatized as solitary imprisonment’. Even so, many of his contemporaries reviled seclusion. Indeed, experience over the years has shown that such limitations of patients' liberty need to be carried out under scrutiny, otherwise abuses may take place. Patients who give staff trouble may be secluded as a punishment or kept in seclusion for long periods without proper attention. For this reason, therefore, doctors need always to take particular care to see that this form of management is carefully regulated.

I would like to bring to light an apparent oversight in the new statutory rules relating to consent to treatment by the mentally ill and mentally handicapped. This will have very serious consequences for the management of patients who are on short-term detention orders. The provisions relating to consent to treatment set out in Part IV of the Mental Health Act 1983 are the first attempt to cover by statutory controls the doctor's clinical freedom to prescribe treatment for his compulsorily detained patient. In addition, certain of the new provisions (which take effect from 30 September 1983) apply to the voluntary patients as well.

Every member of the College is entitled to these two monthlies, which go all over the world, since about a quarter of the membership is overseas. While the Bulletin is predominantly about College work and membership activities, and goes only to the membership, the Journal is an international medical-scientific journal with a circulation also among non-member subscribers worldwide, particularly among university libraries, medical schools and governmental health agencies. Because of this extensive sale, and because the Journal is published by the College instead of by a commercial publisher such as Blackwell or Macmillan (as are many journals), the money coming in is enough to finance the whole publishing operation. This is particularly so since the editors and assessors give their time and expertise entirely without fees, in some cases amounting to many hours a week of honorary labour, although all the editors (for instance) are also in clinical practice. The financial effect is that not one penny of a member's subscription goes to the production and mailing of these two journals to members, indeed, some of the Journal's ‘profit’ can be applied to reducing the cost of other College publications, which are often sold at a loss.

Here is a good teaching case:

Mr Watene, aged 25, was put in prison for seven days on a charge of offensive behaviour, with a charge of robbery pending. On the third day he was recommended for transfer to a psychiatric hospital because he was sullen, depressed and uncommunicative; he had barricaded himself in his cell because he was scared of other prisoners, and he carried a knife for his protection, as he said. Two doctors wrote the order. One noted: ‘It is very difficult to gain his attention. He cerebrates slowly, and replies to repeated questioning are in the main irrelevant.’ The other said: ‘It is not really possible to have a conversation with him, but he does indicate his fear of being left alone in the cell and wished me to stay with him. Says he is mixed up.’