We are continually nagging patients. In a hospital which specializes in the rehabilitation of the chronic psychiatric patient (Morgan, Cushing and Manton, 1965) this is understandable. It goes on informally between nurse or doctor and patient, and at formal case conferences. Good advice is given on these occasions by a variety of people, in a variety of ways, and the patient responds with a variety of results.

A high incidence of men with the 47 XYY karyotype has been repeatedly demonstrated amongst inmates of prisons (Bartlett et al., 1968; Griffiths et al., 1967) and institutions of psychologically abnormal offenders (Jacobs et al., 1968; Casey et al., 1968). Although genetic surveys of the newborn suggest that there must be many more males with this karyotype who remain undetected in the general population, the high incidence of this karyotype amongst these highly selected groups remains unexplained. The initial hypothesis that the extra Y chromosome was associated with aggressiveness no longer appears tenable, at least in its extreme form, as studies indicate that men with this karyotype are less aggressive than other men in the same institution (Price and Whatmore, 1967). It has also been suggested (Hunter, 1966) that because of their increased stature they are more likely to be seen as aggressive and dangerous, and that emotional disturbances arise from problems consequent to being tall. Forssman and Hambert (1969) have suggested that some cerebral abnormality might account for the behaviour of these individuals, and point to reports of EEG abnormalities as being in keeping with this. In support of this idea, Daly (1969) has reported finding neurological abnormalities in 10 out of 12 XYY males that he examined. He further suggested that neurological deficits might prove valuable in identifying individuals of this karyotype. Criticism has been made of such conclusions (Kessler and Moos, 1970) on the grounds that all such studies have been carried out on patients in special institutions, and that the prevalence of similar abnormalities in the rest of these populations is not known. The following report describes neurological findings in 23 XYY men and in a group of patients with a 46 XY karyotype from the same institution, matched in respect of age (6 months), intelligence (15 points on WAIS), and length of stay (within two years). All patients were from Rampton and Moss Side Hospitals (two of the English Special Hospitals) and had been karyotyped in a previous survey (see Casey, 1971). Apart from those on anticonvulsant medication, all patients had been off drugs for at least the preceding four weeks. Controls and index cases were seen in a randomized order by one of us (M.J.G.H.) who did not know at the time of examination to which group the patient belonged. The neurological anomalies detected in the two groups are shown in the table below.

Among the theories of making rational choices under uncertainty, the one which originated with an eighteenth-century English clergyman, the Reverend Thomas Bayes, and which uses observed evidence to modify prior judgements concerning different possible ‘causes' of the evidence, is logically nearest to the paradigm of clinical diagnosis. A simple illustration of this theorem is the classical Bertrand Box problem (Fry, 1928), and its wider implications for decision making have been discussed by Birnbaum and Maxwell (1960). An example of the use of the theorem in clinical classification has been given by Maxwell (1961).

In spite of the importance of sleep disorder in clinical practice, and the widespread use of hypnotics (Johnson and Clift, 1968), no simple technique for objectively recording sleep patterns in clinical situations is available. EEG recording during sleep (Oswald, 1969) or the use of motility beds (Hinton and Marley, 1959) are sophisticated techniques for use largely in laboratory conditions. Many clinical investigations of sleep disorders (Haider, 1968) or trials of hypnotics (Matthew et al., 1969), rely upon subjective assessments of the quality and duration of sleep by the patient, together with a night nurse's assessment largely based upon observed restlessness. Errors in the estimation of duration of sleep are particularly likely to occur in depressed patients where the illness itself produces an altered awareness of the passage of time (Orme, 1969), while nursing observations on sleep are unreliable (Kupfer et al., 1970). Similarly patients suffering from insomnia due to chronic pain or secondary to diffuse organic cerebral disease may misjudge the passage of time and their period of wakefulness during the hours of isolation during the night. Another group who particularly misjudge the passage of time in relation to sleep are those obsessional personalities, with overvalued ideas about the necessity for adequate sleep, who account for so many of the requests for hypnotics in general practice. Hypnotic drug-dependent patients overvalue their insomnia during their withdrawal from drugs, and again make inaccurate assessment of their sleep patterns.

The College strongly supports the Abortion Act which, as the growing number of unwanted pregnancies terminated indicates—37,736 in its first calendar year, 54,819 in 1969 and 80,723 in 1970—has worked well since its inception and has been widely applied throughout the country. We are concerned, however, by the fact that is some areas patients are being denied terminations that they would readily obtain elsewhere. In consequence they have either to persist with an unwelcome pregnancy, resort to the private sector in London (or in some other large city) or have recourse to a back-street abortionist. As a result, commercialization of abortion (the ‘abortion racket’) has developed; this has been attended by adverse publicity in the press which threatens to bring a humane, socially enlightened measure into unnecessary disfavour. There are doubtless many reasons why so few terminations are being performed in some parts of the country, but amongst the more obvious would seem to be: regional disparities in numbers of gynaecologists and gynaecological beds; the influence of certain dominant gynaecologists in swaying their colleagues for or against therapeutic abortion; and the different constructions put on the wording of the Act by gynaecologists, the lay public and non-gynaecological physicians.