No abstract

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.

Patients (672) admitted to a department of medicine during five consecutive months were followed by an investigator who identified 110 clinical manifestations which could have been considered adverse drug reactions. From these, 42 were excluded because they did not correspond to the definition of adverse reaction or they were inadequately documented. The remaining 68 cases were submitted to three independent observers who had to reply to a series of questions; from these replies five degrees of probability for the reaction itself were deduced. Reactions (54; 49% of the manifestations reported) were considered as certain or probable by at least two observers, but only 27 reactions of these (25%) were attributed to the same drug by all three observers. There was a low level of agreement between any two observers (paired agreement ratio: 0.6 to 0.7) and little difference of agreement between any one observer and each of the others (personal agreement ratio: 0.6 to 0.7).

No abstract