
appeared encouraging and almost straightforward. At that time ocstrogen therapy, sometimes combined with orchidectomy, had become well established. In some centres (mainly in North America) radical prostatectomy was recommendcd for early localised tumcurs, but most urologists resected the malignant tissue only when it caused obstruction. When the disease progressed and symptoms, usually bony pain, became severe there remained either palliative local radiotherapy or a pituitary ablation.

More recently several aspects of this policy have been questioned. The large co-operative trials by the Veterans Administration in the United States showed that for patients with early stage tumours the morbidity and mortality from conventional oestrogen therapy were unacceptably high and that a lower dose of stilboestrol (1 mg three times a day) was as cffective and caused fewer cardiovascular complications. Patients presenting with later stages of the disease could also, it seemed, be left untreated until symptoms developed without their survival rate deteriorating.' A further challenge has come from the radiotherapists, whose earlier experience had led them to abandon radiation treatment because of its complications: with radiotherapy alone recent techniques which allow more precise delivery of higher dosages to the prostate have given encouraging five-year survival results.2 Good results have also been reported using interstitial radiation.3 The interaction of the hormone state of the patient and the steroid responsiveness of the malignant prostatic cell have also come under scrutiny. There appear to be two main groups of patients-a majority who respond to androgen suppression as primary treatment, and a minority who do not. 
Dermatitis from cosmetics
Allergic contact dermatitis caused by cosmetics is probably common. Nevertheless, relatively few cases are fully investigated, for several good reasons. Most women who find that they react unfavourably to a particular cosmetic merely stop using it and do not consult a.doctor. If they react to too many different cosmetics they may seek medical advice, but the formidable chemical complexity of these preparations has tended to deter doctors from undertaking a full investigation: with unjustifiable optimism they may merely suggest that yet another brand be tried.
Dermatitis from cosmetics
In fact, the principal sensitisers in cosmetics are perfumes. Just how widespread these have become in our environment is obvious when modern terminology is applied to them; the so-called aroma chemicals include both the fragrance and the flavour chemicals, while many substances belong to both groups and may fulfil both functions. Listing published information about these chemicals, Collins and Mitchell' emphasised both the potential importance and the practical difficulties confronting the clinical investigator. For example, cinnamic aldehyde is an important allergic sensitiser; and not only is it found in some commonly used ingredients of perfumes but it is also used in household deodorisers, detergents, soaps, toothpaste, soft drinks, confectionery, chewing gum, and ice cream.
Dermatitis from cosmetics
Perfumes as such are complex mixtures containing from 10 to over 60 ingredients, some of animal or plant origin and some synthetic.2 This multiplicity of substances is probably an advantage, for, while perfume oils may make up 20% of the volume of the perfume, the concentration of each individual ingredient is low, reducing its capacity to sensitise. When allergic sensitivity is suspected to a perfume as such or to a cosmetic containing perfume-a cream, for example, or an axillary deodorant-the doctor should carry out patch tests with a battery of perfume ingredients, several such batteries being available for preliminary screening.23 Multiple sensitivities are frequent: the most common offenders in one series of patients studied in detail3 were a jasmine synthetic, cinnamic alcohol, and hydroxycitronellal, but very many different substances were implicated.
Dermatitis from cosmetics
Fragrance materials are easily overlooked as being constituents of many proprietary preparations designed for therapeutic use-and therefore for application to already damaged skin. The incidence of allergic sensitivity is very much higher in such circumstances than when the allergen is applied to normal skin, but once sensitivity has been induced normal skin is also likely to react. Cinnamon caused dermatitis in six patients who reacted to TCP ointment-and fragrance materials in other medicaments have been incriminated.-' We need to be aware of the widespread occurrence of aroma chemicals and of their allergenic potential.
Dermatitis from cosmetics
Full investigation of these problems usually requires two things. Firstly, the facilities of a well-equipped department of dermatology. Secondly, the willingness of its staff, and of the patients, to devote much time to unravelling a mystery whose solution may be of great practical help to those patients who are unwittingly encountering the same or related sensitisers in many different products. If more cases are investigated and reported, perhaps manufacturers may be persuaded to omit sensitising fragrances from topical medicaments.
Dermatitis from cosmetics
Collins, F W, and Mitchell, J C, Contact Dermatitis, 1975, 1, 43. 2 Fisher, A A, Contact Dermatitis, 1975, 1, 166. 3 Larsen, W G, Archives of Dermatology, 1977 , 113, 623. 4 Calnan, C D, Cotitact Dermatitis, 1976 
Dangerous patients and prisoners
Perhaps the most important function of a forensic psychiatrist is to advise judicial and nonjudicial bodies on the dangerousness of both prisoners who have offended against the criminal law and of patients in mental hospitals (particularly special hospitals), who are often admitted after criminal proceedings. The element of dangerousness has to be taken into account by the forensic psychiatrist when advising the court that admission to a special hospital is appropriate rather than to a conventional mental hospital, or that a hospital order (Section 60 of the Mental Health Act, 1959) should be accompanied by a restriction order (Section 65) with or without "limitation of time." Similar advice has to be given by psychiatrists appointed to the Parole Board and to mental health review tribunals. In both instances a major preoccupation is the possible danger to the public if the prisoner or patient is tristan59@example.org. The sensational comments that followed the escape this month from an open prison of the child killer Mary Bell provide further evidence of the difficulty of balancing the public interest against the rights of a prisoner to humanitarian treatment.
Dangerous patients and prisoners
On what body of knowledge is advice on this important topic to be founded? There are unfortunately no absolutes in assessing dangerousness. What is offered is, after all, only an opinion, an opinion which may be based at different times on different sets of criteria, all of them somewhat arbitrary. Shakespeare's Caesar attributed Cassius's dangerousness to his lean and hungry look, thus possibly anticipating by some three centuries Lombroso and Bertillon. The constitutional approach has now been largely discredited and today the assessment of prisoners is essentially psychiatric. Research efforts have steadily increased; reports vary in quality, but undoubtedly the most important single contribution thus far is the

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