The incidence of anencephalus and other malformations of the central nervous system (CNS) is much higher in the United Kingdom than in other countries of Western Europe which were not industrialized to the same extent. In the UK the incidence is highest in the unskilled manual occupational group, especially in the large cities of the North of England, Scotland and Northern Ireland. Standards of living have been low in these areas for many years and deteriorated sharply at the time of the worldwide industrial depression from 1928 to 1934. The population tended to be stunted in stature and to show other signs of chronic malnutrition.

The cohort of women born in these years had an unusually high stillbirth rate from anencephalus (and from all other CNS malformations) from about 1946 onwards. It was highest in the early 1960s when these women were at the peak of their reproductive activity. This suggests that the severe malnutrition to which they were subjected before and soon after birth resulted in severe damage, which reduced their reproductive efficiency as demonstrated by the unusually high perinatal death rate from all CNS malformations. Not surprisingly the death rate rose sooner, lasted longer and reached a higher level in social classes IV and V than in social classes I and II. Other evidence of damage was an increase in the incidence of low birth weight babies with a corresponding increase in the perinatal death rate from this cause.

In Scotland the stillbirth rate from anencephalus was approximately 2·1 per 1000 in 1948–49, 3·4 at its highest point between 1961 and 1963 and 2·1 in 1968, by which time the women born in the years of the depression had completed their childbearing. A teratogen acting during a particular period of time could not provide a satisfactory explanation for this sequence of events.

Birth order and family size have been studied in a representative sample (10,000) of the adult population of Great Britain. This was done to test theoretical predictions about the ways in which the birth-order distribution in a population sample will be biased by secular changes in family size. The principal predictions were that, in a sample born during a period when family size was decreasing, the distribution of birth ranks in the larger families would be biased towards an over-representation of later born subjects (i.e. those lower in birth order), while in smaller families there would be an under-representation of later born. In a sample born during a period when family size was increasing, the reverse effects would occur. It was also predicted that among subjects from large families there would be an excess of females; and that the extent of the bias due to decrease in family size would be greatest in the unskilled and least in the highly skilled social classes.

The findings confirmed these predictions. The sample also showed an un-predicted excess of subjects in the middle ranks of families. It is suggested that the hypothesis of birth rate bias may be used for predicting the type of birth-order distribution to be expected in a sample of any population.

The relative stability of many rates of suicide, particularly those of national groups, has for a long time been of interest to sociologists. Durkheim (1952), an early and major writer on suicide, used the fact of relative stability as an argument for the existence of a social dimension to individuals’ actions, even such an apparently personal action as suicide (Cresswell, 1972). Durkheim argued that each nation had a collective tendency towards suicide such that, providing the circumstances of the nation did not change in any essential way, its suicide rate also would not change. His followers, taking this sort of position as given, have related suicide rates to components of social structure or culture of the groups to which the rates refer (e.g. Gibbs & Martin, 1964). Such a procedure implies a relationship, not necessarily a specifically causal one, between suicide and the various aspects of society with which it is correlated. For the procedure to be potentially valid two major conditions must hold good. The first is that the aggregate numbers of ‘suicides’ which are used to compile suicide rates do actually represent the real number of suicidal deaths in a given population over a given period of time. This pre-supposes, of course, that some deaths have defining characteristics in their manner of occurrence which clearly demarcate them as suicide; given this, the problem is one of identification rather than of definition. The second condition is that since suicide rates are compiled from individual deaths, it should be possible to posit, if not actually demon-strate, a relationship between the social or cultural influences which are supposed to generate stable rates of suicide and the individual instances of suicide.

The Board of the Marie Stopes Memorial Foundation organized in 1971 the first of a series of Marie Stopes Memorial Lectures to celebrate the 50th anniversary of the opening of her first clinic in Holloway in 1921 (Taylor, 1971). A second lecture was arranged in 1972 (Mitchell, 1973). For 1973, the Board decided to vary the pattern and asked us to write an account of the clinic in the 1920s and 1930s, a neglected subject compared with the voluminous studies of Marie Stopes herself. In accepting this invitation, we realized that there was some factual material available, but that for the human touch we should have to rely largely on those still available who knew the clinic in its early days. It seemed therefore that the interview technique would be best suited to bringing out the highlights. In this we have been fortunate in having the most helpful co-operation.