MEDICINE AND THE LAW

611

As an alternative to the above the birth-rate maybe calculated on the basis of ovulations experienced,as was done for the pregnancy-rate. On this basiswe have- ,

p - 100 L

13 (M-PI-P2)+T

where L denotes total number of live births, and theother letters have the same significance as before.This form of the live birth-rate has the advantage thatits biological relationship to the pregnancy-rate isat once apparent. It gives the number of livebirths per hundred ovulations during the period ofobservation.

SummaryIn this paper the attempt has been made : (1) to

give a rational definition of the terms " fertility "and "fecundity " ; (2) to describe and discuss certaindistinguishable biological factors in human fertility ;and (3) to suggest and illustrate statistical methodsby the use of which each of these factors may bequantitatively evaluated.

REFERENCES

1. Pearl, R., and Surface, F. M. : Maine Agr. Exp. Stat.Bulletin No. 166, 1909, pp. 49-84.

2. Wolfe, A. B. : Human Biology, 1933, v., 58.3. Pearl: The Biology of Population Growth, New York, 1925,

Chap. viii.4. Pearl: Human Biology, 1932, iv., 363.5. " : Ibid., 1932, iv., 525.6. Hartman, C. G. : Jour. Amer. Med. Assoc., 1929, xcii., 1992.7. Corner, G. W. : Physiol. Rev., 1923, iii., 457.8. Allen, E. : Sex and Internal Secretions, Baltimore, 1932,

Chap. xiv.9. Kelly, H. : Medical Gynecology, New York and London,

1908.10. Heyn, A. : Zeits. f. Geburtsh. u. Gynäk., 1920, lxxxii., 136.11. Sanes, K. J. : Amer. Jour. Obst. and Dis. of Women and

Child., 1916, lxxiii., 93.12. Allen, E. : Amer. Jour. Obst. and Gyn., 1933, xxv., 705.13. King, Jessie L. : Ibid., 1933, xxv., 583.14. Bell, A. G. : Science, 1912, n.s. xxxvi., 378.

MEDICINE AND THE LAW

Verdict of Murder against Mental PatientWE discussed last week the rider attached by a

coroner’s jury to a verdict of murder against a patientin the Macclesfield mental hospital who had killedan attendant with a porcelain utensil. The patientwill not have to stand his trial at the Chester assizesto which he stood committed. The Home Officehas directed his removal to Brixton prison with a viewto his transfer to Broadmoor on being certified unfitto plead. To some it may have seemed a perverseverdict to find a man guilty of wilful murder whosemental condition was such as to justify this interven-tion by the Home Office. Had the case gone fortrial to the assizes, he would in all probability havebeen found either unfit to plead or else insane at thetime of committing the act which caused death ;a verdict of murder would have been extremelyunlikely at the assizes. When magistrates examineallegations of crime, they generally refrain fromcommitting an accused person for trial if there isno reasonable prospect of a conviction. Why then,it may be asked, should a coroner’s jury brand as amurderer a mental patient who will either not beput upon his trial at all or, if tried, will be foundinnocent of criminal intent ? The explanation is thatit is not deemed to be within the province of a coronerand his jury to inquire into the mental state of anyperson except in the case of alleged suicide. Wherethere is no element of suicide, the coroner’s courtmust presume ordinary mental capacity. If thefacts would justify a verdict of murder or manslaughter

in the case of a person of sound mind, such a verdictshould be returned even though doubts may existas to the accused’s mental competence. It is pointedout in " Jervis on Coroners " that this principlespecially applies where an inmate of a mental hospitalhas killed another inmate or a member of the hospitalstaff. Otherwise the public does not obtain the

protection of the coroner’s warrant which in a propercase ensures the arrest of the person concerned andhis detention in the appropriate institution.

Osteopath Fined under the Medical ActLast week the Plymouth magistrates convicted an

osteopath of the offence of unlawfully using the titlesof physician and surgeon. Section 40 of the MedicalAct authorises the infliction of a fine of E20 uponanyone who wilfully and falsely pretends to be a

physician or doctor of medicine or takes or uses anyname, title, addition, or description implying thathe is registered under the Act or that he is recognisedby law as a physician or surgeon. The evidenceindicated that Mr. Emanuel Mitchell, the osteopathagainst whom the proceedings were taken, had on hisbrass plate the title " D.O.," understood to meandoctor of osteopathy. He was entered in the tele-phone directory as "Dr. Emanuel F. Mitchell,osteopath." On his stationery he described himselfas " Osteopathic Surgeon," adding the initials"D.C., D.O., and N.D." (understood to mean

doctor of chiropractic, doctor of osteopathy, andnature doctor), and as medical adviser to the PlymouthWorkers’ Health Council and lecturer to another body.On May 9th he wrote a letter to a west country eveningnewspaper in which he discussed such matters as areusually dealt with by a duly qualified practitioner.There was of course not the slightest objection tohis publishing views on such subjects, but in signingthe letter he used the description " osteopathicphysician and surgeon." Mr. Mitchell was chargedwith four offences : (a) using a title implying that hewas registered by law as a practitioner in medicine ;(b) using the title of "surgeon " ; (c) using the titleof "physician"; and (d) using a title implyingthat he was registered under the Medical Act. Themagistrates convicted him under (b) and (c), apparentlybecause of his signature to the letter in the press, andacquitted him under (a) and (d). Mr. Mitchell, whoconducted his own defence, called witnesses who saidthat they had benefited by his treatment and hadnot been in any way deceived by him as to his qualifica-tions ; they knew, they said, that he was an

unorthodox or drugless practitioner. He told theBench that the General Medical Council could haveno monopoly in the title of

"

surgeon " since there wereplastic surgeons, dental surgeons, and veterinarysurgeons. If, however, Mr. Mitchell were to describehimself as a dental surgeon or veterinary surgeonwithout the necessary qualifications, he might findhimself in the same difficulty. There would be moresympathy with the unregistered practitioners against,whom prosecutions of this kind are undertaken wereit not that they seem to want the best of both worlds.The titles and descriptions adopted are often thosewhich will confuse the minds of the public by suggest-ing that the practitioner is duly qualified. This.confusion is the abuse which the Medical Act, as its.preamble shows, was enacted to remove. In finingMr. Mitchell £20, the magistrates declined to makeany order as to costs. They were impressed perhaps.by his statement that the medical council was arich body with assets of £70,000.

It was, of course, the Medical Defence Union whichwas prosecuting, at its own expense.