107

of control have failed and that, by means of passiveimmunisation by serum or placental extracts, wehave entered on a promising stage in the battle againstmeasles. Much work on the epidemiology of thedisease remains to be done, and those of us to whomthe control of infectious diseases in hospitals, schools,and homes is entrusted are fully alive to the needfor constant experiment.

I am indebted to Dr. W. Gunn for the loan of thethree charts on which the figures are based.

MEDICINE AND THE LAW

Medical Supervision of Special TreatmentEstablishment

THE London County Council has, by Local Act,statutory powers of licensing massage and specialtreatment establishments. Under these powers a

licence was granted to Mr. Alexander Barthels, of

Weymouth House, Hallam-street, with a conditionthat he should not give ultra-violet ray treatmentwithout the supervision of a medical practitioner.An inspector of the L.C.C. found that the conditionwas being broken and Mr. Barthels was summonedat Marlborough-street police-court last week. Theinspector’s evidence was that a patient who wasundergoing such treatment was asked if she had seena doctor and if a doctor had recommended the treat-ment. The patient answered that she had been tomany doctors and had received no benefit and hadtherefore decided to try Mr. Barthels. There wasno question of Mr. Barthels’s competence. His

legal representative was prepared to elaborate thedefendant’s skill, but the magistrate observed thathis competence was irrelevant. The summons wasdismissed under the Probation of Offenders Act onpayment of f:5 5s. costs to the L.C.C. and on thedefendant undertaking not to commit a further breachof his licence. The licensee could hardly contendthat he was unaware of the restrictive condition.Deliberate violation of the condition is hardly theproper method of appealing against it.Fraudulent Conversion by Hospital Secretary

Offences between January and October last yearformed the subject of charges at West Sussex QuarterSessions last week against Major W. I. Rogers,former secretary of the Bognor Regis War MemorialHospital. He pleaded guilty to various charges offraudulent conversion, intent to defraud, and omissionto make entries as to orders of stamps. It was

urged in mitigation of sentence that the accusedhad formerly borne an exemplary character and hadreceived inadequate pay. The chairman of the

bench, Mr. Roland Burrows, K.C., observed that

judges had from time to time commented on thefact that it was only persons with an exemplarycharacter who obtained posts where they couldcommit offences of this kind. Passing sentence of12 months’ imprisonment in the second division, heexpressed the view that the checking of the hospitalaccounts appeared to have been lamentably lax,and that, with better supervision, the defendantwould not have found himself in his present position.

Unfitness to Plead

A careful paper on " unfitness to plead," read lastyear by Dr. W. Davies Higson, medical officer ofLiverpool Prison, before the annual conference ofprison medical officers, is published in the Journal of

Mental Science (1935, cxxxi., 822). He points outthat this preliminary question of fitness to plead incriminal proceedings is one with which prison doctorsmay often have to deal. It is common experience,indeed, that judges pay special respect to theirevidence. It might be added that the Atkin Com-mittee on Insanity and Crime stressed the importanceof medical officers of prisons having special knowledgeof mental disorder. As has sometimes been pointedout, the courts examine a prisoner’s fitness to pleadmore carefully in serious charges like murder than inmerely trivial offences, and, on the whole, the propor-tion of prisoners found unfit to plead is advancing.The Atkin committee advised that a man should

not be found unfit to plead except on the evidenceof two doctors at least ; one of these would usuallybe the medical officer of the prison. The committeerecommended the retention of the procedure.Mental disorder is sometimes so obvious that trialwould be a farce ; on the other hand, where thereis any element of doubt, it is a strong step to puta man away as a criminal lunatic when he has notbeen found to have committed a criminal act. Thecommittee approved the standing orders of thePrison Commissioners which recommend that a

prisoner be left to stand his trial unless there are

strong reasons to the contrary. It remarked thatit was aware of evidence of persons of unsound mind

having pleaded guilty either to gratify an insanedesire for punishment or to avoid inquiry into theirmental condition. The evidence which justifiesa finding of unfitness to plead consists of showingthat a prisoner suffers from such defect or diseaseof the mind as not to be able to understand the natureof the proceedings against him, or the differencebetween a plea of "

guilty " and a plea of "notguilty," or that he is unable to follow the course of thetrial or instruct counsel in his defence or appreciatethat he has the right to challenge a juror. On these

points the medical witness can state the facts he hasobserved and the conclusions he has formed, but it isfor the jury to decide the issue. The law sees no inherentdifficulty in a man or woman being insane and yet fitto plead.By way of illustration Dr. Higson mentions

two instances of the kind of complication which maybe introduced. A woman was to be tried at Liverpoolassizes for murder of her child. She was broughtfrom Manchester where the medical officer had

reported that, during remand there were no indica-tions that she would be likely to be unfit to plead onarraignment. Yet on arrival at the Liverpoolassize-court she was in such a state of extremeemotion and mental distress that the medical witnesswas prepared to give evidence, from further observa-tion, that she was not fit to plead. In the otherinstance the prisoner had been charged with shootingwith intent to murder. His mental conditionindicated a straightforward case of paranoia. Medicalwitnesses for the defence testified that he was unfitto plead. He protested and, his counsel not objecting,the judge told the jury to return a verdict that theman was fit to plead. He was then indicted and,in spite of protests from his counsel, he pleadedguilty ; the result was a sentence of 20 years’ penalservitude. Dr. Higson records the interesting opinionof one of the medical witnesses, who discussed thecase afterwards, that the judge overlooked the

unlikely contingency of the prisoner pleading guilty,and that the jury was the more ready to follow thedirection to find the man fit to plead because theywere anxious to hear what was rather a sensationalcase.