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1193 gastric ulcer, to have had operations of various types. The patient with gastric ulcer has required treatment for iron- deficiency anaemia; and blood-counts have been done on three of the other men, with normal results. Two women have been found to have iron-deficiency anaemia, and one of these has osteoporosis of the spine also. An overlooked patient had had a partial gastrectomy for duodenal ulcer in 1952, and presented with swollen legs, dyspnoea on exertion, and obviously severe anaemia. He proved to have a megaloblastic anaemia with a Hb of 34%. The annual screening of this group of patients will obviously be worth while, but this is only one of several screening exer- cises possible and desirable nowadays. The general practitioner is going to need all the ancillary help available to enable him to do this sort of work effectively. Another possibility is suggested by the splendidly enlightened policy of Dr. T. McG. Galloway, medical officer of health for West Sussex, who has offered a computer service to the local general practitioners.1o If a computer can be used to pro- gramme immunisation over a county, could not the long-term follow-up of gastrectomies, &c., be organised by computer, say, at regional-board or even hospital-group level ? Hayling Island, Hampshire. D. H. BROUGHTON. D. H. BROUGHTON. Medicine and the Law " Substantial Impairment " AT his trial for the murder of his wife, the appellant raised the defence under section 2(1) of the Homicide Act, 1957, that he was suffering from such abnormality of mind as sub- stantially impaired his mental responsibility. Evidence for the appellant was given by a doctor from Birmingham prison who said that the appellant was abnormal and his abnormality was due to mental illness; he then went on to say that the appellant’s mental responsibility was impaired by the ab- normality " to some extent", but he could not go so far as to say that it was " diminished to any substantial degree". A consultant in psychiatry said that the appellant was suffering from a depressive illness, constituting an abnormality of mind, and that such illness affected his mental responsibility " to a degree " which was " not as low as minimal ". The trial judge, in his summing up, directed the jury that " substantially " did not mean totally impaired, nor trivial or minimal, but something in between, and that it was for the jury to say whether, on the evidence, the mental responsibility was impaired and if so, whether it was substantially impaired. The appellant was convicted and he appealed, contending that that was a misdirection and that the jury in a case such as this, should have been directed that " substantially " meant real. Mr. Justice EDMUND DAVIES, giving judgment of the court, said that the substance of the direction in Reg. v. Simcox 11 was the same as in the present case. In that case not one of the mental experts felt that he could say that the impairment was substantial, and the jury refused to return a verdict of man- slaughter, but returned a verdict of capital murder. The trial judge, Mr. Justice Finnemore, had said, " There is no scientific precise test... you should work at it in a broad common-sense way and ask yourselves, having heard what the doctors have said, having made up your mind about it, knowing what this man did, knowing the whole story, Do we think looking at it broadly as common-sense people there was a substantial impairment of his mental responsibility in what he did ? ’ If the answer to that is yes, then you find him not guilty of murder, but guilty of manslaughter. If the answer to that is no, there may be some impairment, but we do not think it was something which really made any great difference, although it may have made it harder to control himself, to refrain from crime; then you would find him guilty as he is charged in the 10. See Pulse, Nov. 20, 1965. 11. See Lancet, 1964, i, 550. only charge to this indictment". That direction as to the meaning of " substantially " had been approved by the Court of Criminal Appeal, and the court felt that it should follow it and could find no ground for criticising the trial judge’s direction in the present case. The appeal accordingly, must fail. Reg. v. Lloyd. Court of Criminal Appeal: Edmund Davies, Fenton Atkinson, and Lyell.y.y. Nov. 22, 1965. Counsel and solicitors: Michael Davies, Q.c., and J. R. Toyn (Varley Hibbs & Co., Coventry); Douglas Lowe, Q.c., and R. D. L. Kelly (Director of Public Prosecution). LUCILLE FUNG Barrister-at-Law Our Legal Correspondent writes: Section 2 of the Homicide Act, 1957, provides for a verdict of manslaughter instead of murder where it is shown that the accused " was suffering from such abnormality of the mind ... as substantially impaired his mental responsibility for his acts or omissions in doing or being a party to the killing ". Reg. v. Simcox, decided in February, 1964, is a more im- portant case than Reg. v. Lloyd. The appeal in the earlier case concerned the direction of the judge as to " substantial impair- ment ": the medical evidence revealed some impairment of responsibility and a persistent and strong degree of paranoid personality. Mr. Justice FINNEMORE’s summing-up was approved, leaving as it did the issue of substantial impairment to the jury, and directing that the test was one of common sense. The word " substantial " was not defined by the Court of Criminal Appeal nor by the trial judge, but it can be deduced from the facts that the standard of substantiality is quite high. In Reg. v. Lloyd the medical evidence was certainly no stronger, and so a frontal assault could not be attempted. Instead, the appeal took a somewhat technical point, that substantial impairment meant impairment in substance as opposed to impairment to a considerable degree. The Court of Criminal Appeal neatly turned this point, saying, in effect, that technical definitions could not be used to interfere with a direction that confided the issue to the common sense of the jury. A bolt hole has been closed, but the difficulties about the level of substantial impairment remain, though of course the issue is less agonising now that capital punishment has been abolished. Appointments ASHFORD HODGES, W. A., M.B. Cantab., F.R.c.s.: consultant orthopaedic surgeon, Great Yarmouth General Hospital and Lowestoft and North Suffolk General Hospital. BRIGGS, J. C., M.B. Lond., M.c. PATH.: second consultant pathologist, department of morbid anatomy, Cossham-Frenchay hospital group. O’MALLEY, J. E., M.R.C.S., D.P.H. : deputy M.O.H. and deputy principal school M.o., St. Helen’s, Lancashire. PARSONS, P. L., M.D., B.sc. Wales, D.P.M. : consultant psychiatrist, North Wales Hospital, Denbigh. PHILLIPS, B. S., M.B. Cantab., D.P.M. : consultant child psychiatrist, Northampton/Kettering area. RAWSTRON, J. R., M.D. Lond., M.C.PATH., D.PATH.: consultant clinical pathologist, Aylesbury/High ’Wycombe area and Wycombe General Hospital. REES, W. E. L., M.B. St. And., D.o.: consultant ophthalmologist, Llwynypia Hospital and Pontypridd and Rhonda hospital group. South East Metropolitan Regional Hospital Board AWTY, M. D., M.R.c.s., F.D.S. : consultant oral surgeon, Tunbridge Wells and Medway and Gravesend hospital groups. BRAMWELL, S. 0., M.B.E., M.B. Edin., F.F.A. R.c.s.: consultant anaesthetist, Hastings hospital group. DE SARUM, P. M., M.B. Lond., F.F.A. R.C.S. : consultant anaathetist, Central Kent hospital group. ECKSTEIN, H. B., M.D. Cantab., F.R.C.S.: consultant paediatric surgeon, Bromley hospital group. GREENWOOD, RAYMOND, M.B. Manc., M.R.C.P., D.PHYS. MED.: consultant in physical medicine, Bromley hospital group. MULCAHY, FRANCIS, M.B. N.U.I., F.F.R., D.M.R.D.: consultant radiologist, Brighton and Lewes and St. Francis and the Lady Chichester hos- pital groups. PARR, D. J., M.D. Lond., D.P.M.: consultant psychiatrist, Brighton and Lewes and St. Francis and the Lady Chichester hospital groups. POTTER, C. J. F., M.B. Cantab., F.F.A. R.c.s.: consultant anxsthetist, South-East Kent hospital group. STEPHENS, D. S. B., M.B. Madras, F.F.A. R.C.S.l.: consultant anasthetist, Medway and Gravesend hospital group. TRAFFORD, J. A. P., M.B. Lond., M.R.C.P.: consultant in general medicine, Brighton and Lewes hospital group. WARLEY, M. A., M.D. Cape Town, D.c.H.: Woolwich and Dartford hospital groups.
Transcript of Medicine and the Law
1193
gastric ulcer, to have had operations of various types. The
patient with gastric ulcer has required treatment for iron-deficiency anaemia; and blood-counts have been done on threeof the other men, with normal results. Two women have beenfound to have iron-deficiency anaemia, and one of these hasosteoporosis of the spine also. An overlooked patient had hada partial gastrectomy for duodenal ulcer in 1952, and presentedwith swollen legs, dyspnoea on exertion, and obviously severeanaemia. He proved to have a megaloblastic anaemia with aHb of 34%.The annual screening of this group of patients will obviously
be worth while, but this is only one of several screening exer-cises possible and desirable nowadays. The general practitioneris going to need all the ancillary help available to enable him todo this sort of work effectively.Another possibility is suggested by the splendidly enlightened
policy of Dr. T. McG. Galloway, medical officer of health forWest Sussex, who has offered a computer service to the localgeneral practitioners.1o If a computer can be used to pro-gramme immunisation over a county, could not the long-termfollow-up of gastrectomies, &c., be organised by computer, say,at regional-board or even hospital-group level ?
Hayling Island, Hampshire. D. H. BROUGHTON.D. H. BROUGHTON.
Medicine and the Law
" Substantial Impairment "AT his trial for the murder of his wife, the appellant raised
the defence under section 2(1) of the Homicide Act, 1957, thathe was suffering from such abnormality of mind as sub-
stantially impaired his mental responsibility. Evidence for theappellant was given by a doctor from Birmingham prison whosaid that the appellant was abnormal and his abnormalitywas due to mental illness; he then went on to say that theappellant’s mental responsibility was impaired by the ab-
normality " to some extent", but he could not go so far as tosay that it was " diminished to any substantial degree".A consultant in psychiatry said that the appellant was sufferingfrom a depressive illness, constituting an abnormality of mind,and that such illness affected his mental responsibility " to adegree " which was " not as low as minimal ".The trial judge, in his summing up, directed the jury that
" substantially " did not mean totally impaired, nor trivial orminimal, but something in between, and that it was for thejury to say whether, on the evidence, the mental responsibilitywas impaired and if so, whether it was substantially impaired.The appellant was convicted and he appealed, contending thatthat was a misdirection and that the jury in a case such asthis, should have been directed that " substantially " meantreal.Mr. Justice EDMUND DAVIES, giving judgment of the court,
said that the substance of the direction in Reg. v. Simcox 11 wasthe same as in the present case. In that case not one of themental experts felt that he could say that the impairment wassubstantial, and the jury refused to return a verdict of man-slaughter, but returned a verdict of capital murder. The trialjudge, Mr. Justice Finnemore, had said, " There is no scientificprecise test... you should work at it in a broad common-senseway and ask yourselves, having heard what the doctors havesaid, having made up your mind about it, knowing what thisman did, knowing the whole story, Do we think looking at itbroadly as common-sense people there was a substantialimpairment of his mental responsibility in what he did ? ’ Ifthe answer to that is yes, then you find him not guilty ofmurder, but guilty of manslaughter. If the answer to that is
no, there may be some impairment, but we do not think it wassomething which really made any great difference, although itmay have made it harder to control himself, to refrain fromcrime; then you would find him guilty as he is charged in the
10. See Pulse, Nov. 20, 1965.11. See Lancet, 1964, i, 550.
only charge to this indictment". That direction as to the
meaning of "
substantially " had been approved by the Courtof Criminal Appeal, and the court felt that it should follow itand could find no ground for criticising the trial judge’sdirection in the present case. The appeal accordingly, mustfail.
Reg. v. Lloyd. Court of Criminal Appeal: Edmund Davies, FentonAtkinson, and Lyell.y.y. Nov. 22, 1965. Counsel and solicitors: MichaelDavies, Q.c., and J. R. Toyn (Varley Hibbs & Co., Coventry); DouglasLowe, Q.c., and R. D. L. Kelly (Director of Public Prosecution).
LUCILLE FUNGBarrister-at-Law
Our Legal Correspondent writes:Section 2 of the Homicide Act, 1957, provides for a verdict
of manslaughter instead of murder where it is shown that theaccused " was suffering from such abnormality of the mind ...as substantially impaired his mental responsibility for his actsor omissions in doing or being a party to the killing ".
Reg. v. Simcox, decided in February, 1964, is a more im-
portant case than Reg. v. Lloyd. The appeal in the earlier caseconcerned the direction of the judge as to " substantial impair-ment ": the medical evidence revealed some impairment ofresponsibility and a persistent and strong degree of paranoidpersonality. Mr. Justice FINNEMORE’s summing-up was
approved, leaving as it did the issue of substantial impairmentto the jury, and directing that the test was one of commonsense. The word " substantial " was not defined by the Courtof Criminal Appeal nor by the trial judge, but it can be deducedfrom the facts that the standard of substantiality is quite high.
In Reg. v. Lloyd the medical evidence was certainly nostronger, and so a frontal assault could not be attempted.Instead, the appeal took a somewhat technical point, thatsubstantial impairment meant impairment in substance as
opposed to impairment to a considerable degree. The Courtof Criminal Appeal neatly turned this point, saying, in effect,that technical definitions could not be used to interfere witha direction that confided the issue to the common sense of the
jury.A bolt hole has been closed, but the difficulties about the
level of substantial impairment remain, though of course theissue is less agonising now that capital punishment has beenabolished.
AppointmentsASHFORD HODGES, W. A., M.B. Cantab., F.R.c.s.: consultant orthopaedic
surgeon, Great Yarmouth General Hospital and Lowestoft and NorthSuffolk General Hospital.
BRIGGS, J. C., M.B. Lond., M.c. PATH.: second consultant pathologist,department of morbid anatomy, Cossham-Frenchay hospital group.
O’MALLEY, J. E., M.R.C.S., D.P.H. : deputy M.O.H. and deputy principal schoolM.o., St. Helen’s, Lancashire.
PARSONS, P. L., M.D., B.sc. Wales, D.P.M. : consultant psychiatrist, NorthWales Hospital, Denbigh.
PHILLIPS, B. S., M.B. Cantab., D.P.M. : consultant child psychiatrist,Northampton/Kettering area.
RAWSTRON, J. R., M.D. Lond., M.C.PATH., D.PATH.: consultant clinicalpathologist, Aylesbury/High ’Wycombe area and Wycombe GeneralHospital.
REES, W. E. L., M.B. St. And., D.o.: consultant ophthalmologist, LlwynypiaHospital and Pontypridd and Rhonda hospital group.
South East Metropolitan Regional Hospital BoardAWTY, M. D., M.R.c.s., F.D.S. : consultant oral surgeon, Tunbridge Wells
and Medway and Gravesend hospital groups.BRAMWELL, S. 0., M.B.E., M.B. Edin., F.F.A. R.c.s.: consultant anaesthetist,
Hastings hospital group.DE SARUM, P. M., M.B. Lond., F.F.A. R.C.S. : consultant anaathetist, Central
Kent hospital group.ECKSTEIN, H. B., M.D. Cantab., F.R.C.S.: consultant paediatric surgeon,
Bromley hospital group.GREENWOOD, RAYMOND, M.B. Manc., M.R.C.P., D.PHYS. MED.: consultant
in physical medicine, Bromley hospital group.MULCAHY, FRANCIS, M.B. N.U.I., F.F.R., D.M.R.D.: consultant radiologist,
Brighton and Lewes and St. Francis and the Lady Chichester hos-pital groups.
PARR, D. J., M.D. Lond., D.P.M.: consultant psychiatrist, Brighton andLewes and St. Francis and the Lady Chichester hospital groups.
POTTER, C. J. F., M.B. Cantab., F.F.A. R.c.s.: consultant anxsthetist,South-East Kent hospital group.
STEPHENS, D. S. B., M.B. Madras, F.F.A. R.C.S.l.: consultant anasthetist,Medway and Gravesend hospital group.
TRAFFORD, J. A. P., M.B. Lond., M.R.C.P.: consultant in general medicine,Brighton and Lewes hospital group.
WARLEY, M. A., M.D. Cape Town, D.c.H.: Woolwich and Dartford hospitalgroups.
