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FITNESS TO PLEAD AND FITNESS TO BE A VICTIM
234 FITNESS TO PLEAD AND FITNESS TO BE A VICTIM SiR,—For some time I have been concerned about the problem presented by an accused who is unfit to plead. I have commented about this in two letters to The Lancet.l,2 A case has come to my attention which highlights some of the problems and illustrates another facet of the Law’s attitude to mental illness. Early in 1969, a patient was killed in a subnormality hospital. Following an investigation by the police, another patient was charged with manslaughter. At a special magistrates’ court held at the hospital he was found unfit to plead. The services of Mr. Geoffrey Howe, Q.c. (now the Solicitor General), were, at that stage, secured for his defence. When the accused appeared before Mr. Justice Thesiger at Chelmsford Assizes, on April 25, 1969, the prosecution had decided to offer no evidence. The normal sequence to this would have been (at the judge’s discretion) a verdict of " not guilty ". However, Mr. Justice Thesiger insisted that the jury be given medical evidence to support a verdict of unfit to plead "; and that was, in fact, the verdict. Since this left the patient open to the brand of killer ", Mr. Howe appealed against the verdict, which was quashed by the Court of Appeal, and the patient duly
this reason it would be disastrous if research were to be confined to university hospitals. We must look forward to a growing relationship between regional and university hospitals in the next decade. Regional hospitals need the institutes and university centres for particularly complex problems, and the use of these specialised resources should be facilitated. Likewise, the specialist centres need regional hospitals, which provide the total range of clinical problems; without this range, comprehensive teaching is impossible. In fact, they need each other, so that methods of postgraduate education are
continuously improved. By and standards of clinical the country. Hellingly Hospital, Hailsham, Sussex.
acquitted. Pending the hearing of the appeal,
a journal which one would expect to be well-informed in such matters published an article stating that, in fact, the one patient had killed the other. Apparently the police have never reopened the case. I believe this case illustrates an important shortcoming of the Law in relationship to fitness to plead. If a person is accused of a crime and found unfit to plead, no trial takes place; but the accused, though not being considered guilty in a legal sense, is still understood to have committed the crime with which he is being charged. Thus it is possible that he may be made the scapegoat for another person’s offence. The other disturbing thing about the case described is that apparently when a mentally ill or subnormal patient is the victim of a crime, the investigation of the crime is not carried out with the same vigour and tenacity as in the case of a person looked upon as normal. The first problem can only be dealt with by a modification in the Law. The second problem can only be solved when our attitude to mental illness and the mentally ill is genuinely changed, and we cease to look upon them as different, alien beings.
St. Francis
Haywards
Hospital, Heath.
J. A. WHITEHEAD.
hospital
morale
be improved throughout RONALD MAGGS.
SERUM GAMMA-GLUTAMYL TRANSPEPTIDASE DEFICIENCY
"
"
these means,
care can
SIR,-In view of the controversy concerning the usefulof determinations of serum gamma-glutamyl transpeptidase,1-5 we should like to report briefly on a patient with deficient activity of this enzyme. The patient is a moderately retarded 33-year-old White male, abandoned at an early age, who was discovered to excrete an abnormal ninhydrin-positive metabolite in the urine during routine screening for disorders of aminoacid metabolism. In fresh urine, this compound had an Rf of 0-1 in butanol/acetic acid/water (12/3/5) and was eluted from a 55 cm. column of UR-30 resin (Beckman model 120 automatic aminoacid analyser) as a broad peak between methionine sulphoxide and aspartic acid. When the urine was allowed to remain at room-temperature for 24 hours, this peak disappeared and was replaced by an even broader Both peaks one between threonine and glutamic acid. absorbed maximally at 570 mc and disappeared completely following hydrolysis of the urine for 16 hours in 6N hydrochloric acid at 110°C. When the compound was isolated by paper chromatography and subsequently hydrolysed, equimolar quantities of glutamic acid, glycine, and -5F 1-cystine were found. Authentic reduced and oxidised glutathione co-chromatographed exactly with, and had the same 570 m m[L absorbance ratios as, the peaks observed in fresh and standing urine, respectively. Estimations of total serum and urine glutathione concentrations6 showed a moderate hyperglutathiona:mia together with more than a thousandfold increase in its concentration in urine (see below). ness
MEDICAL EDUCATION AND MEDICAL RESEARCH
SIR,-It is unfortunate that Dr. Henry Miller (Jan. 2, 1) has taken so narrow a view, particularly in his criticisms of the specialised institutions and his claim that the universities are the mainstay of research and postgraduate training. It is the perpetuation of this notion that often explains the frustration of the newly appointed regional consultant and makes it more likely that he will emigrate. Monro3 has shown clearly that the first psychiatricp.
research units in Britain were established in regional hospitals, usually without help from the universities or the Can psychiatry be so far Medical Research Council. ahead of other specialties ? While I agree with Dr. Miller that postgraduate education and research go together, I believe he has neglected the positive influence of research and teaching upon hospital morale and patient care. For 1. 2. 3.
Whitehead, J. A. Lancet. 1969, ii, 376. Whitehead, J. A. ibid. 1970, ii, 208. Monro, A. B. Br. J. Psychiat. 1971, 118, 542.
Since the initial step in the degradation of glutathione (y-glutamyl-cysteinyl-glycine) involves the action of gammaglutamyl transpeptidasethe activity of this enzyme in the serum of the patient and 14 control subjects was 8 measured.8
Alixing experiments indicated that the profound decrease 1. 2. 3. 4. 5. 6. 7. 8.
Zein, M., Discombe, G. Lancet, 1970, ii, 748. Naftalin, L. ibid. p. 829. Idéo, G., Dioguardi, N. ibid. p. 1036. Rosalki, S. B., Rau, D., Lehmann, D., Prentice, M. ibid. p. 1139. Discombe, G. ibid. p. 1186. Tietze, F. Analyt. Biochem. 1969, 27, 502. Fodor, P. J., Miller, A., Waelsch, H. J. biol. Chem. 1953, 202, 551. Szasz, G. Clin. Chem. 1969, 15, 124.
this reason it would be disastrous if research were to be confined to university hospitals. We must look forward to a growing relationship between regional and university hospitals in the next decade. Regional hospitals need the institutes and university centres for particularly complex problems, and the use of these specialised resources should be facilitated. Likewise, the specialist centres need regional hospitals, which provide the total range of clinical problems; without this range, comprehensive teaching is impossible. In fact, they need each other, so that methods of postgraduate education are
continuously improved. By and standards of clinical the country. Hellingly Hospital, Hailsham, Sussex.
acquitted. Pending the hearing of the appeal,
a journal which one would expect to be well-informed in such matters published an article stating that, in fact, the one patient had killed the other. Apparently the police have never reopened the case. I believe this case illustrates an important shortcoming of the Law in relationship to fitness to plead. If a person is accused of a crime and found unfit to plead, no trial takes place; but the accused, though not being considered guilty in a legal sense, is still understood to have committed the crime with which he is being charged. Thus it is possible that he may be made the scapegoat for another person’s offence. The other disturbing thing about the case described is that apparently when a mentally ill or subnormal patient is the victim of a crime, the investigation of the crime is not carried out with the same vigour and tenacity as in the case of a person looked upon as normal. The first problem can only be dealt with by a modification in the Law. The second problem can only be solved when our attitude to mental illness and the mentally ill is genuinely changed, and we cease to look upon them as different, alien beings.
St. Francis
Haywards
Hospital, Heath.
J. A. WHITEHEAD.
hospital
morale
be improved throughout RONALD MAGGS.
SERUM GAMMA-GLUTAMYL TRANSPEPTIDASE DEFICIENCY
"
"
these means,
care can
SIR,-In view of the controversy concerning the usefulof determinations of serum gamma-glutamyl transpeptidase,1-5 we should like to report briefly on a patient with deficient activity of this enzyme. The patient is a moderately retarded 33-year-old White male, abandoned at an early age, who was discovered to excrete an abnormal ninhydrin-positive metabolite in the urine during routine screening for disorders of aminoacid metabolism. In fresh urine, this compound had an Rf of 0-1 in butanol/acetic acid/water (12/3/5) and was eluted from a 55 cm. column of UR-30 resin (Beckman model 120 automatic aminoacid analyser) as a broad peak between methionine sulphoxide and aspartic acid. When the urine was allowed to remain at room-temperature for 24 hours, this peak disappeared and was replaced by an even broader Both peaks one between threonine and glutamic acid. absorbed maximally at 570 mc and disappeared completely following hydrolysis of the urine for 16 hours in 6N hydrochloric acid at 110°C. When the compound was isolated by paper chromatography and subsequently hydrolysed, equimolar quantities of glutamic acid, glycine, and -5F 1-cystine were found. Authentic reduced and oxidised glutathione co-chromatographed exactly with, and had the same 570 m m[L absorbance ratios as, the peaks observed in fresh and standing urine, respectively. Estimations of total serum and urine glutathione concentrations6 showed a moderate hyperglutathiona:mia together with more than a thousandfold increase in its concentration in urine (see below). ness
MEDICAL EDUCATION AND MEDICAL RESEARCH
SIR,-It is unfortunate that Dr. Henry Miller (Jan. 2, 1) has taken so narrow a view, particularly in his criticisms of the specialised institutions and his claim that the universities are the mainstay of research and postgraduate training. It is the perpetuation of this notion that often explains the frustration of the newly appointed regional consultant and makes it more likely that he will emigrate. Monro3 has shown clearly that the first psychiatricp.
research units in Britain were established in regional hospitals, usually without help from the universities or the Can psychiatry be so far Medical Research Council. ahead of other specialties ? While I agree with Dr. Miller that postgraduate education and research go together, I believe he has neglected the positive influence of research and teaching upon hospital morale and patient care. For 1. 2. 3.
Whitehead, J. A. Lancet. 1969, ii, 376. Whitehead, J. A. ibid. 1970, ii, 208. Monro, A. B. Br. J. Psychiat. 1971, 118, 542.
Since the initial step in the degradation of glutathione (y-glutamyl-cysteinyl-glycine) involves the action of gammaglutamyl transpeptidasethe activity of this enzyme in the serum of the patient and 14 control subjects was 8 measured.8
Alixing experiments indicated that the profound decrease 1. 2. 3. 4. 5. 6. 7. 8.
Zein, M., Discombe, G. Lancet, 1970, ii, 748. Naftalin, L. ibid. p. 829. Idéo, G., Dioguardi, N. ibid. p. 1036. Rosalki, S. B., Rau, D., Lehmann, D., Prentice, M. ibid. p. 1139. Discombe, G. ibid. p. 1186. Tietze, F. Analyt. Biochem. 1969, 27, 502. Fodor, P. J., Miller, A., Waelsch, H. J. biol. Chem. 1953, 202, 551. Szasz, G. Clin. Chem. 1969, 15, 124.