754

Before this case the law on automatism had made little medicalsense, but then there is no reason why it should: as stated in R vRabey (1977), what constitutes a disease of the mind is not a matterfor the doctors but a matter for the judge. R v Quick (1983) madeclear the legal difference between sane and insane automatism.Insane automatisms arise from an "internal factor" such as adiseased brain, an epileptic seizure, or a diabetic coma. Saneautomatism arises from an external factor affecting brain

functioning-for example, an anaesthetic, a blow causingconcussion, or an injection of insulin leading to hypoglycaemia. Thepoint of having this second category of automatism is to preventnormal people being sent to secure mental hospitals.

Medical evidence was given to the court that sleepwalking had agenetic cause, with a positive family history in 80-90% of cases. Itoccasionally resulted in severe violence, and in such a case thedefendant would require treatment. Although there are no knowncases of sleepwalkers offending twice, recurrent violence is verycommon, and a good many wives with sleepwalking spouses haveon occasion been kicked or hit, or even woken to find his handsround their neck. It is thus medically clear that sleepwalking is dueto internal factors, and although it may be precipitated by alcohol,fatigue, or stress, these are only external triggers of an internal state.

Cartledge cited Bratty v Attorney General for Northern Ireland(1961), in which Lord Denning said that automatism "means an actwhich is done by the muscles without any control by the mind, suchas a spasm, a reflex action or convulsion, an act done by a personwho is not conscious of what he is doing, such an act done whilesuffering from concussion or while sleepwalking". Although theseobservations have reinforced the belief that sleepwalking should beconsidered a sane automatism, the comment in Bratty was notrelevant to the issue being tested, and so was not a precedent. Headded that in two subsequent cases, Quick and R v Sullivan (1983),sleepwalking as an example of non-insane automatism was notmentioned. There was thus no clear precedent on which to decidethe law. Cartledge also cited Denning’s view that the prosecution isentitled to raise the issue of insanity, once the defence has raised thequestion of automatism, as this of necessity puts at issue the state ofthe defendant’s mind. He therefore asked the judge to rule thatsleepwalking was insane automatism.On hysterical dissociation Cartledge quoted the Canadian case of

Rabey. A student battered a girl to whom he was emotionallyattached when he learnt that she did not return his feelings.Psychiatric evidence suggested that this pyschological blow causeda hysterical dissociative state. On appeal, it was held that emotionalstress could not be said to be an external factor, but must beconsidered to originate in the respondent’s psychological make-up.In that case the dissociative state constituted a disease of the mind.In Rex v Hennessy (1989) the Court of Appeal held that stress,anxiety, and depression can no doubt result from external factors,but they are not, in themselves, separately or together, externalfactors of the kind capable in law of causing or contributing to a stateof automatism. In R v Isitt (1977), it was held that if, in a hystericalfugue, the actions were so complex that the mind appeared tocontrol the body, then the defence of insane automatism was beingset up. Cartledge argued that complex actions took place in order tohit with the bottle, hit with the video, and strangle manually, andthat therefore they were purposive and that the medical defence ofhysterical dissociation also led to the plea of insane automatism.

Judge Lewis ruled that both sleepwalking and hystericaldissociative states are insane automatisms. The juryreturned a verdict of not guilty, so Judge Lewis was forced tocommit the defendant to a secure mental hospital. Thedefence appealed against the judge’s direction that

sleepwalking was insane automatism, and leave has beengiven to test the issue in the Court of Appeal.

This case also illustrates the difficulties of the fixed

sentence, with the mandatory detention of offendingsleepwalkers in secure mental hospitals, a difficulty whichcould be avoided if judges were given discretionary powersof sentencing. It is to be hoped that the Court of Appeal willconfirm that sleepwalking is an insane automatism, and that

they will recommend changes in the law to allow the judgesto decide on the disposal of the defendant.

Cases cited here are: Bratty v Attorney General for Northern Ireland[1961] 3 3 All ER; R v Hennessy [1989] WLR287;RvIsitt[1977]67CrAppR44, CA; R v Quick [1973] 3 3 All ER 347; R v Rabey [1977] 37 CCC; E vSullivan [1983] 2 All ER 673.

Institute of Psychiatry,London SE5 8AF PETER FENWICK

Obituary

CHARLES EDWARD NEWMANCBE, MD Cantab, FRCP

Dr Newman, dean emeritus of the Royal PostgraduateMedical School, London, died on Aug 22, aged 89.

Charlie Newman was educated at Shrewsbury School andMagdalene College, Cambridge, where he took his BA in 1921. Heproceeded to King’s College, London, to qualify MB BChir, andreturned ten years later as consultant physician and vice-dean. Hebecame MRCP in 1926 (elected fellow in 1932) and MD in 1927.He was was appointed CBE in 1965.

Short, dapper, and full of energy, he had a charming attachmentto the old-fashioned wing collar and bow tie and addressed peopleby their surname without title, rather like a housemaster at a publicschool. He devoted his life to two interests: the Royal College ofPhysicians, and the newly founded Postgraduate Medical School atHammersmith Hospital. At the College of Physicians he was theMurchison scholar (1926), Goulstonian lecturer (1933), FitzPatricklecturer (1954, 1955, 1968), Linacre fellow (1966), and Harveianorator (1973), and after his retirement from the Hammersmith heheld the post of Harveian librarian for 17 years until 1979 (when hewas 79 years old). He was a scholar in the old tradition and had aprodigious memory, which made him an entertainingconversationalist; he was fascinated by the evolution of medicaleducation in the 19th century and published a book on that subjectin 1957. His work at the Postgraduate School has never been fullyappreciated. He became dean in 1946, having acted as sub-deanthroughout the 1939-45 war. With Connie O’Driscoll, his

secretary, he reorganised the administration of the school, obtainedhutted accommodation for new laboratories, and enrolled

postgraduate students in numbers never envisaged before. Herealised that the school built in 1935 had been underfunded and wastoo small, and became the coordinator for all the necessary newbuildings--a lecture theatre complex (the Wolfson building openedin 1961), the Medical Research Council Cyclotron Unit andradiochemical laboratories (1955), and the new school itself (theCommonwealth building, 1966). Indeed when he retired in 1965 hecould look round with pride: all the new buildings were school, allthe old hospital. He entertained Royalty, the powerful, and thewealthy (he had his own "wine cellar" in a cupboard near his tinyoffice). At the Hammersmith he was the diplomat during thoseturbulent and difficult two decades after the war. He composed theannual report of the school and wrote a booklet of the history ofHammersmith Hospital for its jubilee in 1955 and a brief history ofthe school when it received its Royal Charter in 1966. He wasintensely proud of his association with the Royal PostgraduateMedical School and deservedly so. He also found time to bechairman of the board of governors of St Clement Dane’s School,next door to the hospital.

For almost twenty years he had beds in the paediatric departmentat Hammersmith Hospital and at the Belgrave Hospital forChildren. Children were fascinated by him, by his kindliness asmuch as by his appearance. His book Medical Emergencies waspublished in 1932 and ran to three editions until 1948.

Charles Newman was a remarkable man who used his talents forthe benefit of others and enjoyed doing so.

J. C.