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UNION OF SOUTH AFRICA
1094 There are not only spatial frameworks, but also intellectual, social and moral frameworks. Loss of any one of these means loss of security (instancing minority problems as an effect of a social instability).
In cerebral damage failure over a task or an adjustment brings about a " catastrophic reaction " (Goldstein). The patient then fails chaotically in the simplest tests and complains of headache and giddiness. In severe degrees speech may be lost. The patient with cerebral injury has to limit his field and stay within the security zone. Security is connected with " freedom " just as much in intellectual function as in social events. Professor Koffka instanced a dysphasic patient who when shown a fountain pen and asked what it was said " a quarter to five." He had been anxious about the time, and a previous glance at his watch determined his behaviour. His behaviour was not free to transfer from one process of thought to another. Perseveration of speech, a common feature of aphasia, is due to the same loss of freedom of intellectual function. Here again actions are determined not by the present situation but by actions gone before, for all perseveration is related to a trace of a previous performance, and is more obvious the more difficult the task (Goldstein). Such a defect is an exaggeration of a normal process, such as occurs when a difficult new word is acquired and is then applied to other later and not quite appropriate ideas. Perseveration in agnosia and apraxia is an instance of the same phenomenon in other spheres. Object agnosia is not due to failure of visual organisation, but to a failure of objects to find a proper background. If the framework is provided by a previous performance perseveration results. Loss of " freedom " in patients can be seen as an inability to do things, particularly when the actions need much support from memory. Words come easily sometimes, but with most difficulty in situations requiring spontaneity. Thus concrete words are the easiest to produce from memory. The assessment of freedom of action is made on two criteria-actions should follow intention and should be adequate for the total situation. Adequacy comprises both facts in the ego and in the environment. A response may be very concrete though adequate. Primitive peoples are very concrete in thought, and abstract behaviour is developed by western civilisation. Patients with cerebral lesions become more concrete in their type of reaction.
These novel points of view advanced by Professor Koffka have aroused great interest for they explain many curious features of the disorders seen in aphasia, apraxia and agnosia, and promise wider application. The unsatisfying nature of current theories of aphasia is widely felt and a contribution of this kind not only opens the way to a better understanding of this kind of disorder but through that allows better assessment of the nature, extent and progress of cerebral damage. D. D-B.
LOCAL GOVERNMENT POSTS IN IRELAND
(FROM A
OUR IRISH
CORRESPONDENT)
to make certain amendments in the law to local government has been introduced into
BILL
relating
by the minister for local government and public health, and was circulated a few days ago. In it is buried a provision which gravely affects the existing rights of medical and other officers of local the Dail
authorities.
Section 23 proposes to empower the
appropriate minister to declare any specified age to be the age-limit for officers under the local authorities, and when such declaration has been made the holder an office who has reached the specified age shall cease to hold such office. Moreover, in that event he, for the purposes of existing enactments concerning the
of
of officers of local authorities, shall be deemed to have become incapable of discharging the duties of such office with efficiency by reason of old age and shall be deemed to have resigned such office. In fact, the bill provides for a compulsory age of retirement of the officers of local authorities without making any alteration in the scale of superannuation provided by existing laws. There are some eight or nine hundred medical men holding offices under local authorities at the moment, and it would appear that a grave change in their conditions of employment, either now or in the future, is proposed to be made to their detriment without their consent. This seems to be contrary not only to natural justice but to
superannuation
existing practice. It will be remembered that some four or five years department of local government and public health sent a circular letter to the several local authorities under their control, advising them to invite any officer who had reached the age of sixty-five years forthwith to resign. A few, believing that they had no option but to do so, sent in their resignations. The Irish Medical Union advised its members that neither the department nor the local authorities could compel resignation unless the individual officer could be shown to be rendered incapable of performing his duties by old age or bodily incapacity. Without the the formally withdrawing circular, department, recognising its blunder, forbore from pressing any further advice on the local authorities. There is no doubt much to be said in favour of the imposition of an age-limit for the holding of public offices, but it is impossible to justify the compulsory application of a new condition to their detriment on those who have entered the public service on other terms. ago the
UNION OF SOUTH AFRICA EARLY this year Dr. A. J. Orenstein was appointed director-general of medical services to the Union Defence Force. Except for the word " generalthe appointment is the same as the one he relinquished in June, 1919. The rank is that of colonel, as it was 21 years ago. The medical service is basically similar to the other branches of the defence force. It consists of a few officers, W.O.s, N.C.O.s and men on the permanent establishment, a certain number of ambulances with attached medical officers for regimental duties, and hygiene sections on what is called the Active Citizens’ Force. These are the backbone of the whole organisation. They undergo an annual of continuous period training and attend periodical evening or afternoon instructional parades, lectures, Most of the personnel are volunteers. There is &c. also a reserve of the A.C.F. The war organisation is being built up on these A.C.F. units, at present on a voluntary basis, with the assistance of the medical and trained nurses’ associations. Some 80 per cent. of the medical profession have volunteered their services for war work, either full or part-time, and about half of these have offered to serve in any theatre of The response from trained nurses has been war. equally gratifying and the same applies to the dental profession and health workers. Our correspondent adds:" On the whole, for a small people far away from the war theatres, we are not doing so badly. We are not lacking in understanding of the justice of our cause, nor in desire to do all we can to win the war. We can do only what we can manage to do in our circumstances. It may be but a very little, but I doubt not we shall do it reasonably well. So do wish us luck." And we certainly do. v
In cerebral damage failure over a task or an adjustment brings about a " catastrophic reaction " (Goldstein). The patient then fails chaotically in the simplest tests and complains of headache and giddiness. In severe degrees speech may be lost. The patient with cerebral injury has to limit his field and stay within the security zone. Security is connected with " freedom " just as much in intellectual function as in social events. Professor Koffka instanced a dysphasic patient who when shown a fountain pen and asked what it was said " a quarter to five." He had been anxious about the time, and a previous glance at his watch determined his behaviour. His behaviour was not free to transfer from one process of thought to another. Perseveration of speech, a common feature of aphasia, is due to the same loss of freedom of intellectual function. Here again actions are determined not by the present situation but by actions gone before, for all perseveration is related to a trace of a previous performance, and is more obvious the more difficult the task (Goldstein). Such a defect is an exaggeration of a normal process, such as occurs when a difficult new word is acquired and is then applied to other later and not quite appropriate ideas. Perseveration in agnosia and apraxia is an instance of the same phenomenon in other spheres. Object agnosia is not due to failure of visual organisation, but to a failure of objects to find a proper background. If the framework is provided by a previous performance perseveration results. Loss of " freedom " in patients can be seen as an inability to do things, particularly when the actions need much support from memory. Words come easily sometimes, but with most difficulty in situations requiring spontaneity. Thus concrete words are the easiest to produce from memory. The assessment of freedom of action is made on two criteria-actions should follow intention and should be adequate for the total situation. Adequacy comprises both facts in the ego and in the environment. A response may be very concrete though adequate. Primitive peoples are very concrete in thought, and abstract behaviour is developed by western civilisation. Patients with cerebral lesions become more concrete in their type of reaction.
These novel points of view advanced by Professor Koffka have aroused great interest for they explain many curious features of the disorders seen in aphasia, apraxia and agnosia, and promise wider application. The unsatisfying nature of current theories of aphasia is widely felt and a contribution of this kind not only opens the way to a better understanding of this kind of disorder but through that allows better assessment of the nature, extent and progress of cerebral damage. D. D-B.
LOCAL GOVERNMENT POSTS IN IRELAND
(FROM A
OUR IRISH
CORRESPONDENT)
to make certain amendments in the law to local government has been introduced into
BILL
relating
by the minister for local government and public health, and was circulated a few days ago. In it is buried a provision which gravely affects the existing rights of medical and other officers of local the Dail
authorities.
Section 23 proposes to empower the
appropriate minister to declare any specified age to be the age-limit for officers under the local authorities, and when such declaration has been made the holder an office who has reached the specified age shall cease to hold such office. Moreover, in that event he, for the purposes of existing enactments concerning the
of
of officers of local authorities, shall be deemed to have become incapable of discharging the duties of such office with efficiency by reason of old age and shall be deemed to have resigned such office. In fact, the bill provides for a compulsory age of retirement of the officers of local authorities without making any alteration in the scale of superannuation provided by existing laws. There are some eight or nine hundred medical men holding offices under local authorities at the moment, and it would appear that a grave change in their conditions of employment, either now or in the future, is proposed to be made to their detriment without their consent. This seems to be contrary not only to natural justice but to
superannuation
existing practice. It will be remembered that some four or five years department of local government and public health sent a circular letter to the several local authorities under their control, advising them to invite any officer who had reached the age of sixty-five years forthwith to resign. A few, believing that they had no option but to do so, sent in their resignations. The Irish Medical Union advised its members that neither the department nor the local authorities could compel resignation unless the individual officer could be shown to be rendered incapable of performing his duties by old age or bodily incapacity. Without the the formally withdrawing circular, department, recognising its blunder, forbore from pressing any further advice on the local authorities. There is no doubt much to be said in favour of the imposition of an age-limit for the holding of public offices, but it is impossible to justify the compulsory application of a new condition to their detriment on those who have entered the public service on other terms. ago the
UNION OF SOUTH AFRICA EARLY this year Dr. A. J. Orenstein was appointed director-general of medical services to the Union Defence Force. Except for the word " generalthe appointment is the same as the one he relinquished in June, 1919. The rank is that of colonel, as it was 21 years ago. The medical service is basically similar to the other branches of the defence force. It consists of a few officers, W.O.s, N.C.O.s and men on the permanent establishment, a certain number of ambulances with attached medical officers for regimental duties, and hygiene sections on what is called the Active Citizens’ Force. These are the backbone of the whole organisation. They undergo an annual of continuous period training and attend periodical evening or afternoon instructional parades, lectures, Most of the personnel are volunteers. There is &c. also a reserve of the A.C.F. The war organisation is being built up on these A.C.F. units, at present on a voluntary basis, with the assistance of the medical and trained nurses’ associations. Some 80 per cent. of the medical profession have volunteered their services for war work, either full or part-time, and about half of these have offered to serve in any theatre of The response from trained nurses has been war. equally gratifying and the same applies to the dental profession and health workers. Our correspondent adds:" On the whole, for a small people far away from the war theatres, we are not doing so badly. We are not lacking in understanding of the justice of our cause, nor in desire to do all we can to win the war. We can do only what we can manage to do in our circumstances. It may be but a very little, but I doubt not we shall do it reasonably well. So do wish us luck." And we certainly do. v