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Credit and civilization.

This paper analyses financial credit in order to re-examine the work of Norbert Elias, particularly his association of interdependency complexity with social discipline, and his approach to contradiction. Following a discussion of these issues, the paper examines Elias's writing on money and explores the emergence of financial credit networks in early modern England. Attention is paid to credit networks and social discipline, to credit and the state, and to the contradictory images associated with the transition to modern cash economies. From one perspective, early modern credit networks might be read as a confirmation of Elias, particularly his argument that interdependency complexity, changing power balances and self-restraint are interwoven. Yet the development of modern cash money raises questions, not just in relation to Elias's treatment of money, but also with regard to his assumptions about social discipline and his approach to ambivalence and contradiction. Drawing on the foregoing discussion, the paper argues that the relation between interdependency complexity and social discipline is contingent and variable, and that interdependency complexity may simultaneously encourage contradictory processes, such as those of civilizing and barbarity.

Civilization↗

[Remarks about the position of the medico-legal expert in imperative regulations in the Penal and Civil Codes].

In the monograph 'Medico-legal opinions--essays on theory', prof. K. Jaegermann wrote that 'the use of an expert requires theoretical or fairly clear knowledge about the mutual relationship between judge and expert'. In his opinion knowledge of this kind plays a significant role in estimating the usefulness of so-called expert evidence. Practical knowledge about the relationship between the judge and expert is necessary but not a decisive condition not only for a lawyer to be a judge but also for a physician to be a medico-legal expert. An expert can be not only a person appointed by the court but must also possess proper knowledge in a particular field, namely, the required professional and specialist qualifications and must also considered to be impartial. On the basis of the analysis of law in force and imperative regulations in Penal and Civil Codes, the authors have presented remarks relating to the expert's status as well as the lack of judicial control over the activity of experts appointed by court. Verification of professional qualifications in court experts and a reduction of those appointed 'ad hoc' are suggested. In the authors opinion co-operation between lawyers and experts should be improved. It is also essential to introduce statutory legal protection of court experts as well as to undertake activities leading to equaling the status of Polish court experts to that of other European countries.

Civil Rights↗

Effect of civil unrest on the incidence of violent and non-natural deaths.

The unrest situation in South Africa since September 1984 has led to the escalation of violence and numerous incidents of confrontation between security forces and unruly crowds. The failure of routine law enforcement methods to alleviate the situation resulted in declaration of a State of Emergency in various parts of the country on 21 July 1985 and in the Western Cape area on 26 October 1985. The possible effect of civil unrest on the incidence and nature of underlying violence and crime in society leading to non-natural deaths is analysed from data for a 10-year period obtained from the official Death Register of the South African Police mortuary draining the Greater Cape Town area. Yearly and monthly trends in the incidence of non-natural deaths are also compared with those for death from natural causes. Attention is given to the incidence of homicidal sharp and blunt injuries and specifically to fatal gunshot injuries resulting from civilian shootings compared with those resulting from police or security force action. Mortality and general unrest figures associated with the situation in the Greater Cape Town area are finally compared with national figures for 1985 and the first months of 1986. Some effects of lifting of the State of Emergency in the whole country on 7 March 1986 on mortality and unrest figures are presented. In conclusions, some recommendations are made for alterations to riot control methods in an attempt to prevent or reduce fatalities.

Black or African American↗

[Danger to the child and family from civilization and prosperity].

The advances of civilization are more and more endangering the development of the child. The most important problems are traffic accidents, the decay of the family, the falling birth-rate and the increasing abuse of drugs and alcohol as well as suicide in early years of life. The family and the child must be respected in the future to improve the situation. Adults have to accept the age specific problems of the child.

Adolescent↗

New develpments in civil commitment of the mentally ill. Impact for patient, family, and psychiatrist.

In deciding Addington vs Texas the US Supreme Court established "clear and convincing evidence" as the standard of proof necessary for civil commitment of the mentally ill rather than the criminal standard, "beyond a reasonable doubt." This decision has major implications for the mentally ill person, the family, and the psychiatrist. The mentally ill person is returned to the role of patient. The family is given aid in their dilemma of coping with their psychotic member. The psychiatrist is seen as helper rather than jailer.

Civil Rights↗

[The civil legal procedural competence of schizophrenia patients].

Discusses the methodological problems of forensic psychiatric evaluations of mental disorders in the structure of the most incident endogenous psychosis, schizophrenia, under conditions of expert evaluation in a civil process. Presents criteria permitting the differentiation between pathological states.

Civil Rights↗

[Contact disorders as a problem of the civilized society].

Emotional chillness of human living together in modern civilized societies is provoking not only an increasing amount of neurotic diseases on the one hand and unsteadiness on the other, but also beyond that some distinct kinds of mental disorders. Psychodynamic sources of those disturbances are discussed, guided by case reports on paranoic reaction, cardiac neurosis, depressive reaction, delusion of being beloved, alcoholism after getting widowed, and paranoid hallucinatory Psychosis as a result of loneliness.

Adult↗

[Management competency of persons registered as disaster nurses in the Pretorian Civil Defense].

The essential management role of the disaster nurse during disaster action was outlined, researched and described. Her competency to execute effectively disaster relief tasks before, during and after a disaster occurring outside a hospital, was studied. Management tasks were identified which nurses should have mastered regarding disaster situations occurring outside hospital boundaries. Research data were gathered by means of a questionnaire on the biographic detail of disaster nurses registered with Civil Defence in Pretoria, in order to recommend a course specifically aimed at fulfilling their requirements. The research project identified requirements of the disaster nurse for appropriate further training, practise and guidance regarding the identified management tasks. It became evident that training is required in most of the tasks, and a training course for nurses in disaster management was designed.

Adult↗

[Effect of criminal justice on civil rights apprehension].

Private law and criminal law are different in more than one way. On occasion, they overlap. Further liability may result from disregard of a criminal act. As far as the evidence is concerned, criminal law requires a higher degree of probability than private law. If the same case is subject to criminal and civil proceedings, both courts are not bound by each other's decisions.

Civil Rights↗

Stone-Roth model of civil commitment and the California dangerousness standard: operational comparison.

Professional opposition to making "dangerousness" the primary criterion for involuntary civil commitment has galvanized in support of the proposed "new medical model." The Stone-Roth criteria for commitment were applied to patients being committed under California's version of the dangerousness standard. Results showed that 86% of the patients committed under the California statute were viewed by the examining psychiatrists as committable under the Stone-Roth procedures as well.

Adult↗

A study of mandatory review of civil commitment.

The California Civil Commitment Statute provides for prolonged (14-day) involuntary hospitalization of the mentally ill on the basis of grave disability (GD), danger to self, and danger to others. Recently the procedure has been modified to provide mandatory review of all 14-day certificates for GD. Comparison of 47 patients certified before the law change with 58 subjects certified after the change found that correlations between certification category and criterion measures were significant but low. Although the change was directed toward GD, no significant improvement was seen in the specificity of application of the GD category after the legal change. Because of these limited effects, the value of time-consuming mandatory judicial review is questionable. The attempt may have been doomed from the start because of unquantifiable commitment criteria. Before additional judicial burdens are imposed on the psychiatrist, careful assessment of the rationale for such procedures should be made.

Adult↗

Civil commitment in the psychiatric emergency room. I. The assessment of dangerousness by emergency room clinicians.

Critics of the dangerousness standard for civil commitment contend that there is no professional standard for the evaluation of dangerousness. We used Three Ratings of Involuntary Admissibility, a reliable index of behavioral indicators of danger to self, danger to others, and grave disability, and found that when combined into weighted patterns these indicators predicted disposition decisions of 70 clinicians in five psychiatric emergency rooms over 251 cases. A concurrent measure of perceived dangerousness, Clinician's Global Ratings of patients on these criteria, yielded similar results. We conclude that clinicians in California psychiatric emergency rooms apply a shared concept of dangerousness that can be described in behavioral terms.

Adolescent↗

Civil commitment in the psychiatric emergency room. II. Mental disorder indicators and three dangerousness criteria.

Proponents of return to a "need for treatment" standard for civil commitment contend that the current dangerousness standard forces psychiatrists to neglect severely ill patients in favor of those who are less ill but dangerous to others. Among 198 psychiatric emergency patients in five facilities, those rated as most dangerous on Three Ratings of Involuntary Admissibility, a reliable index of indicators employed by clinicians in evaluating danger to self, danger to others, and grave disability, were also most severely ill on diagnostic and symptomatic assessments of mental disorder. Clinicians' Global Ratings of patient dangerousness on the three criteria were similarly related to severity of diagnosis and symptoms. Perceived dangerousness was associated with major mental disorder and severity of most symptom types, especially impulsivity. Danger to self was the criterion related to the fewest indicators of mental disorder.

Adolescent↗

Homeopaths, surgery, and the Civil War: Edward C. Franklin and the struggle to achieve medical pluralism in the Union army.

An important aspect of the Union army medical corps throughout the Civil War was the clinical discord that pitted allopathic, or orthodox, physicians against sectarian, or unorthodox, physicians. Allopaths dominated the corps and its examining boards and consequently denied commissions as army surgeons to sectarian practitioners such as the homeopaths. This probably affected surgical manpower needs, since many well-trained homeopathic surgeons, like Edward C. Franklin, one of the nation's busiest and most prolific surgeons, wished to serve in the northern army but were unable to do so.

Famous Persons↗

Medical advances during the Civil War.

The contributions to medical care that developed during the Civil War have not been fully appreciated, probably because the quality of care administered was compared against modern standards rather than the standards of the time. The specific accomplishments that constituted major advances were as follows. 1. Accumulation of adequate records and detailed reports for the first time permitted a complete military medical history. This led to the publication of the Medical and Surgical History of the War of the Rebellion, which was identified in Europe as the first major academic accomplishment by US medicine. 2. Development of a system of managing mass casualties, including aid stations, field hospitals, and general hospitals, set the pattern for management of the wounded in World War I, World War II, and the Korean War. 3. The pavilion-style general hospitals, which were well ventilated and clean, were copied in the design of large civilian hospitals over the next 75 years. 4. The importance of immediate, definitive treatment of wounds and fractures was demonstrated and it was shown that major operative procedures, such as amputation, were optimally carried out in the first 24 hours after wounding. 5. The importance of sanitation and hygiene in preventing infection, disease, and death among the troops in the field was demonstrated. 6. Female nurses were introduced to hospital care and Catholic orders entered the hospital business. 7. The experience and training of thousands of physicians were upgraded and they were introduced to new ideas and standards of care. These included familiarity with prevention and treatment of infectious disease, with anesthetic agents, and with surgical principles that rapidly advanced the overall quality of American medical practice. 8. The Sanitary Commission was formed, a civilian-organized soldier's relief society that set the pattern for the development of the American Red Cross.

Ambulances↗

Causes of breast cancer malpractice litigation. A 20-year civil court review.

To determine objectively the patient and physician factors that lead to breast cancer malpractice litigation, a review was undertaken of all cases tried in the US federal and state civil court system over a 20-year period from 1971 through 1990. Forty-five cases were identified and all involved a delayed diagnosis of breast cancer (the mean delay was 15 months). The patients were young (mean age, 40 years). Of 45 cases studied, the majority of patients (37 [82%]) found a painless mass by self-examination of the breast. Only 22 patients (49%) had further workup, mostly by mammography (20 [44%]). The results of 16 mammograms (80%) were read as normal. Obstetricians and gynecologists were involved in the greatest number of cases (21 [50%]), followed by family practitioners and internists (17 [41%]), general surgeons (12 [28%]), and radiologists (4 [10%]).

Adult↗

Tuberculosis mortality during a civil war in Guinea-Bissau.

CONTEXT: Tuberculosis (TB) is an increasing global problem, despite effective drug therapies. Access to TB therapy during conflict situations has not been studied. OBJECTIVE: To determine the effect of irregular TB treatment due to an armed conflict in Guinea-Bissau, West Africa. DESIGN, SETTING, AND PATIENTS: Ongoing retrospective cohort study conducted in the capital city of Bissau among 101 patients with TB who received irregular or no treatment during the civil war (war cohort; June 7-December 6, 1998) and 108 patients with TB who received treatment 12 months earlier (peace cohort; June 7-December 6, 1997) and comparison of an additional 42 patients who had completed treatment before June 6, 1998, and 69 patients who had completed treatment before June 6, 1997. MAIN OUTCOME MEASURE: Mortality rates, compared by irregular (war cohort) vs regular (peace cohort) access to treatment, by intensive vs continuation phase of treatment, and by those who had previously completed treatment for TB. RESULTS: Irregular treatment was associated with an increased mortality rate among patients with TB. The mortality rate ratio (MR) was 3.12 (95% confidence interval [CI], 1.20-8.12) in the war cohort, adjusting for age, sex, human immunodeficiency virus (HIV) infection, residence, and length of treatment. Each additional week of treatment before the war started increased probability of survival by 5% (95% CI, 0%-10%). In the intensive phase of treatment, the adjusted MR was 3.30 (95% CI, 1.04-10.50) and in the continuation phase it was 2.26 (95% CI, 0.33-15.34). Increased mortality among the war cohort was most marked in HIV-positive patients, who had an adjusted MR of 8.19 (95% CI, 1.62-41.25). Mortality was not increased in HIV-positive or HIV-negative patients who had completed TB treatment when the war started. CONCLUSIONS: Interruption of treatment had a profound impact on mortality among patients with TB during the war in Guinea-Bissau. Regular treatment for TB was associated with significantly improved survival for HIV-infected individuals. In emergencies, it is crucial to ensure availability of TB drugs.

Adult↗