Michael Hathorn

MEDICAL CARE IN A SOUTH AFRICAN TOWNSHIP

Written in 1955 this article discusses medical care in the township of Alexandra which contained 80000 African and colored people in a 1 1/2 square mile area and lies on Johannesburgs outskirts. The townships population consisted mainly of unskilled underpaid labor and its health committee had an annual budget of 1 pound/individual in contrast with 28 pounds in adjacent Johannesburg. Social and living conditions in the township were very poor. The Alexandra Health Center and University Clinic had a staff of 4 physicians; 4 sisters; 25 nurses; and rotating medical students. Despite clinic overloads an attempt was made to ensure continuity between individual patients and physicians by dividing the towship into 3 areas and assigning each to a physician/sister/nurses/students team. Because of the high number of casualties due to disordered community life curative care almost completely replaced preventive care so the staff tried to use every patient contact as an opportunity for patient teaching. Also a total of 16500 home visits were made in 1953; this was considered an important aspect. 548 new cases of tuberculosis were noted in 1953; the patients were cooperative and the cure rates were high despite the fact that patients hesitated to seek treatment. Prenatal and postnatal encounters were encouraged for pregnant women. A flat fee was charged for all treatment. Breastfeeding was encouraged. Well-baby clinic statistics show 1429 mothers attending in 1953 with 10941 repeat attendances. The main component was nutrition education of mothers seen to be an important strategy for attacking infant mortality due to diarrhea malnutrition and whooping cough. In general the emphasis on home care which was very necessary given the difficulty in finding hospital beds for Africans showed good results. Patients were happier and less stresed and family members could be instructed in caring for the sick.

POSTOPERATIVE THROMBOSIS AND PLASMA FIBRINOLYTIC ACTIVITY: A Comparative Study in Africans, Indians, and Whites

Because venous thrombosis and pulmonary embolism occur so rarely in African and Indian patients a comparative study of this surgical complication was done among whites Indians and Africans in Natal. The control group was 23 Africans and 10 Indians and 11 white patients admitted for minor (nonsurgical) complaints. The patient group undergoing surgical operations consisted of 36 Africans 7 Indians and 11 whites. Blood samples were taken from patients before surgery and at various times during and after operations. Control levels of plasma fibrinolytic activity and fibrinogen were estimated. Fibrinolytic activity was approximately 2 times higher in a healthy African control (group) as it was in either the white or Indian control groups. Plasma fibrinogen levels in the 3 groups fell within accepted normal levels for white patients. During the operation there was no significant change in fibrinolytic activity in the Indian and African patients. In all 3 racial groups fibrinolytic activity decreased in the first 48 postoperative hours but rose again within 6 days postoperation. Postoperatively fibrinogen levels increased in African and white patients. These findings are difficult to correlate with the clinical reality of rare postoperative thromboembolism in the 2 racial groups; there were no cases even among whites of postoperative problems in this series.

Analysis of components of fetal breathing cycles

The duration of the inspiratory phase (Ti) and the expiratory phase (Te) together with the relative amplitude (Amp) of successive breathing movements of the chest wall or abdominal wall were measured by real-time ultrasound in 12 fetuses of normal gestation. The observations were performed at 33-39 gestational weeks. The distributions of Ti, Te, the duration of the breathing cycle (Ttot), Amp and the ratios Amp/Ti and Ti/Te were all considerably skewed. Correlations between these variables differed markedly in different fetuses. Running correlations, however, showed the presence of alternations with time in the correlations between Ti and Te, and between Amp and Ttot. These findings suggest the possibility of central nervous system mechanisms controlling these events, operating over time spans considerably longer than the individual breathing cycle.

Intracellular Iron-containing Enzymes

Case 1.-I first saw this bottle-fed infant when she was 14 weeks old. The mother stated that she had been restless, vomiting, and refusing feeds for about four days. The childs general condition was very good. A roughness of the skin on the forehead was noticeable, and an erythematous rash was apparent on the chest and trunk. The family history was that the father had suffered from nasal catarrh, and that the paternal mother had had bronchial asthma all her life. Treatment was as follows. Milk for feeds was prepared by adding, drop by drop, slowly stirring to avoid curdling, a mixture of 40 minims (2.3 ml.) of dilute hydrochloric acid (B.P.) in 2 drams (7 ml.) of water to one pint (0.6 litre) of cows milk which had previously been boiled for 10 minutes. To prevent scratching, an ointment was applied consisting of a solution of coal tar dr. i (3.5 ml.); zinc oxide dr. 2 (7.8 g.): powdered starch dr. 2 (7.8 g.); soft paraffin dr. 1 (3.5 ml.). Case 2.-This child was also a bottle-fed infant 18 months old. She had a widespread weeping eczematous condition on the face, chest, trunk, and limbs. The rash first appeared at the age of 3 months. It began on the forehead, and gradually spread over the face, chest, and trunk until the whole body was covered. In spite of this the childs geneial condition was good. The childs uncle suffered from asthma. The same treatment was prescribed as in the previous case, and in ten days there was a marked improvement. The weeping condition of the skin had completely disappeared, the irritation wis not present and the child was now sleeping very well. The acid-milk treatment was continued for five months, and after that the child took untreated cows milk without any ill effects.