20,555 ii. general diseases not mentioned above (contd) … · abscess • 5 hepatitis • 7...
TRANSCRIPT
Brought forward
II. GENERAL DISEASES NOT MENTIONED ABOVE (Contd)
III. AFFECTIONS OF THE DERYODS SYSTEM AND ORGANS OF THE SENSES.
3,615
69. Other General Diseases Purpura Haemorrhagica Haemophilia. . .
71. Meningitis (not including Tuberculous Meningitis or Cerebrospinal Meningitis
72. Locomotor Ataxia.
74. Apoplexy:-
(a) Haemorrhage .(b) Embolism .(c) Thrombosis
75. Paralysis
(a) Hemiplegia . .(b) Other Paralyses
77. Other forms of Mental Alienation.
78, Epilepsy • . . .
80. Infantile Convulsions .
81. Chorea.
82. A. HysteriaB. NeuritisC. Neurasthenia .
83. Cerebral Softening .
84. Other affections of the Nervous System, such as Paralysis Agitans. . *
85. Affections of the Organs of Vision -
(a) Diseases of the Eye(b) Conjunctivitis. •(c) Trachoma. . .(d) Tumours of the Eye(e) Other affections of the
Eye. . . . Cataract . .
86. Affections of the Ear or Mastoid Sinus.
20,555
11
11
2
332
1386
39
139
16
9
16126388
2541,178
157
30829
988
Diseases by Systems or Groups.
Nos. Principal Diseases»
Nos.
Brought forward 24,207
IV. AFFECTIONS OF-THECIRCULATORY SYSTEM. 1,414 87. Pericarditis. . » 1
88. Acute Endocarditis orMyocarditis. 77
89. Angina Pectoris 4
90. Other diseases of the Heart 20
(a) Valvular . .Mitral 189Aortic 10Tricuspid 30
(b) Myocarditis. 190
91. Diseases of the Arteries -
(a) Aneurism . . 1-■ * (b) Arterio-Sclerosis . 34
93. Diseases of the Veins -
(a) Haemorrhoids 95(b) Varicose Veins . 32(c) Phlebitis 9
94. Diseases of the LymphaticSystem -
Lymphangiti s . * 10Lymphadenitis, Bubo(non specific). . 667
95. Haemorrhage of undeterminedC5US 6• • a • 10
96. Other affections of theCirculatory System„ 35
V. AFFECTIONS OF THE 8,038 97. Diseases of the NasalRESPIRATORY SYSTEM. Passages -
Adenoids. . , 109Polypus . 81Rhinitis. . 359Coryza . . . 1,188
98. Affections of the Larynx -Laryngitis 128
99. Bronchitis. «.
(a) Acute. 4,255(b) Chronic 1,068
Carried forward 32,809
35.
Brought; forward
V. AFFECTIONS OF THE RESPIRATORY SYSTEM ( C ontd.)
VI. DISEASES OF THE DIGESTIVE SYSTEM.
20,261
100. Broncho-Pneumonia.
101. Pneumonia -
(a) Lobar . .(b) Unclassified.
102. Pleurisy, Empyema.
103. Congestion of Lungs
104. Gangrene of Lungs.
105. Asthma
106. Pulmonary Emphysema
107. Other affections of the Lungs
108. A. Diseases of the teeth
Caries, Pyorrhoea &c.
B. Other affections of the mouth . . .
Stomatis.Glossitis
109. Affections of the Pharynx orTonsils -
Tonsillitis Pharyngitis . .
111. A. Ulcer of the Stomach.
B. Ulcer of the Duodenum
112. Other affections of theStomach -
Gastritis .Dyspepsia * .
113. Diarrhoea and Enteritis -
Under 2 years .
114. Diarrhoea and Enteritis -
Two years and over Colitis .
37,809
105
13758
335
14
1
188
11
1
229
1,848
629
405200
2,090290
24
8
3674,432
.,432
1,264 3 65
Diseases of Systems or Groups.
Nos. Principal Diseases.*
Nos.
Drought forward 47,112
VI. DISEASES OF THE 116. Diseases due to InternalDIGESTIVE SYSTEM Parasites. . •
(Contd.)(a) Cestoda (Taenia) . m 100(c) Neinatoda (other than
Ankylostoma) -Ascaris • 15Oxyuris • 23
* Trichina &c. • 73(e) Other parasites • 1
117. Appendicitis ■ . . • 138
113. Hernia • 69
119. A. Affections of the Anus,Fistula, &c. • 87
3. Other affections of theIntestines -
Entcroptosis • 6Constipations • 6,221
121. Hydatid of the Liver • 2
122. Cirrhosis of the Liver -
(a) Alcoholic • 4(b) Other forms . • 15
124.. Other affections of the Liver -
Abscess • 5Hepatitis • 7Cholecystitis • 16Jaundice « 23
126. Peritonitis (of unknowncause) . . . 3
VII. DISEASES OF THE 6,501 127. Other affections of DigestiveGEHITO-UEIHABY System • 76SYSTEM (NON VENEREAL)
128c. Acute Nephritis . • 30
129. Chronic • 27
131. Other affections of theKidney, Pyelitis, Sec. • 110
132. Urinary Calculus. • 1
133. Diseases of the BladderCystitis . . . • 356
Carried forward 54,520
37.
Brought forward
VII. DISEASES OF TIEGENITC-URINARY SYSTEM (lIOH VENEREAL) (Contd.)
VIII. PUERPERAL STATE.
134. Diseases of the Urethra -
(a) Stricture.(b) Other
135. Diseases of the Frostate -
HypertrophyProstatitis
136. Diseases (Non Venereal) of theGenital Organs of man -
Epididymitis Orchitis . Hydrocele. Paraphimosis Ulcer of Penis Phimosis .
137. Cysts or other non malignantTumours of the Ovaries
138. Salpingitis -
Abscess of the Pelvis.
139. Uterine Tumours (non-malignant).
140. Uterine Haemorrhage (Non-puerperal) . . . .
141. A. Metritis . . . .
B. Other affections of the Female Genital Organs. Displacements of Uterus Amenorrhoea Dysmenorrhoea Leucorrhoea . .
142. Diseases of the Breast (non-puerperal) -
Mastitis. . . . . Abscess of Breast
143. A. Normal LabourB. Accidents of Pregnancy -
(a) Abortion.(b) Ectopic Gestation(c) Other accidents of
Pregnancy
54,520
11341
722
277576 62114
28
798
241
157
314
594
226643
1,572573220
9637
2976
563
Diseases of Systems or Groups.
Nos. Principal Diseases.»
Nos.
Brought forward 61,296
'/III. PUERPERAL STATE 144. Puerperal Haemorrhage. • 21(Contd.)
145. Other accidents ofParturition • 43
146. Puerperal Septicaemia. • 25
147. Puerperal Eclampsia • 80
148. Phlegmasia Dolens • 9
149. Sequelae of Labour • 138
150. Puerperal affections of theBreast . • 65
IX. AFFECTIONS OF THE SKIN 5,957 151. Gangrene . • 9AID CELLULAR TISSUES.
152. Boil - 83Carbuncle • 111
153. Abscess - 279Whitlow . • 206Cellulitis « 427
154. A. Tinea . • 240B. Scabies • 1,149
155. Other diseases of the Skin ~ 402
Erthema • 401Urticaria. • 253Eczema • 1,347Herpes • 56Psoriasis. • 20Myiasis • 95Ulcer • 629Dermatitis • 46Ainhum . • 22Impetigo . • 217
X. DISEASES OF BONES M D 1,104 156. Diseases of Bones -ORGANS OF LOCOMOTION(OTHER THAN TUBERCULOSIS) Osteitis. • 128
157. Diseases of Joints -
Arthritis • 485Synovitis • 190
158. Other Diseases of Bones orOrgans of Locomotion. • 297Myalgia . • 4
Carried forward 68,738
39.
Brought forward
XI. MALFORMATIONS.
Nos.
XII. DISEASES OF INFANCY.
XIII. AFFECTIONS OF OLD AGE.
XIV. AFFECTIONS PRODUCED BY EXTERNAL CAUSES.
70
235
44
2,873
159. Malformations -
Hydrocephalus.Spina Bifida, &c.Foreign Bodies
160. Congenital Debility .
161. Premature Birth
162. Other affections of Infancy
163. Infant neglect (infants ofthree months or over)
164. Senility -
Senile Dementia and Debility
176. Attacks of poisonous animals-
Insect BiteHuman Bite . .
177. Other accidental Poisonings
178. Burns (by Fire)
179. Burns (other than by Fire).
182. Drowning accident
183. Wounds (by Firearms warexcepted)
184. Wounds (by cutting orstabbing instruments)
185. Wounds (by fall)
186. Wounds (in mines or quarries)
187. Wounds (by machinery)
188. Wounds (by crushing e.g.railway accidents) . .
189. Injuries inflicted byAnimals, Bites, Kicks, &c.
192. B. Hunger and Thirst.194. Exposure to Heat -
HeatstrokeSunstroke
68,738
45214
110
10
100
15
44
913
5
187
52
1
590
180
2
2
44
522
39
54
Brought forward
XIV. AFFECTIONS PRODUCED BY EXTERNAL CAUSES (Contd.)
XV. ILL-DEFINED DISEASES.
TOTAL
289
195. Lightning Stroke.
200c Infanticide (murder of Infants) .
201. A. DislocationB. Sprain .C. Fracture
202. Other External Injuries
203. Deaths due to Violence.
205. A. Diseases not alreadyspecified or ill-defined -
Ascites.Oedema .Asthenia . . .Shock .
B. Malingering .Obesity.
70,743
10
108257374
449
3
3172765
1023
72 „264
A P P E N D I X IV.
ANNUAL REPORT ON THE LEPER SETTLEMENT AT BOTSABELO, BASUTOLAND
FOR THE YEAR ENDED 31st DECEMBER, 1937.
The figures quoted below are taken from the detailed medical report submitted by the Medical Offioer, Doctor R. C. Germond.
Population: Notwithstanding a large influx of admissions to the settlement which resulted from a survey of the Quthing and Qacha’s Nek districts, made by Dr. Germond in December 1936 and January 1937, it is satisfactory to note that the downward trend in the leper population, noted in 1S36 and 1935, has continued :-
Gains in Population - Male Female Total
Admissions, new cases 49 55 104Admissions, recurrences 13 12 25Re-admitted deserters 13 14 27
Total gains 156
Losses in Population -
Deaths 31 28 59Desertions 18 23 41Discharges 33 38 71
Total losses 171
Total decrease, 15: the population on 31st December 1937 was 669.
Deaths :
The number of deaths was the same as for 1936, namely 5S, as against 91 in 1935. The causes of death are given as follows :-
Causes of Death Male Female Tota]
Advanced leprosy 13 2 15Laryngeal obstructions 8 7 15Gangrene and senticaemia 4 7 11Pulmonary tuberculosis 2 2 4Myocarditis 1 2 • 3Acute leprosy 1 2 3Pneumonia 1 2 7VDysentery 1 1 2Purpura haemorrhagica 0 1 1Nephr it i s, acut e 0 1 1Nephritis, chronic 1 0 1
Total 32 27 59
Referring to the number of deaths due to laryngeal obstruction Dr. Germond writes that this ”has remained distressingly high but as tracheotoniy is never accepted, and intubation rarely, there is no means of improving this state of affairs” .
Origin of New Cases Admitted: *
District Admissions Percentage
Qacha's Nek 35 34.0Mafeteng 16 17.5Quthing 15 14*6Kaseru 11 10.6Leribe 10 9.7Mohales Hoek 10 9.7Berea 4 3.9
Period of Disease before Admissions;
Excluding 14 transfers from asylums in the Union, and two cases which were incorrectly diagnosed, there were 88 admissions and the duration of disease was given as follows
Duration Admissions Percentage
1 - 1 2 months 43 48.913 - 24 months 15 17.0Over two years * 12 13.6Unknown 18 20.5
The high proportion of oases in -which the duration of disease was unknown vitiates the above table, but in most of these doubtful cases the disease was of considerable duration. In his report for 1937 Dr. Germond emphasises the disquieting feature which is disclosed that there appears to be increasing delay in the diagnosis and admission of new cases. The position improved steadily from 1S29, when the inspectorate system was started, to 1835 but in 1936 and 1937 there has been a decline, and this fact is also depicted in the unusually large number of patients -who have been admitted suffering from the cutaneous form of the disease
Year Proportion of admissions of 1-1?. months?
1829 36.8$ of total admissions1S30 37.3/2 !» tt tt1831 37.6$ If tt tt1832 42.0% If tt tt1933 47.6$ ft tt tt1934 50.0$ tl ti tt1835 55.1$ If tt tt1936 52.2$ ft tt tt
Dr. Germond suggests as causes for this deterioration(a) increasing apathy on the part of the chiefs who fail to notify suspected cases of the disease and (b) less zeal on the part of the leprosy inspectors. It is hoped in due course to make recommendations towards improving some-what, the conditions of service under which the leprosy inspectors work, but the year under review has hardly been a fair test of the inspectorate system as one inspector died and there was delay in finding a suitable recruit, and the work of one inspector became so poor that his appointment is being terminated. It is hoped to increase the staff of inspectors from six to eight in the financial year 1938/39oAverage Age of Patients on Admission.
The age at -which the disease developes is remarkably high, averaging 36.7 years. Reviewing the past seven years this has remained almost constant and it is a feature -which strikes a newcomer to the settlement forcibly.
Leper Children.
The proportion of children under the age of 16 years who 7/ere admitted during 1937 was 15.9$ of total admissions. This was much the same as in previous yearsj in 1936 and 1935 it was 16.2% and 15.5% respectively.
There were 75 children aged 16 years or less in the settlement on 31st December 1937 as against 92 and 90 in 1936 and 1935.A larger number of children than usual has been discharged during 1937 with the disease arrested.
At the end of 1937 there were 21 non-leper infants in the settlement as against 13 in 1936. Plans are being considered for establishing a creche for these infants, which is a highly desirable development.
Treatment.
Hospital and dispensary work during 1937
Chaulmoogra injections 3342Medical out-patients 2781Surgical out-patients 301In-patient admissions 375
Five major amputations were performed during the year.
Antileprotic Treatment.
Routine antileprotic treatment still consists of the intradermal injections of the ethyl esters cf chaulmoogra oil
1937 1936.
Total attendance 7564 8377Average daily attendance 72 85.5Number of injection days 105 95
Dr. Germond notes in his report the decline in attendance for injectional treatment and suggests that as the great majority of treatable cases has now been discharged there is little likelihood of the figures rising to the 1936 total until a large number of early cases has again accumulated. The intradermal injection treatment requires infinite patience on the part of Dr. Germondj treatment is entirely voluntary and the response is very gratifying.
Results of Treatment.
71 patients were discharged as arrested as against the previous maximum of 68 in 1936.
Diet.
In comparison with diets issued at leprosaria in the Union, and -the diet scales for mines labourers, the diet scale at Botsabelo showed a marked deficiency in protein of good biological value and in three months in the year by issuing a soup ration three times a week; the bones from the meat issue, which were previously incinerated, have been used to make the stock and cabbages, carrots, beans or potatoes have been added shortly before the soup is served. Roughly 400 lbs. of cabbage and 60 lbs. of carrots are used weekly in this soup. The issue is popular with the patients.
»Farm.
The season 1S3S/37 was a moderate one. Crops were not too good owing to the water-logged condition of the ground early in the season and to hail-storms later. Fodder viras good and none had to be purchased. The dairy herd is being improved by the purchase of a Friesland bull of a stock with high milk yield and good butter-fat content.
The lands which are farmed by the leper patients have been vastly improved by the formation of contour banks and ditches; this work was undertaken by the Agricultural Department.
Social Condition of Patients.
There have been no serious disturbances during the year and the atmosphere at the settlement is one of surprising contentment.The tactful work of the matron and compound manager is largely responsible for this.
Attempts have been made to extend the occupations and amusements of the patients* A fund, called the "Leper Recreation Fund" was started by voluntary contributions, assisted by the fines inflicted in the patients’ own native court. From this fund, games, carpenters’ tools, gramophone records, vegetable seeds eto., were purchased. No films were obtainable for the "silent" bioscope which is on charge at the settlement but, pending the possible purchase from the fund later of a 16 mm. "talkie” projector, an episcope was obtained for showing pictures to the children. The generous response which was made to the Christmas Fund in 1S3 7 enabled an appreciable balance to be paid into the Recreation Fund.
The Anglican, Paris Evangelical Mission and Roman Catholic Churches at the settlement have been visited regularly during the year by the mission clergy and the Protestant and Roman Catholic schools have now been taken under the direot charge of the missions. Pathfinder guides, under Miss Martin, are flourishing and there were 31 girl patients enrolled by the end of 1937. A boys' club was started by Mr. D. Joblin of the Stores Department, who takes the boys for physical exercises one evening a week. A room has been equipped as a carpenters' shop and instruction in carpentry is given to the boys one evening a week by Mr. Venables, artisan at tiie settlement. Weaving class for boys and girls, started by Miss Johnson, has proved very popular and the children show real talent.
The response made to the Christmas appeal was so generous that every patient could be given some small present and, besides money donations, many excellent toys for the children were presented.
In November the European residents of Maseru, aided by a generous grant from the Native Recruiting Corporation, presented to the settlement a wireless set, relayed by loud speakers to the male «n ̂ female compounds. The set was opened by the Government Secretary.
Changes in Staff.
During 1837 the settlement suffered the loss of the Superintendent, Dr. P. D. Strachan, O.B.E., who retired in July and of the Matron, Miss M. I. Willdon, M.B.E., who also retired.
Doctor Strachan had been in charge of the settlement since 1923, and Miss Willdon had been matron since the settlement was opened in 1914* They knew each patient intimately and their loss has been felt deeply. Miss Martin, who was first appointed to the settlement in 1914, was promoted to the post of matron.
(Sgd.) W. B. JOHNSON,
Super intend ent.
The Leper Settlement,
Botsabelo,
25th January, 1938.
A P P E N D I X V.
REPORT OF A LEPROSY SURVEY OF PART OF THE LOWLANDS OF MAFETENGDISTRICT; JANUARY ISth to FEBRUARY 2nd, 1938,
by Dr. R. C. GERMOND,Medical Officer, Botsabelo Leper Asylum, Maseru.
In the Annual Medical Report of the Botsabelo Leper Asylum for the year 1937 attention was drawn to the fact that in the last eighteen months there had been a tendency for the duration of the disease before admission to the asylum to increase. It was also pointed out that there was reason to believe that conditions in the Mafeteng district were not as good as generally supposed, particularly along the Free State border. It was therefore decided to conduct a short but intensive survey of as much of the lowlands of Mafeteng district as possible0
Area Included in the Survey.
The area covered by the survey includes the whole of Chief Thabo Mojela’s ward, half of Chief Mohlalefi’s ward and the portion of Chief Sekhonyana’s ward situated on the Mafeteng side of the Tsoaing river from opposite Kolo mountain and thence to the frontier. This area is contained vjithin the following limits :-
1. The line of hills from Tsita's Nek to Tsupane Gate, including all Mojela’s villages south of this line.
2. A line running from Tsita*s Nek to Kolo mountain andthence to the Tsoaing river.
3. The Tsoaing river from this point to the Free State frontier.
4o The Caledon river and the boundary fence from the Tsoaing junction to Tsupane Gate.
Method Employed*
It will be remembered that in the survey of the Eastern border districts in 1936 certain villages were chosen as rallying points for the surrounding population. This meant that considerable distances had to be travelled by the people and that there was no possible check on the proportion of stay-at-homes. This method was therefore discarded in the present survey and a point was made of visiting every village in the chosen area* The chances of concealment were thus reduced to a minimum while it was possible to examine all patients and recently confined women in their huts. The only section of the population not examined were the infants of the above mentioned women. Needless to say this would have been done if leprosy had been found in the house. A list of absentees was made and their whe-reabouts noted for future reference.
The actual method of examination was- the same as in 1936. Diseases other than leprosy were noted and special attention was given to the general condition of the population.
Altogether 170 villages were visited and 12,837 people examined, 10,092 of-whom belonged to Mojela's ward.
TABLE I.
Total population accounted for.
Ward Examined Absentees. Total
Thabo Mojela
Mohlalefi and Sekhonyana.
10,092 (88.3$)
2,745
1349
369
11,441
3,114
Total 12,837 1718 14,555
As, accordi of Mojela’s ward of the people we
ng to the last official enumeration, the population was 9,837 there is no doubt that the great majority re either examined or noted as absentees.
TABLE II. ABSENTEES.
WardIn
BasutolandContractLabour
CasualLabour Total
Thabo Mojela
Mohlalefi and Sekhonyana
114
36
1,029
278
206
55
1,349
369
Total 150 1,307 261 1,718
From the above figures it will appear that 75.5% of the absentees from Mojela’s ward were engaged under contract and therefore must have been medically examined before leaving the territory. This gives a proportion of 5,6% of the population of this large ward. In other words about 94% of the population of Mojela's ward have been examined recently.
In striking contrast with the conditions prevailing in Quthing and Qacha's Nek in 1936 there was a total absence of gross undernutrition in the area covered by the survey; little dirt, and not much scabies. The great majority, if not all, of the people appearing under the heading of "undernutrition" in Table III were in reality convalescents from serious illness. 'Where this was not the case the loss of weight was not very great. With regard to skin diseases "prickly-pear rash" was very common, but always easily distinguished from other eruptions.
The two most important findings of the survey are (l) the excellent general condition of the population, and (2) the low incidence and mild form of leprosy. Not a single case of leprosy was discovered among the male population and only seven among females, all of whom were adults. The absence of leprosy among males is explainable by the large proportion of men examined at the frontier before leaving the territory. One of the new cases will
not be admitted to the asylum as she is already spontaneously arrested (N.ll). One case had been previously diagnosed by the Inspector (1931) but turned down by the District Medical Officer; there is now no doubt as to the nature of the disease (N.ll). The remaining five cases are extremely early and mild and all belong to the neural type (N.l). One of these was the "teacher” of an initiation class, the so-called "mosuoe” and wife of a recently admitted cutaneous case. Ten such schools were examined including one for males. Four discharged lepers were examined during the Survey one of whom was found to be a recurrence. Four cases of mild pellagra were encountered.
TABLE III. RESULT OF SURVEY.
Headings Mojela’s Ward Mohlalefi & Sekhonyana Total
Examined 10,092 2,745 12,837Scabies 266 25 291Und e rnutr it i on 52 6 58Syphilis * 26 2 28Leprosy 6 0 6
*As in the previous survey the figures refer only to active external syphilis and do not reflect the actual incidence which is known to be much higher.
The next table is interesting as a comparison between the two mountain areas examined in 1936 and the lowland area covered by the present survey. Needless to say the state of nutrition varies in the same area from season to season.
TABLE IV.
Comparison between Mountain and Lowland Areas.
Headings Quthing & Qacha's Nek Mafeteng Lowlands
Examined 13,187 12,837Scabies 9.0# 2.3#Undemutrition 4.2# .34#Syphilis .2# .2#Leprosy .32# .05#
The last table indicates the type and degree of severity of the cases of leprosy seen in the present survey. The spontaneously arrested case is not included.
TABLE V.
Type and Degree of Severity.
Type Severity Numbers Percentages
Cutaneous C I Nil -C II itC III t!
Mixed C I, N I t»C II, N II ttC III, N III tl
Neural N I 6 85.7$N II I 14.3$N III Nil -
(it will be remembered that the N II case was diagnosed in1931).
Interpretation of Results shown in above Tables.
1. The general nutrition of the population is an extremely unstable factor. It is at present excellent in the lowland area recently examined, whereas in the depression (1S33 & 1S34) and for a year or more afterwards it was one of tiie worst in Basutoland.
2. The incidence of scabies is much lower in the lowlands than it was in the mountain area examined in 1936. The comparison is especially interesting with the well-nourished population of the Melikane Valley.
3. The incidence of active external syphilis was found to be the same in the lowlands as in the mountain area.
4. The incidence of leprosy is very much lower in the surveyed part of the lowlands than in the surveyed part of the Eastern highlands. This is strikingly illustrated by the following comparison
Melikane Valley (1936) incidence ...Qacha’s Bek South " ...Quthing District " ...Mafeteng Lowlands (1938) ” ...
8 per raille4 ff t!2 ft W1E it It
(Sgd). R. C. GERMOND,
Medical Officer,
Botsabelo Leper Asylum, Maseru.
«
»
A P P E N D I X VI*
TREATMENT OF VESTICQ-VAGINAL FISTULA
AMONG BASUTO WOMEN.
By Dr. A. E.Young, Medical Officer, Maseru.
Each year in Basutoland a number* of patients present themselves with Vesico-Vaginal Fistula of severe degree. Such cases are always the result of difficult labour under tribal conditions and where medical aid is difficult to obtain. Until recently, these patients were turned away as incurable after unsuccessful attempts at repair per vaginam and were left to lead a life of misery resultant on the continuous leakage of urine . The operation of Implantation of the Ureters into the colon has altered the outlook considerably and it is cheering to be able to discharge the cases well and happy.
During five years (1931-1935)* nine cases of Vesico-Vaginal Fistula were admitted to Maseru Hospital*. In all these, repair per vaginam was attempted, sometimes two or three times and only two were finally discharged as cured* During two years (1936-1937), eighteen cases were admitted and all were treated by Implantation (after futile attempts by vaginal suture in some cases)« Of these, sixteen were discharged as cured and two died, one from acute pyelo-nephritis and one from peritonitis following leakage of urine through an insecure transplantation site. The mortality rate of eleven per cent, though heavy* can be considered satisfactory as the operation carries a rate of about twenty per cent The patients however, were so unhappy that they were prepared in every instance to take the risks rather than continue in their present state.
METHODS. All cases -were done in two stages* The ureters were implanted at intervals of two to four weeks.
(a) Coffeyfs Catheter Technique was employed in the first sixpatients, but it was abandoned as being too fu3sy with a small theatre staff., There is a tendency for the catheter to block, as happened on three occasions, and the result could have been serious had our efforts failed to clear it. The post operative period seemed more stormy than that where other methods were used.
(b) Coffey's Aseptic Technique No«3.(Transfixion suture). Used in three cases and the condition of the patients operated on by this method gave rise to worry. There was a marked degree of lumbar pain, high temperature, general discomfort, and one waited anxiously for urine to appear per rectum for it is quite possible to miss the lumen of the ureter during transfixion as occurred in expert hands..
(c) Grey Turner’s Method gave satisfactory results in the sixcases in -which it was used. It has the virtue of being simple, quick and with an uneventful convalescence. It is the method here favoured.
(d) Winsbury-White*s Method was used in three cases. Theoretically by this method, a barrier is provided against the ascent of infection from the bowel to the kidney and implantation is brought about without danger to the vitality of the ureter. Practically, the condition of the patients was no better nor worse than when Grey Turner Method was used and the second stage operation is certainly more tedious.
Drainage, recommended, was not used on any occasion and it seems possible that these patients may have acquired a degree of resistance against infection during the period of their disability. Drainage, however, would possibly have saved the case which died as a result of insecure transplantation, in that it would have enabled an earlier diagnosis of the mishap. It is worthy of note that there were no adhesions present at operation in a single case and this was contrary to expectation when one considered their history.
END RESULTS. Several of the patients have presented themselves months after the operation and their health and appearance have been strikingly good. Three months after operation the rectum has so educated itself to the new condition that in the majority of cases the need to micturate during the night has ceased. One women 18 months after operation became pregnant and was warned to present herself before full time, so that Caesarean Section could be performed. She did not do so and died shortly after admission to hospital after having been in labour for four days. In future, all cases will be sterilised at the second operation. No facilities exist for following up the cases as to the functional activity of the kidneys.
ANEASTHESIA. General anaesthesia was abandoned in favour of the spinal method -which seems ideal for this operation.
(Sgd.) A. E. YOUNG,
Medical Officer
Maseru
A P P E N D I X VII.
METEOROLOGICAL REPORT,1937
WEATHER CONDITIONS AT METEROLOGICAL STATION, MASERU FOR
THE YEAR 1937.
Temperature: The average mean temperature for the year was59.3 degrees. The highest screen temperature - 91 degrees was recorded on the 18th November and 12th December; and the lowest 21 degrees on the 18th June and 4th July.
Precipitation: The total precipitation for the year was23.89 inches (2.52 inches less than last year). Precipitation during January,February, March, April, October and November took place in the form of local showers and thunderstorms -which were mostly light, with however, occasional isolated heavy downpours very often accompanied by severe lightning.
Hai1 : Hailstorms occurred during January, March,April and October, causing very little damage.
Snow: No snow recorded during the year.
Frost; Frost occurred almost nightly from April toSeptember, but was most severe during May, June, July and the first half of August.
Wind: The prevailing wind was from the North East.
DISTRICT RAINFALLS IN 1937
A . .. -------------Meteorological Station Jan. Feb. !!ar o April May June July Augo Sept. Oct. Nov. Dec. Total
Butha Buthe S.12 6.08 5.28 0.61 0.18 Nil 0.18 C .05 Nil. 1.99 1.85 2.99 28,33
Leribe 8.25 7.68 3,50 1.11 0.36 - 0.25 - 1.12 1.60 1.72 3.72 29.31
Teyateyaneng 6-59 3.08 3.08 1.23 0.28 - 0.18 0.07 0.90 1.56 3.90 2.47 23.37
Maseru 5.91 4.69 3.03 0.72 0 • 68 0.05 0.43 0.04 0.97 0.89 4.11 2.37 23.89
Mafeteng 7.63 7.26 3.64 0.07 1.00 - 0.35 0.10 0.18 0.41 1.40 2.75 24.79
Mohales Hoek 10.84 8.43 4.24 0*13 1.15 0.22 0.44 - 0.09 0.50 0.76 3.92 30 c 72
t Quthing 6.54 5.17 4.60 0.17 1.48 0.41 0.53 0.03 0.08 2.26 0.99 2.76 25.02
Quchas Nek 8.84 6.32 5.54 0.50 0.32 0.01 0.12 - 1.71 0.83 1.10 5.44 30.73
Sehlabathebe 8o21 11.24 3.79 0.60 - - - - 0.13 1.37 2.70 4.46 32.50
Mokhotlong 4.12 4.10 2.91 0.60 0.09 - 0.10 - 0.04 1.42 1.96 2.67.
18.01
Collection Number: AD1715
SOUTH AFRICAN INSTITUTE OF RACE RELATIONS (SAIRR), 1892-1974
PUBLISHER: Collection Funder:- Atlantic Philanthropies Foundation
Publisher:- Historical Papers Research Archive
Location:- Johannesburg
©2013
LEGAL NOTICES:
Copyright Notice: All materials on the Historical Papers website are protected by South African copyright law and may not be reproduced, distributed, transmitted, displayed, or otherwise published in any format, without the prior written permission of the copyright owner.
Disclaimer and Terms of Use: Provided that you maintain all copyright and other notices contained therein, you may download material (one machine readable copy and one print copy per page) for your personal and/or educational non-commercial use only.
People using these records relating to the archives of Historical Papers, The Library, University of the Witwatersrand, Johannesburg, are reminded that such records sometimes contain material which is uncorroborated, inaccurate, distorted or untrue. While these digital records are true facsimiles of paper documents and the information contained herein is obtained from sources believed to be accurate and reliable, Historical Papers, University of the Witwatersrand has not independently verified their content. Consequently, the University is not responsible for any errors or
omissions and excludes any and all liability for any errors in or omissions from the information on the website or any related information on third party websites accessible from this website.
This document forms part of the archive of the South African Institute of Race Relations (SAIRR), held at the Historical
Papers Research Archive at The University of the Witwatersrand, Johannesburg, South Africa.