Annual report of the Medical Officer of Health [to] the Corporation of the City of Capetown.

  • Cape Town (South Africa). City Health Department.
Date:
[1939]
Catalogue details

Licence: Public Domain Mark

Credit: Annual report of the Medical Officer of Health [to] the Corporation of the City of Capetown. Source: Wellcome Collection.

    52/140 (page 50)
    It will be seen that the hospital patient not only reduces the risk to his family but doubles his chances of recovery. Sputum examination should be carried out in every possible case. This work is under¬ taken, at no cost to the local authority, at the Laboratories of the Union Health Depart¬ ment, who also carry out tests of guinea-pig inoculation in a limited number of difficult cases. The promptitude and accuracy of this service is much appreciated, but it is now recognized that microscopic examination of a stained preparation fails to bring to light many cases of an infectious nature, which are revealed by more expensive and lengthy methods, such as those of Ellerman and Erlandsen, and Lowenstein-Jansen, and the examination of faeces and of the contents of a gastric lavage in children. All that is claimed, therefore, from the preceding division is that over 56 per cent, were known to be grossly infectious. Suspects. With the co-operative patient this is the ideal method of first attendance from an administrative and educational point of view. The main business of the tuberculosis dispensary is diagnosis, and when disease is found in a suspect the notification is made, where possible, in the practitioner’s name as one method of informing him of the result of the investigation. Employers in the home should be encouraged to make use of the clinics. There is little evidence of infection from non-Europeans to Europeans ; but there was one out¬ standing case where an only child was lost through the employment of a tuberculous maid from the country. No employer need remain uneasy as to the safety of her children. The suspected employee should be sent for thorough examination to the family doctor or the clinic. We conceive it to be our duty to inform householders when open cases of tuberculosis are known to be working in the house, and in all such cases hospitalization is urged, and following compliance the dependents are aided if necessary. Employers in factories and offices are making increased use of the clinics and help considerably in many cases by allotting sick pay and arranging for reinstatement when the patient is certified as fit to return. Like all other forms of help, this should be made conditional on the patient’s undergoing an adequate period of treatment. Contacts. This category is restricted to those cases who have attended only because they have recently been, or still are, living in contact with a known- case of tuberculosis : many cases suffering, or suspected to be suffering, from tuberculosis who attend of their own accord or are referred by a private practitioner, give a history of previous contact with a known case ; but this does not bring them into the category of “ contacts.” Almost all contacts attend as the result of advice by the health visitor, and their examination should be one of the more worth-while features of the clinic if it is comprehensive and if early treatment can be secured for the early case. Although all contacts wTere not X-rayed the incidence of the disease in the adult contacts examined was found to reach the astound¬ ing figure of 116 per 1,000 in Europeans, and 129 per 1,000 in non-Europeans ; and the cases thus discovered were mostly in an advanced stage. Thus the main object of the examination of contacts, viz., the discovery of early cases capable of recovering in minimum time, is not achieved. On the contrary it has led to the discovery of yet more advanced cases who have, through poverty, ignorance and apathy, failed to seek advice earlier. Of the few early cases found in this way only 5 were induced to take institutional treat¬ ment for 3 to 6 months : they are now back at work and have a good chance, under super¬ vision, of remaining there. As is found elsewhere, the attendance of the most important group—the young adult contact—is the most difficult to secure, whilst those already sick are the most easily induced to attend. In a more enlightened population, where some form of national health insurance is in force and the local medical services are adequate, many of these cases of established disease are found through other agencies. These cir¬ cumstances partially explain the very high incidence of established disease discovered in contacts. If further emphasis is needed, the truth of the repeated warning of the Union Health Department that tuberculosis is a “ house disease ” is clearly shown here. If it is assumed that there are five house-contacts to each primary notification, over 5,000 new contacts could have been examined during the year. In fact, only 825 contacts were examined, representing 98 per 100 deaths as compared with 178 in England. Tuberculous Meningitis. In the 80 local cases of this condition notified in the year a family history was known oi found in 31 (i.e39 per cent.). In 48 cases we were unable to secure the attendance of any contacts for examination, but 8 of these gave a history of disease in the family. In the 32 families examined, 23 were already known, or found on examination, to have a focus of infection amongst these members.