MEDICAL IN NORTHERN RHODESIA
Northern Rhodesia in the Days of the Charter: A Medical and Social Study 1878-1924
by Michael Gelfand CBE MD FRCP pp xvii+291 illustrated 30s Oxford: Basil Blackwell 1961
Dr Gelfand's study deals primarily with social welfare and medical problems in Northern Rhodesia from 1878 until the British South Africa Company handed over to the Colonial Office in 1924.
The first European missionaries, the Jesuits, came to a land ravaged by disease and lacking all medical services; but in the end they were vanquished by malaria and blackwater fever. They were followed by the Protestants who - although many were carried off by fever - fared better
because of more careful attention to regular dosage with quinine.
When the Company took control, they provided rudimentary medical services for both Europeans and Africans, including cottage hospitals with a trained nurse in charge, in the larger centres. Later the Administration employed increasing numbers of medical officers as hygiene specialists and efficient hospitals, staffed by European sisters, were established in the towns.
The greatest curse of the country, however, was the slave trade. A chief would raid some village, carry off the inhabitants- and then Arab dealers herded them to the coast, many of the miserable wretches perishing on the way. A slave could be purchased for about 100 yards of calico, and two or more for a good gun. By 1903 the export of slaves had been stamped out by force; but domestic slavery among the Africans lingered on until the First World War.
To-day when the fashion is to denounce 'colonialism' it is illuminating to learn how Europeans strove to bring health and justice to a primitive
country, often at the cost of their own.
THE INVESTIGATION OF AN OUTBREAK OF SLEEPING SICKNESS IN NORTHERN RHODESIA.
BY HUMPHREY GILKES, M.D.” Colonial Medical Service (Northern Rhodesia).
Trypanosomiasis in Northern Rhodesia is carried by both Glossina morsitans and G. palpalis. The latter is confined to a few well defined areas round the shore of Lake Tanganyika and the Luapula River. G. morsitans on the other hand infests nearly half of the country and by reason of the virulence and high fatality rate of the disease which it carries it presents a much greater problem. The epidemiology and symptoms of sleeping sickness carried by G. morsitans as met with in Northern Rhodesia appear to differ in some respects from the rather scanty descriptions in the text books, and this paper is an attempt to describe the problems which are encountered when an outbreak occurs
The introduction of training for female nurses in Northern Rhodesia was slow relative to many other colonial territories. In the 1920s the health
department considered African women to be ineducable; missions also, for the most part, employed men in medical roles, and were of the opinion that nursing education was most useful as a preparation for the future role of wife and mother rather than for an independent career. Thus any female employees were generally widows or older married women. Both the colonial health department and the missions, like many African parents, considered girls to be too morally vulnerable to leave home in order to undertake training. The LMS had initiated the first venture in female training at the end of the 1920s, at Mbereshi. This was Mabel Shaw's personal experiment in social engineering, in which she hijacked the medical work, subordinating it to her vision of female emancipation, which paradoxically was the creation of the perfect Christian wife and mother. That she was able to pursue her dream in a male-oriented milieu was due to the force of her personality, and her visibility in wider circles.
However, her tenacity led to the loss of the respect of the government health department and thus delayed official recognition of the training of African medical staff by many years. Shaw'sproject ultimately failed because it did not fit in with the wider, colonial plan for medical systems within African colonies. She had been joined in her missionary venture by Dr Margaret Morton, but, by the mid-1940s, both Shaw and Morton had left the station, disillusioned and frustrated. For the UMCA, medical work had come to be designated as women's work, and was marginalised within the wider missionary project. European nurses were isolated from each other, and feared by priests for the potential power of their superior nowledge of medicine as well as their female ability to distract the celibate cleric from his vocation. In this subordinate position, nurses struggled to achieve an adequate standard of training for their male orderlies. Since these orderlies often had to work unsupervised, the training of women could not be seriously considered, as they were deemed to require protection. This position changed when Bishop Selby Taylor, a strong advocate of missionary medicine who agreed with the health department that female training would be "better done" by missions, set in motion a process that led to the establishment of only the second school of nursing in the territory, and the foundation of what is now the largest mission hospital
in Zambia.
Superficially, the failure of Mabel Shaw and the UMCA nurses may appear to be a straightforward case of the marginalisation of women within a
patriarchal missionary milieu. On closer inspection, however, the apparent success of Bishop Selby Taylor (gained, significantly, at the cost of the vision of a male doctor-priest) was predicated on his own desire for "progress" in the medical field being in tune with that of the colonial government, and at a broader level, the colonial office in an era of accelerated change and colonial development. This in turn was based upon particular notions of caring femininity and the vulnerability of African female morality. This prescriptive view of women's role within medicine allowed a degree of freedom for some, but the autonomy of the nursing profession that ultimately developed was limited.
Friis-Hansen B, McCullough F. J Pediatr 1962;60:114-21
Fat-soluble substances associated with severe ophthalmologic problems including xerophthalmia (dry eyes) and night blindness were first dentified a century ago. Most consequences of this ‘‘vitamin A’’ deficiency were sooneradicated in developed countries by emphasizing the need for fortified foods, especially liver and cow’s milk. However, the problem persisted in developing countries, and after World War II scientists focused on vitamin A deficiency worldwide, where limited food choices and availability led to deficiencies in crucial vitamins and micronutrients. Fifty years ago, Friis-Hansen and McCullough from the World Health Organization (WHO) measured plasma vitamin A and carotene in children and lactating women in northern Rhodesia, as part of an investigation of the high incidence of eye and skin problems in this population. One-third of the children had severe deficiency, and young men suffering from night blindness demonstrated low vitamin A levels. The authors also noted an emerging phenomenon of worse infections in association with vitamin A deficiency, and proposed lower resistance in these children.
In 1974, the WHO and United States Agency for International Development stressed the problem of blinding xerophthalmia in the developing world. The need to treat or prevent vitamin A deficiency by breast-feeding, dietary improvement, food fortification, and supplementation soon became well accepted. Beginning in the 1980s, large-scale studies documented that periodic vitamin A supplementation reduced childhood mortality, particularly from measles and diarrhea. A recent meta-analysis documented that preventive vitamin A supplementation significantly lowers all cause mortality in developing countries.
Despite this progress, the problem persists. The WHO estimates that 140-250 million children under age 5 years suffer from vitamin A deficiency and are at risk for blindness and serious illnesses. The WHO recommends oral vitamin A supplementation with measles vaccination and periodically thereafter, typically 100 000-200 000 IU every 4-6 months. Current research is focusing on specific aspects of vitamin A, from epidemiology to genetics to maternal and fetal health; notably, the latter topic was described presciently in this 1962 study by Friis-Hansen and McCollough. A cornucopia of information and research is available for efforts aimed at addressing this preventable and treatable
deficiency
BCG Vaccination by the Multiple Puncture Method in Northern Rhodesia
By I. L. BRIGGS and C. SMITH from tile Federal Ministry of tlealth, Northern Rhodesia
An investigation into the use of fresh liquid BCG vaccine obtained from the South African Institute for Medical Research, Johannesburg, was commenced in October 195 3. The opportunity was taken of gaining experience in the use of the Heaf multiple puncture tubercul in test and of comparing the results obtained in BCG vaccinated and unvaccinated subjects with those obtained by the Mantoux intradermal method .
Thiamine (vitamin B1) was the first B vitamin which has been identified. It serves as a cofactor for several enzymes involved in energy metabolism. The thiamine-dependent enzymes are important for the biosynthesis of neurotransmitters and for the production of reducing substances used in oxidant stress defenses, as well as for the synthesis of pentose used as nucleic acid precursors. Thiamine also plays a central role in cerebral metabolism.
There are 2 major manifestations of thiamine deficiency(TD):
cardiovascular disease (wet beriberi) and nervous system disease (dry beriberi and Wernicke–Korsakoff syndrome). In wet beriberi, ardiomyopathy with edema and lactic acidosis and in dry beriberi, peripheral neuropathy occurs. Manifestations of Wernicke–Korsakoff syndrome, consist of nystagmus, ophthalmoplegia and ataxia evolving into confusion, retrograde amnesia, cognitive impairment and confabulation.
Thiamine deficiency is now very rare in developed countries, but still common in South East Asia specially in developing countries like Bangladesh. It is an important public health problem with potentially fatal consequences. Now a days highly polished rice (Minicut rice) is a popular staple food and other primary dietary sources of thiamine are in short supply. In wet beriberi myocardial disease is prominent which causes a high cardiac output with peripheral vasodilation and warm extremities. Before heart failure, tachycardia, a wide pulse pressure, sweating, warm skin and lactic acidosis develop leading to salt and water retention by the kidneys. The resulting fluid overload leads to edema of the dependent extremities. If it is left untreated the severity of potential outcome will be increased even up to death. Therefore, makes it essential for physician, cardiologists and Paediatrician to have an understanding of this condition and its optimal treatment.
Patients on a strict thiamine-deficient diet display a state of severe depletion within 18 days. The most common cause of thiamine deficiency in affluent countries is either alcoholism or malnutrition in nonalcoholic patients especially in children. Treatment by thiamine supplementation is beneficial for diagnostic and therapeutic purposes.
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