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Urban Clinics in Lusaka
(Medical Journal of Zambia., 1967-10) Noak, J. L.
There are five large urban clinics in Lusaka (urban and peri-urban population 150,000 in 1966)1. These clinics are open from 8 a.in. to 4 p.in. on weekdays and from 8 a.in. to 10 a.in. on Sundays. They are extremely overworked as js the outpatient department of Lusaka Central Hospital to which clinic [)atients are referred. For six weeks during December 1965 and January 1966 a survey was conducted to see exactly what work the clinics and outpatient department were doing, with a view to planning future work. The survey was necessary because the official clinic returns are based on the patient's complaint and not on the diagnosis.
The diagnosis of leprosy - common errors
(Medical journal of zambia, 1967-10) Imkamp, F.M.J.H.
Would the correct diagnosis of leprosy have been easier if this disease had been described in textbooks on Neurology instead of Dermatology? The emphasis on the changes in the skin of the patient with leprosy may well be the cause of misdiagnosis in many cases. Leprosy is a chronic infective disease and it is generally accepted to be caused by Mycobacterium Leprae discovered by Dr. A. Hansen in 1873 and published by him in 1874. M. Leprae is an acid-alcohol fast bacillus. So far no artificial medium has been found in which to culture the bacillus, but it can be kept alive and will multiply in the earholes and foot pads of the mouse and hamster. The foot pads are used solely as a culture medium enabling the testing of the effect of drugs on the bacillus. It is important to know that M. Leprae has a special affinity for the Schwann cells of the sensory nerves in which they lie, protected by the basement membrane, (only seen by electron microscopy) and if conditions are suitable multiply. Only nerves of the Peripheral Nervous system are affected in leprosy. Therefore without symptoms showing nerve involvement the diagnosis of leprosy should not be made in the absence of positive skin smears. The great auricular nerve-the ulner and median and peroneal nerves are easy to palpate and possess predominantly cutaneous sensory fibres. In the early stages of the disease the bacillary invasion is directed to the sensory fibres while later on all types of fibres are affected due to granulomatous infiltration, scarring, ischaemic damage or even possibly tramsneuronal spread. Autonomic nerve fibres are commonly involved early in the disease, shown by the characteristic dryness and roughness of the skin and anhydrosis. This article is mainly written for doctors who have never worked in countries where leprosy is prevalent and therefore have some difficulty in recognising the disease. To be Leprosy-conscious is as important and essential as to be Malaria-conscious and this applies to patients of all races. Leprosy can occur in ALL races and at any age. It should bc born in mind that Europeans are not exempt from leprosy and unfortunately it has happened that Europeans have been treated for many years for an unidentified skin disease which later proved to be leprosy.
Aspects of renal disease in Zambia
(University of Zambia, Medical Library, 1968-10) Johnston, S. M.
Chronic renal disease is a problem seen not infrequently on the medical wards of hospitals in Zambia. This paper represents an attempt to study the types seen both clinically and at post-mortem, as have occurred throughout the year 1967 on the medical wards at Lusaka Central Hospital. Both the adult and children's medical wards are included in the study but the surgical wards are excluded.
The geography of Lusaka city clinics
(Medical Journal of Zambia., 1968-10) McGlashan, N. D.
The following account describes a study undertaken by senior geography and social work students of the University of Zambia in a fact-finding exercise for the Ministry of Health. The aims were to enumerate all out-patients treated in the city in a single working day, to obtain information on the distances and the means of travel to seek medical assistance, and to assess the cost to the patient of the journey. Adminstrative, rather than medical, data was to be gathered.
Endomyocardial fibrosis in a Zambian
(University of Zambia, Medical Library, 1968-10) Lowenthal, M. N.; Fine, J.
The purpose of this communication is to report a proven case of endomyocardial fibrosis 03.M.F.) in a Zambian African. Most of Zambia is situated on a high plateau 4,000 feet or more above sea level. and the country enjoys a temperate climate with sharp differentiation between the rain season (November-April) and the dry season (May-October). Parry (1964, 1965) points out that endomyocardial fibrosis (E.M.F.) has been extensively reported from the hot, wet parts of Africa, but not from the drier or more temperate parts at the northern and southern extremeties of the continent. Brockington et al. (1967) in reviewing the cases of E.M.F. that have been reported in Europeans resident in tropical Africa, state that the disease is one of humid tropical zones in Africa and South America. Cases have also been reported from Ceylon and Malaya (Nagaratnam and Dissanayake, 1959; La'Brooy 1957) and South India and Brazil (W.H.O. Chronicle 1967). Davidson and Ross (1966) briefly described a case from the Ndola General Hospital who at autopsy. was found to have a "thin, fibrotic film covering the endocardium of the left ventricle"` and in whom, microscopically, the endocardium showed fibrosis. Davidson subsequently, (1967), stated that this case was one of E.M.F. A case of endomyocardial fibrosis proved at postmortem is described in a young Zambian African male.This is probably the first well-documented case report of the condition from Southern Africa. It is believed that the condition will not prove to be a rarity locally.
Schistosomiasis Mansoni: A survey of its incidence at Luampa Hospital
(Medical Journal of Zambia, 1969-01) Henderson, A. C.
Because of the frequent finding of Schistosoma Mansoni in the stools of patients seen at Luampa Mission Hospital, it was decided to endeavour to determine the incidence of the parasite in this area. Luampa Mission is located on the Luampa River in the Mankoya District of Barotse Province, 35 miles S-W. of Mankoya Boma. The report is based on stool examinations of 436 patients picked at random from people attending the OutPatient Department between June lst and July 31st,1968. The specimens were examined by the direct smear method, and many of those proving negative were then concentrated and examined again. However few of the latter were found to be positive, and we came to the conclusion that it was not worth the extra time to repeat the examination. Also because of shortage of personnel, we examined only one specimen in the majority of patients. (Where a second or third examination was made the parasite was found in at least a few cases, justifying the assumption that the incidence in this locality is even higher than our figures show.) Urinalysis was done on most of the patients in this series, but Schistosoma Haematobium was not found in a single instance in the urine. In one patierit both S.mansoni and S. haematobium were found in the stool. (In the past two years only about 5 cases of urinary b`ilharzia have been diagnosed in this Hospital.) One patient in this series, and one seen prior to the commencement of this survey had clinical and X-Ray evidence of cor pulmonale. Both had S. mansoni. present in the stools, and enlargement of both liver and spleen. (The latter of these two was also one of the few cases of urinary bilharzia we have seen here.) 67 of the patients were children (i.e. under 15 years) and 369 were adults, of whom 265 were women and 104 men. There was an equal number of boys and girls in the series, and the incidence of positive results was approximately the same-60%. Among the adults however, there was a much higher incidence among women than among men-65 % and 43 % respectively.
Investigation of suspected Resistance of P. falciparum to Chloroquine in Zambia
(Medical Journal of Zambia, 1969-01) Wolfe, H. L.; Hudleston, J. A.
In 1967 Himpoo and MacCallum (1967) reported three cases of possible chloroquine resistance of P. falciparum in Broken Hill (Kabwe), Zambia. Although a number of such claims of chloroquine resistance in Africa have been published, a report by a World Health Organization Scientific Group (1967) on the Chemotherapy of Malaria stated that such reports are, as yet, unsubstantiated. So far, therefore, there has been no confirmed incidence of a chloroquine resistant strain of P. Faciparum in Africa. For this reason, it was decided to investigate the Suspected chloroquine resistance reported in Kabwe. This investigation has not yet been completed and it will be continued during the main malaria season 1968-1969. The aim of this paper is to present the results of this investigation during the malaria season 1967-.68.
Disseminated Cryptococcosis
(Medical Journal of Zambia., 1969-01) Bhagwandeen, S.
Infection with C. neoformans, a yeast-like fungus is being recognised more frequently than hitherto. The clinical diagnosis of Cryptococcosis is difficult. Symptoms of meningo-encephalitis are the commonest presenting feature of disseminated Cryptococcosis due to the predeliction of the fungus for the C.S.F. (Moss 1960). The disease is frequently diagnosed by the discovery of the organism in the C.S.F. Although neurological symptoms are common their presentation may be bizzare. The signs may be of meningeal irritation, a Space occupying lesion, encephalitis, hemiplegia or coma, (Aberfeld and Gladstone 1967). The case presented below is interesting as a clinicobathological correlation. The wide spread systemic dissemination of the organism in relation to the paucity of presenting signs and symptoms is alarming.
A Surgical Aspect of Pulmonary Tuberculosis in African Children
(University of Zambia, Medical Library, 1969-01) Crawshaw, G. R.
The main purpose of this paper is to present a plea for a rational approach to hilar lymphadenectomy in the prevention of bronchiectasis, destroyed lung, emphysema and a massive tally of crippling respiratory disease. Operation should be considered at an early stage if drug therapy and physiotherapy are not clearly relieving bronchial compression or perforation by mediastinal lymph glands, either where the bronchial obstruction in itself is causing symptoms or where the resulting pulmonary lesion may be regarded as still reversible. This is an infinitely more attractive proposition to me as a surgeon than to be presented with the late effects of bronchostenosis and to be asked to salvage a respiratory cripple. I want to condemn in the strongest possible terms the indiscriminate use of drugs and bed rest in pulmonary tuberculosis when an obvious mechanical problem exists.
The Red Eye
(Medical Journal of Zambia., 1969-01) Phillips, C. M.
The majority of recently-qualified practitioners approach the red eye with considerable trepidation, presumably because ophthalmology occupied a small part of their training, or, more likely, that it was improbable that an `eye case' would feature in the written or clinical parts of their final examination and so could be ignored with a high degree of safety-for the student, if not for subsequent patients. Once qualified, there seems to be a marked reluctance on the part of most practitioners to close this gap in their medical knowledge. Here in Zambia it is safe to say that nearly every person develops ocular pathology at some time in his life, and I do not include errors of refraction in the category of pathology. The diagnosis of the red eye is made more difficult for the practitioner by the fact that seldom is any attempt made to take a proper history, and even less attempt to record the eye's function, i.e. to record the visual acuity. Even such basic factors as to whether the pathology was spontaneous or the result of trauma and the duration of the complaint are usually omitted. Any previous ophthalmic history, including surgery, is only recorded if the patient vouchsafes the information. I hope that no practitioner would refer a patient to a consultant surgeon with the entire contribution towards a diagnosis being "abdominal pain" or to a consultant physician with "coughing" but it is extremely common to find a patient referred to a consultant ophthalmologist with "sore eyes" "poor sight" or "bad eyes" as the total sum of symptoms and signs. It is to help the general duties Medical Officers, especially those far distant from consultant help that the following article has been prepared. Trauma as will be appreciated this covers an enormous field in ocular pathology and is extremely common. Such trauma may be from physical contact or instrumental injury such as is seen so frequently with beer hall fights, car, industrial and other accidents, burns, caustic and chemical injuries (including cobra-venom), thermal as with eclipse scotoma and abiotic as with `arc eyes'. Many of these require specialist attention, but the following are listed as frequent and/or important
Neonatal hypoglycaemia
(Medical Journal of Zambia., 1970-01) Lucas, C.; Hassim, A. M.
The clinical significance of blood glucose levels in the newborn of diabetic and non-diabetic mothers is still under debate. Low blood glucose levels which would cause serious symptoms in adults have been frequently recorded in the newborn without any adverse effect. In recent years, however, neonatal hypoglycaemia when occurring in association with a characteristic symptomatology has been recognised as an important cause of cerebral damage (Cornblath et al.,1961; Brown and Wallis,1963 ; Tynan and Haas,1963 ; Chance and Bower,1966). Brown (1967) reported 10 cases of symptomatic neonatal hypoglycaemia in which the blood glucose level was less than 20 mg. per 100 ml. Due to inadequate treatment in the first 6 cases, 2 babies died and the 4 survivors were left with brain damage of varying severity. Craig (1966) believes that if apnoea, cyanosis, collapse or convulsions are found in association with a blood glucose level of 10 mg. per 100 ml. or less, immediate treatment indicated to avert death or irreversible cerebral damage. Several authorities now accept as critical hypoglycaemia a blood glucose level of 20 mg. per 100 in/. in the first week of life (Lancet, 1969).
Total Hip replacement
(Medical Journal of Zambia., 1974-10) El-Morshidy, M. E.
The indications of total hip replacement are discussed. Some cases were presented where the procedure was performed; these included cases of degenerative arthritis as well as selected cases of old healed infective arthritis. It is evident that total hip replacement has a definite place in the surgical treatment of the advanced stages of degenerative arthritis, and possibly in some selected cases of old healed infective arthritis.
Infestation of man by the cestode in inermicapsifer madagascariensis in Lusaka, Zambia
(University of Zambia, Medical Library, 1974-10) Hira, P.R.
The infestation of a child with the cestode Inermicapsifer madagascariensis is reported for the first time in Zambia. The criteria used in arriving at the species diagnosis are discussed. As the probable rodent reservoir hosts are widely distributed in the country, the infection in man is likely to be more common than hitherto recognized. Review of the case six months after treatment with Niclosamide(Yomesan) indicated that the chemotherapy was successful.
An analytical study of 33 cases of mortal head injuries
(University of Zambia, Medical Library, 1974-10) Gawish, H.; Siddiqui, M.
Lusaka Teaching Hospital is the biggest in the country. Out of its thousand beds there are about 220 general surgical beds. The management of head injuries in the University Teaching Hospital is the responsibility of the duty general surgeon who admits and treats them. Neurosurgical opinion is sought whenever it is. 33 cases of mortal head injuries are analysed regarding the clinical presentation,treatment and post mortem findings. 14 cases were operated on with a high incidence of post operative recollection of the haematoma. 19 cases were treated non-surgically; this latter group showed high incidence of systemic injuries as well as short survival.
Sleeping sickness in children
(Medical Journal of Zambia., 1975-01) Balint, O.; Wenninger, R.L.
Twenty-three cases of Sleeping Sickness in children have been analysed at the Arthur Davison Hospital and Mukinge Hospital during the past five years. The overall mortality was 34.8%. This was especially high when trypanosomes were found in the CSF (43.8%), in patients with a CSF cell count greater than 101 /cumm (50.0%), and in patients with associated protein calorie malnutrition (PCM) (30.0%). Some clinical features of sleeping sickness (SS) in children are discussed and the therapeutic approach reviewed. The importance of early diagnosis is stressed.
Nutrition Rehabilitation in Lusaka
(University of Zambia, Medical Library, 1975-12) Waterston, T.
The incidence and present modes of management of malnutrition in the country are first discussed, and the idea of rehabilitation village, where the mother learns in a practical way about child feeding, is described. Details of the Chipata centre are given and it is recommended that these centres should be established on a wider scale.
Bacterial Meningitis in infancy and Childhood in Lusaka
(Medical Journal of Zambia., 1975-12) Chintu, C.; Bathirunathan, N.
ln approximately 10,000 admissions in a 12 months period, at University Teaching Hospital, Lusaka 85 cases of meningitis were recorded. The signs and symptoms in these patients do not greatly differ from other similar studies' in Africa. The commonest organism isolated was pneumococcus. There was high mortality rate which was to a large extent due to parents not bringing their children to hospital early enough for medical treatment to be instituted. This is borne out by the fact that 50% of the children that 50% of the children with meningitis died within the first 24 hours. The C.S.F. protein and peripheral white blood count may be of prognostic value. Spasticity, cranial nerve palsises hydrocephalus and subdural effusion were the commonest complications.
Congenital atresia of the oesophagus
(Medical Journal of Zambia, 1976-06) Shija, J. K.
Experiences elsewhere in well-established Specialist Centres have shown that the management of Congenital Oesophageal Atresia is beset with many problems, including serious post-operative complications , and that this anomaly carries a high mortality (Cozzi & Wilkinson,1975).During january-December 1975, the first year of its existence, the newly-established Paediatric Surgical Unit at Muhimbili Hospital, Dar es Salaam,has had 2 cases of Oesophageal Atresia referred to it from the Neonatal Unit for treatment. The first case(F.N.) was, in spite of the late diagnosis, a total success (the first such success reported at this hospital), and the patient was last seen alive and well at the age of 9 months; the second case also had successful surgery but succumbed on the 11 th postoperative day due to intractable pulmonary complications. The problems faced and experience gained in the management of these cases are discussed.
A case of the eisenmenger syndrome
(University of Zambia, Medical Library, 1976-06) Obineche, E.N.; Suntharam, S. S.
ln 1897 Eisenmenger described a case of a 32 year old man with cyanosis and exercise intolerance.Congestive heart failure was a preterminal event and death followed an episode of haemoptysis. Post-mortem examination showed a large defect in the membranous septum, right ventricular enlargement and overriding oarta. More recently it has been appreciated that the position of the aorta is irrelevant to the diagnosis of the Eisenmenger complex.
Cushing's syndrome associated with thymic tumour in a 32 year old Zambian African female
(Medical Journal of Zambia, 1976-06) Mpofu, P.; Amin, EI A. M.; Nyelesani, E. K.
As early as 1928 Brown noticed the association of Cushing's Syndrome with Bronchial Carcinoma.Since then, similar cases have been recorded by different authors with increasing frequency. Biochemical and bioassay techniques have left little doubt that under these circumstances the adrenal hypersecretion responsible for the Gushing Syndrome is the result of stimulation of Adrenocorticotrophin (ACTH) or by an adrenocorticotrophin-like hormone elaborated by the malignant cells themselves. Recently, extra-adrenal carcinomas, especially those arising from thymus, the ovaries and the pancreas have been shown to produce similar adrenal hyperactivity with overt clinical and biochemical Cushing's Syndrome. To the best of our knowledge, however, none of these conditions have been described in the Southern African or Zambian Medical Literature.

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