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]
    The transactions on the list of midwives during the year are shown in the following table :— Midwives. Certificated. Uncertificated. Total. Eur. Non-E. Eur. Non-E. On the list 30th June, 1938 .. Ill 43 14 48 216 Added to list during 1938-39 .. 15 3 3 — 21 Removed from list during 1938-39 by resolution of Council.. -. 1 1 3 5 Removed from list during 1938-39, having ceased to practise in the Municipality .. 19 2 3 2 26 On list 30th June, 1939 107 43 13 43 206 Three applications to bo added to the list were refused by resolution. In recent years the proportion of certificated midwives practising in Cape Town has steadily increased. During the year under report the (extern) confinements attended by certificated midwives in private practice were for the first time greater in number than those attended by uncertificated midwives (see page 16). One of the health visitors is appointed as supervisor of midwives. She made 1,626 visits during the year, including 901 visits to midwives in their own homes. Thirteen midwifery inspections were held at the welfare centres, at which the total attendances of midwives numbered 193. These were all conducted by the supervisor, and usually under the supervision of a medical officer. In 52 cases mid wives were required to attend for special interview by a medical officer and in 36 cases midwives were reprimanded by letter. Two women (non-European) were prosecuted for practising as midwives when their names were not on the City Council’s list. They were both found guilty and fined, the sentence in one case being suspended. Assisted midwifery :—In the outlying parts of the municipality, where extern mid¬ wifery for indigent persons is not available, there have been many confinements where no midwife was in attendance. Throughout the municipality there were 276 such births in the year. There is a need for the provision of free or assisted midwifery services in certain out-lying areas. Since the end of the year under report a municipal midwife (non- European) has been appointed in the Athlone district. During the year midwifery fees were paid for attendance on indigent women in 29 cases, 16 by the City Council and 13 by a voluntary fund at the disposal of the Department. Six maternity baskets are available in the Department for use in indigent cases. During the year two midwifery films were purchased by the Department, at the cost of production ; they were specially made at the Liverpool Maternity Hospital by courtesy of Mr. C. McIntosh Marshall, F.R.C.S., of that institution. To supplement them, a film was made locally by Mr. L. Lewis, of the Southern Life Association, at the Aspeling Street centre, dealing with the preparation for confinement. These films have been most useful for showing at the midwifery inspections, and have befell especially useful when instructing untrained midwives, who have given them an enthusiastic reception. A lecture demonstration of pre- and post-natal exercises was given at one of thes« midwifery inspections by Mrs. Landsberg. At the request of the matron of a training institution pupil midwives have been per¬ mitted to attend for observation at municipal pre-natal clinics since 25th May, 1939. NURSING AND MATERNITY HOMES. Private nursing and maternity homes may be carried on- only if registered by the Secretary for Public Health, and are to be conducted in accordance with the regulations made by the Minister under the Public Health Act. The inspections of such premises are made by the City Health Department on behalf of the Secretary for Public Health, to whom reports of the inspections are sent. This work is undertaken by the Deputy Medical Officer of Health through the maternal and child welfare branch of the Depart¬ ment. On December 1st, 1938, one of the health visitors was appointed as assistant inspector of nursing homes in addition to her other duties.
    On June 30th, 1939, there were 31 registered nursing or maternity homes in the municipal area, as follows : General Maternity Combined— .. General . . Maternity Premises. Beds. 17 328 11 155 3 19 24 31 526 During the year ended 30th June, 1939, 4 registered premises, viz., 1 general (10 beds) and 3 maternity (12 beds) were closed. One new nursing home (13 beds, general) was registered. Three applications for registration of nursing homes (2 maternity and 1 general) were refused on the ground of unsuitability. From December 1st, 1938, to June 30th, 1939, the assistant inspector made 75 visits of inspections to nursing and maternity homes. These include inspections made to maternity homes under the Children’s Act at the request of the Commissioner of Child Welfare. Full reports were sent to the Secretary for Public Health in respect of 24 premises reported on by the assistant inspector, as follows :— Re new Registered, applications. premises. General 2 4 Maternity 2 13 Combined . . — 3 In addition to the above, 7 registered nursing homes (general) were inspected by the Deputy Medical Officer of Health and reports sent to the Secretary for Public Health. PUERPERAL FEVER. Reported cases of this notifiable disease are investigated by the Maternal and Child Welfare branch. Cases are admitted to the City Hospital. The cases of puerperal fever reported in the year 1938-39, corrected for imported cases and misdiagnosis, numbered 84 (22 European and 62 non-European). The number of deaths amongst the 84 Cape Town cases was 8 (1 of the 22 European cases and 7 of the 62 non-European). The total Cape Town deaths from the disease registered during the year numbered 7 (1 European and 6 non-European). The mortality from this cause for a series of years, expressed as a rate per 1,000 live births, is shown on page 15. Attendance at Confinement.—56 of the cases were confined at home and 28 in hospitals. Of the 56 at home 13 were attended in labour by midwives only, 14 by doctors only, and 19 by doctors and midwives : 10 were unattended (7 being abortions). Condition of Child.—47 of the cases supervened upon the birth of a living child and 36 of a dead foetus (in 1 case no information). Of the 36 cases following delivery of a dead foetus, 16 were of a dead viable foetus and 20 of a non-viable foetus. Primiparae.—32 of the cases were reported as primiparae (i.e., women in their first confinement) and 51 multiparae (in 1 case no information). Treatment.—50 of the cases (corrected for misdiagnosis and imported cases) were treated in the City Hospital, 8 in the Peninsula Maternity Hospital, 3 in the Groote Schuur Hospital, and 1 in the House of Correction ; the remaining 22 were treated at home. There were no cases at the Langa native location. THE WORK OF THE HEALTH VISITORS. There are in this branch of the Health Department 28 health visitors whose time is < evoted to maternity and child welfare, besides the chief health visitor, the supervisor of mi< " 've's’ ^nd one health visitor in charge of the school clinics and one of work in connection v it l diphtheria prophylaxis. There is in addition one social welfare investigator. The health visitors’ duties usually have as their starting point the visiting of mothers W1. 1 newborn infants. Where the mother was attended at confinement by a trained mu e * ie V1S1^ *s postponed until after the tenth day, but mothers attended by un-
    certificated persons are visited as soon as possible after the infant’s birth in order to see that all is well w’th mother and babe. The health visitor gives advice as to the care and feeding of the baby and invites the mother to attend the centre as soon as she is able to do so. As far as possible the health visitor keeps in touch with mother and child during the whole period until the child goes to school. Expectant mothers known to the Depart¬ ment are also visited and advised to attend the pre-natal clinic unless they are under the regular care of their own doctor. Visits are also made to cases of puerperal fever, ophthalmia, pneumonia, measles and whooping cough, and advice is given as to nursing and other precautions to be taken. Protected Infants.—The health visitors make periodic visits of inspection to foster¬ homes (under the Children’s Act) to supervise those children under ten years, known as protected infants, who are in the care of foster-parents. 3,516 such visits were made by health visitors, and there were 386 new protected infants registered during the year. Reports on these children are submitted by the Medical Officer of Health every three months to the Commissioner of Child Welfare. Where conditions are found unsuitable assistance is given to the parents in making better provision for such children. Each health visitor assists at sessions at the welfare centre in her own district. The following table shows the number of visits made during 1938-39 and previous years by the health visitors and the social welfare investigator (including the visits made by the tuberculosis health visitors and the V.D. nurse visitors) :— Classification of Visits. Number of Visits. 1938-39 1937-38 1936-37 1935-36 1934-35 1933-34 1932-33 1931-32 1930-31 1929-30 Visits to houses where births have occurred. . 10,516 9,580 10,272 10,416 9,360 9,822 9,649 10,029 10,510 9,637 Subsequent visits to houses where births have occurred 34,792 34,862 35,642 32,774 32,399 34,741 35,558 31,951 34,334 31,405 Visits to houses where deaths under 5 years of age have occurred 1,315 1,213 815 859 729 736 457 466 226 166 Visits to expectant mothers 2,966 2,547 2,862 2,595 2,480 2,200 2,278 1,713 1,381 762 Visits re Protected In- fants .. 3,516 3,252 2,899 3,097 3,091 3,253 3,123 3,166 3,229 2,699 Special follow-up visits 3,639 3,833 4,434 4,207 3,890 Visits to cases of tuber- culosis 9,900 8,683 8,989 8,142 6,547 6,087 6,624 6,265 6,450 5,234 Visits re cases of puer- peral fever 85 70 75 107 109 239 74 69 96 82 Visits re measles 42 227 8 16 324 97 8 56 125 38 Visits re whooping cough 41 26 39 250 51 18 76 34 99 14 Visits re diarrhoea 27 14 20 21 56 310 11 37 23 8 Visits re chicken-pox .. 19 3 16 18 10 26 18 26 24 25 Visits re ophthalmia neonatorum 579 726 698 650 919 765 845 927 1,058 615 Visits re pneumonia . . 481 526 495 670 754 344 309 461 365 366 Visits re trachoma 5 19 6 8 15 2 12 13 11 40 Visits re influenza 3 47 2 22 22 8 22 264 268 631 Visits re other diseases 188 29 27 6 42 Visits re diphtheria im- munization . . 2,337 2,272 1,823 1,240 1,220 2,686 1,756 1,660 Visits re midwives 1,254 1,270 1,185 1,754 2,171 1,976 1,118 1,434 1,118 748 Visits to schools 479 403 330 284 288 146 161 138 64 46 Visits to school children 851 1,048 791 1,273 1,248 815 1,098 567 Visits to shops and factories 135 142 180 75 57 73 147 165 188 125 Visits to nursing homes 85 41 41 33 27 40 31 29 48 11 Visits re verminous persons 25 1 2 11 6 30 3 10 12 39 Visits re dental treat- i ment 268 110 153 165 141 218 258 273 191 87 House-to-house visita- tions. . 4,446 2,637 1,831 970 642 Visits re venereal disease 4,597 3,996 312 Other visits 1,118 644 954 514 635 5,067 5,731 4,216 4,232 2,499 Visits bv Social Welfare Investigator .. 2,890 3.528 3,075 3,581 3,056 2,195 4,309 3,373 4,541 3,782 Total visits 86,699 81,749 77,976 73,758 70,289 71,894 73.676 67,348 68,593 59,059 Complaints referred to Chief Health Inspector 38 30 22 27 60 12 9 27 28 28
    Social Welfare Investigator. Many cases come to the notice of medical officers and health visitors which require advice and guidance from the social and moral standpoint, especially in connection with the unmarried mother. Such cases are referred to the social welfare investigator, who is specially appointed for this work. A record of work done during the year 1938-39 by the social welfare investigator given below :— New cases investigated • • • • • • 762 Visits to institutions 588 Visits to cases .. .. 1,508 Visits to Government Offices .. .181 Other visits 613 Total visits 2,890 Office consultations • • • • • • 1,160 MATERNAL AND CHILD WELFARE CENTRES. Thirteen maternal and child welfare centres are maintained, at which 56£ medical (or dental) sessions are held each week. A medical (or dental) officer attends at each of these sessions ; except that at 8 of them the medical officer attends only twice a month, and at 2 of them two medical officers attend each week. This is equivalent to 54| weekly sessions actually held by medical (or dental) officers. The details as at 30th June, 1939, are shown in the following table Address of centre. Infant con¬ sultations. Pre-natal clinics. Dental clinics. School clinics.* E. n-E. B. E. n-E. B. E. n-E. B. B. 12, Keerom Street, Cape Town . . 2 2 Aspeling Street, Cape Town ip) 5 2(2) St. James Street, Woodstock 3 3 1 1 1 2 3(8) Norfolk Road, Maitland .. 1 2 1 1 Good Hope Village Hall, Brooklyn 1 *(4) Native Hospital, Langa . . 1P)(5) Lawrence Road, Athlone .. IP) 2 1(3) £(4) Station Road, Claremont . . 1 1 1 IP) Off Second Avenue, Claremont . . 2P) Lansdowne Hall, Lansdowne K1) 1 Town Hall, Wynberg 1P)(°) 2 1 1 i(4) Retreat Road, Retreat 1 2 R4) Holy Trinity Church Hall, Kalk Bay IP) Toddlers’ clinics K7) ' Total sessions per week 14 23 1 1 6 1 2 1 6 E.—European ; n-E.—non-European ; B.—both. * Including dental clinics for school children. P) Session held weekly, but medical officer attends only twice a month. (2) At one of these weekly sessions two medical officers attend. (3) At this weekly session two medical officers attend. (4) i.e., session held twice a month. (5) Natives only. (6) This weekly session is a pre-natal clinic as well as an infant consultation. (7) The weekly toddlers’ clinic is held in rotation at Woodstock (twice a month), and Maitland and Wynberg (once a month each). (8) One general, one ophthalmic and one dental. All the other school-clinic sessions are general. Of the 54| weekly sessions as shown above, 23 were ordinarily conducted by full¬ time medical officers and the remainder by part-time medical or dental officers. When full-time medical officers were engaged on other work (particularly diphtheria-immuniza¬ tion sessions) or were on leave, their place was taken by part-time medical officers.
    The next table shows the attendances (classified for race) made at the infant consulta¬ tions (including pre-school children), pre-natal clinics, school clinics and dinners, held at the centres during the year 1938-39 :— Centre. Race. Infant consultations. Pre-natal clinics. School clinics. Dinners for children under school age, and nursing and expectant mothers. First attendances. Total attend¬ ances. Attendances. Attendances. Attendances. Under 1 year. Over 1 year. First. Total. First. Total. Adults. Chil¬ dren. 12, Keerom St., Eur. 214 62 4,505 85 240 Cape Town. Non-Eur. 485 158 7,191 3,003 10,500 Total 699 220 11,696 3,088 10,740 Aspeling Street, Eur. 25 11 972 13 23 14 51 Cape Town. Non-Eur. 1.022 294 16,620 961 3.932 3,634 15,944 Total 1,047 305 17,592 974 3,955 3,648 15,995 Woodstock Eur. 382 181 8,481 233 990 1,081 2,265 722 1,590 Non-Eur. 484 195 9,501 299 1,195 1,147 1,773 4,360 9,628 Total 866 376 17,982 532 2,185 2,228 4,038 5,082 11,218 Maitland Eur. 168 63 3,292 51 165 75 288 82 297 Non-Eur. 391 185 7,437 293 1,223 154 674 3,266 6,727 Total 559 248 10,729 344 1,388 229 962 3,348 7,024 Brooklyn Eur. 75 37 2,279 17 53 Non-Eur. — — — — — Total 75 37 2,279 17 53 Langa .. Eur. — 1 3 Non-Eur. 120 13 1,231 Total 120 14 1,234 Athlone Eur. 19 11 365 11 58 6 6 3 3 Non-Eur. 509 316 8,289 453 2,298 444 1,444 3,314 8,366 Total 528 327 8,654 464 2,356 450 1,450 3,317 8,369 Station Road, Eur. 115 62 2,410 58 180 145 462 3 2 Claremont. Non-Eur. 303 153 7,051 339 1,072 201 710 1,616 4,203 Total 418 215 9,461 397 1,252 346 1,172 1,619 4,205 2nd Avenue, Eur. — — — Claremont(1) Non-Eur. 68 66 1,963 Total 68 66 1,963 Lansdowne Eur. 63 36 2,181 315 660 Non-Eur. 136 87 4,074 1,991 11,563 Total 199 123 6,255 2,306 12,223 Wynberg Eur. 108 60 2,405 57 185 61 217 2 15 Non-Eur. 418 201 5,926 346 1,198 170 337 2,309 3,729 Total 526 261 8,331 403 1,383 231 554 2,311 3,744 Retreat Eur. 64 32 1,306 23 60 64 613 16 33 Non-Eur. 390 167 5,973 361 1,529 183 955 2,416 5,867 Total 454 199 7,279 384 1,589 247 1,568 2,432 5,900 Kalk Bay(2) . . Eur. 10 5 67 Non-Eur. 29 33 595 Total 39 38 662 Total . . Eur. 1,243 561 28,266 1 463 1,714 1,432 3,851 1,242 2,891 Non-Eur. 4,355 1,868 75,851 3,052 12,447 2,299 5,893 25,909 76,527 Total 5,598 2,429 104,117 3,515 14,161 3,731 9,744 27,151 79,418 d) Opened 2nd March, 1939. (2) Opened 17th January, 1939. Figures for dental clinics, whether for school children or for mothers and pre-school children are not included in the above table. Infant Consultations. In visiting the health visitors invite the mothers to bring their infants to the welfare centres for advice as to feeding and care and for medical supervision, and periodical attendance is encouraged for children up to school age. The infant consultations are primarily for preventive and educational purposes. They are not intended for the treatment of disease, but minor ailments are dealt with and cases of illness are referred either to the family doctor or, in cases of poverty, to the hospitals and dispensaries.