Scragg, Joan

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Suid--Afrikaanse Tydskrif vir GeneeskundeSouth African Medical JournalPosbus 643, Kaapstad P.O. Box 643, Cape TownKoopstod, 1 November 1958Weekliks 2s. 6d. Deel 32 No. 44 Volume 32Cope Town, 1 November 1958Weekliks 2s. 6d.CONGENITAL HYPERTROPHIC PYLORIC STENOSIS IN THE AFRICAJOAN SCRAGG, M.B., CH.B., D.C.H. (LOND.), Departmellt ofPaediatrics, University of Nataland King Edward VIII Hospital, DurbanCongenit~t hypertrophic pyloric stenosis in the Africanappears to be an extremely uncommon condition, sincevery few cases in tbe Afri~an have been reported in the litera-ture. Ladd, Ware and Pickett1 state that they have notedno particular racial disposition, and ascribe the fact that theyhave never observed a case in a Negro infant to pure chance.Donovanl reported 2 cases in Negro infants, and later3be states that he has found the condition in all races andnationalities and he has seen about 2 Coloured babies withthis condition in each 100 cases. Many authors have statedthat the condition is rare in egro infants. Benson andWarden4 describe the condition in 63 Coloured infants out of707 consecutive cases reviewed by them during a 16-yearperiod from 1940 to 1955 at the children's hospital of Michi-gan.Before 1955 the condition bad not been described in theAfrican infant. Shepherd Wilson and Gelfand5 describedthe first case in an African male aged 2 months. The follow-ing year Luder6 reported another case in a male Gandainfant aged I month. Since then, at Johannesburg, Griffiths7has described I proved case seen at Baragwanath Hospitalin a I-month-old Bantu male and has stated that a singlecase, which was treated medically, was seen at CoronationHospital. Hamilton8 stated that the literature appeared tocontain reports of only 4 cases of congenital pyloric stenosisoccurring in Africans, and he described another provedcase in a male Dama aged I month. Unfortunately thereferences to these 4 cases were not published with hisarticle, but it would appear that he was referring to the4 cases described by the abovenamed authors. Thusto date only 5 cases, 4 of which were proved by operation,have beeri described in Africans.During a period of 6 years at King Edward VIll Hospital,Durban, this diagnosis has been made on 3 occasions in theBantu paediatric department. This department has a verylarge turn-over, both in the in-patient and out-patient sec-tion, and the fact that only 3 cases of pyloric stenosis werediagnosed out of an admission rate of approximately 5,000cases a year, is an indication of its rarity. It seems unlikelythat the diagnosis is missed, for the condition has never beendiscovered as a chance finding at autopsy.As the condition is usually slowly progressive and does notcause sudden dea"th, presumably the affected infant at somestage would be brought to the out-patient department. TheAfrican mother has become increasingly hospital-consciou ,and thousands of infants attend for such complaints as failureto thrive, vomiting and constipation; this latter symptombeing particularly distressing to the enema-conscious Africanmother. It is unlikely therefore that cases of pyloric stenosisin any numbers are dying outside the hospital.There was I proved case in each of the years 1953, 1954 and1956, and these are summarized briefly as follows:Case 1A 4-week-old African male was admitted on 24 June 1953.He was a first-born child, his birth was normal and he was breastfe-d. His birth weight is unknown. The mother, a pure Africanwho came from the kraal, was extremely 'raw' and was unable togive a reliable history even with the help of an interpreter. Itappeared that the infant was subject to persis ent vomiting andconstipation, but tbe duration could not be ascertained. J wasable to interview the father and was satisfied that he too was apure-bred African.The infant weighed 6 lb. He was small and miserable, and therewas depression of the fontanelle, but skin turgor was satisfactory.All systems were apparently normal. No peristaltic waves w~reobserved after feeding and no mass was palpable. Test feedmgwas carried out. After 48 hours it was obvious that the infantwas vomiting most of what he took in. Tbe vomiting was notprojectile in type, but on tbe following day on I occasion it wasnoticed to be so. Still no mass was palpated. The stomach waswashed out and Eumydrin (J :10,000 solution) was given in aa dose of 2· 5 c.C. 20 minutes before each feed. For the next 48hours the vomiting lessened and the infant appeared to be im-proving. At this stage, after a feed, gastric peristalsis was visibleand a pyloric tumour was palpated. After this examinationprojectile vomiting occurred again. Eurnydrin was tried for afurther period of 48 hours. Breast milk was now inadequateso that complementary feeds were required. ~ince dehydrationwas developing and practically nothing was being passed perrectum, operation was deemed advisable. The diagnosis of pyloricstenosis was confirmed at operation and Rammstedt's pyloro-plasty was performed. .The post-operative progress of the infant was satisfactory for16 days when, unfo~unately. he developed bronchopneumoniawhich failed to respond to antibiotic treatment, and 'he died2 days lafer.Comment. This case tragically illustrates the danger ofkeeping these babie in ho pital longer than is ab olutelynecessary, because there is the ever-present risk of crossinfection. In this case we were influenced by the fact that the105331054 S.A. MEDICAL JOURNAL 1 November 1958mother was pnnutlve and had to return to a distant kraalwith an artifi~ally fed infant who had not improved as well aswe had hoped. Had we been able to discharge him early andfollow up his case outside the hospital, this death from'bronchopneumonia might well have been prevented.Cast! 2A 8-week-old African male was admitted on 10 May 1954.He was a first-born child, his binh was normal and he was breastfed. His birth weight was unknown. Both parents were pureAfricans. The infant was well UTIli] he was 5 days old when hebegan vomiting a little .after each feed. The vomiting was notprojectile in type from the beginning, but had been so for the past ./5 weeks. Stools were passed normally for some time after birth,but lately there had been marked constipation and the mothersaid many days would go by without a stool being passed, andthen only a very small quantity would be passed.His weight was 7 lb. 5 oz. Mild dehydration was present, butthere was evidence of marked weight loss. The infant was alertwith a lusty cry. All systems were normal apart from the gastro-intestinal system. The abdomen was not distended. He was givena breast feed, and after this peristaltic waves were seen movingfrom left to right, and an easily palpable tumour was detectedon the right side just below the costal margin. The surgeon con-sulted agreed on the diagnosis. The administration of intravenousfluids were started, and the stomach was washed out and leftempty. Operation was performed and the diagnosis was con-firmed. The infant made an uninterrupted recovery and wasdischarged 8 days after operation weighing 8 lb. 6 oz.Case 3A 4-week-old African male was admitted on 27 December1956. He was a first-born child, his birth was normal and he wasbreast fed. His birth weight was unknown. Both parents werepure Africans. The infant was well until he was 5 days old, whenhe started vomiting after feeds. The mother described the vomitingas 'shooting out'. The infant never passed a stool unless given anenema.His weight was 6 lb. 5 oz. He was thin and there was evidenceof some dehydration. All systems were normal apart from thegastro-intestinal system. The abdomen was soft. Visible peris--talsis was present. It was thought that a pyloric tumour waspalpable. Rectal examination revealed a trace of green formedstool. This was the state of affairs on admission in the evening.Throughout the night frequent small feeds of Ha.rtman's solutionwere given. The following morning, 12 hours later, it was re-ported that the infant had vomited each, feed of Hartman's solu-tion. 0 stool had been passed. Mild dehydration was stillpresent. A bottle of Hartman's solution was offered and whilesucking this, typical peristaltic waves were seen, and now a pylorictumour was definitely palpated, followed by projectile vomiting.Intravenous .fluids were given and the stomach was emptied.Operation confirmed the diagnosis. By the fifth day after theoperation the infant was fully breast fed, in excellent conditionand improving. On discharge on the ninth day his weight was7 lb. 6 oz.SUMMARYThree cases of congenital hypertrophic pyloric stenosis inAfricans are recorded. The condition would appear to beextremely rare in this race.Note: Since completion' of this paper 2 more cases ofpyloric stenosis in African infants have been diagnosed in thisdepartment.I wish to thank Dr. S. Disler, Medical Superintendent, KingEdward VIII Hospital, Durban, for permission to publish thisarticle, and Dr. H. L. Wallace and Dr. Pauline Kleneman inwhose wards these cases were examined.REFERENCESI. Ladd, W. E., Ware. P. F. and Pickett, L. K. (1946): 1. Am';r. Med. AJIoc.,131, 647.2. Donovan. E. 1. (1932): Ann. Sure., 'S, 174.3. Idmr (19<46): Ibid., 124. 109.4. Benson, C. D. and Warden, M. J. (19'7): SUT'I!. Gynec. Ob>tet.• 105,348.,. Wilson, w. S. and Gelfand, M. (1933): Cent. Afr. 1. MCd.• I, 99.6. Luder, 1. (l9S6): E. Afr. Med. J•• 33, lOO.7. Griffitbs, J. (19'6): Hum. BioI., 21, 414. .8. Hamilton: D. M. (lClS7): E. AIr. Med. 1.. 34.44j.EAST LONDON to 'GRESS 1959 AND THE JEWISH l\TEW YEAR : KO GRES TE 008-LONDEN1959 E DIE JOODSE NUWEJAARIt is much regretted that the dates chosen for the 42nd SouthAfrican Medical Congress conflict with the Jewish New Yearcelebrations. The Organizing Committee have fully investigatedthe possibility of a change of dates, but it has proved to be im.possible bec.ause the buildings to be used for the main Congresswork are closed for the Spring holidays only from Friday 25 Sep-tember to Monday 5 October inclusive.However, the plenary sessions and the main Congress socialfunctions have been arranged to be over by Thursday 1 October1959, so that Je\vish colleagues will feel free to return home shouldthey wish to do so. The greatest possible hospitality will of coursebe extended by the local Jewish community to any colleague andhis family wishing to celebrate the ew Year in East London.Elizabeth McCabeOrganizing SecretaryDit is baie jammer dat die datums wat vir die 42ste Suid-Afri-kaanse Mediese Kongres gekies is, met die Joodse Nuwejaar-feesvierings bots. Die Organiserende Komitee het die moontlik-heid om die daturns te wysig deeglik ondersoek maar dit blykonmoontlik te wees want die gebou wat vir die belangriksteKongresverrigtinge gebruik sal word is slegs van Vrydag 25September tot Maandag 5 Oktober ink1uis, vir die Lentevakansiegesluit en dus vir die Kongres beskikbaar.ReeIings is egter getref om die voltallige sessies en die belang-rikste sosiale funksies van die Kongres teen Donderdag 1 Oktober1959 af te handel sodat Joodse kollegas vry sal wees indien huldit verkies, om huis toe te gaan.Aan enige kollega en sy gesin wat die Nuwejaar in Oos-Londen\vi] vier bied die plaaslike Joodse gemeenskap die. mees gulhartigegasvryheid aan.Elizabeth McCabeOrganiserende SekretaresseCOLLEGE OF GENERAL PRACTITIONERSOn 30 September 1958 the following resolution was passed by theExecutive Committee of the National General PractitionersGroup of the Medical Association of South Africa: 'The ationalGeneral Practitioners Group unanimously agreed to form Facul-ties of the College of General Practitioners'.It was as a result of this resolution that the letter dated 3 Octoberwhich was published on page 1028 of the issue of this JOlunalof 18 October 1958, was addressed to the Hon. Secretary of theCouncil of the College of General Practitioners, London. This let-ter intimated Ihat the Group would sponsor the formation of aCollege of General Practitioners in South Africa, using the facul-ties offered by the College of General Practitioners in' GreatBritain. To thi, end the Group is encouraging the formation ofFaculties of the College in South Africa; and, when a sufficientnumber of Faculties have been formed, the Group proposes toapply for the formation of a South African Council. As Dr.lan Grant stated in his address reported in this Journal of 25October 1958 (32, 1046) a South African Council 'would to avery large extent be autonomous ... and would have (its) ownBoard of Censors'. It is the intention of the National GeneralPractitioners Group, when the South African College is strongenough, to withdraw and leave it to manage its own affairs.

Congenital hypertrophic pyloric stenosis in the African

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Congenital hypertrophic pyloric stenosis in the African

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