A journal article on multiple pregnancies in the then Southern Rhodesia colony.The ratio of twin pregnancies to single pregnancies in England and the United. States of America is reported to be approximately one in eighty. By Hellins Law the incidence of quintuplets is therefore approximately one in 40 million.
Quintuplets in these countries are obviously of extreme rarity. It is known, however, that in Rhodesia the incidence of twins is much higher among the African population and one would, therefore, expect the incidence of quintuplets to be higher.
The incidence of twins is reported to be in the region of one in thirty-five, and by application of Hellins Law the incidence of quintuplets should be approximately one in 1.5 million births

Husband, A.W.

Smith, F. Morley

Central African Journal of Medicine

English

IDS OpenDocs

VotT "2------NO. 5 MAY, 1956
C O N T E X T S
ORIGINAL ARTICLES
Leprosy and Childhood 
The Mtoko Quintuplets
Muscle Relaxants in Anaesthesia 
The Retroverted Uterus 
Effects of Certain Diseases on Population 
African Leishmaniasis 
Mukuwapasi Remedial Clinic 
Establishment of the Medical School in 
Bulawayo
Amyloidosis in the African
J. A. Kinnear Brown - -  - 113
F. Morley Smith and
A. W. Husband 181
S . B a d e r ..................................... 185
K. Duff ................................191
M. G e l f a n d .....................194
R. K ir k ..............................199
Mrs. Glutton Brock -  - - - 204
/. S a ck s .......................  306
C. F. Sanders .............................. 208
EDITORIALS
The Treatment of Nephrosis by Inducing 
Malaria
Lord Malvern’s Letter
The Doctor and His Car
The Wilkins Infectious Diseases Hospital
Kitwe Conference on Alcoholism
209
209
210 
210
212
Correspondence - - -  - -  - -  - 211 The Journal Library - - - - - -  213
Book Review - - -  - -  - -  - -  213 Latest Pharmaceutical Preparations 214
PUBLISHED MONTHLY, ANNUAL SUBSCRIPTION £2 2s. Od.
Registered at the General Post Office as a Newspaper.
Vol. 2. No. 5. M ay, 1956. T he Central AfricanJournal of Medicine
An Unusual Case of M ultiple 
Pregnancy
BY
F. MORLEY SMITH,
M.C., l .r .c.p . (Lond.), m .r .c.s. (Eng.)
Government Medical Officer, Mtoko, S. Rhodesia 
AND
A. W. HUSBAND, m .b ., c h .b . (Cape)
Government Medical Officer, Harari Maternity 
Hospital, Salisbury.
Introduction
The ratio of twin pregnancies to single preg­
nancies in England and the United. States of 
America is reported to be approximately one 
in eighty. By Hellins Law the incidence of 
quintuplets is therefore approximately one in 
40 million.
Quintuplets in these countries are obviously 
of extreme rarity. It is known, however, that 
in Rhodesia the incidence of twins is much 
higher among the African population and one 
would, therefore, expect the incidence of quin­
tuplets to be higher.
The incidence of twins is reported to be in 
the region of one in thirty-five, and by appli­
cation of Hellins Law the incidence of quin­
tuplets should be approximately one in 1.5 
million births.
Quintuplets then must be considered as a 
rarity even amongst the Africans, and as this 
case is the only one known to the authors to 
have occurred in Rhodesia, it was thought to 
be worth recording.
T he Obstetrical History of Judith T anzeni
First pregnancy, a male child which died after 
three days.
Second pregnancy, a female child, living and 
at school.
Third pregnancy, a female child, living and 
at school.
Fourth pregnancy, triplets, all female, all 
dead.
Fifth pregnancy, triplets, all male; two died 
soon after birth, one is still alive.
Sixth pregnancy, twins, both female, both 
dead.
Seventh pregnancy, quintuplets.
Details of Seventh Pregnancy
With regard to this last pregnancy, Judith by 
all accounts was normal throughout, but her
mother and an African woman Bika, who was 
later destined to act as midwife, observed that 
she was very large. This was by no means 
unusual for Judith, as she had previously had 
a number of multiple pregnancies. Her attend­
ants were not, therefore, unduly perturbed, and 
at no time during the pregnancy did Judith 
consult a doctor.
D etails of Confinement
The confinement took place in a Native hut 
in Chief Kowo’s district of the Mtoko Reserve, 
about twenty miles from the village of Mtoko.
The hut is the usual type of Native hut of 
pole and dagga, eight feet in diameter and 
furnished with a small fireplace. A fire was 
kept burning during the night of the confinement 
in order to provide light by which the midwife 
could work. The woman who attended Judith 
during her confinement was an ordinary African 
woman, untrained in midwifery, who lived at 
a nearby kraal.
At approximately 10 o’clock on the night of 
the 21st of June, 1955, Tanzeni, the father, 
asked the midwife to come to his kraal as his 
wife was in labour. On arrival at the kraal the 
midwife found that Judith had already given 
birth to the first infant, a girl, delivered as a 
normal vertex. At approximately 1 a.m. on 
the 22nd of June the second infant, also a girl, 
was delivered as a vertex, and this was followed 
shortly afterwards by a boy, also a vertex pre­
sentation. At about 5 a.m. a girl which pre­
sented as a breech was delivered, and finally at 
about 6 a.m. a boy was delivered as a vertex.
The placenta was delivered immediately after 
the birth of the last baby, and its expulsion was 
accompanied by only a minimal loss of blood.
Judith appears to have stood up to her con­
finement well and was not unduly exhausted by 
her efforts.
After delivery the babies were placed on a 
reed mat and the cords were tied with a strand 
of cotton.
When the midwife informed the husband that 
his wife had given birth to quintuplets the 
husband was so taken aback that he sent for 
Chief Kowo, who arrived to view the babies. 
The Chief then directed the father to set off 
on Ms bicycle to All Souls Mission to obtain 
help. Following his arrival at the Mission, a 
priest and two African nurses set off by car for 
Tanzeni’s kraal. They wrapped the babies in 
blankets and transported them back to the 
Mission, where they were placed in cots with
Page One Hundred and Eighty-One
May, 1956 A CASE OF MULTIPLE PREGNANCY The Central AfricanJournal ui Medicine
hot water bottles and put into the care of the 
European Sister.
At this time it was noticed that the smallest 
baby, a girl, was looking very grey and wrinkled. 
This baby later vomited a small quantity of 
blood and died during the night. Its weight 
was found to be two pounds four ounces.
Next morning, 23rd June, 1955, the four 
remaining babies were conveyed by car to the 
Harari Maternity Hospital, Salisbury.
Hospital Progress
On admission to hospital, examination of 
Judith revealed that her general condition was 
good. The only features of importance were 
that the uterus was very bulky, the fundus of 
the uterus being situated about two inches above 
the umbilicus, while the abdominal wall was 
very lax. In all other respects Judith appeared 
normal. The blood pressure was recorded as 
115 over 75 mm. Hg. and her pulse rate was 
88 per minute. The Wassermann reaction was 
found to be negative. There was no evidence 
to suggest that the pregnancy and delivery had 
exhausted Judith unduly.
The four remaining infants were weighed and 
placed in incubators. Their weights were found 
to be as follows:—•
Maria, female, three pounds seven ounces.
Sophia, male, three pounds six ounces.
Alois, male, two pounds six ounces.
Pauline, female, three pounds seven ounces.
The children had been christened at All 
Souls Mission, and the names given them were 
adhered to throughout their stay in hospital.
On admission, all the children appeared to be 
in a satisfactory condition and there was every 
hope of all four surviving.
The body temperatures of all four were 
slightly below' normal on admission, but all 
rapidly regained normal temperatures in the 
incubators.
The initial treatment was confined to keeping 
the children in the incubators with a continuous 
supply of oxygen, while feeding was instituted 
at three-hourly intervals.
With the exception of Alois the children were 
considered to be fit enough to dispense with the 
continuous oxygen after three days. Froi%this 
time until they were two weeks old, oxygen was 
only administered after feeds for a period of 
about fifteen minutes. Alois, however, had to 
be kept on continuous oxygen from admission 
until the time of his death.
Page One Hundred and Eighty-Two
Since the children had received no feeds prior 
to admission, it was decided to institute tube 
feeding immediately. All the children were 
started, therefore, on quarter strength expressed 
breast milk in quantities of from six to eight 
drachms at three-hourly intervals. The quantity 
of the feed was altered according to the size of 
the child and its response.
With the exception of Alois the children were 
later moved on to bottle feeds of expressed 
breast milk. This was done as the children 
gained strength and exhibited the ability to suck. 
The quantity of each feed was gradually in­
creased un'til approximately two ounces were 
being taken from the bottle. At this stage the 
children were placed on the breast and test- 
weighed. It was found, however, that Judith 
could not feed all three adequately, and com­
plementary feeds of expressed breast milk had 
to be given.
After approximately one wreek it was found 
possible to dispense with the complementary 
feeds, and from this stage until the children 
were discharged from hospital they W'ere fed 
entirely on the breast.
Alois presented a rather special problem and 
was treated accordingly. On*admission his con­
dition appeared to be satisfactory, but he was 
considerably smaller than the other three and 
looked a less robust infant. Initially he ap­
peared to be doing well, but after three days 
it was found that, unlike the others, he could 
not thrive without continuous oxygen. Never­
theless he show'ed a similar initial gain in weight 
over the first few days, although by the seventh 
day his weight was back to that found on 
admission.
After twelve days he had gained only half an 
ounce, and on the twelfth day vomited imme­
diately after some of his feeds. Treatment was 
continued and his condition was unchanged 
until after the fifteenth day, by which time he 
had gained one ounce in weight. On the even­
ing of the fifteenth day it was noticed that the 
limbs twitched intermittently and he was then 
taken off his tube feeds and given subcutaneous 
injections of saline at six-hourly intervals and 
sedated with chloral.
His condition deteriorated rapidly and, despite 
coramine injections, oxygen given through a 
face mask and subcutaneous saline, he died at 
10.45 a.m. on the sixteenth day. A post-mortem 
examination was carried out, but the only 
abnormal finding was a partial atelectasis of 
one lung.
M ay, 1956 A CASE OF MULTIPLE PREGNANCY T he Central Africa**Journal of Medicine
M A R IA
I a 3 h- <*• 6 7 s
S O P H IA
A G E  IN  W E E K S L e g e n d :
a = T ube  F e e d in g .
B = B o t t l e  F e e d in g  in  In c u b a t d r .
C =  Breast  F e e d in g  o u t  of In c u b a t o r .
The relevant details are summarised as follows:
Date of admission to hospital: 23rd June, 1955. Date of discharge: 16th August, 1955.
H eights on Admission—
Maria: three pounds seven ounces. 
Sophia: three pounds six ounces. 
Paulina: three pounds seven ounces. 
Alois: two pounds six ounces.
Weights on Discharge—
Maria: six pounds five ounces.
Sophia: six pounds two ounces.
Paulina: five pounds seven ounces.
Alois (at time of death): two pounds five 
ounces.
Page One Hundred and Eighty-Three
A CASE OF MULTIPLE PREGNANCYM ay , 1956 T he Central A irm anJournal op Medicine
Discussion
The incidence of multiple pregnancy varies 
considerably in different countries, but generally 
the incidence appears to be higher in the 
coloured races.
Hellin (1895) postulated a rule regarding 
the mathematical frequency of multiple births 
based on the incidence of twins being one in 
eighty pregnancies. By his rule triplets then 
occur in one in 802 pregnancies and quadruplets 
one in 803.
Stocks (1952) quotes figures for England and 
Wales which correspond fairly closely to those 
which were given by Hellin and also with figures 
from the United States and Canada.
Ross (1952) found the incidence of multiple 
pregnancies in Africans admitted to the Harari 
Maternity Hospital, Salisbury, to be one in 35.
Whatever the incidence of multiple pregnan­
cies, even if the figure is as high as one in 35, 
the incidence of quintuplets is obviously very 
small indeed, but it is of interest to note that 
Mayer (1952) found apparently authentic re­
cords of even thirteen foetuses resulting from 
one pregnancy.
The factors which influence the frequency of 
multiple pregnancy appear to be rather vague, 
and climate, fertility and even chemical agents 
may be adduced to have some influence.
In our case it was found that the people at 
the mother’s kraal are of the opinion that a bad
spirit is the cause, This spirit, a “ shawe,”  has 
come fro'm the wife’s ancestors and its presence 
in the vicinity is responsible for the repeated 
multiple pregnancies. It was decided that on 
the return of the family to the kraal, a witch­
doctor would be sought to advise them as to 
how this evil spirit might be banished.
Prior to discharge from the hospital, Judith 
was asked if she intended to have more children, 
and she replied in the affirmative.
Sum m ary
A case of multiple pregnancy is described in 
ivhich quintuplets were delivered without medi­
cal aid. The case was followed from the time 
of delivery until the time of discharge from 
hospital. Relevant details regarding treatment 
and progress are given.
REFERENCES
Holland, Sir Eardley & Bourne, A. W. (1955). Bri­
tish Obstetrical Practice, p. 637.
M ayer (1952). Quoted Holland & Bourne (1955). See 
above.
Ross. W. F. (1952). Brit. Med. }., 2, 1336.
Stocks (1952). Quoted Holland & Bourne (1955). See 
above.
A cknowledgment
We wish to thank Dr. R. M. Morris, o .b.e., 
Secretary for Health, for permission to publish 
this paper.
Page One Hundred and Eighty-Four
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The Mtoko quintuplets

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The Mtoko quintuplets

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