Vital statistics in Malaya are of limited value but annual reports show that the infant mortality in Penang Municipality is 125, in Singapore Municipality 172.2, in the Straits Settlements 165.28, and in the State of Kedah 137 per thousand births. The tables show a similarity to those of large English towns fifty years ago.
Poverty, ignorance and superstition account for many of these deaths and much maternal ill-health. Children are seldom taken out in infancy and houses are frequently dark, stuffy and closely-shuttered. Solid carbohydrate food is given to infants even during the first month. Congenital Syphilis causes a number of deaths and in an investigation in Singapore of mothers whose infants died in the first year of life 30.9 per cent. were Wassermann-positive.
Increasing use is made of maternity wards in the Hospitals and in Kuala Lumpur there is a Chinese maternity hospital with a Chinese woman doctor on the staff. The infant death-rate among Malays is much higher than that of other races, who are more willing to make use of the hospitals.
In the rural areas labour commonly takes place under the most primitive conditions with no help except that of an untrained handy-woman (bidan). A better midwifery service for these areas is gradually being developed and Malay women are being trained to replace the old "bidan" in the villages.
Education is doing something to inculcate modern views on the bringing up of children. The teaching of personal hygiene to teachers and pupils in the vernacular girls' schools is proving of value, and the Girl Guide movement has given an added interest to this.
Medical inspection of school children is more complete in the towns than in the rural areas. Dental caries, skin conditions, intestinal worms, and enlarged tonsils are common in the junior schools.
Tables are given of vital statistics and records of school medical inspection from the reports of the health officers of the Straits Settlements, Singapore, and Kedah. W. H. Peacock.
Brief clinical and parasitological details of a case which recovered from a malarial infection of unusual severity are described. It is noted that little information seems to be available regarding the highest degree of infestation with the parasites of human malaria which is consistent with life.
An analysis is made of parasite counts made on the first day of treatment in a series of 750 cases of acute subtertian malaria. The analysis affords data of the parasitological intensity of the subtertian infections prevalent in the Kuala Lumpur district of the Malay States during 2 years of normal malarial incidence and severity, and suggests:- 1. (a) That parasite counts made on the first day of treatment are of considerable prognostic reliability. 2. (b) That the counts made during the course of treatment are a useful guide to progress but are open to occasional fallacy. 3. (c) That the extreme limit of tolerance of Asiatic adults for the local strains of P. falciparum is probably in the region of three quarters of a million parasites per c.mm. of peripheral blood.
1. 1. The results of various studies by other workers on the spleen and parasite rates in Indians, Malays and Bantu are summarized. 2. 2. The results of our own observations on Khonds in India, and on Masai and Bantu in East Africa are also summarized and compared with the foregoing and with one another. 3. 3. It is pointed out that wide differences may be found in the malarial status of communities in the same country and, in the case of the Bantu, of the same race; while close similarities occur in different countries. 4. 4. The results of experimental infections in birds and monkeys are cited and interpreted in terms of the two states of allergy and immunity. The probable significance of these is illustrated by reference to the role of the two states in tuberculosis. 5. 5. It is suggested that the observed contrasts in the spleen and parasite rates in diverse communities may also be explained in terms of immunity and hypersensitivity. 6. 6. It is concluded that the immune status is dependent not on race but on the frequency of infection; and that the most accurate index of endemicity is the frequency of infections in the non-immune, that is the rate in early infancy. 7. 7. While a consideration of the Spleen Rate and Endemic Index may be of value in forming an estimate of endemicity and immunity when similar communities are being compared, these indices may be misleading when the epidemiological surroundings are dissimilar. 8. 8. A consideration of the variation with age in the spleen and parasite rates throws more light on endemicity and immunity and on such variation a rough classification may be made into immune and sub-immune communities. 9. 9. But it is suggested that by far the most sensitive index at present available for field studies is the average parasite count, and its variation with age. c 1937.