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  1. Milne JJC
    Med J Malaya, 1947;1:140-56.
    The history of malaria and its control in Kuala Lumpur between 1890 and 1941 is summarised. The disease increased in the early years, largely owing to clearing of valleys without adequate draining, but nevertheless the incidence has been low in relation to the population of the town. Outbreaks are stated to have occurred in 1930 and 1937-38. Lists are given of the Anophelines found in Kuala Lumpur, showing their usual breeding places in that locality and their importance as vectors of malaria as recorded in the literature. The commonest vector is Anopheles maculatus, Theo., though the outbreak in 1930 was associated with A. hyrcanus var. nigerrimus, Giles, and A. h. sinensis Wied. [R.A.E., B 20 276; 21 192]. The methods used to control Anophelines are discussed.
  2. Danaraj TJ
    Med J Malaya, 1947;4:278-288.
    Eight caaes of this condition are described, the patients being four Ceylonese, three Indians, and one Chinese, all males except one. Symptoms consisted of breathlessness and cough, sputum being sometimes purulent and occasionally blood-stained. Six of the patients complained of loss of weight, and in one, a Ceylonese schoolboy, this was the only presenting symptom. The authors found the most troublesome complaint to be a paroxysmal cough which was always worst at night. On clinical examination rhonchi were heard scattered throughout both lung fields in five cases, the lungs being clear in the other three. X-ray examination showed characteristic mottling of both lungs in four cases and of one lung in one case; another showed increased vascular markings, while in two the lungs were clear. Sputum was examined for tubercle bacilli and mites but none were found. The technique used for searching for mites is not described. A marked eosinophilia was found in all cases, the highest count recorded being 33, 264 eosinophils per cmm.Treatment consisted of arsenic, given in the form of neoarsphenamine, six injections of 0.3 gm. in six cases, and stovarsol 4 grains t.d.s. for seven and ten days respectively in the other two. Four of the patients were cured, three were improved, while one was showing a favourable response although treatment had not been completed.The author emphasizes the importance of performing repeated blood counts in order to avoid missing this condition. Out of the eight cases which he describes, one had been wrongly diagnosed as pulmonary tuberculosis and three as bronchial asthma. One of the latter had an initial eosinophil count of 4, 092 which rose to 17, 700 three weeks later. H. T. H. Wilson
  3. Strahan JH
    Med J Malaya, 1947;2:83-92.
    The author carried out a rapid survey of coastal and inland malaria in Sarawak in December 1946. Before recording the results of that survey, he summarizes previous reports concerning malaria in that country. [For information concerning malaria in Borneo, see this Bulletin, 1946, v. 43, 516 & 1, 000.] From May till November 1946, simultaneous epidemics of malaria occurred along the coast of Sarawak at the mouth of the Kuching River, Bintulu, Miri, Lutong, and at Kuala Bêlait and Seria in Brunei. These were aggravated by migrations of population. The epidemics were severe in type; the Kuching area had to be evacuated. In Miri and Lutong, malaria was epidemic to some degree in 1945 but the incidence fell to a low level in December and remained low until April 1946. Thereafter there was a very rapid rise until October, when the disease was reported as being out of control; the entire population was sick. The epidemic here was almost entirely due to P. falciparum. In the Kuala Bêlait and Seria epidemics, P. vivax was most in evidence. The Malay communities suffered much more than the Chinese; the latter are said to have become ' mepacrine conscious ' to the extent that they are willing to purchase the drug. Malays made no attempt at self protection. Spleen and parasite rates of Malay school children were found by the author to be more than twice as high as the Chinese school rates. Low rainfall in July, August and September allowed brackish water to infiltrate far up the Miri and Lutong Rivers and their tributaries; intense A. sundaicus breeding resulted. Moreover in 1946 spring tides flooded an area ravaged by war, with defective drainage, broken tidal gates, ponds and swamps. It is suggested that while A. leucosphyrus and A. umbrosus may transmit malaria along the coast, A. sundaicus is responsible for epidemic manifestations and this by reason of intense breeding rather than of its high infectivity. Further investigation is necessary to determine the importance of A. leucosphyrus and A. umbrosus as vectors. Norman White.
  4. Worth HI
    Med J Malaya, 1947;1:252-272.
    European standards on height, weight, centres of ossification and date of onset of puberty are not applicable to Asiatic girls in Malaya. " Asiatics " could not be grouped together, racial groups showed differences, especially the three main groups-Chinese, Indians and Malays. Nine tables are furnished showing the average and maximum and minimum heights and weights of the four main groups examined, as well as of some of the minor groups, arranged according to ages from 5 years to 19 years. The conclusion is drawn that the European standard of height and weight is higher than that of any of the Asiatic races in Malaya; a greater difference is noted in the weight than in the height and there is a much greater range in the weight of Asiatics but a smaller range in the height. Onset of menstruation tended to be earlier in the local Asiatic groups than in Europeans. The date of eruption of permanent teeth appeared to be earlier among Asiatic races. No deciduous teeth were found at the age of 12-13 years, the lower second molar was seen in all those examined at that age and the whole lower set was present, excluding the third molar. Earlier efuption of the canine teeth was also noticeable. Details should be consulted in the original by all those interested in medico legal work in tropical countries. P. A. Clearkin.
  5. Crawford R
    Med J Malaya, 1947;2:10-19.
    The data here published were collected [presumably in Malaya] in 1941. The average diet of South Indian labourers was found to be ill-balanced and deficient in protein, especially animal protein, vitamins, especially fatsoluble, Ca and P. Many conditions generally accepted as being due to dietary deficiency were prevalent, particularly among children and pregnant women. Suggestions for improving the diet include the increased use of millet, maize, legumes, leafy vegetables, fruit and red palm oil. The value of milk is stressed, and it is suggested that the estate should supply this. Dietetic education of the labourers is considered essential.-A. Synge.
  6. Milne JJC
    Med J Malaya, 1948;2:161-73.
    This is an interesting piece of Colonial history, compiled, one presumes, from official reports. It cannot satisfactorily be summarized. The author deals with his subject under various heads: hospitals, health legislation, dangerous infectious diseases, prevailing diseases, beriberi, fever and malaria, dysentery, and diarrhoea, influenza and enteric fever. In a table are given the numbers of cases of smallpox, cholera, plague, beriberi, dysentery, diarfhoea and fevers reported each year from 1890 to 1939. The only one of these to show steady reduction is beriberi, which began to decline from figures over 2,000 per annum before the 1914-18 war to 69-444 per annum from 1930 to 1939. Plague was never common and neither cholera nor smallpox was responsible for large numbers of cases. The author does not give any systematic accounts of the outstanding investigations made during the period, but rather quotes opinions expressed by Government servants, medical or lay, in their reports. Charles Wilcocks.
  7. Puleston-Jones W
    Med J Malaya, 1948;2:255-260.
    The main contention of the author is that although the tuberculosis problem is serious enough in Malaya, it is not so disastrous as some reports have indicated. He quotes death rates which compare favpurably with many European rates, though not with all. For instance, the death rate from tuberculosis in London between 1938 and 1946 varied around 80 per 100, 000; the rate for Kuala Lumpur in 1938 was 78, and this rose to 128 and 140 in 1946 and 1947 respectively. Compared with the war-time increases, in Warsaw, Rome, Prague and Paris, these rates are not high. In the State of Selangor the rate for 1937 was 71, rising to 86 in 1947. [It would have been interesting if the author had given an indication of how complete medical certification of death is in Kuala Lumpur and the other parts of Selangor. In the towns, no doubt, most deaths are correctly certified, but a reader is. not certain that in more remote places deaths, actually due to tuberculosis, may not have been ascribed by the head-men to other causes.] Charles Wilcocks.
  8. Lamprell BA
    Med J Malaya, 1948;3:34-40.
    The author during a long tropical service has seen a distressing number of cases of tropical neurasthenia including a number that ended in suicide. The condition is common in Malaya of which he is writing. In a group of rubber plantations with an average staff of 75 (presumably Europeans) in the past two years, one has committed suicide, eight have been repatriated for nervous breakdown, and two have been sent on home leave for the same reason. In a series of 33 invalidings analysed by SQUIRES [no reference given] 45 per cent. [15] were for psychological reasons. Neurasthenia in the tropics differs from that seen in practice in temperate countries by the predominance of cerebral over spinal symptoms. The mild cases show increased irritability with occasional outbursts of uncon rolled rages, restlessness, and moderate amnesia. In the intermediate cases these symptoms are worse and periods of worry and depression occur, often amounting to delusions of persecution with insomnia. In the severe cases, the depression is predominant; to this is added procrastination and indecision, loss of confidence, fear of insanity and of loss of employment, which constitute a vicious cycle that may end in suicide. The author classes the causes as personal and environmental, the former being the more important; the prominence of the personal factor is due to the tendency for social misfits and others who are dissatisfied with home conditions to seek employment in the tropics where they hope to find life easier. The environmental factors are (i) Exile from one's own country and loss of firm roots in a place that one calls home, (ii) The excessive stimuli of the tropics; under this heading the author includes the direct effects of the climate and discusses the sexual factor, (iii) Overwork and excessive responsibility, (iv) Isolation and monotony; under this last heading [the sequence of thought is obscure to the reviewer] he includes a suggestion that the recent increased rate of breakdown in Malaya may be due to years of war strain and present economic and political difficulties. The preventive measures he advocates include more careful selection of candidates for service in the tropics and the suggestion that a psychiatric assessment as well as a physical examination should be made; more frequent home leave; annual local leave to a hill station; shorter office hours; more security of tenure of appointments in commercial undertakings; and freedom to marry early in his service. Finally, the author suggests that, since this problem is an admittedly serious one, the Malayan branch of the British Medical Association should make a study of its aetiology and prevention, and convey their conclusions to the Government and to commercial and industrial associations. L. E. Napier.
  9. Burgess RC
    Med J Malaya, 1948;2:239-246.
    Malnutrition is one of the most important causes of ill-health in Malaya. The incidence of deficiency diseases was extremely high during the Japanese occupation, but there has been satisfactory improvement since 1945, though in some respects, particularly in the case of beriberi, this improvement can only be regarded as due to artificial and transitory circumstances, mainly the importation of Australian wheat. Surveys have recently been undertaken of nutritional status in rural areas in Malaya, embracing clinical, dietary, sociological and economic aspects of the problem. Data derived from clinical examinations, height and weight data and vital statistics indicate deficiency in almost all nutrients, and these are confirmed by dietary survey. Poverty is the main cause of the poor dietary intake. Investigations have shown that protein and calorie intakes are directly related to the money available in the family for expenditure on food. Vitamin A and riboflavin intakes are, on the other hand, largely uninfluenced by economic factors and their deficiency in the diet is mainly a matter of ignorance, prejudice and the unavailability of foodstuffs rich in these nutrients. As the economic side of the survey showed that the money spent on food, in most families, is over 80 per cent. of the total expenditure, the problem is clearly an economic one, and can only be solved by country-wide measures of increased and better food production, education and economic betterment. Dean A. Smith.
  10. Strahan JH
    Med J Malaya, 1948;2:221-238.
    This presidential address delivered at the Annual Meeting of the Malaya Branch of the British Medical Association deals with the history of the impact of western medicine on Malaya. In the early years curative medicine monopolized attention. A Port Quarantine Service was established in 1900 but serious attention to preventive medicine had to wait till 1911 When the Health Service of the then Federated Malay States was founded. Rubber had brought amazing prosperity and disease prevention yielded increased dividends. The address provides much interesting information about Malaya, its peoples and their diseases, and the efforts made by research workers and health departments to control disease prevalence during the last 28 years: this does not lend itself to summary. For the future, outstanding tasks include the application of recently acquired knowledge and techniques to the control of malaria; an allout attack on tuberculosis; much more attention to nutrition and deficiency diseases, and an orientation of the work of the Health Services towards social medicine. Norman White.
  11. Harrison JL
    Med J Malaya, 1949;4:96-105.
    Although this paper makes a special appeal to workers in Malaya it will be found interesting and instructive by the many medical men elsewhere who have been perplexed by the confusing nomenclature of rats and related animals. The author describes the following, which are the six common house and field animals of Malaya popularly called "rats ". A. Rodentia: Muridae. (1) Rattus rattus (Sp. R.r. diardi; R. r. argentiventer; R. r. jalorensis. (2) R. norvegicus. (3) R. exulans. (4) Mus musculus. (5) Bandicota bengalensis. B. Insectivora: Soricidae. (6) Suncus caeruleus, the musk shrew which is grossly slandered by being called a rat; it is an insectivore and the author states that there is no evidence of its being concerned in the transmission of any disease. A clear description is given of the habits, external appearance, skull characters, and association, if any, with disease, of each of the above animals. The animals chiefly concerned in the transmission of disease in Malaya are stated as being R. r. diardi (murine typhus), and R. r. argentiventer, (scrub typhus and probably leptospirosis). Plague is not occurring at present in Malaya. Medical men in Malaya are fortunate in being provided in this and other papers with simple practical guides to the local fauna which are important from the public health point of view. [See also this Bulletin, 1949, v. 46, 245, 247.] John W. D. Megaw.
  12. Reid JA, Abu Hassan O
    Med J Malaya, 1950;5.
    Field experiments have been made with DDT in oil as a larvicide on flowing water against Anopheles maculatus. 1. In unweeded drains and streams, 2 oz. DDT per acre applied evenly with a pipette as a 5% solution in Malariol, gave control 1 day later of over 900%. 2. The same dose in an oil (Malariol H S) with a very high spreading pressure (33 dynes/cm) when applied at intervals of 30 yards gave only 50% control. When applied evenly control was 98%. When applied at intervals of 22 yards (one chain) in a grassy roadside drain, control was 61% before the drain was weeded and 73% afterwards. The DDT in oil when applied at intervals was prevented from reaching all the larva e by strong surface films, obstructions and side pockets, and it is clear that to control A. maculatus application must be continuous and not at spaced intervals. 3. Continuous application by spraying with a Mish pump was compared with even distribution of the same dose with a pipette. Control by pipette was only 72% on this occasion, due probably to a heavy growth of weeds, but control by spraying was considerably less, only 56%, apparently because much of the fine spray was blown away before reaching the water. The sprayer was very tiring to use. 4. DDT in Malariol with a spreading pressure of about 20 dynes/cm was compared with DDT in Malariol H S (S P about 33 dynes/cm). Both solutions were applied at intervals of 30 yards at the rate of about 2 oz. of DDT per acre. Control 1 day later was 84% with DDT in Malariol H S and 78% with DDT in Malariol. It is concluded that under the adverse conditions of these experiments (drains not weeded or maintain ed, DDT applied at intervals), better control is obtained by using oil with a very high spreading pressure. 5. Doses of about 4 ounces and 2 ounces of DDT per acre were compared. Application was by even distribution with dropping bottles. The heavier dose gave somewhat better immediate control, and had a better lasting effect, delaying the reappearance of large larvae (4th instar), usually until later than the sixth day after treatment. 6. DDT in Malariol applied evenly with dropping bottle at about 4 oz. DDT per acre was compared with ordinary oiling with a knapsack sprayer at about 23 gallons per acre. The experiment was made in weeded and well maintained drains in the Kuala Lumpur oiling area. Both treatments gave complete immediate control, no larvae being found two days afterwards, but breeding recovered a little more rapidly after the DDT treatment, though there were no large larvae on the sixth day. 7. Numerous readings were made of the strength of natural surface films on the water of breeding places. The results show a fair measure of agreement with those obtained in West Africa by Toms. The commonest film strength was found to be 7.5 – 13.0 dynes/cm., but the proportion stronger than this varied from place to place. The readings from the breeding places of A maculatus suggest that for an ordinary anti malarial oil a spreading pressure close to 25 dynes/cm will usually be sufficient. 8. It is concluded that DDT in oil at about 4 oz. of DDT per acre (=½gal of a 5% solution) can give satisfactory control of A maculatus, especially in properly maintained drains. However, the solution must be applied evenly, and with such small quantities there seems as yet to be no method of doing so which would be suitable for general use. Possible ways of overcoming this difficulty are discussed.
  13. Wallace RB
    Med J Malaya, 1950;4:190-204.
    This work, carried out on a rubber estate in Malaya during 1949, was a Continuation of the trials begun in 1948 previously recorded [this Bulletin, 1949, v 46, 1116]. Full details concerning the terrain and the nature of the experiment were given in the previous publication. In 1949 the malaria rate in the area approached the rates which were customary in pre-war years, for the first time since the reoccupation of the country. The Indian population which was chosen for the experiment contains the survivors of the Japanese occupation; many had been in Siam and almost all had suffered from malaria. Treatment had been entirely lacking or very inadequate, with the result that the survivors had developed a high degree of immunity by the end of the war. These facts probably explain the low incidence of malaria in post-war years in spite of high prevalence of A. maculatus. No anti-larval measures have been carried out since 1941. Neo-premaline completely suppressed malaria in one group, the control group showing a high incidence. In other groups chloroquine, or chloroquine and pentaquine combined, given once a week, promptly brought to an end primary waves of malaria which were rising rapidly.
  14. Wallace RB
    Med J Malaya, 1950;5:115-139.
    1. Several experiments were carried out in the field and in the laboratory with various insecticides against A maculatus. 2. Almost all the mosquitoes that came into contact with surfaces sprayed with DDT preparations died in less than 30 hours but the length of life varied with the preparation and depended on various factors that are mentioned. Control mosquitoes lived almost twice as long. 3. Gammexane Dispersible Powder (P 520) killed in a much shorter time than the DDT preparations and holds out a greater hope of success in controlling ‘A maculatus’ malaria with insecticides. 4. It is difficult to assess the value of insecticides in any one year in areas where breeding of the vector is intense. The results of long term field experiments, under strict control, are awaited. 5. Meanwhile, Mass Suppression with drugs still remains the method of choice – in this area.
  15. Wharton RH
    Med J Malaya, 1950;5.
    The prospects in Malaya in the immediate future may be briefly summarized as follows : For residual sprays, DDT and gamma BHC, unless some outstanding new compound appears, will continue to be the most widely used. Both kill the principal malaria carrier. Anopheles maculatus and gamma BHC for a short period after application also kills the common nuisance mosquito, Culex fatigans. Though DDT does not kill C fatigans it prevents them from resting in rooms and reduces the number of biting. Both insecticides should eliminate bed bugs Cimex hemipterus during the course of spraying and reduce cockroach infestation. For the elimination of cockroaches and ants from houses gamma BHC is superior to DDT but the effect is short lived. The other residual insecticides, Chlordane, Toxaphene, Methoxychlor and the newer products Aldrin and Dieldrin are not likely to be used extensively in Malaya. They cannot yet be purchased locally and on present indications have no outstanding advantages to recommend them instead of DDT or BHC. Personal protection against scrub typhus infection is now satisfactory. Either DBP or benzyl benzoate rubbed into clothing should prevent the attachment of mites for several days, and DMP is also effective if applied daily to the skin or clothing. The mite population in an infective area can probably be reduced effectively by spraying BHC on the vegetation, but this method of control is not likely to be attempted in many areas. DMP is a good mosquito repellent and forms the main ingredient of several commercial preparations; it is not as effective when incorpora ted in a cream as it is when pure. Of the several simple, efficient remedies now available for head louse and scabies control, gamma BHC in coconut oil is probably the most useful because of its cheapness, ease of application, and effect on both parasites.
  16. Wharton RH
    Med J Malaya, 1950;4:260-271.
    This paper records some interesting findings of anophelines resting by day in vegetation In' Malaya. Anophëles maculatus was the commonest species and the majority of specimens were found to have had a recent blood meal, In general few Malayan anophelines are endophilic, so the author instituted systematic searches of vegetation in the vicinity of labourers' lines and cattle sheds on a rubber estate, where breeding sites of A. maculatus in the form of small streams and ravines abounded. Searching was carried out by trained assistants using hand catching with cyanide tubes, and catches on different occasions yielded results varying from 1 to 13 anophelines per man-hour. It was found that the densely shaded banks of streams had a relatively small population of anophelines. Rather they favoured the more open type of vegetation under trees, represented mostly by the common Malayan bracken fern. A. maculatus was by far the commonest anopheline found under these conditions, usually within a few inches of the ground where the bracken was 1-2 feet high and sheltered but reasonably free of access. Of the other 8 species of anophelines found, A. hyrcanus and A. barbirostris were usually found at a greater height from the ground, A. aconitus in more secluded spots and A. philippinensis in vegetation where ferns were replaced by sedges and small bushes. Analysis of the specimens captured showed that there were more than six times as many females as males of A. maculatus. Of these females approximately two-thirds contained fresh blood while the remainder were gravid or unfed indicating that adults in all stages of development make use of the same daytime harbourages. Dissections showed that maturation of the ovaries was complete 48 hours after a single blood meal and this same period appeared to hold good for several other of the species concerned. A. vagus, however, probably completes the whole cycle in 24 hours. Precipitin tests showed that 20 per cent. of A. maculatus had fed on man and nearly all of the remaining 80 per cent. on cattle. Of the other species only 7 per cent. of A. hyrcanus and a single specimen of A. karwari had fed at all on man.
  17. Wyile HW
    Med J Malaya, 1950;5.
    A general survey has been made of tuberculosis in the Jesselton – Tauran area. Climatical, living, and occupational conditions tend to favour the spread and advancement of the disease. The death rate is high, but has been influenced by conditions attributable to the war. The native population, due to their mode of life, succumbs more easily to the disease that do the Chinese. Cases are usually seen in the late stages, mainly due to ignorance.
  18. Cameron JAP
    Med J Malaya, 1950;5.
    1. The importance of the mental and physical reactions of the amputee. 2. Ideal sites and the technique of amputations are discussed briefly. 3. Rehabilitation and training of the amputee is important if the best results are to be obtained. 4. Some of the special reasons for amputation are considered. 5. The component parts of an artificial limb and their alignment are outlined. 6. Special features in fitting limbs for women and children. 7. Some complications resulting from the wearing of an artificial limb are described. 8. Limb fitting in Malaya has its own peculiar difficulties which time and experience will rectify.
  19. Iyer KG
    Med J Malaya, 1950;5.
    The viability of three recently isolated local strains of Bact. typhosus has been studied on 20 specimens of local hawker’s syrup used for sweetening ice balls and ice water. Precise survival times cannot be stated and only relatively wide limits can be estimated differing possibly in every individual case. Survival is influenced by the following factors : 1. The character of the containing material 2. The presence of other bacteria 3. Temperature 4. The presence of bactericidal agents or substances Significant diminution of the number of bacteria in 2 to 5 days after inoculation to sugar solutions is an important observation although survival up to two weeks has been noticed in repeated experiments. The results of experiments conducted in market syrup samples and on control experiments with laboratory sugar solutions indicate that the survival of the organisms tends to be more prolonged in dilute solutions than in concentrated
  20. Lugg JWH
    Med J Malaya, 1950;5.
    1. It is shown that in contradistinction to the marked stability of ascorbic acid in acid solution towards nitrate is its sensitiveness towards nitrite. 2. The primary major product of the action of the nitrite is dehydroascorbic acid, which appears to be relatively stable towards the nitrite. 3. The nutritional and other physiological implications of these findings are discussed.
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