As part of a research programme concerned with the need to lighten the load carried by soldiers engaged in long foot patrols, a field experiment was undertaken in West Malaysia. For 12 d a group of 15 men consumed 7.4 MJ/d (1770 kcal/d) whilst a control group of 14 men ate 12.9 MJ/d (3080 kcal/d); both groups expended on average about 15.8 MJ/d (3770 kcal/d). The low-energy group incurred an energy deficit of 98 MJ (23 410 kcal) with a weight loss of 3.9 kg, whereas corresponding figures for the control group were 37 MJ (8840 kcal) and 2.4 kg. Before, during and after the energy deprivation phase, assessment was made of work capacity (estimated VO2 max), vigilance and military skills but no difference was found between the groups.
Titres of melioidosis haemagglutinating antibodies of 1/40 or more were found in 18 of 905 British, Australian, and New Zealand soldiers serving in West Malaysia. Previous mild unsuspected melioidosis seemed to be responsible for these positive titres, which were more common in men exposed to surface water at work and during recreation. This accords with the current view that soil and surface water is the normal habitat of Pseudomonas pseudomallei, the causal organism. Pyrexia of unknown origin after arriving in Malaysia was significantly more common in men with titres of 1/40 or more than in the remainder. It is suggested that mild melioidosis may present as pyrexia of unknown origin. Pyrexias of unknown origin should be investigated vigorously in patients who are in or who have visited endemic areas.
A random sample of 102 hypertensives out of a total of 347 in the Malaysian Armed Forces were studied with regard to patient education, knowledge of hypertension and therapy compliance. It was found that for 53 percent, patient education was unsatisfactory and as a result 67 percent had inadequate knowledge of hypertension. Adherance to therapy - drug intake, weight reduction and cessation of smoking - was poor (more than 59 percent, 96 percent and 70 percent failure respectively). There was no significant difference between asymptomatically and symptomatically detected hypertensives.
279 cases of pulmonary tuberculosis were diagnosed during a 10 year period from 1969 to 1978. 60% as a result of self-referral and 40% from mass miniature radiography of the chest. For every case of pulmonary tuberculosis picked up, the number of MMRs required has been steadily rising from 1 in 1900 to 1 in 6700. Using South Korea study figures, it costs US$42600 for a case of pulmonary tuberculosis detected by MMR. Besides being not cost effective, there is little advantage in early detection with regard to prognosis, in preventing subsequent cases and in picking up other lung or cardiac abnormalities. Unnecessary radiation results from frequent MMR whose dosage is 10 or more times greater than standard chest X-rays. MMR should be limited to. contact tracing, prior to overseas courses and on termination of service.
Study site: medical boards submitted to Medical Directorate, Ministry of Defence, Malaysia
The 1980 malaria notifications in Malaysian soldiers are analysed. The number of new cases notified was 964, giving an annual incidence of11.81/1000 soldiers. Sixty-three percent were falciparum and 36 percent were vivax infections. There were 48 relapses and recrudescences. Twenty-three carriers were detected on mass screening. The yield from mass screening was very low - 5.09/1000 screened. The current practice of chemotherapy, though generally acceptable, was unsuitable for a number of patients. Recommended regimens are not being adhered to. There were two cases ofcerebral malaria, one of whom died.
The rapid increase in the use of helicopters for hospital transport during the 1980s is the culmination of several hundred years of military medical innovation. Mass battefield casualties spurred both technologic and medical changes necessary for today's sophisticated helicopter systems in use worldwide, particularly in the United States. The Napoleonic Era and the American Civil War provided the framework for the evolution of today's state-of-the-art emergency medical techniques. The use of airplanes to evacuate the wounded eventually led to using helicopters for rescue missions in World War II. The combat experiences of the United States in Korea, the British in Malaya, and the French in Indochina proved that rotary-wing aircraft were invaluable in reducing battlefield death rates. Any skepticism about the efficacy of helicopter medical evacuation was erased during the Vietnam conflict. As an integral part of the modern battlefield, these specialized aircraft became a necessity. The observations and experience of American servicemen and medical personnel in Vietnam established the foundation for the acceptance of helicopter transport in modern hospital systems.