1. Seventy-seven cases of tropical ulcer were studied in the General Hospital, Johore.
2. Age was found to be an important factor in the incidence and duration of the disease.
3. One or more debilitating factors could always be established. After removal of these factors, the ulcer in many cases tended to heal.
4. The course of the ulcer is divided into three stages. Stage I is the spreading stage. In Stage II, a mild sloughing occurs within the original boundaries of the ulcer. This is a chronic stage. In stage III, there is either a stationary or a healing ulcer.
5. Treatment for the first stage is mainly directed towards the general condition of the patient. In the second stage the associated debilitating factors are treated. In cases which do not respond to these measures we tried many forms of treatment. Of these, the most rational seems to be application of strong antiseptics to the sloughs themselves. We have used quinine, as recommended by Innes for this purpose, and we have obtained very satisfactory results in a small series of obstinate cases. Stage III is treated by the application of elastic adhesive bandage.
This study presents clinical observations in pregnancy made on aborigines of the deep jungle and "outside" populations. Migration out of the jungle results in lowered nutritional status as a result of low socio-economic status in the "outside" aborigine. This, together with food habits, increased family size and higher incidence of helminthic infestations, results in lower mean values of Hb, PVC and MCHC and a higher prevalence of anaemia in pregnancy in the migrant aborigine. A higher population density in the "outside" population resulting in frequent intermingling and increased chances of cross-contamination probably explains the increased vaginal bacterial growth in the "outside" Aborigine women. A higher prevalence of vaginal candidiasis in the "outside" aborigine woman is probably related to exposure to oral contraceptives and broad-spectrum antibiotics. On the other hand, better medical and obstetrical services become more readily available to the "outside" aborigine and this results in a favourable influence on perinatal health.
Development of a human community are not without changes in its environment. Such changes result in either beneficial or adverse effects on human health. In Malaysia, in the wake of the New Economic Policy aimed at the redressing of the poor population and income distribution, development of the nation has brought about various changes in the environment. Some of these changes have elevated basic public health problems, while others, particularly new agricultural practices and industrialisation programmes with urbanisation trends, have brought a new set of problems due to water pollution and sanitation. Various measures are being taken to protect and to improve the environment so that progress can be realised with minimum adverse effects. This also calls for assistance from international sources, in terms of expertise, training and funds.