1. Using ordinary clinical thermometers resting oral temperatures were taken in 4,463 schoolgirls between the ages of 6 and 20 years. 2. From 2,500 readings in clinically healthy and apyrexial girls charts were made to show temperature variations. 3. It was demonstrated that in the age group 6-10 the mean temperature was 99.5 F. That in the age group 10-14 the mean temperature was 99.3 F and in the age group 14-20 the mean temperature was 99.1 F. 4. For all age groups the majority fell within the limit of 98.9 – 100 F. 5. It is not uncommon to encounter a temperature of over 100º and up to 100.8º of no pathological significance. 6. Temperature readings are not a reliable guide in the clinical assessment of children unless the above considerations are borne in mind.
Two hundred parts of polished rice, washed in running water and rubbed by hand, were mixed with 1 part of Rochemix, rice fortified per lb. with 400 mg. vitamin B 200 mg. riboflavin and 2400 mg. nicotinic acid. The rice was cooked on a perforated tray in a closed cooker by steam; the condensed liquid was poured back over it every 15 min., the total cooking time being 1 hr. Estimation, were made of vitamin B, in the polished rice before and after cooking, in the Rochemix and in the cooked, enriched rice. The percentage of moisture ranged from 12.4 to 13.4 for the Rochemix, from 13.6 to 14.5 for the unwashed, polished rice, from 15.7 to 19.3 for the washed, polished rice and from 66.2 to 73.9 for the cooked, enriched rice. The unwashed, polished rice con tained between 0.6 and 1.05 g. vitamin B, per g. wet weight, of which from 38 to 70 per cent. was lost during washing. The enriched rice after cooking contained from 1.03 to 1.28 g. per g. About 10 per cent. of the vitamin was found in the condensed liquid and 12 per cent. was destroyed by heat. In a further series of tests, the enriched rice was cooked for 32 min. in a steamer on a non .perforated tray; it was stirred once after 12 min. The vitamin was found to be unevenly distributed through the rice but the total loss of vitamin due to heat was about 5 per cent.-V. R. Jackson.
A report is given of 60 cases of bronchopneumonia in infants treated with Aureomycin during a period of 4 months, Aureomycin was given orally in a mixture. Dosage depended on the severity of the infection, the age and weight of the patient. The results of this series are compared with a series of penicillin treated cases and showed a distinct improvement. The cure rate of Aureomycin treated cases is about 70%.
In the staining of leucocytes successful use has be en made in this Department of the method described by Field (1941) in the demonstration of malarial parasites in thick films. The methylene blue solution is made up according to the formula of Hitch (quoted by Field). In the staining of these films the procedure of Field is modified so that the red cells are left intact and stained. The method as carried out is as follows. The two solutions of stain are mixed as required in the proportion of 6 drops of the methylene blue solution to 2 drops of the eosin solution and with the addition of 10 drops of buffered water at about pH 6.4. The mixture is then thoroughly shaken. The blood film is fixed with pure, acetone free, methyl alcohol for 10 seconds. The alcohol is then run off and the stain mixture applied to the slide with a pipette. Staining is continued for 10 minutes after which time the film is washed by waving about in a beaker of the buffered water at pH 6.4 for a few seconds. This method stains the leukocytes very clearly and is not subject to the several difficulties in using alcoholic solutions especially in the tropics.
Motor nerves to voluntary muscle terminate in motor end plates applied to the muscle fibers. Between these two is a membrane with different electric potentials on each side of it. When a motor impulse arrives at the end plate, acetylcholine is released. As a result of this the electric potential difference across the membrane disappears (“depolarization”) and an electrical wave spreads from it throughout the muscle, causing it to contract. Curare blocks the action of the acetylcholine on the end plate, competing with it for a place on the end plate molecules, and so is called a “competitive blocker”. Gallamine (Flaxedil) acts in the same way. Scoline, on the other hand, causes depolarization of the end plate membrane (hence the description “depolarizing” group of relaxants) and this does not produce, as one might expect, a sustained tetanic contraction of the muscle, but renders it unexcitable so that nerve impulses produce no effect. Thus, we have our two groups of relaxants – the competitive blockers like curare, and the depolarizers like scoline (suxamethonium).
A brief review of the literature of carcinoid tumour is given and a case of primary carcinoid tumour of the mesentery is reported – there being only three other cases of a carcinoid, in a similar situation, recorded in the literature.
1. Observations on filariasis made during medical travels in the Malay Peninsula are described. 2. The tentative diagnosis of endemic filariasis was made when cases typical of filarial elephantiasis were found in members of the indigenous population who have never resided in a previously known filariasis area, and was confirmed by finding microfilariae of Wuchereria malayi in bloods from that population. 3. Endemic filariasis has previously been reported associated with jungle swamp along the lower reaches of some of the larger rivers, and in certain coastal ricefield areas. It is reported in this paper in undeveloped inland areas of Perak, Pahang and Selangor, far distant from the previously described foci. This data has been summarized in maps and an Appendix. 4. In most inland areas where a search has been made, it has been possible to find evidence of endemic filariasis and sometimes the parasite rate has been over 50%. 5. The geographical distribution of the disease has not yet been defined, but is certainly more extensive than that described in this paper. 6. Infection probably takes place at an altitude of 1,500 feet in mountain valleys in Malaya.
1. Observations have been quoted which mention the existence of goiter in remote inland areas of Malaya. 2. 39.5% of 618 Malays and 40.8% of 710 aborigines from inland areas were found on examination to have visible thyroid glands. A high incidence of thyroid enlargement was found in almost all areas where these observations were made, on a wide range of Geological Formations. 3. In the seaside populations studied, the low incidence of ‘visible’ thyroid glands (2/184) is typical of that of other ‘goiter free’ areas. 4. Iodine estimations have been carried out on seven water samples from rivers draining inland areas where thyroid data have been collected, and gave values of 0.2 to 0.6 parts of iodine per thousand million. The development of goiter is to be expected when the iodine content is so low. 5. High calcium content of waters cannot be important in causing goiter in Malaya. 6. The availability of dried seafoods is thought to be an important factor in goiter prevention in Malaya. Four dried marine foods contained 360 to 1,340 parts of iodine per thousand million.
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.
In a Malay school, 150 school boys, all clinically positive for scabies, were divided into three approximately equal groups. The first group was treated with 0.5 per cent γ BHC [' Gammexane'] in coconut oil, the second with 20 per cent emulsion of benzyl benzoate and the third, as a control, with coconut oil. Each group received two treatments with a week's interval between. One week after the second treatment the patients were re-examined for clinical evidence of scabies. The percentage of cases recorded as cured after the two treatments was 48 for γ BHC, 39 for benzyl benzoate and 9 for coconut oil. [This paper is a good example of the danger of estimating the chemotherapeutic value of sarcopticidal drugs on purely clinical evidence.]
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.
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
Report on 174 cases of tetanus neonatorum collected between 1946 and 1950 in the General Hospital, Singapore. There is a marked reduction in the incidence, which is attributed to a better maternity service. The results of treatment are bad – with a mortality of 90% of cases.
In Malaya the author estimates that there are probably 500,000 to 600,000 tuberculous persons, representing about 10 per cent of the population, there are about 2,000 hospital beds for tuberculosis, of which 500 are in Singapore for a population of just over 1,000,000. The author states that in Malaya, for every 240 tuberculous patients, only one can have accommodation in hospital He discusses the subject and urges that mass radiography should be undertaken, and that cheaply built homes should be constructed to house infective patients under supervision He gives details of the structures he has in mind Education in health matters should be pressed, and BCG should be used.
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.
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.
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.
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.