Manifestations of vitamin deficiencies observed in 6,000 Tamil and 4,000 Malay children and young adults during a survey carried out by the Institute for Medical Research in the Federated Malay States included phrynoderma, Bitot spots
and angular stomatitis. They were more frequent in Tamils than in Malays. Phrynoderma and Bitot spots responded rapidly to administration of vitamin A or carotene, though in some patients with phrynoderma improvement was not attained unless also the protein intake was increased and vitamin B complex added. Angular stomatitis was benefited by administration of riboflavin or vitamin B complex. The clinical and histologie observations of phrynoderma in Tamils and Malays in Malaya were identical with those previously reported in Chinese, Ceylonese and southern Indians. A supplementary food ration, composed of soy beans, skim milk powder, dal and red palm oil, given to Tamil children on rubber estates not only increased the general state of health but led to a rapid regression of the manifestations of vitamin deficiencies.
The author summarizes the information given by 13 governments-Afghanistan, Burma, Ceylon, China, India, Indonesia, Malaya, Netherlands New Guinea, Philippines, Portuguese India, Sarawak, Thailand, and Viet Nam-on their existing and proposed malaria-control programmes in response to a questionnaire prepared by WHO for discussion at the First Asian Malaria Conference, which was held in Bangkok in September 1953.Although in late 1953 nearly 46.5 million of the 271 million people living in malarious regions were protected against the disease, more than 224 million others were still unprotected.It is noted that residual-insecticide spraying-the basis of most campaigns-has significantly reduced spleen- and parasite-rates; that the minor opposition to spraying initially encountered in some places quickly disappeared as the benefits became apparent; that malaria control has resulted in general improvements in public health and has promoted socio-economic development; that anopheline resistance to the insecticides used has not been observed; that ten governments voiced the need for indoctrination of public officials concerning malaria control; and that there is a trend among governments to make financial provision for long-term malaria-control schemes.
(1) The use of the thiochrome method for the estimation of thiamine in human milk is discussed, with special reference to the possible production of an artefact, following the incubation of the milk with pepsin, in addition to the use of takadiastase (clarase). No evidence could be found to suggest that an artefact resembling thiamine was produced by the method of analysis described.
(2) The thiamine content of 91 samples of full lactation human milk from apparently "normal" Malay, Chinese and Indian women in Malaya is recorded. The mean milk thiamine level of 11.3 ug/100 ml. found is considerably lower than the levels recorded for milk samples from apparently "normal " women in the United Kingdom and the U.S.A.; and slightly lower than that recorded in Australia. The results suggest that the dietary
intake of thiamine in Malaya is inadequate to maintain optimum thiamine levels in the milk of lactating women.
(3) No significant difference was found in the mean thiamine content of milk from women of the three principal racial groups in Malaya ; nor was any significant difference found to be associated with the parity or age of the women or, in the case of full lactation milks, with the time after parturition at which the sample was collected. No significant difference was found in samples collected from the same woman at different times of the day or before and after a main meal.
(4) Marked differences were found in the thiamine content of samples of milk from individual women, and the possible reasons for this are discussed.
(5) The examfnation of 48 samples of milk collected during the first month after parturition confirmed previous recorded observations that the thiamine content of such milks, initially low, gradually increases to reach "normal" levels towards the end of the first month of lactation.
Six cases of Ebstein's malformation are reported. The notable clinical features seen in four patients were gross enlargement of the
heart, venous congestion and marked hepatosplenomegaly. There was complete heart block in one patient and auricular fibrillation in the remaining three. The unusual pathologic features in the four cases that came to necropsy were the large pericardial effusions associated with the cardiomegaly, the absence of an atrial septal defect or patent foramen ovale, the gross enlargement of liver with cirrhotic changes and the large spleen. Histologic examination of heart muscle revealed certain unusual features which are described.
The ABO, MN and Rh blood types, and the Hp, Tf, and Gm [Gm (a), Gm (x), Gm(b), and Gm-like] factors were determined for 128 unrelated Indians (parents of families, 63 with two parents tested and two with one parent tested), and 90 unrelated Chinese (parents of 46 families, 44 with two parents tested and two with one parent tested), and for the offspring from these families. The frequencies of the several blood types are presented. They were done primarily to aid in paternity testing. They compare favorably with the findings of previous studies. The allele Hp1 is rare in the Indian population (.09) and relatively infrequent in the Chinese (.29). Unfortunately, the data shed no light on the problem of the inheritance of the phenotype Hp O. Only Tf C was found among the Indians. About four per cent of the Chinese were heterozygous for Tf CD,, all other were Tf CC. The Indians have a high frequency of Gm(a) and of Gm (x), and a low frequency of Gm (b). They appear to have alleles Gma, Gmax, and Gmb in the following frequencies: .535, .234(5), and .230(5), respectively. Three families appear to have a GMxb allele, providing the offspring are not extra-marital. The Chinese appear to have the alleles Gm^ab, Gm^a, and Gm^ax in the following frequencies: .741, .231, and .028, respectively.
There has been little change since 1955 in the laboratory techniques for seeking new antifilarial compounds, although one valuable addition to laboratory study has been the experimental infection of cats with Brugia malayi.The chief drug for the treatment and control of filariasis-whether caused by Wuchereria bancrofti or by B. malayi-continues to be diethylcarbamazine, and the author reviews the reports recently published on its use. In India and China large-scale campaigns involving the use of this drug have been undertaken; and in Tahiti filariasis has been suppressed and almost eliminated. Campaigns on a smaller scale and pilot projects considered in this survey include those conducted in Pacific islands, Malaya, Ceylon, Brazil, Surinam and East and West Africa.It is generally agreed that the administration of diethylcarbamazine produces a great diminution in the microfilarial counts of those taking it, and in many persons both microfilariae and adult worms are eradicated. The difficulties which arise are due to toxic effects which occur in some recipients and which may adversely affect the acceptability of treatment.
A double-blind study with control was done to assess the effect of mono-amine-oxidase inhibitors and anticoagulant therapy in the mortality of acute myocardial infarction, in the first 4 weeks. The results show that no effect whether beneficial or adverse was seen with the use of monoamine inhibitor. On the other hand, there is a distinct decrease in mortality amongst cases not on anticoagulants. It is believed that the rarity of phlebothrombosis in local patients is the cause of the difference between local and foreign results so far as anticoagulant therapy goes. It is postulated too that one of the reasons for the difference may be due to the fact that patients are not on so strict a bed rest as elsewhere. There appears to be a definite increase of incidence in Indians, and also at least a third of myocardial infarction cases had low normal serum cholesterol readings.
The evidence presented by the nine cases described in this paper indicates that primary arteritis of the aorta is a single clinico-pathological entity of which Takayashu's syndrome is a part. Different segments of the aorta may be affected resulting in a variety of symptom complexes. In this series, the mode of presentation was hypertension consequent on renal artery stenosis. Early diagnosis is important and surgical treatment is indicated to relieve the hypertension which carries an immediately serious prognosis.