Brief clinical and parasitological details of a case which recovered from a malarial infection of unusual severity are described. It is noted that little information seems to be available regarding the highest degree of infestation with the parasites of human malaria which is consistent with life.
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.
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.
This report is a brief statement of the status of leprosy activities in Malaya, which includes both the Straits Settlements and the Federated Malay States. Data relating to numbers of cases and treatment refer to the year 1932 especially.