MED J MALAYSIA VOL 35 NO 1 MARCH by fjzhangxiaoquan


									MED J MALAYSIA VOL 35 NO 1 MARCH 1980

S W Lim

The Association of South East Asian Nations (ASEAN) came into being when the
governments of Indonesia, Malaysia, Philippines, Singapore and Thailand
agreed on the ASEAN Declaration or as it is more commonly known 'the Bangkok
Declaration' on 08 August 1967. The formation of ASEAN was based on the
premise that cooperation among nations in the spirit of equality and
partnership would bring mutual benefits and stimulate solidarity which can
contribute to building the foundation for peace, stability and prosperity in
the world community at large and in the ASEAN region in particular.

Initial doubts and criticism combined with a host of teething problems to
make for slow progress. Differences in culture, language, religion and
historical past contributed to poor understanding and poor communications to
delay early mutual cooperation projects ranging from economic matters,
scientific and technological joint research projects to youth seminars and
film festivals. Though the painfully slow quest for first ten years had no
'achievements' to speak of, on reflection today, the first decade allowed the
evolution of the ASEAN identity and the development of an 'ASEAN SPIRIT' of
mutual trust, solidarity, understanding and close cooperation.

It would not be unfair to state that ASEAN as a regional organization for
economic, social and cultural cooperation only gained recognition after the
Bali Summit in February 1976 when the ASEAN Heads of Governments undertook to
consolidate, expand and accelerate the ASEAN activities in all fields by
drawing up new directions for the implementation of ASEAN projects. A
permanent ASEAN Secretariat in Jakarta as the central machinery for the
Association was also established after the Bali Summit. Another historic
event for ASEAN was the Kuala Lumpur Summit held on 04 - 05 August 1977 to
celebrate the tenth anniversary. The Kuala Lumpur Summit of ASEAN Heads of
Governments reviewed the work and overall progress of the Association
especially the resolutions adopted at Bali the year before. The continuation
of ASEAN cooperative efforts toward peace, stability and progress in the
region gained impetus and international awareness at this second summit when
the Heads of Governments reaffirmed their commitment to the programme of
development in the forthcoming decade; it further ensured that further
exertions would be pursued to translate the ASEAN aspirations into concrete

Asean Development
From inception, a policy-making body and a number of Permanent, Special and
Ad-Hoc Committees were established as the machinery to carry out ASEAN aims
and activities and to look into all possible aspects of cooperation.
Consequently, ASEAN has issued a great number of recommendations and has
approved many cooperative projects.

The projects of ASEAN concern economic cooperation and development with the
intensification of trade among member countries and between the region and
the   world;  joint   research  and  technological   programmes;  educational
exchanges; cooperation in transportation and communications; the promotion of
tourism and South East Asian Studies; developing beneficial dialogues and
cooperation with other countries and regional and international organizations
and cultural, scientific and administrative exchanges. Many of the approved
projects have already been successfully implemented whilst others are
underway and several agreements on different subjects were signed among
member countries in the past.

In the realm of politics, the major initiative of ASEAN was the proposal to
neutralize South East Asia. The collective scheme developed in 1971 at the
initiative of the late Prime Minister of Malaysia, Tun Abdul Razak, who
appealed for the recognition of South East Asia as a 'zone of Peace, Freedom
and Neutrality'. The result has been the signing of one of the most
significant documents in the development of ASEAN - the Kuala Lumpur
Declaration on 27 November 1971. Another historic attempt of ASEAN to secure
more durable peace and stability in the region was the joint effort in 1973
to find a peaceful solution to the wars in Indochina by formulating the ASEAN
Coordinating Committee for the Reconstruction and Rehabilitation of Indochina
States (ACCRRIS). Successful attempts were also made to normalize relations
with China and other countries in East Asia and the Pacific region. Very
recently, the European Economic Community (EEC) and ASEAN held their second
meeting of ASEAN-EEC Foreign Ministers in Kuala Lumpur at which both the
regional groups condemned the military intervention in Afghanistan and also
urged the speeding up of the implementation of the United Nations' resolution
on Kampuchea.

The practice of cooperation and consultation through ASEAN has succeeded in
an increasing degree of political cohesion among the member countries in
ASEAN. ASEAN can now claim to have grown over the years into a significant
and constructive force in South East Asian politics, able to assume an
appropriate role in finding indigenous solutions to many common problems and
to promote peace, stability and strength to the region. To surmise, ASEAN is
now at the stage where the habit of consultation on all matters of common
interest has become normal practice among its member countries whose
increasing collective efforts and responsibilities have thus enabled ASEAN to
become a cohesive and dynamic regional organization.

1979 & 1976 Summit of Medical Presidents
The medical fraternity in ASEAN has not been idle. The "ASEAN spirit" had
also infected medical practitioners and in early 1976 a summit of the
presidents of national medical associations in ASEAN was convened in Jakarta
after which a Statement of Intent was issued whereby the national medical
associations pledged to study the feasibility of establishing the individual
medical organizations of their countries into a cooperative association. They
envisaged that the proposed cooperative association would serve as a forum
for the exchange of views, information and resources which would in turn lead
to a pooling of talent and resources to formulate programmes and researches
culminating in projects and joint efforts designed and agreed upon to improve
the services in health care delivery to the people of ASEAN.

ASEAN Congress of Anaesthesiologists
Though the World Federation of Societies of Anaesthesiologists (WFSA) holds a
World Congress once in every four years (on a leap year) and the Asian and
Australasian Region of the WFSA also has a regional congress once in every
four years so that biennially there is a Congress for anaesthesiologists to
attend to update their knowledge of recent advances in anaesthetic drugs and
techniques   and   the   anaesthesiologic  care   of   patients,   very   few
anaesthesiologists in ASEAN actually attend such events. Opportunity, the
high cost and time would appear to continue to preclude participation in
these meetings in far-off places. To overcome this lack of opportunity to
meet with each other and to exchange scientific information, concerned
anaesthesiologists in ASEAN met in Kuala Lumpur in 1977 to discuss the
organisation of a regular meeting among ASEAN anaesthesiologists.

Thus, the anaesthesiologists in ASEAN held the First Asean Congress of
Anaesthesiologists in Manila from 02 to 05 December 1979 in which 'Training
and certification of anaesthesiologists in ASEAN' was the main theme. This
symposium allowed participants an insight into the different educational
systems in practice in the different member countries of ASEAN. It also
provoked an interesting discussion on the objectives and results of
postgraduate training in anaesthesiology in ASEAN member countries. Over
fifty papers on different aspects of anaesthesiology and intensive care were
presented and this very successful meeting ended with the establishment of a
Confederation of Asean Societies of Anaesthesiologists which aims to promote
closer ties amongst ASEAN anaesthesiologists and to effect and maintain high
standards in the training of anaesthesiologists and in the practice of
Anaesthesiology and Intensive Care in the ASEAN region.

The very evident desire amongst the medical fraternity to forge closer ties
was manifest at the recent "preparatory meeting" of ASEAN medical
associations hosted by the Indonesian Medical Association in Jakarta from 29
February to 01 March 1980. The chief representatives of all the five national
medical associations in ASEAN agreed to call the Confederation 'MASEAN', drew
up its Constitution and By-laws, discussed ways of making MASEAN viable and
meaningful to medical practitioners and the people of ASEAN and assigned a
project to each member association to undertake in line with the objectives
of the Confederation. A pro-tem committee was also elected to serve the
Confederation until the Inaugural Meeting of MASEAN on 10 April 1980 in
Penang, Malaysia when designated office-bearers will be elected to serve two-
year terms.

The successful permeation of the 'ASEAN SPIRIT' of mutual trust, solidarity,
understanding and close cooperation has led the medical associations in ASEAN
to realize the establishment of MASEAN. It is hoped that MASEAN will not
confine itself to cooperation and exchange of views and facilities at inter-
medical association level. Identification of common problems in medicine (and
their solutions), joint studies on controversial issues such as quality
control of drugs, availability of drugs, traditional medicine, etc, are just
as needed as practical schemes for the continuing education of doctors,
utilization of recognized centres in postgraduate training in the different
medical specialties, elevation of the standards of practice, standardization
of ethics and laws and regulations affecting medical practice and programmes
to assist the Governments in the delivery of health care to the people of
ASEAN. May MASEAN live up to expectations in the years to come.......

Low Attendance of PreSchool Children in Government Clinics in a Rural Community
P Joginder Singh, FRSH, Public Health Insitute, Jalan Bangsar, Kuala Lumpur

It is found that the attendance of preschool children aged one to six years
is generally unsatisfactory in government clinics in Malaysia, compared to
that of infants. Reports on Maternal and Child Health Services in various
States of Malaysia (1979) showed that in 1978 the attendance of children aged
one to four years ranged from 4.5% to 18% in all the States in Peninsular
Malaysia except in Melaka and Perlis where it was 60% and 32% respectively.
Whereas in the same year attendance of infants under the age of one year
ranged from 75% to 100% in all the States. This study shows the reasons why
attendance of preschool children aged one to six years from a rural community
is low in government clinics.

Habits and Attitudes of Malaysian Military Doctors Towards Smoking
V Supramaniam, MSPH, Ministry of Defence, Kuala Lumpur

Tobacco smoking is rapidly growing in third world countries (The Malay Mail,
1979) including Malaysia as evidenced by the increase in the volume of
cigarette sales of 26 million pounds valued at 551 million ringgit in 1977
(Information Malaysia, 1978/79) compared to 16.25 million pounds valued at
249 million ringgit in 1970 (Information Malaysia, 1975/76). The military
population is also presumed to be involved in this disturbing epidemic even
without the free cigarette ration or duty-free cigarettes. This survey was
carried out to determine the prevalence of smoking among military doctors and
their attitudes towards smoking.

A Community Based Study on the Epidemiology of Hypertension in Selangor
N Kandiah, DPH*, R Lekhraj, MPH**, S Paranjothy, MSc***, Ajeet Kaur Gill,
DPH*, *Division of Rural Health Research, Institute for Medical Research,
Kuala Lumpur, **Medical Officer of Health, Klang District and Head of Health
Department, Municipality of Klang, ***Statistics Department, Kuala Lumpur

Cardiovascular diseases are a major health problem not only in the developed
countries but also in developing countries such as Malaysia. The WHO Expert
Committee on Arterial Hypertension found that 8% - 18% of the adult
population in most countries have hypertension (WHO, 1978). "Hypertension is
a silent secret threat to the health of people around the world. As the blood
pressure rises, so does the risk of stroke and coronary heart disease"
(Mahler, 1978). The review on the significance of stroke for the health of
population at a WHO seminar in 1970 showed that many cases of stroke could be
prevented if hypertension was treated with great vigour and attention (WHO,
1970). Elevated blood pressure has been repeatedly shown to be among the
leading "Risk Factor" for the development of coronary heart disease and
cerebrovascular accidents. The higher the arterial pressure, the greater is
the risk of coronary heart disease. Hypertension is a key contributing cause
for at least one third of premature deaths due to heart attacks and even a
higher proportion of premature deaths due to stroke. The Framingham's study
on the role of blood pressure in the development of congestive heart failure
showed that the dominant aetiological precursor was hypertension in 75% of
the cases. There is increasing evidence that control of hypertension will
reduce the incidence of coronary heart disease and cerebrovascular accidents.
These facts show the importance of hypertension as a cause of morbidity and
mortality in any country. Extensive surveys of blood pressure have been
carried out in countries like USA, Japan, Australia, New Zealand and in some
European countries. Volp (1976) did a study on hypertension in the Parit
subdistrict in Malaysia on patients attending health clinics. In most
developing countries including Malaysia very few community based studies have
been done.

In America and some European countries there has been a decline in the
mortality from hypertension but in Malaysia there is a rising incidence of
cardiovascular diseases. The deaths from cardiovascular diseases have
increased from 3% of total deaths in 1965 to approximately 20% in 1976. In
1977 heart diseases ranked second and cardiovascular diseases fourth among
the 10 principal causes of deaths in government hospitals.

Migraine : Epidemiological Aspects of 17 Malaysian Patients
C S Kam, MRCP, Department of Medicine, Universiti Kebangsaan Malaysia, Kuala

Migraine is a common disease that occurs worldwide. Up to the present time,
however, there is no report from Malaysia. This communication is a report of
epidemiologic aspects of 17 Malaysian migraineurs.

An Inquiry into the State of Food, Nutrition and Health in Plantations
N Chandrasekharan*, T Marimuthu**, *Faculty               of   Medicine,   **Faculty   of
Education, University of Malaya, Kuala Lumpur

The plantations in Malaysia are the mainstay of the present booming economy
and the workers' contribution to our prosperity is considerable. This study
aims to assess the nutritional status of the plantation workers and their
families as reflected by their food and dietary habits, and indirectly the
significance of nutrition as a component of health and socio-economic status.

Ethnic Distribution of Patients with S.L.E. seen in University Hospital, Kuala Lumpur 1967
- 1976
A O Frank, MBBS, Department of Medicine, Faculty of Medicine, Unviersity of
Malaya, Kuala Lumpur

Systemic lupus erythematosus (SLE) is a disease of uncertain aetiology. As
awareness of the condition increases and serological techniques for its
definition improve, it is being more frequently diagnosed. It has been known
for many years that the incidence of the disease is increased in the
relatives of patients suffering from the disease, and the genetic component
of its pathogenesis has been recently confirmed in twin studies. Current
thinking, however, is that certain individuals are predisposed by their
genetic background to suffer from the illness, and that the triggering factor
is likely to be a virus.

The effect of race has not been studied very frequently, apart from the major
study by Siegal and Lee (1973) which showed that in New York City the disease
was more common in black females than white females with Puerto Ricans in
between. Siegel and Lee also showed that race can affect the age of onset of
SLE. Thus in New York City all the patients diagnosed as SLE before the age
of 15 were Puerto Ricans (even though the disease was more prevalent in the
Negro population). In one centre in the western United States an increased
prevalence of SLE has been noted in people of oriental race.

It is also interesting that 4 out of 110 patients with SLE reported by Lee
et. al. (1977) was 'Orientals'. Morton et. al. (1976) also reported a
difference in the annual incidence of SLE in inbred North American Indian
tribes. However, Estes and Christian (1971) and Dubois (1974), felt that
there was no ethnic or racial predisposition to SLE within the hospital
population studied. More recently Hughes (1977) noted a very high prevalence
of SLE in the Jamaican population.

At the University of Malaya, SLE appeared to be seen frequently, and in view
of the interest of various faculty members in this illness, it seemed
reasonable to study the disease in some depth. Consequently in June, 1974, a
Systemic Lupus Erythematosus Study Group was set up by members of the
Departments of Medicine, Pathology and Psychiatry in order to facilitate the
diagnosis and consequent study of the disease and its management. No large
study of the effect of race on SLE in West Malaysia has been performed. The
study performed in Singapore (Tay and Khoo, 1971) did not suggest any
difference in the prevalence of SLE within minority ethnic groups in
comparison with the Chinese majority, but the minority groups were small in
size. In West Malaysia, however, the population is derived predominantly from
people of Malay, Chinese and Indian origins. It therefore seemed to be of
value to determine the ethnic groups of patients with SLE in West Malaysia.

Rural Health Care : Malaysian Physicians' Opinions about Traditional Malay Medicine and
Hospital Assistants - A Pilot Study
H K Heggenhougen, University of California International                 for   Medical
Research, Institute for Medical Research, Kuala Lumpur

Increased attention to traditional Chinese medicine and the 1977 World Health
Organization resolution calling on all member governments to integrate
traditional medicine into their official health care systems wherever
possible, has created world wide interest. This is also evident in Malaysia.
Although traditional healers, throughout the world (local folk healers as
well as practitioners of regional medical systems, such as Ayurveda) practice
in urban areas, most of them work in rural settings. The Director General of
the World Health Organization’s directive "Health for all by the year 2000",
emphasizes primary health care in rural areas, alternative approaches in
health care delivery, including greater reliance on auxiliary health workers;
and increased use of, or cooperation with, traditional healers and their
medicine. Such renewed emphasis implies changes within the health care
systems now operating in most countries.

Cosmopolitan medical systems in western countries have long been accused of
an over-reliance on highly sophisticated technology, an over-adherence to a
strictly   scientific   bio-medical   model   of    unjustifiable growth  of
specialization and physician maldistribution with an urban concentration of
practitioners. It is further lamented that General and Family Practice have
been accorded inferior status and that inadequate attention is paid to rural
health care. Such accusation, have often been justified despite the somewhat
sensational nature of some notably those by Illich.
It is no secret that the official health care systems in third world
countries all too often mirror the cosmopolitan systems of industrialized
nations and where such systems are seen in need of change in the West, a
strict adherence to these "western" models is more inappropriate in
"developing" countries especially as the majority of the population of such
countries is rural.

The futility, inappropriateness and phenomenal cost of having a physician in
every village have been pointed out by many and there are few who would now
advocate such a goal. Yet cosmopolitan physicians are, of course, key
personnel in rural as well as urban health care. What is increasingly being
pointed out, however, is that physicians might most appropriately work in
coordination with other health personnel in providing curative services to
rural areas. Thus an increased reliance on a team approach, with cooperation
between different levels of cosmopolitan medical personnel, is advocated. In
addition to providing direct services themselves, physicians would then
function more as teachers, managers and as the final, rather than the
initial, health care resources, than they do now.

Reliance on resources already available in rural areas is also advocated and
thus, where appropriate, it is suggested that traditional healers be
considered to the point of incorporation into the official health care
system. Of course, any move in this direction is complex and fraught with
innumerable problems and, if at all, should be undertaken with great care.
But whether or not cooperation or contact is to take place the current
widespread practice of traditional medicine cannot be denied and it is once
again receiving public, and professional, recognition. An examination of the
reasons for the persistence of traditional medicine even in areas where
cosmopolitan medicine is readily available, will not only throw light on
these traditional practices, but can provide a perspective from which to
critique the official health system and has been mentioned elsewhere.

Physicians play a dominant role in most health care systems and changes in
the systems depend on their opinions and attitudes. We therefore surveyed
physicians  in   Malaysia  regarding   appropriate  rural  health   care  and
traditional Malay medicine. Special attention was drawn to traditional Malay
medicine since the rural population is largely Malay (with an estimated 80%
of all Malays being rural), whereas most (though not all) traditional Chinese
and Indian health practitioners operate in larger cities and towns. Because
Hospital Assistants (HAs), auxiliary cosmopolitan health care workers, can be
considered currently to constitute the backbone of the rural government
curative health care service, this study also focused on them but no special
linkage, or comparison, between the HAs or traditional practitioners is

Syphilis in the Military Community
V Supramaniam, Ministry of Defence, Kuala Lumpur

Though syphilis, as a public health problem, in the military community is of
minor   importance  based   on   reported cases  of   syphilis,  its  proper
understanding including management is important to the efficient control of
syphilis. This study describes the current practices in the Armed Forces and
the problems associated with it.
Studies on the Biology of Anopheles Letifer Sandosham (Diptera, Culicidae), and its
Response to Residual Spraying, Carried Out in Sarawak, Malaysia
E S Thevasagayam, PhD*, Liaw Choon Fah**, *WHO Consultant in Entomology,
**Malaria Eradication Programme, Sarawak, Malaysia

Anopheles Letifer Sandosham 1944, a member of the Anopheles 'umbrosus' group
was first recognised by Gater (1935) who described it as A. umbrosus. Later
he re-described it in 1941 giving it the name A. letifer. His manuscript
apparently was lost in transit during the 1939 - 1945 war, and Sandosham
(1944) assuming that publication had taken place described the species
ascribing it to Gater. As Sandosham's was the first publication of the name
A. letifer, he becomes the author of the name.

Reid (1963) described two new species closely resembling A. letifer and named
them A. collessi roperi the 'A. letifer' sub-group. A. whartoni has been
found in Peninsular Malaysia only, while A. collessi has been found in Sabah
and Brunei and therefore probably occurs in Sarawak also. Up to the time of
the present study, all specimens of the sub-group taken in Sarawak, have been
identified as A. letifer and no A. collessi has been found.

The role of A. letifer in malaria transmission in Sarawak has been uncertain,
although it is a vector of malaria in Peninsular Malaysia. Reid and Hodgkin
(1950) found 0.3% and 0.7% sporozoite rates in 8411 and 4964 respectively,
wild caught A. letifer in Peninsular Malaysia and spleen rates of 48 - 71%
and parasites rates of 22 - 44% in areas where this species was predominant.
In Sarawak, however, it has been suspected as a vector for sometime. Zulueta
(1956) found 6 sporozoites in 3195 A. letifer dissected from Sarawak but
these were later shown to be of non-human origin. From 1963 to 1966, 3725 A.
letifer had been dissected by the entomology staff of the malaria programme,
of which 7 were found with sporozoites, which were also confirmed to be of
non-primate origin.

From about 1963, A. letifer was found to be the predominant, if not the only
anopheline in some areas of proven local transmission, especially in timber
camps and road construction sites in the coastal areas of the First and
Second divisions of Sarawak. These activities are in the peat swamp areas for
which workers come from other parts of the state and live in temporary
structures. With the clearing of jungle, there is a high density of A.
letifer and with an imported parasite carrier, local transmission had been
known to occur time and time again, in the absence of the established vectors
of Sarawak. Epidemiological evidence, therefore, is overwhelming in favour of
considering A. letifer a vector of Malaria in Sarawak.

Primary Liver Cancer in Malaysian Children
D Sinniah, DCH*, E Sumithran, MRCPath**, H P Lin, FRACP*, L L Chan, MBBS*, C
K Toh, MBBS*, *Departments of Paediatrics and **Pathology, University of
Malaya, Kuala Lumpur

There is a high incidence of primary hepatic cancer in the adult population
in many parts of Africa and Asia. It is the most common malignancy among
Malay males, the second most common cancer in Indian males and the third most
common cancer among Chinese males in Singapore. Despite the high incidence of
liver cancer in the adult population in these regions, there is a paucity of
reported cases in children. The International Union Against Cancer (U.I.C.C.)
has drawn attention to the need for more epidemiological information from
different countries regarding these tumours. In addition, the outlook for
children with primary hepatic cancer seems to be improving with the
introduction of multimodal therapy.

Characteristics of First Schizophrenic Admissions to the General Hospital Kuala Lumpur
Neil Buhrich, MD*, Syed Haq, FRCP*, *Department of Psychiatry, Faculty of
Medicine, National University of Malaysia, Kuala Lumpur

There is little difference in the admission rates for schizophrenia for males
and females in England and Wales, in the United States and in Japan. This
does not appear to be the case in Malaysia and Singapore. Tan (1964) reported
a male to female sex ratio of 1.8:1 in 1321 patients, ninety percent of whom
were diagnosed as schizophrenia, admitted to Tampoi Mental Hospital,
Malaysia. Kok (1975) reported a male to female ratio of 2.4:1 in sixty one
consecutive schizophrenic admissions to the Singapore Mental Hospital. It is
unknown whether the reported sex difference of schizophrenic admissions in
Malaysia and in Singapore as a consequence of males preferentially seeking
medical help or whether the sex difference of schizophrenic admissions is a
true reflection of a differing sexual incidence of schizophrenia in these

The aim of this study was to investigate the characteristics of new
admissions diagnosed as schizophrenia to the Psychiatric Department of the
General Hospital, Kuala Lumpur, in order to replicate the findings of Tan
(1964) and to determine whether an observed difference in the sex ratio of
schizophrenic admissions could be accounted for by any of the three major
ethnic groups, namely Malay, Chinese and Indian.

Remedial Education in Specific Reading Retardation
Tan Chee Khuan, MRANZCP*, K K Malhotra, LCST**, Woon Tai Hwang, MRANZCP*,
*Department of Psychological Medicine, Faculty of Medicine, University of
Malaya, Kuala Lumpur, **University Hospital, Kuala Lumpur

Specific reading retardation is a term used to describe a specific disability
in reading - specific in the sense that the reading difficulty is not
explicable in terms of the child's general intelligence. The U.S.
Congressional Bill entitled "The Learning Disabilities Act of 1969" stated
that children with special (specific) learning disabilities exhibit a
disorder in one or more of the basic psychological processes involved in
understanding or in using spoken or written language. These may be manifested
in disorders of listening, thinking, talking, reading, writing, spelling or
arithmetic. They include conditions which have been referred to as perceptual
handicaps, brain injury, minimal brain dysfunction, dyslexia, developmental
aphasia, etc. They do not include learning problems which are due to visual,
hearing or motor handicaps, to mental retardation, emotional disturbance or
to environmental disadvantages. Specific reading retardation is therefore,
one of the specific learning disabilities.

The National Advisory Committee on Handicapped Children (1968) of the U.S.
Office of Education stated that the total number of children involved cannot
be accurately determined until more adequate diagnostic procedures and
criteria have been developed. At the present time, the best guess is from 1
to 3 per cent at the U.S. school population, require special remedial
education. In Malaysia, the situation may be more serious. It is estimated
that 10 to 15 per cent of Malaysian school children are slow learners who
fall behind the normal achievement of their age group. The following case
report will highlight the problems of a child with specific reading
retardation, and describe the assessment and management.

Depressant Action of Averrhoa Carambola
Colin K Muir, PhD, Chan Kit Lam, PhD, School of Pharmaceutical Sciences,
Universiti Sains Malaysia, Penang

Preparations of Averrhoa carambola (starfruit) have been used in an attempt
to treat ailments of several different types both by bomohs (the Malay
medicine men) and by traditional Chinese herbalists. Among these ailments for
which starfruit preparations have been 'prescribed' are headache, vomiting,
coughing and restlessness. This paper describes an attempt to determine
whether starfruit contains any pharmacologically active depressant agent.

A Battered Wife
T H Woon, MRANZCP*, Shirley George, MPM**, *Department of Psychological
Medicine,   Faculty  of   Medicine,  University of Malaya, Kuala Lumpur,
**Psychiatric Unit, General Hospital, Seremban

Until about one hundred and fifty years ago, the English law allowed a man to
chastise his wife using any instrument he deemed suitable, and the law made
no provision for her to escape from the husband. In spite of the emancipation
of woman, wife beating has continued over the years, and especially so in
certain sub-cultures where wife abuse is accepted as the norm. The term
"battered wife" was probably introduced after the concept of the "battered
baby syndrome". Scott (1974) defines a battered wife as a woman who has
suffered serious or repeated physical injury from the main with whom she

This paper will illustrate the psychodynamics of a family where the wife is
the victim of repeated assaults from her husband and some structural factors
contributing to violence in marriage. Hopefully, this paper will stimulate
early diagnosis and management of the persons related to a battered wife.

Psychological Medicine in the Undergraduate Medical Curriculum
M Parameshvara Deva,      Department      of   Psychological   Medicine,   University
Hospital, Kuala Lumpur

Psychological medicine has been a latecomer into the undergraduate medical
curriculum the world over. Indeed, there are still many medical schools in
developing countries where there are no formal departments of psychiatry, and
where the subject is covered in a series of a dozen or so lectured-
demonstrations. This late and often cursory reference to psychiatry has its
origins in a wider attitude of fear, ignorance and even ridicule towards
mental illness the world over. From such beginnings, it was not surprising
that mental illness was confined to large asylums that the first
psychiatrists referred to as 'alienists'.

It was a name that denoted the psychiatrist's tradition of being alienated in
their 'asylums' outside the main stream of medical knowledge and practice.
The earliest psychiatric entrants into the medical school were largely mental
hospital doctors who gave lectures or demonstrations to medical students far
removed from the realities of psychiatric hospital practice. The consequent
attitude of the students themselves was one of psychiatry being alien to
medicine, as they knew it.

On the other hand, psychological medicine over the past four decades since
the Second World War has become recognized as an essential skill of all
practitioners engaged in health care. Psychological medicine has not only a
great deal to contribute by way of understanding and management of the major
syndromes of mental illness but a considerable amount in such major fields as
psychosomatic medicine interview skills and in the shaping of attitudes of
the future medical practitioners of the community at large.

Is Chest X-Ray Screening for Pulmonary Tuberculosis by Mass Radiography - A Cost-
Effective Tool in a Military Population?
V Supramaniam, MSPH, Ministry of Defence, Kuala Lumpur

Pulmonary tuberculosis is a classic disease that satisfies all the criteria
for screening and has been carried out extensively with mass radiography.
However its contribution to lowering the risk of infection by tuberculosis is
contradictory. Pulmonary tuberculosis screening by mass miniature radiography
has been standard practice in the Malaysian Armed Forces since its inception.
It is carried out prior to entry and at regular intervals of 1-4 years for
different categories of personnel, on special occasions and on discharge.
This study is to assess its effectiveness in a military population.

Reproduction Research and Health : Part III Fertility Health
T A Sinnathuray, FACS, Department of Obstetrics & Gynaecology, Faculty of
Medicine, University of Malaya, Kuala Lumpur

In the two preceding papers which represent the first two parts of my
inaugural address, the impacts of reproductive research on Maternal Health
(Part I) and on Fetal Health (Part II) have been presented at some length. In
this paper is presented the impact of reproductive research on Fertility
Health, and it covers the last two areas of my inaugural address, namely
fertility    regulation   (family  planning)   and   fertility   augmentation
(infertility management).
Acute Appendicitis and the Leucocyte Count
K J Singh, FICS, General Hospital Miri, Sarawak

The total leucocyte count in the diagnosis of acute appendicitis has been the
subject of frequent reviews. Various authors have published reports giving a
splintered view on the value of such estimation. Lansden (1963) reported
leucocytosis in 84% of cases of acute appendicitis with a relative increase
in 88%. Sass et al (1970) demonstrated significant leucocytosis in 90% of a
series of 525 patients. Lee (1973) reported a white cell count elevation in
82% of cases. Raftery (1976) claims leucocytosis in 96%. Bolton et al (1975)
reported a high count in 63% of their cases but consider the laboratory data
of limited supportive value. Shepherd (1968) is of the opinion that
estimation of the total leukocyte count is of no diagnostic value.

Bolton et al (1975) also reported a survey of the differential white cell
count and neutrophil morphology and suggests that these parameters be of no
greater value than the total white cell count. The present study reviews 100
cases of acute appendicitis operated by the author or his assistant.

Recurrent Aphthous Stomatitis
K Ramanathan, AM*, Ng Kok Han, BDS, P I Chelvanayagam, BDS, *Department of
Stomatology, Institute for Medical Research, Kuala Lumpur

Of all the common illnesses of man few are as baffling to medical science as
oral ulcers. Despite their high prevalence little is known about what causes
them. Equally distressing to patient and physician is the lack of effective
treatment or preventive measures. The Greek word aphthae introduced by
Hippocrates comes from two other words meaning "mouth ulcer" and "to set on
fire". This is a most appropriate name for intense pain and burning sensation
are some of the most characteristic symptoms of aphthous ulce. Recurrent
aphthous stomatitis is a chronic inflammatory disease characterized by
painful recurring ulceration of the oral mucosa. Prevalence studies by Sircus
et al (1957) and Shapiro et al indicate the incidence rate in a hospital to
be 20% and Ship et al (1960, 1961) found the incidence to be 60% among
university students. RAS can be clinically subdivided into four varieties of
recurrent oral ulcers.

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