I -l f ,f> A P\ V <

EELANTAN

ANNUAL REPORT

ON THE

MEDICAL DEPARTMENT

FOR
' . f • • •

1927
<r ^ ■

BY

L. W. EVANS
Acting Chief Medical Officer, Kelantan

SINGAPORE :

Printed at the Government Printing Office, Singapore,

by W. T. Cherry, Government Printer

1928
 KELANTAN ANNUAL REPORT ON THE
MEDICAL DEPARTMENT FOR 1927

SECTION I.
I.—ADMINISTRATION.
A.—Staff.
1. Dr. J. H. Bowyer acted as Residency Surgeon until
August 13th.
On August 13th, Dr. L. W. Evans was appointed Acting
Chief Medical Officer while Dr. Bowyer took the new
appointment of Health Officer.

2. On November 12th, Dr. Bowyer was transferred to

Singapore being relieved by Dr. T. C. Lonie.
3. Dr. W. J. Geale acted as Medical Officer, Ulu
Kelantan throughout the year, and Dr. Lim Shin Thwin
assisted at Kota Bharu when required.
4. The post of Matron to the European Hospital was
held by Miss H. Youle (acting) until 30th January, 1927, on
which date she was transferred to Singapore being relieved
by Miss C. Monk who held the appointment till the end of
the year.

The total staff of the Department is given in Appendix I.

R.—Ordinances affecting Public Health.
The Indian Immigration Enactment was enacted during
the year.
C.—Financial.
The total expenditure of the Department was $152,537.67
(compared with $115,011.65 in 1926) and the revenue was
$17,675.36 (compared with $11,149.83 in 1926) Details in
Appendix //.
The increased expenditure is partly accounted for by the
inclusion of Kuala Krai Hospital expenses which were pre¬
viously paid by the District Officer, Ulu Kelantan. These
include ‘‘Diets and Extras” $15,309.31, Personal Emoluments
$4,565.50, Wages to Hospital Servants $3,066.20, Contingent
and Travelling $1,597.19 and Motor Cycle Allowance $360.
The total Revenue of the State was $2,448,089 so that the
percentage of the Revenue allotted to the Medical Depart¬
ment was 6*22. The above expenditure figures exclude the
cost of all buildings and the upkeep thereof.
 2

SECTION II.
: PUBLIC HEALTH.
A.—General Remarks.

1. The General Health was adversely affected by the

conditions following the floods of December and January,
but Infectious Diseases proper were conspiciously few.
2. There were no cases of Cholera and Small-pox.
3. Chicken-pox.—Four cases occurred in Kota Bharu
and two were reported from Pasir Puteh.
4. Measles.-—Fourteen cases were reported (12 from
Kota Bharu and two from Pasir Puteh).
5. Mumps.—One hundred and three cases were reported
(69 from Kota Bharu, 23 from Kuala Krai and 11 from Pasir
Puteh). ,
Of those occurring in Kota Bharu, 21 were from the
Police Barracks and 38 in the Prison.
6. Unfortunately the Statistics for other communicable
diseases are not so satisfactory.
f]

7. Malarias—Offers the most difficult problems. 37%

of cases admitted to Government Hospitals and 36% of cases
admitted to Estate Hospitals were for these diseases, while
of 48 patients admitted to the European Hospital, 25 were
for Malaria.
8. Taking Estates as an Index, out of 6,494 labourers
2,881 or 447% were admitted to Hospital for Malaria.
19. More than 1/3 of the 204 deaths in the Kuala Krai
District Hospital, and 1/4 of the 407 deaths notified by Estates
were due to these diseases.
10. It is difficult to get Statistics for other communities,
but Kota Bharu Town appears to be fairly free and there
have been no cases among 27 Europeans who resided here.
This freedom is fortunate, and, if no Anti-mosquito measures
are adopted, can only be temporary, as there is no scarcity
of malaria carrying Anopheles in Kota Bharu, and the dis¬
ease is not uncommon in the Kampongs on the outskirts of
the town.

11. Malaria has already invaded Kuala Krai which was, -

until this year considered to be fairly healthy.
Here five Europeans out of about eight resident there
had malaria during the year, while there has been a great
increase of the disease among Asiatics in the town.
 3

12. Of other mosquito borne diseases.—Elephantiasis is

the only one at all commonly seen.
There were no cases of Dengue.
13. Of Helminthic Diseases.—Hook-worms and round-
worms are extremely common, but Tape-worms are very
rare.
Out of 1,000 Stool Examinations made in the State
Hospital—
391 showed ove of Ascaris
201 ,, ,, of Tricocephalus.
193 ,, ,, of Ankylostomes.
1 ,, ,, of Taenia.
B.—Vital Statistics.

14. Three thousand seven hundred and twenty-five births

and 4,192 deaths were notified during the year.
The 1921 census gave a population of 309,300, and work¬
ing of this the birth-rate must be given as 12-4 per mille and
the death-rate as 13-6 per mille.
These figures are obviously far too low, and it is
improbable that the death-rate really exceeds the birth-rate.
It is therefore futile to try to arrive at an estimated popula¬
tion for 1927. We must wait till our System is working
better. [Table III of Model Report is therefore not
included.]
Five hundred and fourteen deaths under one year of age
were reported, giving an infantile mortality of 138 per
thousand births.
15. Birth and Death notification was only introduced
last year, and is still voluntary. It is therefore made
as simple as possible.

In towns, notification should be made to Police Stations,

and in Rural Areas Deaths are reported by Imams and Births
by Penggawas.
16. For Rural Areas, the System appears to be fairly
satisfactory, apart from a few Daerahs. Here the popula¬
tion is almost entirely Malay, and as the deaths are reported
by the Imams, few should be missed. Delinquent Pangga-
was can be picked out by the percentage of births reported
for if these are far below the deaths obviously many are
being missed.
17. As a method for towns, where the population is
mixed, the system is a total failure, very few births or deaths
 4

Ijging reported. I lius Kots Blmru with 3. population of

about 10,833 (1921) reported only 13 births and 22 deaths and
Kuala Krai Town three births and five deaths.
18. The Statistics for the three Districts supports this : —
Notification from Kota Bharu district are the poorest,
while the Pasir Puteh District, with the largest percentage
of Malays, gives the best figures, Kuala Krai being inter-
mediate.
Thus : —
Kota Bharu District—
Population (1921 199,128.
Births notified = 2,162 - Birth-rate io*8 per mille.
Deaths „ =2,276 - Death ,, n*4 >> >>
Kuala Krai District—
Population (1921) 41,351.
Births notified = 444- Birth-rate 107 per mille.
Deaths „ - 725 = Death „ 17-5 ,,

Pasir Puteh District—

Population (1921) 68,821.
Births notified = 1,114 - Birth-rate 16-2 per mille.
Deaths ,, = 1,191 - Death ,, 17-3 ,,

Vital Statistics of Estate Labourers.

These are given in detail in Appendix IV.

Out of 6,494 labourers of all nationalities 390 died giving
a death-rate of 6o*i per mille, while there were 114 births
giving a birth-rate of 17-5 per mille.
It will be seen that the Indian labourers succumb more
readily than any others, having a much heavier sickness rate,
and a death-rate of 78*3 per mille.
The death under one year of age were 39, giving an
infantile mortality of 342 per 1,000 births.

Vital Statistics of Europeans.

The number of European resident in all parts of Kelantan

is approximately 100.

During the year there were four deaths and one birth.
There was no infantile mortality.
 5
WvnuOWb
Table showing the Sick, IhvQ'Ii’W^s, and Death-rates of
European Officials.

Total number of Officials resident ... 17

Average number of resident ... ... 17
Total number on sick list ... ... 7
Total number of days on sick list ... 56
Average daily number on sick list ... 0*15
Percentage of sick to average number
resident ... ... ... 41-
Average number of days on sick list for
each patient ... ... 8*o
Average sick time to each resident ... 3-29
Total number invalided ... ... Nil.
Percentage of invaliding^ to total resi¬
dents ... ... ... Nil.
Total deaths ... ... ... Nil.
Percentage of deaths to total residents ... Nil.
Percentage of deaths to total average
number resident ... ... Nil.
Number of cases of sickness contracted
away fiom residence ... ... ?
Table showing the Sick, Invaliding, and Death-rates of
non-European Officials.

Total number of Officials resident ... 1,196

Average number resident ... ... 1,196
Total number on sick list ... ... 473
Total number days on sick list ... 4,913
Average daily number on sick list ... 0-3
Percentage of sick to average number
resident ... ... ... 39*5
Average number of days on sick list for
each patient ... ... 10-4
Average sick time to each resident ... 4‘i
Total number invalided ... ... 13
Percentage of invalidings to total resi¬
dents ... ... ••• 1,1
Total deaths ... ... ••• 2
Percentage of deaths to total residents ... 0*17
Percentage of deaths to total average
number resident ... ... 0*17
Number of cases of sickness contracted
away from residence ... ... '?
 6
1
^ -Nt\

section hi

HYGIENE AND SANITATION

A.—General

1. As mentioned in Section I, a Health Officer was

appointed in August.
2. This year his activities have been concentrated on
a thorough inspection of the various rubber Estates, where
the health of the labourers is of such vital importance, and
of the larger towns, with special reference to Malaria.
3. Next year his staff will be increased.

B.—Preventive Measures

4. Previous to the appointment of a Health Officer,

apart from vaccination and dealing with epidemics of in¬
fectious disease that might arise, no preventive work was
carried out by the State.

5. Even now wholesale treatment of Ankylostomiasis,

and education in prevention are not practicable, and in
rural areas malaria can only be dealt with by treatment of
cases. To aid this Mr. Bradley, District Officer, Ulu
Kelantan suggested the training of School Masters and
other selected men in the treatment of these, and other
simple ailments and supplying them with the necessary
medicines. This is being done and should prove very useful
in the more inaccessible areas.

6. Since August, oiling has been practiced (on a

fairly extensive scale) in Kota Bharu only, while, elsewhere,
any areas found to be breeding known carriers of Malaria
were dealt with as well as possible.

7. Vaccination.—The total number vaccinated was

7,593 of these 806 were done in the various Hospitals and
Dispensaries, and 6,787 by out door vaccinators. Appendix
VII.
Vaccination like Yaws treatment is generally appreciated
and no compulsion is necessary.

8. On Estates.—Anti-Malarial Work is carried out

extensively, though systematic oiling, and Quinine pro¬
phylaxis are, in most cases, the only methods that can be
practiced.

Periodical wholesale treatment for Ankylostomiasis is

carried out in all.
 7

C.—Sanitation

9- Town Sanitation is carried out in Kota Bharu and

Tumpat by the Conservancy Board, and in Kuala Krai and
Pasir Puteh by the District Officers.

The Principle followed is provision of rubbish boxes

by householders and the removal of refuse from these by
Motor Lorry and cart.

10. The Street are kept clean by Prison Labour.

ii- Conservancy is still primitive, but is receiving- the

attention of the Chairman of the Conservancy Board and the
Health Officer.

D.—School Hygiene

12. Systematic Inspection of schools is not practicable

in Kelantan, Where possible, the children are examined
periodically and their ailments treated.

E.—Labour Conditions

13. Until November, Dr. Geale was employed as Medi¬

cal Officer by all Estates, and has done very valuable work
under difficult conditions.

14. In November the Duff Development Co., Ltd. de¬

cided that the amount of work on their estates justified the
employment of a whole time Medical Officer, and
Dr. Francis was appointed. He however left the Company
in December, from which date no Medical supervision of
these estates has been available, as the New Medical Officer,
who is expected shortly, had not arrived by the end of the
year.

15. All Estates lost their cooly lines, etc., during the
flood of last December and January, but satisfactory recons¬
truction has been carried out on most.
16. The after effects of the flood are chiefly responsible
for the poor health on Estates (and elsewhere) this year.
For many months work was carried out under great difficulty.
Immediately following it severe “Beri beri” was common,
and later malaria assumed almost Epidemic proportions.

The energy shown by the Managers in rapid reconstruc¬

tion and by Dr. Geale in controlling the ill health is deserv¬
ing of great praise. Towards the end of the year the
improvement in health on these estates was marked, as is
shown in Appendix VI giving number of deaths in each half
of the year.
 8

E.—Food in Relation to Health

Importation of polished rice into the State is not con¬

trolled. Most Government Institutions insist of Kelantan
rice or, when this is not available, Singora Rice, as rice
from these places in under milled. This is also recommended
to Estate Managers, etc. Indians as a rule insist on par¬
boiled rice. White rice (Siamese or Rangoon) is almost
universally taken by Chinese, and largely by Malays in towns.
The total number of cases of Beri Beri treated was 692
of these 299 were treated in the various Estates Hospitals,
186 at District Hospital, Kuala Krai, 140 at State Hospital,
Kota Bharu and 20 in the Gaol Hospital, and 47 in the
Railway hospitals.

Prophylactic Vaccination of Pilgrims

In October it was decided to vaccinate all people in¬

tending to make a pilgrimage to Mecca against Small Pox,
and innoculate them against Cholera, in the hope that, by
so doing, quarantine at Kamaran Island would not be
required.
By the end of the year 379 pilgrims were thus treated.
Each was given two Cholera innoculations (1,000 million and
2,000 millions) in addition to being vaccinated, and a Certi¬
ficate was given to this effect.

Instruction in Sanitation, etc.

As the Health Department has been in existence

only five months, little can be said on measures taken to
spread knowledge on Hygiene and Sanitation; training of
personel or Recommendations for future work.

SECTION IV
PORT HEALTH WORK AND ADMINISTRATION
Mr. Sie Sing Chang, Deputy Health Officer remained
at Tumpat throughout the year and boarded all vessels.
The total number of steamers calling at the Port was
170 with 5,298 passengers, 167 of whom were Europeans.
All were inspected but no case of infectious disease was seen.
During the cholera epidemic in Bangkok during the
early part of the year, all passengers arriving from Siam
were required to report daily for five days.
There is a Quarantine Camp at Tumpat, but the only case
admitted during the year was a Bengali suspected of having
bubonic plague.
 9

SECTION V
MATERNITY AND CHILD WELFARE

There is no organised Infant Welfare Work in

Kelantan at present.

An attempt at this was made in 1926, which met with

very little success.

It cannot be organised satisfactorily until there is pro¬

vision for a certain amount of out-door work, and simple
propaganda by pamphlets on proper methods of infant feed¬
ing, etc.

In the meantime, many infants are brought to the hos¬

pitals and Dispensaries for treatment.

SECTION VI

HOSPITALS AND DISPENSARIES

The Government Hospitals and Dispensaries are as

follows: —

The State Hospital is at Kota Bharu where there are

also a small European Hospital, and Isolation Hospital and
a Gaol Hospital. The Gaol Hospital also houses lunatics.

A new State Hospital was commenced in 1926. The

first ward was completed on October 13th, and a second
ward on November 19th. These were immediately utilized
to relieve the congestion in the Old Hospital.

A third General Ward and two 2nd class wards and one
block of attendant’s quarters were practically completed by
the end of the year.

At Kuala Krai there is a District Hospital erected in

1924 to accommodate 50 patients. In 1926 the buildings of
the vacated Railway Hospital were taken over and have hel¬
ped to deal with the increased number of patients.

There are two out-door Dispensaries. Each with a

Dresser (Grade I) in charge, one is at Tumpat, the other
at Pasir Puteh.
There are two Isolation Hospitals one at Kota Bharu
and the Other at Tumpat, and at Kota Bharu there is a
separate Gaol Hospital.
 A.—EUROPEAN HOSPITAL

Forty-eight patients were admitted (compared with 37

in 1926).

Forty-five were discharged and 3 died.

There was one maternity case.

B.—STATE HOSPITAL, KOTA BAHRU

Mr. Devota, was in charge throughout the year and did

excellent work.
In-patients.—One hundred and eight remained on Jan¬
uary, 1st. Three thousand three hundred and sixty were
admitted during the year, giving a total of 3,468 treated
(compared with 2,792 in 1926).

Of these, 1,293 or 37.3 per cent were Malays, and there

were 318 female patients.

There were 103 deaths giving a Death-rate of 2.97 per

cent Excluding the 32 deaths which occurred within 48 hours
of admission the Death-rate was 2.01 per cent.
The most prevalent diseases were : —
Malaria.—Nine hundred and seventy-five cases with
19 deaths.
Ankylostomiasis.—One hundred and sixty cases with
5 deaths.
Vcncral DiseaseThree hundred and ninety-nine;
Ulcers 160.
Lung Diseases.—Two hundred and ninety-two with al
deaths.
These include 80 cases of Phthisis (27 deaths)
63 of Lobar Pneumonia (9 deaths) and 27 of
Broncho Pneumonia (4 deaths).
Beri-beri.—One hundred and forty cases were ad¬
mitted of whom 12 died.
Dysentery.—Forty four cases Amoebic Dysentery
with one death and 65 cases of Bacillary Dysen¬
tery with 13 deaths.
Operations.—Forty-one Major operations were per¬
formed under general Anaesthetic and 106 Minor
Operations under local Analgesia.
Out-patients.—The number of attendances at the
Dispensary was 36,651 (compared with 36,572 in
1926), of these 28,559 or 77.9 per cent were
Malays.
 Details of sickness are given in Appendix VIII.
.

Twenty-six Post Mortem examinations were made.

C.—DISTRICT HOSPITAL, KUALA KRAI

In-patients — Two thousand five hundred and eighty-
three were admitted during the year, which, with the 98
remaining on January, 1st gives a total of 2,681 treated
(compared with 1,437 in 1926).
Of these only 11.9 per cent were Malays, the majority
of patients being Indians (43 per cent) and Chinese (39 per
cent).
One hundred fifty-six were female patients.
There were 204 deaths giving a Death-rate of 7.61, but
of the 61 deaths which occurred within 24 hours be excluded,
this is reduced to 5.33 per cent. This rather high figure is
accounted for by the poor condition of many of the patients
and the difficulties under which treatment had to be carried
out. *
The most prevalent diseases were : —
Malaria.—One thousand two hundred and fifty-nine
cases with 70 deaths.
Ulcers.—Three hundred cases and Vencral Diseases
114 cases.
Only 44 cases were admitted for Ankylostomiasis (3
deaths).
Lung Disease.--One hundred and sixty-two cases were
admitted, including 48 cases of Lobar Pneu¬
monia (with 24 deaths). Three cases of Broncho
Pneumonia and 65 cases of phthisis (11 deaths).
Dysentery.—There were 176 (86 Amoebic and 90
Bacillary) with 29 deaths.
Beri-beri.—One hundred and eighty-six cases 45 of
whom died.
Seventy-nine operations including two Amputations were
performed.
Out-patients.—The number of attendances at the Dis¬
pensary was 11,236 (compared with 10,789 in 1926).
Details of sickness are given in Appendix IX.
The worst overcrowding in this Hospital occurred in
the early months of the year, when patients from Estates
and Railway Construction Camps whose Hospitals had been
washed away by the flood, were accommodated.
 12

The Average number of patients in the wards during

the first six months of the year was 171 while during the
2nd six months it was reduced to 118.
The largest number in at any one time was 210.
During the last two months of the year it was possible
to relieve the congestion by removing patients to Kota
Bharu, and 42 were thus transferred.
Dr. Geale and his staff are to be congratulated on the
arrangements made for dealing with the large number of
patients with the limited accommodation available.
D.—TUMPAT DISPENSARY
The number of attendances was 8,463 (compared with
11,907 in 1926) 23 cases were admitted to the Emergency
ward. These were mostly “Police cases”. There was one
death,—a Tamil labourer newly arrived from Singapore who
died of Cerebral Malaria.
E.—PASIR PUTEH DISPENSARY
Here there were 14,515 attendances (compared with
7,268 in 1926) 85 per cent of whom are Malays.
The Dresser in Charge (Mr. Kandagnany) also, occa¬
sionally, visited the larger villages in the District on
rearranged days to give treatment. He vaccinated 3,422
children.

SECTION VII.
PRISONS AND ASYLUMS.
I.—Prison and Gaol Hospital, Kota Bharu.

The total number of prisoners under detention in the

prison at Kota Bharu was 1,092 of these 312 were admitted
to the Gaol Hospital and 4 died.
Most of the patients were admitted for minor complaints,
c.g. Bronchial Catarrh (73 cases) and Intestinal Parasites
(40 cases) but there were 20 cases of Beri-Beri, and a small
epidemic of mumps (38 cases).
There was one execution.
II.—Lunatics.
There is no Lunatic Asylum in Kelantan. Lunatics who
cannot be taken care of by their relatives or friends are
detained in the Gaol Hospital at Kota Bharu.
Here there are 6 cells of simple design which are avail¬
able for uncontrollable patients although not designed for
this purpose.
 13

All females have to be accommodated in these, as there

is no female ward.
In 1925 permission was obtained to send lunatics to the
Central Mental Hospital, Tanjong Rambutan, Federated
Malay States to a maximum of 10 male and 10 female
patients. Kelantanese, unfortunately, cannot be so trans¬
ferred so that they have to be dealt with in accommodation
mentioned above.
The numbers dealt with are as follows: —
On January ist-13 lunatics remained in the Gaol
Hospital.
Forty-four were admitted during the year.
Twenty-four were discharged in care of relatives or
friends.
Five were transferred to Central Mental Hospital,
Tanjong Rambutan.
Three died, 1 absconded.
Twenty-four remained at the end of the year.

SECTION VIII.
METEOROLOGY.
Meteorological.
Details of rainfall and temperature for all places where
these are recorded are given in Appendix XV and XVI.
The observations made at Kota Bharu (State Hospital)
give the following figures: —
Temperature.

Highest Shade Maximum of 92.°f on May 21st. and

September 14th.
Lowest Shade Maximum of 70.of on January 29th.
Highest Sun Temperature of i570f on August 18th,
19th and 28th.
Average Mean Temperature of 8o.98of (compared with
82.36 in 1926).

Rainfall. SOS.&o /??€X<95

T otal.—Cinri h ihw dr c d -amfr' e/iTC-TiR'gre,c niue-fry-feofr (com¬
pared with 128.09 in 1926).
Greatest rainfall of 5.62 inches on October 30th.
Rain fell on 189 days (compared with 179 during 1926).

• L. W. EVANS,
Acting Chief Medical Officer,
Kelantan.
 14

APPENDIX I.
TABLE /.
Total Staff of the Medical Department during T927
State Hospital: —
No. 1 Ag. Chief Medical Officer.
2 Health Officer.
3 Senior Hospital Assistant.
4 Hospital Assistant (Gaol Hospital).
5 Dresser Grade I.
6 Do. II.
7 Do. II.
8 Do. II.
9 Do. III.
10 Do. III.
11 Probationer Dresser.
12 Do.
13 Do.
14 Do. i

15 Dispenser Grade III.

16 Do. III.
17 Chief Clerk Grade II.
18 Probationer Clerk.
19 Do.
20 Malay Clerk Grade III
21 Assistant Store Keeper.
22 Travelling Dispenser.
23 Vaccinator.
24 Do.
25 Peon.
26 Do.
27 Do.
28 Chief Attendant.
29 Dispensary Attendant.
30 Ward Attendant.
31 Do7 —.
32 Do.
33 Do.
34 Do.
35 Do.
36 Do.
37 Do.
 i5

APPENDIX I —Continued.

State Hospital—Continued
38 Night Attendant.
39 Ward Attendant (female).
40 Do. ( do. )
41 Head Cook.
42 Do.
43 Assistant Cook.
44 Do.
45 Gardener.
46 Do.
47 Do.
48 Do.
49 Bullock Cart Driver.
50 Toty.
51 Do.
52 Do-
53 Do.
54 Watchman.
55 Do. (I. Camp).
56 Cook and Attendant (I. Camp).
57 Toty (I. Camp).
58 Tukang Ayer.
59 Do.
European Hospital: —
No. 1 Matron (Assists in Supervision of State Hos¬
pital.
2 Sister.
3 Nurse.
4 Attendant.
5 Do.
6 Cook (European Hospital).
7 Do. (Sister’s Quarters).
8 Servant to Matron.
9 Do. Sister.
10 Tukang Ayer.
11 Gardener.
12 Toty.
13 Watchman.
 i6

APPENDIX I.—Concluded.

Kuala Krai Hospital: —

No. i Medical Officer.
2 Hospital Assistant.
3 Dresser Grade III.
4 Do. III.
5 Probationer Dresser.
6 Do.
7 Attendant.
8 Do.
9... Do.
10 Do.
11 Do.
12 Do. (female).
13 Dispensary Orderly.
14 Cook.
15 Cook.
16 Toty.
17 Do.
18 Gardener.
19 Do.
20 Watchman.

Tumpat Dispensary : —
No. 1 Deputy Health Officer.
2 Attendant.
3 Watchman.

Pasir Puteh Dispensary : —

No. 1 Dresser in Charge.

2 Attendant.
 17

APPENDIX II.

TABLE II.

Expenditure 1927.

$ r.
Personal Emoluments 48,872 76

Allowance Travelling and Personal ... 2,167 16

,, Motor Car L324 93

,, Motor Cycle ... 1,080 00

,, Bicycle 590 00

,, for Nurses 669 68

Contingent Expenses 3.569 60

,, Travelling Expenses 1.597 19

Diets and Extras 30,900 25

Equipment 9,306 42

Infectious Diseases 1,816 24

Anti-Malarial Work 443 35

Medicines and Instruments 27,214 15

Maintenance of Lunatics 2,176 28

Uniforms 356 95

Wages Hospital Servants I3,Il6 2C

Allowance Sisters (Transport) 699 10

,, Dr. Geale in U. K. 2,743 32

Temporary Allowance 3,894 09

$i52.S37 67
 18

APPENDIX II.—Continued.

Revenue Return I927-

Kota Bharu: —
$ C. c.

Hospital Fees ... 6,297 89

Sale of Medicines . •• • 1,748 87

Out-door Dispensary Receipts 98 25

Licence Fees ... 21 50

Miscellaneous Receipts ••• 124 64

8,291 15

Tumpat: —

Sale of Medicines ... ... 749 40

Hospital Fees ••• n 50

Out-door Dispensary Receipts 144 65

9°5 55

Kuala Krai: —

Hospital Fees • • • 6,510 40

Sale of Medicines ... •• • 1,768 06

8,278 46

Pasir Put eh: —

Sale of Medicines ... • • • 88 45

Out-door Dispensary Receipts in 75

200 20

$17,675 36
APPENDIX III
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Infantile mortality 342 per mille.

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 22

APPEN

Sickness on

cluding dependents
.

Average monthly
labour force in¬
Estate Hospitals Total Admission Malaria Ankylos

D. D. C. L., Group:— cases deaths cases deaths cases deaths

Kluat and Taku ... 426 441 26 138 6 1 •••

Kenneth 405 641 24 143 6 36 •••

Lower Sokor 349 49 18 220 2 1 ...
Kerilla 441 106 10 46 2 3 ...
Kuala Gris * 182 83 13 58 7 fc ♦ • •••

Kelantan R. Estate Chaning

and Lepan Kabu +- 581 1,100 43 477 13 7 •••

Pasir Jinggi 131 587 J4 143 3 25 • *•

Kuala Pergau 171 360 19 105 2 8 •••

•
Balah 176 240 12 81 2 4 •••

Kuala Nal 4i7 459 21 160 2 32 ...

Dominion R. Co. (Tebing

Tinggi 476 5i8 24 44 •• *
27 •••

Sungei Bagan 251 9 V 2 • •• • •• Statis tics incc

Kuala Hau 196 82 20 34 8 6 1

Pasir Besar 276 153 9 46 1 6 •••

Stapoh Nal, K. Geh R. Co.

Limited 422 597 28 247 17 4i ...
Mengkebang Estate 237 121 5 49 2 8
Kuala Pertang 600 823 42 477 16 11 •••
l
Pasir Gajah 159 262 11 63 I 29 •••

Ulu Kesial 278 442 16 9i 7 12 •••

Kuala Pahi 397 917 24 150 5 3 •••

Kuala Hidong 148 307 8 50 1 23 •••

St. Cyr ••• ... ••• •#• *•« No re urn rec

Cherang Tuli 177 4i 1 32 ••• • ...

Total ... 6,494 8.038 390 2,881 103 283

* Statistics incomplete t Includes contractors coolies

 DIX V
Estates 1927

& J*
V*s
Diarrhoea and
Veneral disease Ulcers Lung disease *
Dysentery
$ * if
Nr < v
* V
9.

cases deaths cases deaths cases deaths cases deaths cases deaths

50 3 2 •.. 78 ••• 24 2

1—1
o
1,035
62 • 8 5 ... 47 ••• 52 1,583
3 59'3
n3 5 11 ••• 69 ••• 43 1 140 51*6

9 2 1 ... 7 «•• 10 1 240 22 ’ 7

11 3 3 ... 2 ... 2 466
4 7i'4

84 xi2 23 1 64 1 46 1,892 74'o

3

45 ... 2 t•• 16 ... 44 8 4,48o io5'q

24 2 7 ... 20 ... + 143 2,105 111T

5
-
5 ••• 1 ... 8 13 5 i,3-3 68‘ 1

59 ••• 24 35 8 1,101
q
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...
Ul

... 13

88 5 4 ••• 21 ... 62 1,0:7 50-4

4
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9 4 2 ••• 5 ... 7 3 418 1020

14 1 29 ... 21 ... 8 1 554 32'6

45 5 3 ... 38 13 3 i,4i5 66'4

23 ... 3 ... 20 ... 18 1 5ii 21 I

112 7 2 ... 73 ... 32 6 i,372 /O O

39 3 8 •. * * 58 ... 33 2 1,648 6g'2

19 1 6 ... 53 ... 72 1 1,590 57'6

78 3 3 ... 33 153 9 2,284 6o‘5

i5 ... 2 ... 3 .... 21 ••• 2,074 54'o

ived by 5-2-28

1 ••• 3 ••• ••• 2 ••• 232 16*9

905 64 154 1 671 1 821 70 1,238 60'1

X Influenza Epidemic
 24

APPENDIX VI.

Deaths on Estates from January to June, iQ2j.

Percentage of T.ota
Total No. No. of Deaths Deaths Occurring
of During 1st six
Name of Estate Durng 1st
Deaths 1927 months 1927 Half Year

D. D. C. L., Group: —

Lower Soker 18 10 55-6

Kenneth 24 18 75-o
Kerilla 8 4 50.0
Kuala Gris 21 LI 52-4
Taku and Kluat 26 15 577
Stapoh Nal |
28
Kuala Geh j 13 i20 7M
Ulu Kesial l6 12 75-
Balab 12 6 50-
Tebing Tinggi 25 19 76.0
Kuala Pertang 42 26 61.9
Pasir Jinggi 14 10 71.4
Chening and Lepan
Kabu 43 33 76.7
Kuala Nal 21 14 66.7
Kuala Hidong 8 8 100.
Pasir Gajah 12 9 75-
Mengkebang 5 2 40.
Kuala Pahi 24 19 79.2
Kuala Hau 20 13 65-
Pasir Besar 11 7 63.6
Kuala Pergau 19 9 47-4
 25

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NATIONALITIES OF
Specific Diseases.

PATIENTS.

Eurasians ...
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Chinese

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 APPENDIX X.

Most Prevalent Diseases in Government Hospitals.

Kota Bharu Hospital Kuala Krai Hospital

Diseases
Death Death
Cases Deaths Cases Deaths
rate rate

Malaria

Benign Tertian 280 1 656

Quartan 11

Malignant Tertian ... 270 io 46 i5

yi-94% >5-55%
Mixed Infection 52

Type Undiagnosed ... 202 3 185

Cachexia 160 4 J 372 50

Dysentery and
Diarrhoea l

Amoebic 44 i 1 86)

Bacillary 65 13 >13-93% 90 29
116. 2 z
Diarrhoea 13 3 52 8 I)
Ankylostomiasis 121 5 4-13% 44 6.81%

Veneral Diseases

Syphilis 186 1 36 1

Gonorrhoea and its > Nil.

sequalac 205 >o-75% 76

Soft Chancre 8 2 J

Ulcers 160 I 0.62% 300 I o.330^

Pneumonia 90 13 14.44% 51 24 47.05%

Phthisis 80 27 • • • 46 11 2.39%

Beri-Beri 140 12 8-57% l86 45 24.19^

 L
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Assault Cases treated in Government Hospitals.

During the year 1927.

Name of Hospital Malays Chinese Indians Others Total

Kota Bharu ... 225 53 28 l8 324

Kuala Krai 23 17 24 64

Pasir Puteh 55 4 6 65

Tumpat 95 10 11 9 125

Total 398 84 69 27 578

 59

APPENDIX XIII.

Microscopical Examination in State Hospital, Kota Bharu

Faeces—

Ova Ascaris Lumbricoides ... 3^

,, Ankylostoma duodenale ... ^3
,, Trico caphalus dispensary ... 201
,, Entamoeba Histolytica ... ... 87
» Negative ... ... ... I30

1,002

Blood—

Benign tertian ... ... ... 263

Sub ” ••• ••• ••• 353
Quartan ... ... ... 27
Mixed infection ... ... ... 67
Sputum T. B. ... ... ... 4I
Bacilli Lepra ... ... ... 7
Negative ... ... ... 894

1,652

Kuala Krai Hospital.

^aeces—

Ova Ascaris Lumbricoides ... .... 19

,, Ankylostoma duodenale ... ... 48
,, Entamoeba Histolytica ... ... 196

263

3lood—•
Benign tertian ... ... ... 682
Sub ,, ... ... .... 47
Negative ... ... ... 3°4
Sputum T. B. ... ... ... 51

1,084
 6o

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