PUBLIC RECORD OFFICE
Reference :-
C.O. 885
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO
22 PUBLIC RECORD OFFICE, LONDON
15.
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With regard to the question of the endemicity of yellow fever in Jamaica, it may be stated broadly that the local theory is that in certain places, especially Port Royal and Up Park Camp, in St. Andrews, and less presumably in some other centres of population long occupied or visited by Imperial troops or other unacclima- tised Europeans who have shown themselves specially susceptible to the disease, the germs of yellow fever are latent here and there in the soil, and that outbreaks have resulted and may result from disturbance of the ground. The history of such cases as have occurred in recent years appears to bear out this theory. The more recent contributions to the theory of the dissemination of yellow fever have added the recognition of the stegomyia mosquito as the carrier of the germ of infection. I do not think that it has ever been held that yellow fever may not appear in Jamaica in such localities as those I have referred to without being introduced from outside, but it is, as Captain Potter remarks, of interest to observe that of all the explanations of the causes of vomiting sickness yellow fever has never been suggested, notwithstand- ing that vomiting sickness is a complaint of considerable prevalence occurring in certain parts of the Island every year, and that cases of the illness so described have constantly come under the observation of the medical practitioners acquainted with yellow fever.
16. It appears to me that a very strong presumption against Captain Potter's hypothesis is suggested by the facts:-
(1) That vomiting sickness has not been identified as yellow fever by medical
practitioners familiar with the latter disease;
(2) That_it.commonly prevails in localities never identified as habitats of
yellow fever;
(3) That it does not commonly prevail in other localities which have been
specially notorious as such habitats.
(4) That it does not prevail amongst those racial sections of the population who have always been recognised as most susceptible to yellow fever, but rather especially amongst those who have always been considered least susceptible to that disease;
(5) That it prevails predominantly amongst children, whereas yellow fever is a discase to which adults have, in the experience of the past, been con- sidered more liable;
(6) That it does not prevail at that time of the year in which yellow fever has in the past principally prevailed, but that it is most prevalent at a period of the year and under climatic conditions in which yellow fever has been most usually absent, and which have been regarded as the safest in respect of that disease for those persons specially liable to it. 17. Captain Potter observes that in countries where yellow fever is admitted to be endemic, Brazil, Peru, and Mexico, there is described a disease in every way similar to the vomiting sickness of Jamaica, and that it is suggestive that one of the popular terms for vomiting sickness is black vomit. He might have stated that in Brazil and other Spanish-American countries the disease known to him as yellow fever is commonly called “El Vomito."
18. Captain Potter expresses his opinion that there is no justification for the use of the term " vomiting sickness," and that it is not a separate clinical entity.
It would appear to me that if the various grades of disease which he is prepared to describe under the term " yellow fever" are to be so regarded, then it might be equally true to say that " yellow fever " is not a separate clinical entity.
19. I have not noticed in any part of Captain Potter's report the slightest indication that he made any attempt to study the possible history of the infection of the cases he was reporting on by stegomyia mosquitoes. The presence or absence of stegomyia mosquitoes and the possibilities of their causing infection to the patients, and any evidence of such mosquitoes having been able to convey infection from one case to another, would have appeared to me to be a very important and requisite section of any study of the subject involved in Captain Potter's hypothesis.
20. It is quite possible, of course, that such investigations were made, though not referred to. observe in Appendix F a statement purporting to give the results of laboratory cultures, whereas Captain Potter does not give any particulars in his report of the carrying on of such cultures, and did not, I understand, obtain from the Colonial Government means of conducting such extensive experiments as are indicated.
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21. In view of the fact that the Government has expended more than £700 on the investigations conducted by Captain Potter with results which appear to me to be inconclusive, and which suggest conclusions which appear in some respects to be fallacious, and to be founded upon investigations in some respects (as I have indicated) somewhat incomplete and perfunctory, I have not thought it advisable or justifiable to apply to the Legislative Council for any further provision at this stage for the expedition of another mission from England.
22. ↑ believe that the Government has at its disposal in the Island sufficient medical talent to enable it to effect, by means of steps that are now being taken, a considerable advance in the identification of the various diseases that have been grouped under the name of vomiting sickness. In connection with this investiga- tion Captain Potter's suggestion that the fatal cases are generally cases of yellow fever is of arresting importance, and it cannot be doubted that the greatest care will be exercised to test this hypothesis whilst at the same time not neglecting the means of identifying by bacteriological examinations any other specific disease that may be present, and am disposed to concur in the views expressed by Dr. Ker in his minute of the 4th instant, and that Dr. Scott and other officers of the local medical service might be allowed the opportunity of earning the credit of completing the solution of the questions left undetermined by Captain Potter.
I have, &c.,
Enclosure 1 in No. 46.
SYDNEY OLIVIER,
Governor.
MINUTE by Mr. P. C. CORK, Acting Governor.
It will be necessary for post-mortems to be ordered in accordance with the law and to take their usual course. But the District Medical Officers should be supplied with forms for special reports in addition. The Superintending Medical Officer's drafts of history and post-mortem forms should be sent to the Government Printing Office for 1,000 copies of each to be printed on paper of a different colour from the post-mortem form, and the District Medical Officers should be instructed to fill in and send to the Senior Medical Officer direct, in addition to the usual report to the Coroner, the coloured forms duly filled in in cases where the post-mortem examination does not disclose that death occurred from some recognised disease. The Senior Medical Officer shall be the judge as to whether the case was one which should have been reported specially, and he shall be at liberty to refuse to pay for histories or post-mortem reports made contrary to these instructions. Histories shall be sent in when the District Medical Officer saw the patient during illuess and is in a position to furnish all particulars: post-morteni reports shall be sub- mitted when an autopsy has been made and the death cannot be attributed to any recognised cause except the so-called vomiting sickness. For each history report let 10s. 6d. be paid, and for each post-mortem report 10s. 6d., in addition to the usual fees for the autopsy and report to the Coroner.
I have made out a separate statement of procedure. Let the forms be printed at once, then bring up the papers for the Governor to see on his return. His Excellency may desire to alter the instructions.
In the meantime, the Senior Medical Officer has been asked to state in what districts vomiting sickness appeared last winter. As soon as the information is received special measures should be instituted to prevent the breeding of stegomvia in those places, and general instructions again pressed on the Boards to institute an anti-mosquito campaign.
P. C.
15 July, 1912.
Enclosure 2 in No. 46.
MINUTE by Mr. P. C. Cork, Acting Governor.
Further information of as exact a nature as possible being required concerning the so-called vomiting sickness, the following procedure should be adopted.
1,000 copies each of the history form and the post-mortem report form attached to 9187/12 should be printed on paper of a different colour from that used for the ordinary post-mortem form.