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(4) M.C., female, 13 years, cousin to the last and living in the same hut. Vomiting began at the same hour, 5 p.m., as the last, but there was no complaint of pain. The vomiting ceased at midnight, but returned There were no convul- again about noon and lasted till 9 p.m., 18th.
The post Died at 3 a.m., 19th. sions, but come with restlessness. mortem examination revealed conditions similar to those present in the last named.
Food: part of the same meal as the last patient, namely, the "soup” of the yam, bananas, ackees, which had been boiled together.
Mother of N.R.D. (No. 3) and aunt of M.C. (5) R.C., female, 26 years.
(No. 4).
Vomiting began at 5 p.m., 17th, and continued all night. It ceased in the early hours of the following morning, and as she felt better she took more of the same articles of food during the day as had been boiled The vomiting started for the family on the 17th (see last two cases). again in the evening of the 18th, continued during the 19th; she was then scen by the District Medical Officer and appeared collapsed. She was given hot milk and rum. She had no return of the vomiting, but rapidly recovered, and when I myself saw her on the 25th she seemed to be quite well.
She lived with the last three and was the (6) J.J., female, 65 years of age.
mother of R.C. (No. 5) and grandmother of N.R.D. (No. 3).
Vomiting began about 8 p.m., 18th February, and continued until 2 a.m., 19th, with abdominal pain. At first the food was brought up, later watery matter. Vomited off and on during 19th, but felt better, though "dizzy," next day. She made a good recovery.
Food: this woman partook of the same meal as the last, namely, yams. bananas, salt-fish, and acker.
(7) B.J., female, 21 years. Another daughter of the last named. Vomiting began during the evening of the 18th and continued at intervals during the 19th, ceasing on the night of the latter date. She was seen at the same time as R.C. and was similarly treated, with the same result.
Her food was the same as that of Nos. 3, 4, 5, and 6.
An important point to note in this series of cases is that the same food was used by all; the older members ate the solid and recovered, the younger were given the "soup
" or "pot-water" and died. Also No. 5 showed a return of the symptoms on again partaking of a similar diet.
(8) G.G., male, 8 years. Badly nourished. Was quite well till 17th February; he was given some 'tea and crackers" early and then went with his parents and sisters to their provision ground (I believe about a At noon a meal was cooked there which mile away from the town). consisted of yam, bananas, and ackee all boiled together. The parents stated that they themselves ate the ackees while the patient and his sister
p.m. had the "pot-water" and some of the other ingredients. At 3 vomited twice, and was carried home at 4 p.m. and given "mint tea,' which he brought up again almost at once (5 to 6 p.m.). At 9 p.m. he had convulsions, became comatose, and died at 2 a.m. on the 18th.
he
The autopsy revealed the same state of things. In the description of the rest of the cases, where nothing special is mentioned, it may be taken for granted that the usual post-mortem findings of vomiting sick- ness were present.
(9) D.G., female, 11 years; sister of the last. Vomited at 3 a.m., 18th, and Soon afterwards she was seen three times between this hour and 7 a.m.
by the District Medical Officer and was then unconscious. Convulsions set in at 9 a.m., and death took place an hour later.
Her history as regards food was the same as the last.
This one remained at (10) W.G., male, 9 years: brother of the last two.
home and did not accompany the others to the provision ground: Thera were many ackees in the yard where the hut was situated, but the parents did not know whether he had eaten any, though he may have had some of the remains of the food cooked at the ground (yam, bananas, ackee, as above). The parents only gave him three biscuits for his meals during their absence, and with so many ackees in the yard the probabilities are that he ate some. There was no other food tree in the yard.
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He started vomiting about 7 a.m.. 18th; be was seen by the doctor, who gave him some ether and ammonia. He had no convulsions, no coma or loss of consciousness, and made a good recovery.
(11) A.G., female, 4 years; sister to the last; she also remained at home. This patient was vomiting when seen by the District Medical Officer at
1
p.m., 18th. She was given some of the same mixture containing ether and ammonia; the vomiting ceased and she recovered; she was at no time seriously ill.
Food: there was some doubt on this point. The parents said that she, too, had had only biscuits (three for a day's food), but the child her- self stated that she had yam and bananas. Possibly she had some of the remains of the food cooked at the provision ground.
(4
These four cases are instructive. They all belong to the same family. Two undoubtedly were given ackee or ackee-water ("pot-water "), the other two had prob- pot-water" ably eaten some. Those who were known to have had the "soup" or died; while the others suffered from vomiting but were not seriously ill and soon recovered.
(12) F.W., female, 9 years. Went to school on 16th February quite well apparently, but at noon returned home with "fever." She slept well during the night and seemed to have quite recovered by the next morning She had a breakfast of "yam, bananas, pumpkin, and possibly ackee (there were many in the yard) "all boiled together." Vomiting began late in the evening of the 17th, and almost at once the child became con- vulsed and comatose; she continued in this state till death, which took place at noon on 18th.
(13) H.W., male. 1 year 9 months; brother to the last. Apparently quite well on going to bed on 17th February; about dawn on the 18th he com- plained of pain in the stomach; very soon he was attacked by convulsions, became comatose, and died at 8 a.m.
Food: "soup" or "pot-water," that is, the gravy or liquid from boiling the above articles of food.
(14) P.C., female, 25 years; mother of the last two patients. On 17th February she had a breakfast consisting of yam, banana, pumpkin, and ackees. Early on the 18th (about dawn) she had griping pains, vomiting, and diarrhoea. These symptoms continued all day, and she felt so ill that she was not able to attend to the two children who were dying. The next day she was seen by Dr. Thomson and was then very weak; the vomit- ing had ceased, but the diarrhoea still continued. She quite recovered in the succeeding twenty-four hours.
The history of the food in this last case tends to prove the presence of ackee in the meal of the two children (Nos. 12 and 13). It is incredible that a poor woman, such as this was, would cook two similar breakfasts, one for the children and another for herself, one of yam, bananas, and pumpkin, and the other of yam, bananas, pumpkin and ackee. Probably, nay, almost certainly, all four ingredients were cooked together, the ackees were picked out and eaten by the mother, the more solid residue by the older child, while the "pot-water" was given to the younger.
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Note the graded acuteness of the illnesses; the parent who ate the solid ackee was ill for thirty-six hours or so. but had only gastro-intestinal symptoms; the older child, who had some of the other ingredients with (probably) some of the absorbed pot-water" only, was acutely ill and died in about two hours. Very likely the "fever" on the 16th in the case of the older child was merely malaise with slight rise of temperature, or a mild malarial attack, which is a common thing in the district after rains.
(15) W.B.H., male, 5 years. Went to bed well on the night of 17th February; about 5 a.m.. 18th, began to vomit and did so for about an hour, but complained of no pain. Convulsions came on just after 6 a.m., he passed rapidly into a state of coma, and died at 9 a.m.
Food: see after the next case.
(16) G.S.H., male, 2 years 10 months; brother to the last. Started to vomit. at 7 a.m., 18th, had convulsions almost immediately, became comatose, and died at noon.
Food both children spent the day (17th) with their grandmother. who fed them This woman stated that she gave them yam and bananas,