PUBLIC RECORD OFFICE
Reference :-
C.O. 885
23 PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH—NOT TO
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but there were many ackee trees with ripe fruit in the yard, and many ackees were lying on the ground. She denied that she gave them to the children, but owned that they might easily have picked them up and eaten
them.
I am inclined to think that this is more likely, because the delay in onset would then be explained by the fact that only a small part of the fruit might be toxic (some soft part, for example), and, being solid, took longer in being absorbed; there was, it will be noted, very little local action, if any; there was no complaint of abdominal pain, but almost entirely nervous symptoms.
(17) A.M.H., female, 8 years; sister to the last two. She was helping with her brothers when she herself began to vomit at 10 a.m., 18th, and con- tinued to vomit for two-three hours. About 1 p.m. convulsions set in, followed immediately by coma, which lasted tilf death, between 6 and 7 p.m.
This child had also been for a short time to the hut of the grand- mother, not all day as the others had; the mother stated that she had given her a meal of yam, bananas, "salt-fish," and "possibly a little ackee.” (See the next case.)
(18) A.H., female, 42 years: mother of the last three. Began to vomit about dawn (6 a.m.). 18th February, and during the succeeding two hours vomited three times, and then felt faint and giddy, but had no convul- sions or twitchings, and did not lose consciousness. The next day she On the 24th, when I still complained of the faintness and dizziness. interviewed her, she was much better, but still felt weak and slightly dizzy.
This woman definitely stated that her food on the day in question (17th) consisted of yam, bananas, and ackees; and, seeing that the daughter, A.M.H., was with her for practically the whole day, and took her meal with her, the former almost certainly had ackees too, for, as mentioned in the last series, it is most unlikely, to say the least, that the mother would cook two dinners of the same ingredients-yam, bananas- and place ackees in one and not in the other. More probably all three constituents were boiled up together, and then, as appears to be cus- tomary, the mother ate the ackees herself and the child had some of the
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The latter's attack yam and bananas and the "soup pot-water." terminated in death, while the former suffered from gastric symptoms in the main with some vertigo and recovered.
Was quite well on 17th February, (19) J.Mc. B.B., male, 6 years 9 months.
but early on 18th appeared "droopy and dull." His food had on the 17th consisted of yam, bananas, and ackees boiled up together. During the 18th " soup "of a similar meal was given to him, but he only took a little of it, and the rest of the liquid was thrown away.
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At 5.30 p.m. he vomited, but did not complain of any pain. Con- vulsions set in immediately afterwards with coma, which lasted till death at 4 a.m., 19th.
(20) L.R., female, 26 years, mother of the last named. She began to vomit about 9 a.m., 19th, and vomited several times between then and 3 p.m., when the doctor who had come up to perform the autopsy of the child (No. 19) saw her and gave her some rum and milk. The vomiting ceased soon after. She had no convulsions nor any loss of consciousness, and made a good recovery.
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The food was the same as that mentioned above-yam, bananas, and ackees of which she took the solid, the liquid being thrown away after being refused by the child. It will thus be seen that the mother ate the solid ingredients and so much of the liquid as had soaked into them: she vomited and recovered, whereas the child had some of the " soup and died.
Was well until the afternoon of the 17th February, when at 4 p.m. she started to vomit, and continued doing so at intervals during the night; she brought un some ascarides. During the 18th she became unconscious (no convulsions were observed) and remained so till 4 p.m., 19th, when death took place.
(21) B.R.. female, 14 years 11 months.
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Food all that the mother would say was 'ordinary food," and 'yam and beef." There were ackee trees in the yard, and the mother rather over-protested against the idea of the girl having eaten any.
was not likely to be beef and yam. The place The "ordinary food was very poor, the child emaciated; beef would be a great luxury, and in their state of poverty ackees would be used for a certainty, as they were fairly plentiful in the yard.
(22) R.M., female, 4 years. Was quite well on going to bed on the evening of the 17th February, and on getting up on the following morning. At 10 a.m. she was seized with convulsions (no previous vomiting was noticed), rapidly became comatose, and died at 21 p.m. The post-mortem findings were those of vomiting sickness, and the case was reported as such, but otherwise it might be merely one of ordinary infantile con- vulsions of gastric or gastro-intestinal origin associated with worms, for there were many ascarides present.
Food: uncertain; said to be " pap," but the child was running about and there were many ackees in the yard, and she could easily have picked up an unsound one and eaten it. (23) Č.S., female, 25 years. Was quite well on 18th February, when she went to Montego Bay. While there she began to vomit, and on the way home at 3 p.m. vomited again. Within ten minutes of returning she vomited for the third time, was seized with convulsions and lost con- sciousness. She was seen by Dr. Thomson at 10 a.m. on the 19th, and was then comatose, but showing a tonic contraction of the arms, recur- ring every minute or so. She died, without recovering consciousness, at 4 p.m., 19th.
Nothing could be discovered about the food of this patient, but it may be noted that she lived in the same yard as the case No. 19, already related, where ackees were numerous.
(24) E.B., female, aged 13 months. Well until the evening of 19th Feb- ruary, when she began to vomit, and almost immediately was attacked by convulsions, passed into coma, and died at 4 a.m., 20th.
Food: "not known, probably pap." But the child, it was stated, was accustomed to crawl about unattended and unwatched, and there were ackees lying about in the yard.
(25) C.W., female, aged 8 years. Suddenly began to vomit at 2 p.m., 20th February. The District Medical Officer saw her soon afterwards, when she was still vomiting. She was then quite conscious, with temperature 10240 Fahr The vomited matter appeared to consist of yam and banana. She was brought to the hospital at 5 p.m., and a mixture con- taining ether and ammonia was given. She did not vomit again. Con- sciousness was retained until 8 p.m., when, without any convulsions, she passed comparatively suddenly into a state of coma. Stimulation was tried by injections of camphor, enemata containing whisky, etc., but she did not regain consciousness, and died at 10.30 a.m., 22nd, the condi- tion of coma lasting, therefore, for over thirty-eight hours.
This case was related to me on my arrival at Montego Bay, and Dr. Thomson and I performed the autopsy the following morning at the hospital. The body was somewhat emaciated, and two worms were making their way out through the mouth and nostrils.
There was no jaundice or discoloration of the conjuctive. The lungs showed hypos- tasis, the bronchial glands were swollen, the heart showed pulmonary stenosis with a patent ductus arteriosus. The liver was fatty, the spleen large (14 cms. x 3 cms. x 3 cms.) and dark; the pancreas was normal. The small intestines contained ascarides, with patchy conges- tion of the mucous membrane where these were collected; the stomach also contained worms, was congested, and showed small petechiæ near the cardiac end. The mesenteric glands were slightly enlarged, but not hyperemic. The meningeal vessels were engorged. The cerebro- spinal fluid flowed under pressure on making a lumbar puncture, but was quite clear. The culture tubes into which the fluid was inoculated remained sterile on incubation, and nothing abnormal was seen in the smears made of the fluid.