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from the upper level of the blood to the clean end (the blood must not be heated), which is then sealed in the flame. As the air cools the blood is drawn away from the end by which it entered and this end is sealed in its turn.
To make a thin blood smear: Let a clean slide touch the drop of blood (not the finger itself) about half-inch from the end. Then with the short edge of another slide held at an angle of about 45, or with a needle held horizontally on the slide, touch the drop and wait a second or so till the blood has extended by capillary attraction nearly the breadth of the first slide, and then draw the upper slide (or needle, if that is used) once along the lower slide.
To obtain a specimen of cerebro-spinal fluid: this is not at all difficult and is of paramount importance in this investigation. A line joining the upper points of the iliac crests crosses the spine at the upper edge of the spinous process of the 4th lumbar vertebra. With the patient lying on the left side, the knees drawn up, identify the space between the 3rd and 4th vertibræ. Clean this part. Enter a hypodermic needle (or preferably one a little longer) through the centre of this interspace, I centimetre (one third of an inch) to the right of the middle line, and direct it forwards, slightly upwards and slightly inwards. Note whether the fluid appears to flow as if it were under pressure.
Allow the first few drops to escape, and then let some flow directly on to the medium in the tube provided. Remove the india-rubber cap on the tube, heat the wool plug to sterilise it, and remove it, keeping it in the hand, and allow the cerebro- spinal fluid to drop into the open tube. As soon as a few drops have fallen on to the surface of the medium, remove the tube, hold the neck and the wool plug in a flame, in order to destroy any extraneous organisms which have settled on them from the air, replace the wool plug and the rubber cap, and despatch to the Laboratory.
The fluid from the cerebral ventricles at the post-mortem can be withdrawn by means of a sterile hypodermic syringe and the tube of medium be inoculated in à similar manner, taking care to keep out extraneous contamination as above, hy flaming the neck and the plug. A culture tube inoculated with some fluid should be forwarded in every case: if seen during life, that taken from the spinal canal; if not, that taken from one of the cerebral ventricles.
Enclosure 4 in No. 46.
From the SUPERINTENDING MEDICAL OFFICER to the ACTING COLONIAL SECRETARY. SIR,
Island Medical Office, Kingston, 3rd August, 1911. REFERRING to my minute, dated 20 July, 1911, on your No. 6036 10, I have the honour to forward, for the information of His Excellency the Governor, the accompanying copy of a letter from Captain Potter, R.A.M.C., and to ask that arrangements be made for obtaining his return passage to England.
The Honourable
The Acting Colonial Secretary,
Kingston.
SIR,
I have, &c..
J. E. KER, Superintending Medical Officer.
Enclosure 5 in No. 46.
From Captain POTTER to the SUPERINTENDING MEDICAL OFFICER.
Kingston, 2nd August, 1911.
I HAVE the honour to report that I shall have completed my investigations into the so-called Vomiting Sickness" and "Peripheral Neuritis" by about the 10th of the present month, and request that a passage may be provided for me on August 14th by Messrs. Elders and Fyffes.
I shall prepare my reports on vomiting sickness and peripheral neuritis on arrival in England.
63
The former I hope to have ready in about six weeks after arrival in England, and the latter in about a couple of months later.
I have, &c.,
The Honourable
Superintending Medical Officer.
T. J. POTTER,
Captain, R.A.M.C.
Enclosure 6 in No. 46.
From the ACTING SUPERINTENDING MEDICAL OFFICER to the COLONIAL SECRETARY. SIR,
Island Medical Office, Kingston, 20th September, 1912.
I HAVE the honour to transmit herewith, for the information of His Excellency the Governor, a report by Dr. Scott upon the recent outbreak of the so-called "vomit- ing sickness" in Franklin Town, together with the pathological findings in connection therewith.
I have, &c.,
The Honourable
SIR,
The Colonial Secretary, Kingston.
LAWSON GIFFORD,
Acting Superintending Medical Officer.
The Pathological Laboratory,
The Public Hospital, September 16th, 1912.
I HAVE the honour to report upon the recent outbreak of the so-called “ vomit- ing sickness" in Franklin Town, together with the pathological findings in connection therewith.
"..
Briefly, the history of these cases is as follows:-
A cigar maker, named Adolphus Peart, his wife and seven children, lived in a small house of two apartments, No. 6, Norfolk Lang, Franklin Town. Three of the children, named Constantine, Adolphus, and Ruby, aged 8, 5, and 3 years respec- tively, were a little out of sorts and had slight attacks of vomiting during Wednesday, September 4th, but were not, to all appearance, sufficiently ill to call for any treat- ment, and at night the whole family retired apparently in ordinary health. About midnight, the youngest (Ruby) again began to vomit, and shortly afterwards Adolphus and Constantine did the same. This, however, seems to have ceased temporarily, and the children fell asleep again. In the early morning the second child (Adolphus) woke up, asked for some food, but, before having any, went off in a convulsive attack; the other two (Constantine and Ruby) within a short period were also attacked by convulsions, and all three lapsed into a state of coma. doctor was called in, but shortly after 7 a.m. the one first attacked (Adolphus) died. The other two were brought to the hospital at 9 a.m., suffered at intervals of a few seconds from convulsive seizures, the spastic condition of the neck, in the case of the older patient at all events, not completely relaxing even in the intervals, and the younger (Ruby) died at 10 a.m., the older (Constantine) at 10.55, without recovery of consciousness in either case.
A
In the meantime the eldest girl of the family, Ethel, aged 14 years, started to vomit, and within a few minutes became, to a certain degree at least, unconscious. She was also brought to the hospital, arriving at 9.30 a.m. When. I saw her at 10.30 with Dr. Thomson, who is in charge of the ward to which she was admitted, she had recovered consciousness. but showed rigidity of the neck (and possibly spine), and while being examined had a convulsive attack; these were repeated, but were not so severe as in the case of the boy; nevertheless the patient sank more deeply into coma and died at 5.55 p.m. Thus, four of the children had died between 7 a.m. and 6 p.m.
L.
No dietetic error could be discovered in any of the cases, and apparently the only previous history obtainable was of a cold in the head" for two or three days preceding. This, however, had been disregarded, as the condition is common in the city.
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Post-mortem examinations were held in all four cases; the details of three of them, performed by me, will be spoken of shortly, after the history has been related.
At the funeral of these four on September 7th, another sister, Violet, aged 11 years, suddenly complained of headache, vomited, and became collapsed and semi- conscious. She too was hurried off to the hospital. She had recovered consciousness by the time she arrived, but showed a slight degree of rigidity of the neck, Kernig's sign present on the right side, but to a much less degree on the left (in fact, it is doubtful whether it was present on that side at all). The vomiting was effortless and not accompanied by marked nausea, the pupils were equal and somewhat dilated. This patient is making a good recovery.
Pathological Details. Cerebro-spinal fluid was taken by lumbar puncture from Constantine, Ethel, and Violet. (Ruby was dead, and Adolphus had died at home.) The fluid in the first two cases was clear, in the last-named distinctly turbid. Enu- meration of the leucocytes in this last revealed 92 per cent. polymorphonuclear cells, and in several were small gram-negative diplococci. Cultures were made from all three, and in every case the meningococcus, or, to give it the full name, the diplo- coccus intracellularis meningitidis of Weichselbaum, was isolated. The nature of the organism was proved by sub-cultivation with various media and by fermenta- tion tests. It was also obtained from the intraventricular fluid of the child, Ruby, post-mortem.
The macroscopic post-mortem signs were similar in every case, but were more marked in Ethel, who had been longest ill. There was a distinct pearly haziness over the brain surface and base, extending down the cord, with excess of fluid (culti- vation of this also gave the organism), while in the case of Ethel the whole surface of the convexity of the brain, and particularly at the interpeduncular space at the base, showed a much thicker layer of pearly lymph, and here and there definite flakes
These meningeal signs were common to all, varying only in degree.
The only other morbid conditions found were, in the case of Constantine, some ordema of the lungs and some scattered petechiae on the surface (he had exhibited the most violent convulsions), and in the case of Ethel there were firm adhesions of the left pleura of old-standing, and a similar but less marked condition of the right. There were no signs of tubercle anywhere in any of the cases.
of it.
The viscera of all four who died were sent in sealed jars to the Island Chemist for examination, but he reports that no signs of any poison were discovered.
The initial catarrhal symptoms were, in all probability, what has been noted (by French writers particularly) as the "preminingeal catarrh," set up by the presence of the organism at its "site of election" in the upper part of the naso- pharynx, whence it spreads by way of the nerve canals through the cribriform plate of the ethmoid to reach the meninges.
The mother, the baby, and the son Reuben were admitted to hospital for observation, and swabs were taken from the upper reaches of the naso-pharynx in each case.
The meningococcus was isolated from the boy's throat, not from the other two. He is, therefore, carrying" the organism and has been detained at the hospital. Further examination will be made to see later on whether he still harbours the coccus. Authorities state that it is rarely found after three weeks.
The above history is typical of nearly all the acute cases of vomiting sickness, so I venture to hope that this unexpected series of cases may lead to the saving of many lives, owing to the discovery of the causative organism, for, as is well known, the mortality is very high in the centres in which the disease becomes epidemic in the colder months of the year. In epidemics elsewhere the appropriate use of the anti-meningococcic serum has reduced the mortality from over 80 per cent. to about 25 per cent. Vials of the serum have been ordered from home. From the cultures obtained I have prepared a vaccine in considerable quantity, and, should any more cases occur before the arrival of the serum, I would suggest the employment of this vaccine, which should be beneficial in some degree at least for those cases which from their severity are probably associated with meningococcæmia.
Summary(1.) In four cases presenting the typical symptoms of "vomiting sickness," the Weichselbaum's diplococcus has been isolated.
(2.) The organism was obtained from the cerebro-spinal fluid of all those from whom this fluid was taken during life, and from the ventricular fluid post-mortem.
(3.) The organism was obtained from the naso-pharynx of one of the contacts of these cases; though himself apparently in perfect health.
65
(4.) The intrecranial post-mortem signs are such as are consistent with death from cerebro-spinal meningitis at such an early stage, that is, with fulminating 'cases of the disease.
I have, &c.,
H. H. SCOTT, M.D., London,
Government Pathologist.
The Acting Superintending Medical Officer.
Enclosure 7 in No. 46.
From the SUPERINTENDING MEDICAL OFFICER to the COLONIAL SECRETARY. (Confidential.)
HONOURABLE COLONIAL SECRETARY.
November 4th, 1912.
Dr. Scott's findings show the absolute necessity for having a first-class and keen medically-qualified bacteriologist.
With regard to the Commission that it is proposed should come out from the Tropical School of Medicine of Liverpool, I can only express regret that they did not consider it possible to send out an investigation when I wrote and asked them or Sir Alfred Jones to come and help us about the year 1905. I forget the actual facts of the case, but the matter was reported, if I remember rightly, to the Secretary of State by Sir Alexander Swettenham.
2. I think, now, that as Dr. Scott has, perhaps, got on the right track, and in view of his very high qualifications, he might very reasonably be allowed to make such investigation as is necessary this year, and that the Tropical School might delay their Commission for a further occasion if found necessary.
Forms have been sent out to each District Medical Officer requiring full infor- mation on every case seen.
4.
*
*
#
It may be that the cases recently investigated have been sporadic cases of cerebro-spinal meningitis, a disease which may become epidemic as so-called vomiting sickness during the colder months, as appears to be the case with the disease elsewhere.
Under the circumstances I hope that His Excellency will devote any monies he may have for the purpose in allowing Dr. Scott to make a proper investigation, and ask the Tropical School to hold their hand for this winter anyhow.
J. ERRINGTON KER,
37231
No. 47.
JAMAICA.
Superintending Medical Officer.
RETURN OF MALARIAL FEVER. BLACKWATER FEVER, YELLOW FEVER, FILARIASIS, AND DENGUE DURING THE YEAR FROM THE 1ST JANUARY TO THE 31ST DECEMBER, 1911.
37664
(Received in Colonial Office, 25 November, 1912.)
[Published us No. 11A in Appendix I. to [Cd. 6669], March, 1913.]
(No. 283.)
No. 48.
FIJI.
THE GOVERNOR to THE SECRETARY OF STATE. (Received 27 November, 1912.)
Government House, Suva, Fiji,
24th October, 1912.
[Published as No. 5 in Appendir VI. to [Cd. 7261), March, 1914.]
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