CO885-(23-24) — Page 365

PUBLIC RECORD OFFICE

سلسل

Reference :-

C.O. 885.

23 PUBLIC RECORD OFFICE, LONDON

ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO |

136

Was taken ill with vomiting about the same time as her sister, 3 p.m., 20th February, and was sent to hospital. Temperature on admission was 1010 Fahr.; the same medicine was given-ether and ammonia-and the child ceased vomiting, had no convulsions or loss of consciousness, and was appa- rently well by the following day.

(26) S.W., female, aged 6 years; sister to the last.

Nothing was known for certain about the nature of the food of either of these two, but there were several ackee trees in the yard where they lived.

These two cases show well what I have previously recorded, namely, the rapidity of recovery and the completeness of it, and how two children of a family may appear to be equally ill but in a few hours one may be dead while the other is up and about and to all appearances quite well. It is possible that the older child took more of the poison-whatever it be since the vomiting in her case came on an hour earlier than in the younger sister, and the latter was therefore treated sooner after the onset of the symptoms.

(27) I.F., female, 4 years. Was apparently quite well until 3 p.m., 20th An hour later her February, when she lay down and went to sleep.

gave her mint tea and mother tried to wake her, but could not. She rubbed her with asafoetida," and the child seemed to revive a little. Almost directly there was some twitching and a “slight convulsion," and the child lost consciousness and remained in a state of coma until death at 1 p.m., 21st February.

The food had consisted of "yam, bananas, and possibly ackee." There were Mother was not quite certain whether the patient ate any. large numbers in the yard.

In my report last year* I spoke of the primary gastric symptoms, with pain and vomiting, and the usually secondary cerebral symptoms of convulsions and coma, preceded by "cerebral vomiting." The above case would be a good example of the usually later cerebral effects, with suppression of the irritant and local gastric symptoms what has been described as "vomiting sickness without vomiting."

看感

(28) C.Y., female, 10 years. Complained on the evening of 22nd February scratching of pain in the abdomen, and the mother noticed that she was her nose.' Knowing (as the woman stated) that these were symptoms of worms, she gave the child a worm powder. The pain was eased, and during the 23rd the child was going about apparently quite well. On that day at 3 p.m. she vomited twice, and within the succeeding five hours three times more. She seemed much better, but said that she was hungry, and was given some tea, and slept well afterwards.

At 7 a.m., 24th. she seemed to be "droopy," and her mother gave her some castor oil "to work off the worm powder "; this was brought up again, and she vomited after this three times in all, but retained consciousness and talked to her mother. At 8 a.m. she suddenly was seized with convulsions, and became comatose, remaining in this con- dition till death at 10.30 a.m.

C

The food on 21st consisted of yam, salt-fish, bananas, and ackees. The mother knew for certain that the child had ackees on that day, and

may have had them later, but was not quite sure."

I performed the autopsy with Dr. Thomson, and the pathological findings were the same as those previously described.

(29) E.M., female, aged 25 years. I interviewed this patient, and obtained the following history from her. She had been vomiting on and off shortly after meals for about a week preceding the date on which I saw her (24th February). Her food had consisted of bananas and ackees.

weakness,"

," and on 23rd she therefore These attacks she attributed to

took a larger meal, made up of fish, ackees, and bananas. The vomiting had been much worse since, but she had had no twitchings or fits. When preparing her food she had always boiled the ingredients up together, but had been careful to throw away the "pot-water."

This woman, therefore, had suffered from repeated attacks of vomiting after taking ackees, and a more severe attack after a larger

*See No. 7 in Appendix VIII. in [Cd. 7796], April, 1915.

137

meal containing them. She always threw away the water, but some had doubtless been absorbed by the solid food. (See later the suggested significance of this.)

(30) P.M., female, aged 8 years. On 23rd February, about noon, she was given a meal of fish (herring), bananas, and ackees, all boiled together, pot- but, as she said she did not want it, the ackees were removed, the "

At water soup" was left, and the patient took some of it.

"J

or

2 p.m. she suddenly vomited. This stopped before 5 p.m., and the patient slept well all night, and the abdominal pain which had been complained of disappeared. At 6.30 a.m., 24th, she again complained of pain and vomited, and was sent to hospital. The temperature on admission was subnormal, 97.60 Fahr., pulse 80. The spleen was palpable, the tongue furred, and pain in the epigastrium was com plained of, but palpation was not resisted. Blood-smears were taken, but no malarial parasites were seen, and a differential count of the leucocytes did not reveal anything definite: polymorphonuclears 61 per cent., large mononuclears 6 per cent., transitional 1 per cent., lympho- cytes 31 per cent., eosinophile 1 per cent.

She was given a mixture containing ether and ammonia; there was no further vomiting, the child felt better the same evening, and appeared quite well by the following morning, 25th.

This case is a good one as showing the toxicity of the "pot-water." (31) P.R., male, aged 8 years. Quite well until 5 p.m., 24th February, He suddenly began when he had a dinner of salt-fish and ackees. vomiting at 7 p.m., but did not complain of any pain; he vomited up ackee. He then went to lie down, and seemed much better in an hour or so, and slept till 5 a.m., 25th, when he had a fit and became uncon- scious. He had frequent twitchings of the limbs, and at times more generalized tonic contractions. At 7.30 a.m. the pupils were contracted, but when seen again at 9.30 a.m. they were dilated and there was no conjunctival or pupillary reflex. Temperature subnormal; bowels acted twice after an enema. The knee-jerks were well marked, if anything, somewhat exaggerated. He showed frequent twitching movements, and was in a state of cerebral irritation, lying generally flexed up, though apparently unconscious, turned away restlessly when disturbed. He continued in practically the same state, but with deepening coma, until death at 3 p.m.

Blood-smears were taken, but no malarial parasites were seen, and a differential count of the leucocytes gave: polymorphonuclears 77 per cent., large mononuclears 3 per cent. (none pigmented), lymphocytes 17 per cent., eosinophile, basophile, and transitional each 1 per cent. The spinal fluid flowed under considerable pressure in a steady stream. but on cultivation the tubes remained quite sterile, both with agar and nasgar, though smears of the same fluid showed a few cocci, mainly diploid, not readily decolorized by Gram's method, and not intracellular. At the autopsy the meninges were found very congested, the vessels and those of the brain surface being engorged, and there were hazy, milky-looking deposits in patches on the surface of the pia.

The other appearances ventricular fluid was in excess, but clear.

The were

like those already described-liver somewhat fatty, mesenteric glands enlarged and hyperemic, stomach congested.

As this case occurred in Montego Bay itself I was able to watch it throughout its course. It afforded a typical example of the usual vomiting sickness attack-the initial gastric irritation with vomiting, the temporary amelioration of symptoms, the subsequent return with symptoms of a cerebral nature, convulsions, and coma, terminating in death.

(32) A.R., female, aged 2 years 10 months. Apparently in usual good health until 1 p.m., 24th February, when she started to vomit. She had complained of pain in the stomach about noon, but this did not appear to be severe, and at 1.10 p.m., after vomiting twice, the child went to lie down. The vomiting soon increased in frequency, but was not so violent that is, it was more of the character of regurgitation and

પ