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PUBLIC RECORD OFFICE

Reference :-

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23 PUBLIC RECORD OFFICE, LONDON

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effortless-till at 2 p.m. muscular twitchings and convulsive attacks supervened; the child lost consciousness, and died comatose at 5

p.m.

The

The usual post-mortem findings were present in this case. spinal fluid flowed fairly freely, but was not under pressure as in the last patient. In the culture only two colonies of Staphylococcus aureus grew.

The food in this instance consisted of pumpkin, yam, peas, and ackees, all boiled together for the family, and the child was given the

pot-water" at 11 a.ni.

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In these cases, where the hour of the last meal and that of the onset of the vomiting could be ascertained with accuracy (Nos. 3, 4, 30, and 32), where "pot-water was taken, the interval between partaking of the food and beginning of the attack of vomiting was two hours. The best way of considering these cases is, I think, to group them in the follow- ing manner :-

1.

2.

In sixteen cases, namely, Nos. 3, 4, 5, 6, 7, 8, 9, 14, 18, 19, 20, 28, 29, 30, 31, and 32, there was a definite history of eating ackees or extracts ("soup or "pot-water" made with ackee) at the meal preceding the onset of the illness. If No. 17 be included-and there is almost sufficient evidence to warrant its inclusion-in this group, there are seventeen out of the thirty- two where there is no doubt that the attack followed closely on the inges- tion of ackees or an extract from them.

Those cases in which there is sufficient evidence to warrant a strong probability that ackees comprised one of the constituents of the meal prior to the onset of the illness. There are six which would come under this head, namely, Nos. 2, 12, 13, 15, 16, and 27; or, if No. 17 be taken from group 1 and placed here, seven.

3. This contains only two cases, Nos. 10 and 11, in which there is some evidence pointing to the fact that ackees were eaten, but not sufficiently strong to warrant their inclusion under the foregoing groups.

4. Lastly, there are seven in which no history was elicited of the eating of ackees, but it must be noted that in every instance trees bearing ripe fruit were growing in the yard in which the huts were situated, and amongst the poor people it would be most unlikely that the use of a food which was ready at hand, a food of which they all appear to be fond, and which was then ripe, would be avoided, and that at a time when other articles of food are scarce, or at least relatively expensive. The seven included under this category are Nos. 1, 21, 22, 23, 24, 25, and 26.

Briefly, then, we may say that in none of the thirty-two cases could the eating of ackees shortly before the onset of symptoms be definitely excluded; in sixteen the fact was absolutely certain, in seven more it was almost certain, in another two-giving a total of twenty-five-it was probable, while in the remaining seven it was possible. The eliciting of a history of ackee-eating is not always easy, for if the native once gets the idea that there is any suspicion of food or other poisoning he either becomes stolid and unable (?) to grasp the meaning of the simplest question, or states something quite false with the aim of putting the questioner off the scent. Thus, in the case of No. 21, the patient was badly nourished and lived in a poor hut, but surrounded by ackee trees bearing ripe fruit; the mother stated that the child had been given "just ordinary food," and when pressed for details would only reply "yam and beef," and tried to make me believe that the family practically lived on these two articles always, and protested most vehemently that they would not think of eating any of the ackecs which grew so plentifully at their very door.

Again, "salt-fish' is frequently named as an article of diet in the country districts, and in towns such as Kingston "salt-fish and ackee" is a favourite dish

" may not be fish at all.

I with many. In the country parts, however, "salt-fish had suspicions of this because, when asked what form of salt fish they had had (where this had been named as part of the meal preceding the illness), there was Dr. Thomson, the District Medical Officer. frequently no answer forthcoming. wrote to me on 28th February a letter from which I quote:

"I have since learnt, and I have made enquiries myself from several of the same class of people as those of Salt Spring and Granville, etc., and found that the statement is true, viz., that these people are in the habit of

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adding salt to the ackees and boiling it, and then add it to their food, calling it salt-fish. In many instances, when they say they had yam, banana, and salt-fish for breakfast, the salt-fish they refer to is the salted ackee.

"GEO. WM. THOMSON,

"District Medical Officer.

"26th February, 1915." People generally in this island are convinced that ackees, under certain con- ditions, are poisonous: among these conditions may be mentioned:

i. Unopened ackees, and, by consequence,

ii. Ackees which have not opened naturally, but have been forced after

falling unopened.

iii. Ackees with some soft spot in an otherwise apparently sound fruit. Now, among the better classes the ackees are gathered carefully one by one, and none are cooked but such as appear ripe and sound in every respect. Among the poorer people, on the other hand, as exemplified in the districts of Salt Spring, Granville, etc., a boy is sent up the tree to shake the branches; ripe fruit and some unopened and unripe ones fall together; the former are collected, while the latter are left on the ground. These in time open, and may then be gathered with the new ripe ackees which fall at the next shaking. Apparently an ackee fruit which has opened in the natural way on the tree and then is allowed to become over-ripe or even decayed is not poisonous (so I am informed; I have not had an opportunity of proving the statement); but an unripe, unopened fruit which becomes "forced" open the adult native is suspicious of. Children, naturally, would not make this distinction; hence the great incidence among those of tender age.

Some apparently ripe and wholesome ackees have a soft spot in the otherwise firm, fleshy part of the fruit; whether this is due to primary microbial develop- ment, or whether it arises from bruising when shaken from the tree, I cannot say, but the fact remains that if this is noticed the ackee in question is not used for food. I, personally, do not think that the latter explanation-bruising on falling -is the true one, because, as already stated, a ripe ackee which is allowed to decay is not believed to be poisonous, and experiments so far support this.

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Next, from a careful consideration of the histories of the above cases, the poison is apparently extracted by boiling the affected fruit with water. Nos. 3 and 4, 8 and 9, 12, 13 and 14, 19 and 32 support this. The bananas, pumpkins, yam, and ackee are boiled up together; the parents eat the ackees, while the children partake of the rest of the food, the older ones having more of the solid parts, which naturally have absorbed some of the water, and the younger children are given the "soup" or pot-water." The degrees of toxicity are varied in such cases, as in the series of the Johnson-Clark family (Nos. 37), where the adults who ate the ackees were slightly affected, having attacks of vomiting but recovering, the older child taking the solid part of the residue, with, of course, absorbed watery extract, and dying after thirty-four hours, the younger child, who mainly had the "soup," died in nineteen hours. The Glenn cases (Nos. 8 and 9) and the Cook-Wait cases (Nos. 12-14) are other instances in point.

pot- No. 32, a case of a young child under 3 years of age, who only had " water," is another example of the toxicity of the extract, death taking place in four to five hours.

pet- Undoubtedly a certain degree of suspicion attaches to the use of the "

as an article of diet, for, if the family is small and the food sufficient, this water is thrown away before the meal is taken, or the ackees are boiled separately and the fruit taken out and mixed with the other ingredients-yam, banana, pumpkin, etc.-while the water is cast aside.

water"

Whatever the nature of the toxin, it seems to be rendered inert, partially or completely, by stimulants in some cases; those patients who were seen in quite an early stage, the initial vomiting period, which, as I have previously reported, is, in my opinion. gastric in origin, had the best chance of recovery, the stimulant-rum, ether, ammonia, etc.-being followed by recovery, as in cases 5, 11, and 26.

On the other hand, when secondary vomiting has made its appearance which I believe to be cerebral, owing to its character differing from the former in being effortless and being followed almost at once by convulsions and coma, such stimula- tion seems to have no beneficial effect at all.