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140
However mild a case seems to be, and however good the general condition, I have never yet seen recovery take place in "vomiting sickness" if convulsions occur or if consciousness is once lost, and I have notes now of nearly three hundred cases. The points I have noted previously may be briefly recapitulated in this connection:-
1. That, in view of the sudden onset in apparently perfect health, without any prodromata, and the absence of any bacterial findings in a typical case under favourable circumstances, the weight of evidence is against the disease being due to a bacteræmia.
2.
That the rapidity of progress of symptoms with early fatal termina- tion, or, in rarer instances, an equally rapid and complete recovery without deleterious after-effects, rather indicates the action of poison. 3. That, in view of the early symptoms being gastric and the cerebral succeeding soon after, this poison probably acts first upon, and is then absorbed from, the stomach; the gastric and duodenal congestion present tend to support this.
4. That, since chemical tests of the stomach contents (which in former years have been repeatedly tried by the Island Chemist) have revealed none of the usual poisons and no signs of alkaloids, the poison (if such it be) is one which rapidly leaves the stomach or is rapidly decomposed; for example, it may be of the nature of a glucoside. 5. That it rapidly spreads over the whole body, as is evidenced by the hæmorrhages and other changes which may be present in almost every organ and tissue.
6.
That it produces its effects, apart from the clinical symptoms arising from cerebral causes, in the main upon the liver, as evidenced by the extensive fatty changes set up in that organ.
These are the points to which I drew attention last year, and to them may be added the fact that the vomiting sickness outbreaks correspond in respect of time exactly with the main ackee season; that is, the end of November to the middle of March or, in favourable years, to the end of that month or even the first week or so of April.
So extensive an outbreak as that above recorded in the Montego Bay district is sufficient to make out a strong case inculpating the ackee, since so large a number of patients being attacked in such rapid sequence with toxic symptoms, giving almost identical histories as regards the question of diet, cannot be ascribed to mere coincidence.
In conclusion, I beg to add that no one is better aware than myself that the chain of evidence is not complete without confirmation by means of animal experi- ment. This will be the next step in the investigation; I have, in fact, started upon this aspect of the question, but it is a difficult matter to obtain "suspected" ackees, the season being just over.
One small, but nevertheless important, point may be mentioned now, and that is that I prepared an extract ("pot-water") exactly in accordance with the methods detailed, by boiling with water. A small quantity of this extract, after being filtered, was administered intragastrically to a kitten previously in perfect health. Within forty minutes it began to show signs of being affected, vomiting ensuing, with recovery in two to three hours. A second dose, a little larger (the two together would be not quite the extract from one ackee), was similarly adminis tered the following day, when vomiting again came on after about the same interval, followed some fifty minutes later by a comatose condition, which terminated fatally the same day.
The autopsy showed a pale condition of the liver and intense congestion of the meningeal and cerebral vessels, just as one sees them in human vomiting sickness. The tissues show a close similarity as regards the histological changes, but the examination of these is not yet completed. I have prepared a considerable amount of the extract from suspected ackees for analysis, in order to ascertain what is the toxic ingredient of the extract, and, if possible, to discover an antidote for it.
I have, &c.,
H. HAROLD SCOTT.
M.D. London: D.P.H, Government Bacteriologist.
Pus
Sputa
141
TABLE 1.
SHOWING THE NUMBERS OF SPECIMENs examined MONTH BY MONTH.
September 20th
to 30th, 1914.
126
November.
JP8⠀⠀⠀ December.
January, 1915.
February.
March 1st to 21st.
Totals.
114
Blood for Widal's test
50
130 121
86
75
38 |
626
Faces for helminthiasis
109
300
296
328 299
242
1,912
Faces for dysentery, typhoid, etc.
3
18
26
20
10
11.
1
Blood smears for malaria, etc.
35
101
79
114
120
62
641
1
6
6
10
11
7
51
Urines
7
11
21
17
15
6
99
11
25
32
30
21
16
168
6
45
121
16
52
32
292
7
14
14
7
14
+
69
5
11
20
23
25
24
129
106
296 339 263 131 204
117 1,456
Totals
43 70 65 140 165 160
383 1,027 1,140 | 1,138 947 1,006
118
761
677
6,318
Tissues for section
Water analyses
Autopsies... Rats for plague Miscellaneous
TABLE II.
NUMBERS OF SERA EXAMINED BY WIDAL'S REACTION FOR ENTERIC FEVER, MONTH BY MONTH AND FOR THE WHOLE PERIOD OF BIX MONTHS.
1914.
September 21st to 30th
October November December
1915.
January February
March 1st to 21st
Total
Month,
...
D
...
TABLE III.
Total.
Positive. Negative.
Doubtful.
=98 582
88%
50
11
35
130
42
121
44
126
33
86
31
29
19
626
209 1
380
37
285 28 289
S on 23
3
NUMBERS OF WIDAL'S TESTS WITH SERA SENT UP FROM KINGSTON AND THE PUBLIC HOSPITAL, WITH PERCENTAGE RESULTS MONTH BY MONTH and for WHOLE PERIOD.
1914.
September 21st to 30th October
November
December
1915. January February
March 18 to 21st
Whole period
Month,
:
3
Total Number.
Percentage Percentage Percentage
positive.
megative.
doubtful.
31
22:58
67.74
9.68
71
30+98
66.19
2.83
71
35.21
59.15
5.64
73
27.39
64.39
8.22
49
30-61
65.31
4-08
37
29-73
62.16
8-11
19
36-84
52.63
10.53
351
30-48
63.25
6.27
The Honourable
The Superintending Medical Officer.
Bay-la-Mar
Alexandria
Brown's Town
Gayle
Manchionsal Grange Hill
District.
Number sent.
Positive.
Negative.
Doubtful.
Kingston and Hospital
351
107
222
St. Andrew
55
22
24
22 9
Port Antonio
47
8
36
Mandeville
24
18
5
Montego Bay ...
23
8
15
Buff Bay
19
12
18
10
Lionel Town
Plantain Garden River
16
10
Spanish Town
12
3
Luces ...
Linstead
St. Ann's Bay
Port Maria
Annotto Bay
Morant Bay
Chapelton
Richmond
11
11
9
7
6
May Pen
Old Harbour
Ulster Spring
Totala
Percentage
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