Annual report of the Superintending Medical Officer / Jamaica.
- Jamaica. Medical Department
- Date:
- [1918]
Licence: Attribution 4.0 International (CC BY 4.0)
Credit: Annual report of the Superintending Medical Officer / Jamaica. Source: Wellcome Collection.
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![The,, fruit has been eaten for many years, and these mysterious sudden deaths have occurred year after year but the two things have never been connected until one’s investigation a.nd experimental work of 1915 onwards had the fortunate results of elucidating the matter. These deaths were and even are now attributed to worms, to cold (in the tropics!), to starvation (although the majority are well nourished), to duppies and evil spirits and to obeah. This last is not an imaginary danger, for the poison almost certainly belongs to the Toxalbumin or phyto-albumose (phyotoxin) group in common with llicin, Crotin, Abrin and Robin for which no distinctive test is known, and may be used for purposes of homicide with little risk of detection. These points, however are side-issues; what one would impress upon the people is that if the pre¬ cautions recommended were conscientiously carried out, vomiting sickness and ackee poisoning would disappear from the record of causes of death and hundreds of lives would be saved. Even this year with a large incidence of cases the reduction of the mortality by some 60% is gratifying in showing that one’s efforts have not been altogether fruitless and gives ground for the hope that fmdher propagandist efforts may lead to total eradication of the disease in epidemic form. I would like to acknowledge the help which has been afforded me in this last investigation by the various Medical Officers who took the trouble to make personal enquiries as to the histories of the cases, particularly Drs. Campbell, Purchas and Watson in Trelawny; Dr. Dryden in Clarendon; Dr. Wilson in St. Ann’s; Dr. Gideon in Portland and Dr. Crooks in St. Andrew. Direct questioning of parents in nearly every case is met at first with a flat denial of the use of the food at the meal preceding the illness. .The reason for this are three: 1. The child may have picked the immature fruit and eaten it without the parents’ knowledge. 2. The use of the term “Ackee poisoning.When the police make the preliminary enquiries before an autopsy is ordered, the native is afraid that he will get into trouble either for not looking after the children carefully, or on the graver charge of “poisoning” the children. 3. They fear that, if it is acknowledged, the trees may be cut down and they will thus be deprived of a useful and palatable food. d'ho denial is valueless. In many instances at the post-mortem examination ackees are found in the stomach. In this connection the following extract from a letter sent to me by a District Medical Officer is of interest:. “I.may mention that in the past there have been several instances at post-mortem in which ackee has been found by me in the alimentary tract, but out of several only in one case did the relatives admit that the child ate the ackees.”. . . . If the vomiting has removed these, confirmation of the suspicion is often found by examination of the kitchen, where ackees ripe, and unripe, and husks of those which have been recently used, are seen. Many examples of this are afforded by the brief histories given in the fuller report. Fortunately although there is no known chemical test for proving the presence of the poisons of this class in the tissues, the microscopical changes are so very marked and characteristic that they are unmistakable. These changes need not be given in detail here, they have been described in my former reports and monograph on this subject. In a detailed report sent to the Tropical Diseases Research Committee full accounts of all the 172 cases either seen by me or brought personally to my notice were given, but this cannot be done in the present report. The essential points are set down in the accompanying Table and where the statement in the “Remarks” column occurs “For details see text,” the fuller detailed report is there referred to. In order to make the investigation-as complete as possible, I requested that autopsies might be carried out on all cases terminating fatally and that tissues should be sent up to the Laboratory for sectioning. As will be readily understood this has entailed an enormous amount of work, especially when one is single handed and the routine work had to be dealt with at the same time. However, the response to my request was almost universally acceded to; in the majority of cases the post-mortems were ordered and specimens sent. I regret to say that in one district in the island where cases are rare, burial was ordered and post-mortem exa.mination refused, but this is almost the only place where full investigation was negatived. The Table then. Table X, appended to this report has been compiled in order that the salient facts may be brought together in an easily comprehended form and in order that general conclusions may be deduced from the large number of patients affected in this epidemic. Two or thi-ee points only need be especially insisted upon. • The most important of these is the fact that of all the cases which have been reported to me as vomiting sickness in this epidemic, there was one case of Fish poisoning, terminating in recovery, one of ptomaine from fish in which, however, ackee was a part cause of death; two of Gastritis, both recovering; one fata] case of Scarlatinal nephritis; seven of malignant malaria, only one of which recovered, and one in which death was due to ackee during the course of a malarial attack, and one from gastro-intestinal troubles associated with dentition. There fore of the 172 cases all but 14 were cases of ackee poisoning, and in two out of these 14 ackee took part, although not being solely responsible for the symptoms, in other words in the recent epidemic out o ' 172 cases which were brought personally to my knowledge as “Vomiting Sickness” no less than 158 or 91.86% were instances of ackee posioning. This in a nutshell is the final corroboration of my discoveries of 1916, the proof of what I put forward then-merely as a theory that Vomiting Sickness, the true vomiting siickness which was recorded as ac¬ counting for so many deaths each year, was nothing more nor less than Ackee poisoning, the fruit of the Blighia sapida used in an unfit, immature condition for food. Experimental work carried out with extracts made from these constituted the proof and has been already recorded and need not be narrated again in the present report. It is high time then that this reprehensible term of Vomiting Sickness be expunged from the momen- clature of diseases in this island, for the labelling of a disease by the name of one symptom, which symptom even may be absent, hinders advancement and leads to carelessness in diagnosis. This state of things would be analogous to diagnosing “death from headache” when the patient may have suffered from the headacheof typhoid fever, or that of cerebral tumour, or that of urmmia, and so forth, and disregarding the origin of the headache. Seeing that the macroscopica and still more the microscopical anatomy](https://iiif.wellcomecollection.org/image/b3148184x_0027.jp2/full/800%2C/0/default.jpg)
