MORBID ANATOMY 1697 



Morbid Anatomy. — There is a general hypersemia, with a tendency 

 to haemorrhages in various organs. The mucous membrane of the 

 stomach and the bowels is congested, while the lumen of these 

 organs may contain a dark slimy substance. There is fatty 

 degeneration in the liver and kidneys, and in the former case this 

 change is said to be more acute than in phosphorus poisoning. 

 Microscopically necrobiotic changes are found in the cells of the 

 liver, kidneys, and pancreas. 



Pathology. — The illness comes on suddenly in a person who has 

 previously been in perfect health, and is characterized by primary 

 or gastric vomiting, followed by a few hours of temporary cerebral 

 vomiting, which is rapidly followed by convulsions, coma, and 

 death, the average duracion of the illness being twelve and a half 

 hours. 



The poison appears to be an irritant to the stomach, and to cause 

 vomiting, which may rid the body of it, when the patient rapidly 

 recovers; but if it remains in the system it acts upon the nervous 

 system, causing the cerebral vomiting, convulsions, and coma, 

 which, apparently, always end in death. 



Symptomatology. — Somewhere about midnight a child wakes up 

 and complains of pain in its stomach, in a little time vomits its 

 last meal, and after this feels better. In certain cases no further 

 symptoms occur, and there is a rapid recovery. 



More usually, however, after a period of temporary relief the 

 vomiting commences again, and may be accompanied by fever, while 

 the vomit consists of frothy mucus. These symptoms continue 

 until the child passes into a state of collapse, with cold sweats, a 

 weak and rapid pulse, and irregular respirations. 



These symptoms invariably lead to death, which is preceded by 

 convulsions. 



Variety. — In rare cases there is no vomiting, and only the cerebral 

 symptoms, drowsiness, convulsions, and coma, leading to death. 

 This is the so-called ' vomiting sickness without vomiting.' 



Diagnosis. — -The cardinal points in the diagnosis are: — Its 

 endemicity; its seasonal prevalence; its sudden onset in m.em- 

 bers of one family or in neighbours; in native children without 

 regard to sex; the quick complete recovery of some cases, while 

 others, after showing cerebral symptoms, end fatally; and finally 

 the evidenc e of having partaken of a meal containing ackees or their 

 extracts. It can be diagnosed from yellow fever by the absence of 

 the black vomit, and from cerebrospinal meningitis by an absence 

 of Koenig's sign and of the meningococcus. 



Prognosis. — This is very bad, as some 80 to 90 per cent, of the 

 patients die. If recovery is to take place, it is rapid and complete. 



Treatment. — No specific treatment is known. 



Prophylaxis. — Instruct the people not to use unsound ackees. 

 This has been done, with the resuli that in 1916 there were only three 

 deaths from vomiting sickness in Jamaica. 



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