Physical assessment of 30 chronic cannabis users and 30 matched controls

Ganja is used extensively in the working-class population of Jamaica, particularly in certain agricultural and fishing communities. Ganja smoking is illegal but can be accepted as part of the culture in these areas. Sixty male subjects were chosen for assessment, 30 chronic smokers and 30 controls from comparable social, economic, and cultural backgrounds, and were matched for height and age. A chronic smoker had smoked a minimum of three spliffs per day for a minimum of 10 years. The subjects were admitted to the hospital for 1 week for psychologic and physical assessment. The physical assessment included a detailed medical history and examination, heart and lung radiography, electrocardiograms, respiratory, liver, and renal function tests, hematology, treponemal serology and chromosomal studies. No significant physical abnormalities were found, except in two smokers, and there was no reason to suspect that these disabilities were related to ganja. No significant differences between the two groups were demonstrated in the wide range of tests administered (Summary)

A neurological, ophthalmological and audiological survey of a suburban Jamaican community

A neurological, opthalmological and audiological survey was conducted in a suburban Jamaican community aged 35-74 years. One aim was to determine the prevalence of signs found in the Jamaican neuropathy syndrome and their association with sensorineural hearing loss and retrobulbar neuropathy. Mean hearing levels of Jamaicans were better than those reported from a comparable Scottish population. Conductive hearing losses, including otosclerosis, were uncommon. Sensorineural loss was found in 5.0 percent of men and 11.4 percent of women; presbyacusis was a possible cause in older subjects but in many the aetiology was unknown. Noise-induced hearing loss was not an important cause of impaired hearing. Refractive errors in vision were common and many needed proper correction. Pterygia were common (15.9 percent) but less prevalent among those of predominantly African origin, suggesting a racial difference in susceptibility. The prevalence of progressive cataract rose from 3.2 percent at 35-44 years to 71.7 percent at 65-74 years and was greater in diabetics than non-diabetics. Eight cases of chronic simple glaucoma were detected, a prevalence greater than that reported in a Welsh population. Tropical amblyopia (poor visual acuity, temporal pallor and field defects) was found in eight cases. Unexplained neurological signs, possibly representing manifestations of the Jamaican neuropathy syndrome, were found in 25 subjects (4.8 percent of females and 4.0 percent of males). Sensorineural hearing losses and retrobular neuropathy were common in these than in normal subjects but also occurred separately; it is unknown to what extent they are due to the same aetiology (AU)

Neurological disease in a Jamaican suburban population

A survey designed to measure the prevalence of ophthalmological, auditory and neurological disease in a general population sample, and to investigate the inter-relationships of so-called Jamaican neuropathy, sensorineural deafness and primary optic atrophy, was carried out between October 1966 and January 1967. Five hundred and seventy-six adults aged 35-74 years from August Town, a suburb close to U.W.I., co-operated in the study, representing 85 per cent of all such adults in the community. All underwent a clinical examination to screen for abnormal neurological signs and symptoms, and a comprehensive ophthalmological investigation. 552 of them were examined audiometrically. Those with relevant neurological signs were referred to the Department of Medicine, U.W.I. for fuller examination. Sixteen females (4.8 per cent) and 9 males (4.0 per cent) were found to have abnormal neurological signs of which the aetiology was obscure but which are found in the Jamaican neuropathy syndrome. Eleven of the 25 cases had predominantly spastic signs, the remaining 14 had ataxic signs. Sensorineural deafness was present in 49 people and was found significantly more frequently in females (11 per cent) than in males (5 per cent), and was significantly associated with neuropathy. Pallor of the optic disc was found in 15 subjects and again was significantly more frequent in those with neuropathies. Pallor of the disc and sensorineural deafness were observed in association more frequently than would be expected by chance. It is possible that the neuropathy, nerve deafness and optic atrophy have a common aetiology but some other factor must also be involved in the causation of nerve deafness which, unlike the others, is more common in women than in men (AU)

A pattern of neurosyphilis as seen at the University Hospital - abstract

Neurosyphilis accounted for a significant number of neurological admissions. The incidence of spinal syphilis was high, contrary to reports from Trinidad, and all forms of disease have been seen. The varied presentations of the disease was stressed and it was pointed out that response to therapy can be excellent (AU)

Clinical and pathological observations on Jamaican neuropathy: a report on 206 cases

The clinical features of 206 cases of a neuropathic syndrome in Jamaica are presented. The dominant feature is a spastic paraplegia. Approximately half of the cases have evidence of associated posterior column damage. In a minority optic atrophy, nerve deafness of selective anterior horn cell damage is found. The patients have been divided arbitrarily into two categories: 25 cases presenting predominantly with sensory ataxia, and in whom there is a high incidence of optic atrophy and eighth nerve deafness, with slight evidence of pyramidal tract damage. This group has a background of poor nutrition. (b) 181 cases presenting predominantly as a spastic myelopathy, and with a relative low incidence of optic atrophy and eight nerve deafness. The findings in ten necropsies from the spastic group are presented with their cases record. The histopathology is that of a chronic meningo-myelitis, with damage to the long tracts as the major lesion. Involvement of the brain, they grey matter of the cord and spinal nerve roots occurs to a lesser extent. An eleventh case is described with similar pathology, which clinically was thought to be an example of neurosyphilis. The relationship of this syndrome to other neuropathies is considered. The aetiology is discussed, with special reference to the possible role of syphilis and yaws in the spastic group. The majority of these cases have positive treponemal tests in the blood, but only 6 per cent have positive tests in the spinal fluid. The pathology has much in common with that of neurosyphilis, but lacks some of the features generally accepted as typical. The incidence is extremely high relative to other known forms of neurosyphilis in Jamaica. Other factors such as ingested toxins and vitamin deficiences may add to, or modify, the metabolic impairment. It is possible to envisage a spectrum of disease varying from a picture of non-inflammatory long tract degeneration to the active meningo-vascular reaction of florid adhesive arachnoiditis-a spectrum in which common causal factors could operate with variable degrees of intensity. This study emphasizes that our understanding of the pathogenesis and pathology of neurosyphilis in its many forms is far from complete (AU)

Spinal arachnoiditis

The pathology of spinal arachnoiditis is described. The clinical features of twenty patients are presented. The aetiology is discussed. Initial treatment should be with corticosteroids particularly in early cases. If there is doubt laminectomy should be carried out to exclude a tumour (AU)

Multiple sclerosis in Jamaica

Four cases of clinical multiple scelerosis are described in indegenous Jamaicans, three of whom had never left the Island. Three were in the higher social grades and two were Negro. The course of the disease resembled that in temperate countries. A survey of other neurological cases among 10,000 in-patients and 1,500 autopsies reveal no evidence of syndromes which could be attributed to multiple sclerosis in an unusual form. It is concluded that multiple sclerosis in indigenous Jamaicans is extremely rare, but shows no unusual features

A report on investigations designed to measure an index of the hardness of arteries in vivo and in situ

It was considered that if means could be devised which measured the compressibility and distensibility of the arteries in vivo it might be possible to measure those changes which are generally designated as hardening. It is proposed in this communication to deal with the first of these two factors, that is , compressibility. The key to the measurement of the compressibility of the arteries was a technique which provides a measurement of the resistance to flow through the larger arterial vessels. This arterial flow measurement was used to provide an index of the degree of collapse of the brachial artery when various external pressures were applied. This technique will be described and a preliminary report on the use of this record on those subjects which were clinically designated as having hardened arteries (AU)

Sickle cell-thalassemia disease in Jamaica

Two cases of sickle-cell thalassemia disease are described in young women of mixed Chinese and African parentage. On hemoglobin electrophoresis, a complete suppression of hemoglobin A was found, giving a picture indistinguishable from that seen in sickle-cell anemia. The findings in these two cases are contrasted with those in other examples of this disease which we have studied in Jamaica. The importance of these findings in relation to the diagnosis of sickle cell anaemia is discussed (Summary)

A neuropathic syndrome of uncertain origin: review of 100 cases

The clinical features of 100 cases of a neuropathic syndrome observed in the University College Hospital of the West Indies over a period of 3.5 years are described. The four main features are:- (a) upper motor neuron damage (93) (b) damage to the first sensory neuron (c) retrobulbar neuropathy (d) eighth nerve deafness. The onset is from the second to the sixth decade and may be sudden or gradual. The sex incidence is equal. Maximum incapacity occurs within a few months and the disease thereafter appears to be stationary. No pathological material has yet been available for study but the nature of the lesion and the possible causes are discussed. The diet of the patients varied from good to very poor but few showed overt signs of vitamin deficency or malnutrition. A dietary factor is possibly responsible but there is no definite evidence of this. (AU)