Aggressive behaviour in a small rural community in Jamaica: The report of a cooperative epidemiological study

Several incidents of aggressive behaviour in a rural community in Jamaica were investigated by a team of workers each of whose contributions enabled a composite picture of the incidents to be built up. Social and economic factors as well as the influence of close kin marriages were considered to be important causes of these incidents. Recommenations based on the investigating team's appraisal of the situation were made. Such an epidemiological study could not have been undertaken without the cooperation and special skills of the individual members of the team. (AU)

Observations on the features of infantile hepatic cirrhosis in Jamaica. Being undertaken over the years 1940-1946

The manifold function of the liver in maintaining the nutrient equilibrium of the normal internal milieu, render it vulnerable in many ways. For these activities, like those of all tissues, are a projection of the intrinsic metabolism and needs of the organ, and hepatic dysfunction follows any nutrient imbalance. Recent research has shown that persisting dietary defect eventually results in primary histological changes which may take two distinct forms. Intracellular lipoid may appear, as for instance with lack of dietary protein combined chemically with a labile methyl group; cytolytic necrosis may also occur, as in the absence of dietary protein with sulphydry group. Both are followed by antolysis and fibrous proliferation, though the pattern of fibrosis in the former is more regular. To say that protein deficiency results in fibrosis may be true, but it is hardly the whole truth. The relative and absolute amounts of all the food factors are involved. Again, to differentiate the patterns of fibrous disposition is an arbitrary abstraction of facts. The complexity of these problems are recognised in experimental animal investigations. It is evident that the complexities will be even greater in man in society. It is equally evident nevertheless, that careful observations must replace the dialectical approach. The principal features of this study may be reviewed summarily. 1. The study was based on the findings in thirty-two children with hepatic fibrosis, who were seen in Jamaica. 2. An outline of the literature relating to hepatic fibrosis occurring in infants in some tropical countries has shown that early investigations have been largely limited to clinical observations of the condition at a relatively late stage, and the concepts of the aetiology and pathology have often been based on unfounded hypothesis. 3. The analysis of the records in this series show: a. the absence of familial history; b. the association of the disorder with dietary imbalance as the chief features of which were a lack of protein and various undetermined vitamin B factors with an excess of carbohydrate: c. the average age of onset being four years, and the frequency was four times as common in males. d. the early histories, in which the frequency of various infectious illnesses were well above the average: e. in a number of cases the onset of symptoms seemed to be related to a tozaemic episode: f. the clinical findings, showing the classical features of portal cirrhosis, superimposed on a state of deficient nutrition: g. the clinical pathology, with an increase in the serum bilirubin values and the serum globulin/serum albumin ratios which had some degree of positive correlation with the parenchymal injury; and anaemia of hypochromictype being also noted: h. biopsy studies revealed the relative incidence and the changes in the histopathological features; lipoid being most prominent in cases of uncomplicated nutritional defect, whereas necrosis was common in the cases associated with toxaemia; fibrosis varied greatly in amount and distribution, being most irregular after severe infections which caused much necrosis: i. the severity and courses varied greatly, the prognosis being on the whole somewhat better than in India: j. optimal therapeutic results followed administration of firstly, papain digest of cow's milk, then later a high protein diet: k. the status of the disorder is considered and it is seen to be identical with classical portal cirrhosis; reasons are given however, for the unsuitability of the latter term and the preferred designation, hepatic necrosis with fibrosis: l. the aetiology is realised to be uncertain; the roles of deficiency, protein and vitamin B factors appear important while toxaemia seems to be a precipitating agent in many cases (Summary)