344 S.A. TYDSKRIF VIR GENEESKUNDE 1 Mei 1965 LKW22 (Byvoegsel- Sllid-Afrikaanse Tydskrif vir LaboralOrillm- en Kliniekwerk) AN INVESTIGATION INTO CASES OF SUSPECTED POISONING IN AFRICANS IN NORTHERN RHODESIA DOllW G. STEYN, B.Se., DR.MEDVET., DV.Se., Emeritus Professor of Pharmacology, Medical Faculty, University of Pretoria .. Chief Research Officer, Division of Life Sciences, Atomic Energy Board, Pretoria This investigation was undertaken following a letter not developing the disease. This phenomenon at once dated 19 November 1959, in which Dr. M. H. Webster, at directed my attention to the fact that boys under 16 years that time Director of Medical Services of the Federation of age and all females had their meals together, while of Rhodesia and Nyasaland, sought my advice in connec­ males above 16 years had their meals separately. While tion with serious mortality from a mysterious disease the males were occupied in the building of houses and the affecting a certain tribe of Africans in Northern Rhodesia. tilling of lands in the re-settlement area, the females and children under 16 years of age went out into the bush History (forest) to collect food, which consisted almost solely of Dr. Webster supplied me with full details of all aspects the fruits, roots and tubers of wild plants. of the disease. I collected further valuable information during the course of a meeting he called at Lusaka. It was At the time the disease broke out, the affected area was attended by various officers of his Department and by a afflicted by a very severe drought, and one effect of this veterinary officer, a botanist, and an officer of the Depart­ was that the above-ground portions of the wild plants ment of Fisheries; as well as by an officer of the Criminal had been severely damaged, with the result that it was Investigation Department. I also obtained information in very difficult for the Africans to identify the plants, the course of my own investigation in the affected area, especially those species that resembled the species they had during which I was accompanied by Dr. Webster, Dr. E. been accustomed to eating in their abandoned homeland. Tauber (specialist surgeon at Lusaka), Drs. A. Haworth This often led to confusion, with the result that poisonous and A. W. I1jon (medical officers of the Department of plants were mistaken for edible species, with fatal results. Health, Lusaka), Mr. Elvidge (medical inspector), and Symptoms officers of the Northern Rhodesian Police and Criminal When Europeans conduct investigations into diseases in Investigation Department. African territories, they operate under great disadvantages The construction of the Kariba Dam in the Zambesi because they are seriously hampered in their efforts to River necessitated the removal of some 50,000 Africans obtain reliable information. This is due chiefly to witch­ from the basin of the dam to re-settlement areas. The craft and to various African customs and beliefs, which move was completed in October 1958, and the mysterious vary from race to race and from tribe to tribe. Africans disease and deaths started in the beginning of September very reluctantly give permission for specimens to be taken 1959. The following were significant features of the from their people or from food or other materials in their disease: huts or on their lands. They are also most reluctant to Some villages were harder hit than others. give permission for the conducting of autopsies and the There were strong family connections between the con­ removal of specimens of organs. In spite of these difficul­ secutive cases of the disease. ties all of us who were concerned in the investigation According to information supplied by Dr. Webster, 'the into the cause(s) of the disaster that had befallen this trouble was limited to a small group of villages containing African tribe received the friendly cooperation of a some 500 people and fairly sharply localized in an area number of the Africans; the African police especially 2 - 3 miles in diameter in the angle formed by the con­ were of great assistance to us. This, I am sure, was due to fluence of the Lusita with the Zambesi River'. the fact that they realized that we were genuinely interested Mortality was very high (about 80 - 90%) and most in helping them as much as we possibly could. However, patients died within 24 hours after the onset of symptoms. if we had been permitted to take more specimens from Young children usually died within 6 hours after being victims of the disease and to conduct more autopsies, our taken ill. Up to the time of my visit to Northern Rhodesia difficult task would have been much easier, the results of (December 1959) some 80 victims of the disease had died. our investigation more reliable, and our conclusions more The African tribe attacked by the mysterious disease definite. was the most 'uncivilized' of the tribes moved to the new The following are the symptoms described by Dr. M. H. settlement area. This tribe was also the one that was Webster, Dr. A. Park, Dr. E. Tauber, Dr. K. G. Gadd, moved lhe longest distance away from their original Dr. A. W. I1jon and Dr. A. Haworth. homeland. Members of this tribe took very reluctantly to Peracute cases. In a few cases, children who had appa­ eating the European type of food (maize, beans, etc.) and rently been well when last seen, were found dead a few lived chiefly on the fruits, roots and tubers of wild plants. hours later, in some cases under trees and bushes. Although there was free movement and close contact Acute cases. Young children usually died within 4 - 6 between the inhabitants of the affected villages and other hours of the onset of symptoms, while older children and parts of the re-settlement area, no cases appeared among adults lived up to 24 hours or longer. Children who had members of the other tribes. gone to bed apparently in good health would wake up in Only adult females and children of both sexes under 16 the early hours of the morning. complaining of thirst. They years of age were affected, males above 16 years of age were restless and the drinking of water appeared to I I May 1965 S.A. MEDICAL JOURNAL 345 (SlIpplemelll- SOlllh African Jourl/al of Lt/boratory and Clinical Medicine) LCM23 I aggravate the symptoms. The following symptoms were in THE AUTHOR'S INVESTIGATION evidence: vomiting (in some cases); precordial discom­ On 11 Dec. 1959 Drs. Webster, Tauber, IIjon, HaWOrlh fort; loose stools; very fast and thready pulse; pulmonary and I visited the affected area. There we met officers of oedema; apprehension; restlessness; dizziness; headache; the N. Rhodesian Police and the Criminal Investigation I abdominal irritability towards the end; hypertonicity of Department, and Mr. Elvidge, medical inspector. Also the limbs, which were constantly moved; enlarged liver; here I found evidence of the extreme thoroughness with jaundice (in some cases); pupils in some cases normal, in which the officers of each Department concerned had I some dilated and in some constricted; towards the end conducted their investigations. The CID and the Police there were signs of pronounced renal irritation (marked Department investigated the possibility of criminal poison­ albuminuria, scanty urine, and red cells and granular and ing. In spite of the most searching and intensive investiga­ cellular casts in the urine); prostration; delirium; some­ tion, they failed to find any clues. Through the kind I times profuse sweating, coma, and shock. In most cases efforts of these two Departments, I obtained specimens of fever was absent, while a few cases showed minor degrees about 40 plants which the tribe concerned used as reme· of fever. Dr. Gadd established a pronounced hypoglycae­ dies or relishes. Unfortunately most of these consisted of I mia, the liver being negative for glycogen. This appears roots, leaves and branches which were unidentifiable. quite conceivable owing to the very severe liver damage. Treatment with various drugs (sulphonamides, tetracy­ Drinking water. Chemical analysis and bacteriological clines, atropine, alcohol) had no effect. examination of the drinking water supplied at various I points revealed nothing harmful to health, and there were Postmortem Appearances no poisonous algae present. As reports had reached Dr. Dr. K. G. Gadd, Director of the Public Health Labora­ Webste;- that the toxic South African alga Polycyslis tories, Lusaka, conducted 12 autopsies and found the loxica Ktitzing (= P. aemginosa Ktitzing = Microcyslis I following: All cases showed very severe damage of the toxica Stephens) had been found on the Kariba Dam, I liver, kidneys, spleen, and heart; pronounced oedema of was requested to visit the dam. An intensive search was the lungs; sloughing of the mucosa of the small intestine, made for this very toxic alga, which has been killing I right into the deepest layers; contents of the large bowel thousands of stock, fish and birds in South Africa, but no softish. trace of it could be found. Unfortunately the Kariba Dam Histology (Dr. K. G. Gadd) is infested with the plant Salvinia auriculata, which is Liver. Marked degree of necrosis of the centre of the I lobules, with fatty degeneration. Kidneys. Very marked fatty degeneration and necrosis of the tubules (nephrosis rather than nephritis). I Heart. All stages of degenerative changes. Spleen. Massive necrosis. Submandibular gland. Degenerative changes with mlrked desquamation in the salivary duct. I Adrenals. Generally normal. Cerebrospinal fluid. Normal. Cerebral cortex. Mainly oedema with no exudative re­ I sponse. Neurone changes are early degenerative. Pancreas. Gross degeneration, with no nuclear staining. Or. Gadd kindly supplied me with specimens of the organs of 3 of the deceased victims.