Ciguatera Fish Poisoning in the Virgin Islands

To the Editor.— The prominence afforded the problem of ciguatera by the publication of "Ciguatera Fish Poisoning in Miami" by Lawrence et al (1980;244:254) and by two editorials on the topic in the same issue is belated but heartening recognition by a major medical journal of a widespread disease that has attracted little general attention. Having practiced internal medicine in St Thomas for more than six years, I can attest to the magnitude of the problem in the US Virgin Islands. The Virgin Islanders are thoroughly familiar with the disease and rarely seek medical attention for it unless symptoms are severe. The probable annual incidence of at least five cases per 10,000 residents calculated for the Miami area is much lower than what was uncovered by the College of the Virgin Islands' Biomedical Research Unit, which I founded in 1977. An eight-month survey in 1978 of the records of the