PART X.

INTOXICATIONS AND SUNSTROKE.

POISONING BY FOOD; PTOMAIN-POISONING.

FOOD may act as a poison in one of two ways—either as a result of bacteria which have gained access to the food and produced their ptomains, or through an admixture of chemic poisons either organic or inorganic. The form of foodpoisoning from chemicals of an organic or inorganic variety belongs to the domain of toxicology.

Food-poisoning due to bacteria may occur in one of three ways: First, the food may have undergone putrefactive changes, with the formation of toxic chemic substances (ptomains), before having been eaten, in which case the symptoms are extremely rapid in their onset. Second, the food may contain pathogenic micro-organisms, which, if they have been swallowed, set up toxic phenomena; in most instances of this sort there is a period of incubation, and this often precedes local lesions elsewhere than in the intestinal tract. Third, putrefaction may occur in the large or small intestine, the food having been in apparently good condition when swallowed.

Various ptomains, which were first studied by Selmi and later by Brieger, have been found in the cadaver. Cadaverin, putrescin, and cholin are only slightly poisonous. A muscarin-like alkaloid that occurs in decomposing flesh when swallowed gives rise to profuse diarrhea, lacrimation, salivation, and sweating, in which clonic spasms occur, with heart-failure.

Sepsin, obtained from decomposing yeast, when introduced into the system, causes vomiting and bloody diarrhea. Mydalein, derived from the human cadaver, causes a rise in temperature with dilatation of the pupil, paralysis, and convulsions. None of the other ptomains, as a rule, produces fever.

When fever occurs, it is due to the albumoses or digested proteids.

Symptoms of Food-poisoning.-The symptoms produced may be due to the bacterium itself, to its chemic products, or to a combination of both. If the symptoms be due to the bacterium itself, a period of incubation occurs that varies as regards the individual micro-organism. The onset of the disease is sudden. The patient is frequently seized with chill, abdominal pain, and muscular weakness. Vomiting and vertigo are frequent symptoms. Diarrhea with offensive stools, which may be bloody, accompanied by great thirst, is a prominent and almost invariable symptom. Some febrile reaction almost always occurs, the temperature in individual cases, however, showing great fluctuation. The pulse is rapid; there are muscular twitching, disturbance of vision, with dilatation of the pupils, and drowsiness. Urticarial and erythematous rashes show themselves. If death takes place, it is preceded by coma. Convalescence is often protracted.

Treatment.-A brisk purgative should be administered: I ounce of castor oil or from 3 to 5 grains of calomel, as it is necessary to rid the intestinal tract of the poisonous material. Opium is necessary to relieve the pain; and when there is profuse diarrhea, with offensive stools, intestinal antiseptics, such as beta-naphthol and salol, are of value. Stimulants are necessary for the prostration and for the cardiac asthenia.

GRAIN-POISONING.

This is an extremely rare condition. The principal effects of the poison usually fall upon the brain and nervous system, especially upon the spinal cord.

Ergotism.-Etiology. The disease is due to the microbe. known as the claviceps purpurea. Predisposing factors are starvation and ill health.

Symptoms. The symptomatology shows itself in one of two varieties-first, the spasmodic or convulsive; and, second, the gangrenous variety. The acute form of the disease is most common in children. The symptoms are giddiness, depression of spirits, formication, with clonic and tonic spasms, colicky pains, tympanites, precordial distress, violent vomiting with purging, stupor, occasionally a vesicular eruption, and in the rapid cases the symptoms frequently resemble those of Asiatic cholera. When convalescence follows, which is rare,

it is prolonged and tedious, and sequels, such as epilepsy and cataract, appear. The gangrenous variety may also set in acutely, although the destruction of the limbs requires a longer time. Pain penetrates the affected part, but in some rare instances pain is entirely absent. An erysipelatoid eruption may precede the lividity of the part, but this is unusual, the lividity passing into a darker color, the limbs soon becoming black. Generally the gangrene is of the dry variety. More than one part of the body may be affected, and one part after another and one organ after another may be involved, until death takes place. If the disease be arrested, the patient may recover with the loss of a hand, foot, or limb. In some other cases the disease is more chronic, and in others there is a mixture of the spasmodic and gangrenous forms.

Diagnosis. If the condition be epidemic, there is no difficulty in the recognition, but sporadic cases give rise to great difficulty in diagnosis. It has been claimed by Ehlers that Raynaud's disease, acrodynia, and erythromelalgia are only varieties of ergotism.

Prognosis.—The mortality in severe epidemics is 60%, and during less severe epidemics it may be about 10%.

Treatment. There is no specific remedy, the treatment being entirely symptomatic.

Pellagra has already been described. (See p. 683.)

Lathyrism. This is a name given by Cantani to an affection produced by diseased grain. The disease has been noted in parts of France, Italy, and Egypt. It follows an almost exclusive diet of chick-pea, with unsanitary conditions of life. These appear to be the most prominent predisposing causes.

Symptoms. The symptoms come on rapidly, the patient being unable to arise from his bed in the morning, previously being in an apparently healthy condition. There is a stiff and

creepy sensation in the limbs, and often a pain in the back is characteristic. Soon an unsteadiness in the hands, associated with tremor, occurs upon rising, and a peculiar gait is noted, resembling spastic paraplegia. Occasionally the gait may have an ataxic character, and shooting pains and great disturbance of sensation occur, such as hyperesthesia, paresthesia, and anesthesia. The tendon reflexes, however, are exaggerated. These symptoms require from four to five weeks to attain their full development. As a rule, the sphincters are not affected.

Prognosis. The prognosis is generally favorable. If the

diet be changed soon enough before marked alterations take place in the cord, recovery may result.

Treatment. The treatment consists in removing the cause, in putting the patient amid the best sanitary surroundings, and in administering tonics and stimulants.

MUSHROOM-POISONING.

This results from the eating of certain fungi which do not belong to the edible variety of mushroom, the toxic agent being muscarin, which is similar to those substances known as ptomains. Cholin is a substance closely allied to muscarin, and may also produce the same toxic effects.

Symptoms. Shortly after a meal of poisonous mushrooms vomiting, diarrhea, severe cramps, and intense prostration promptly develop. Some disturbance of vision is common, muscarin having a myotic effect. Salivation is frequent, but perspiration is arrested. Muscarin paralyzes the cardiac muscle. In children convulsions are frequent.

Diagnosis. This depends upon the contraction of the pupils, and upon the appearance of the fungus in the vomited material or in the stools.

Prognosis. Recovery frequently occurs unless an enormous proportion of poisonous mushroom be taken and vomiting and diarrhea do not take place. Collapse and heart failure are the principal causes of death.

Treatment. The stomach should be emptied and stimulants promptly administered, preferably hypodermically. The physiologic antagonist to muscarin is atropin, hence a hypodermic injection of atropin is almost a specific. Other symptoms must be treated as they arise.

SNAKE POISON.

Venomous snakes exist in nearly all the temperate and tropical parts of the world.

It may

The venom may enter the body in different ways. enter through the subcutaneous tissue by means of the bite, thus reaching the circulation by absorption by the bloodvessels. If introduced directly into a vein, the effects occur much more quickly. Venom taken by the mouth, with the exception of the cobra venom, does not seem capable of producing poisonous effects, providing there is no abrasion in the

mucous membrane of the alimentary canal. The venom is excreted particularly by the kidney and to a slight extent by the salivary glands of the reptile.

Immediately

Symptoms of Snake-bite.- Cobra-bite. after a bite there is a sensation of burning and stinging in the wound, which soon becomes red, tender, and swollen. In the course of a half-hour constitutional symptoms begin to manifest themselves, such as desire to sleep, a feeling of intoxication, and weakness in the legs, which increases until the patient is unable to stand. Paralysis of the tongue, with profuse salivation, and inability to speak or swallow soon appear. With these symptoms there are nausea and vomiting. The signs of paralysis rapidly spread. breathing becomes slower and the cardiac action quicker. After a while convulsions may occur; this is not necessarily unfavorable. The breathing ceases and the heart stops. During all this time the pupil is contracted, but reacts to light. Hemorrhages may occur from the mucous surfaces. The urine never becomes albuminous. If the patient recovers, convalescence is rapid.

The

Rattlesnake. After the inoculation of the poison, severe pain takes place in the wound, accompanied by great swelling and discoloration, often slight bleeding occurring from the wound. Constitutional symptoms may appear within fifteen minutes. There is marked prostration, staggering gait, nausea, vomiting, cold sweats, dilated pupil, quick and feeble pulse. In a condition of this sort the patient may die within twelve hours after receiving the bite of a rattlesnake. If recovery occur from the depression, the swelling and discoloration rapidly extend, and there is a rise of temperature. The face becomes puffy and there are marked prostration and rapid syncope. Labored respiration, quick and feeble pulse, and a clear mind are characteristic. Occasionally there is restlessness, which may be preceded by convulsions. Suppuration may take place in the wound, and even gangrene may form, to which the patient may succumb several weeks afterward. On the other hand, the swelling may become less, the pain may gradually ameliorate, and recovery may occur. As a rule, when recovery occurs, it is rapid and will result in a few hours, even after the patient has been apparently in a moribund condition.

Prognosis. The prognosis depends upon whether treatment has been prompt, and whether the reptile has embedded