Mann (1938) stated that a diagnosis of fish poisoning can be 

 made from the following data % 



lo History of eating fish 1 to 10 hours before the onset 



of the illness o 

 2o A metallic taste in the mouth,, 

 3° Paresthesia o 

 U» A prolonged convalescence <> 



Hurd (191+5) * however, indicated that the metallic taste in the 

 mouth is of no diagnostic value, since in cases where repeated vomiting 

 occurred due to causes other than fish poisoning, bile appearing in the 

 mouth imparted a metallic taste „ In view of the fact that severe muscle 

 and joint pains are one of the chief complaints, it appears that more 

 significance should be attached to these symptoms o The author believed 

 that these symptoms are of greater diagnostic value than that of the 

 metallic taste in the moutho It is felt that the symptoms listed above 

 distinguish Ciguatera, and make it a distinct entity from other types of 

 animal, plant, mineral, or bacterial food poisoningo 



Outbreaks of Poisonin g 



Numerous outbreaks of poisoning due to the ingestion of fish have 

 been recorde'd in the areas where this poisoning exists » Only those will be 

 considered which clinically resemble Ciguatera as described by Mann (1938) 

 and O'Neill (1938) „ In the Caribbean area Walker (1922) recorded 13 out- 

 breaks at Sto Thomas, V I», between the years 1918 and 1921, involving 

 70 individuals . Gregory (1925) reported 2 cases involving 5 men near St. 

 Thomas o Costa Mandry (1928 and 19U0) in Puerto Rico reported 2 outbreaks 

 in 1928 involving 5I+ people and 1 in 1933 involving 39 individuals., O'Neill 

 (1938) reported an outbreak near Culebra Island in 1938 in which 19 were 

 poisoned o Gilman ( 191*2) also reported one outbreak involving 10 individuals 

 at Culebra Island, Schneck ( 191+5) recorded an outbreak in which ll+ indi- 

 viduals were poisoned in Puerto Rico The U. S° Fish and Wildlife Service 

 Laboratory in Mayaguez, Puerto Rico, has the following records of poisonings 



lo One case in 191+1+ involving 2 individuals. 

 2o One case in 191+5 involving 11 people; and one in 191+6 

 involving I4O people „ (See Table 2)„ 



