POISONOUS FISHES 327 



a factor in the production of the poison. The symptoms generally de- 

 velop within a few minutes after ingesting the fish and consist of nausea, 

 vomiting, redness and flushing of the face, engorgement of the soft tis- 

 sues of the eyes, swelling and cyanosis of the lips, tongue and gums, 

 giant urticaria, severe itching, headache and respiratory distress. The 

 victim usually recovers Avithin eight to twelve hours. The few bacte- 

 riological analyses of the fish flesh for human pathogens have been nega- 

 tive. Moreover, the toxin appears to be water soluble and is not de- 

 stroyed by ordinary cooking procedures. The problem of scombroid 

 poisoning has been discussed in greater detail elsewhere.'^ 



Treatment 



There is no known specific antidote at the present time. An at- 

 tack of fish poisoning does not impart immunity. The treatment is 

 purely symptomatic. Gastric lavage and catharsis should be instituted 

 at the earliest possible time. Intravenous 10 per cent calcium gluconate 

 in many instances has given prompt relief while in others it has been 

 ineffective. Victims suffering from moray eel poisoning appear to be 

 particularly susceptible to violent convulsions and may present dif- 

 ficult nursing problems. Since the convulsions are precipitated by noise, 

 rest, quiet and sedation are essential. Paraldehyde and drop ether have 

 been reported to be the drugs of choice in controlling the convulsions. 

 Coramine or one of the other respiratory stimulants are advisable in 

 cases of respiratory depression. Excessive mucus production in the 

 buccal cavity is treated by aspiration and constant turning of the 

 patient. Atropine has been found to make the mucus more viscid and 

 difficult to aspirate, and is not recommended. If laryngeal spasm is 

 present, intubation and tracheotomy may be necessary. Nasal oxygen 

 and intravenous fluids supplemented with parenteral vitamins are usual- 

 ly beneficial. If the pain is severe, opiates will probably be required. 

 Morphine given in small divided doses has been recommended. Cool 

 showers have been found to be effective in relieving the severe itching. 

 Fluids given to patients suffering from the paradoxical sensory disturb- 

 ance should be warmed. Vitamin B complex supplements are advisable. 



Summary 

 The expansion of commercial fishing interests and the utilization 

 of various species of shore fishes in the tropical Pacific impose upon 

 fisheries and public health organizations an urgent solution to the prob- 

 lem of poisonous fishes. Poisonous fishes are widely distributed through- 

 out the torrid zone, but some species occur in temperate and arctic 

 waters. Poisonous fishes are distributed throughout the entire phylo- 



