ACKEE POISONING 455 



Kreotoximus is a gastro-intestinal disturbance which may simulate 

 cholera, and is produced by the ingestion of semi-decomposed animal 

 foods. The bacillus of Gartner and the paratyphoid bacillus give rise 

 to ptomaines causing the symptoms. 



Emetics, purgatives, stimulants and salines are indicated, with a 

 course later of intestinal antiseptics as salol or calomel. 



ACKEE POISONING. 



The Vomiting Sickness of Jamaica. (After Scott.) 



DEFINITION. 



A localized, epidemic, acute toxaemia probably due to the ingestion 

 and absorption of toxins from the ackee fruit, Blighia sapida. 



It occurs in young adults and children in Jamaica and is accom- 

 panied by a heavy mortality. 



iETIOLOGY. 



The disease, whicii is prevalent in the cooler months, November 

 to March or April, seems to be caused by the ingestion of the ackee 

 fruit that has fallen unripe from the tree. The epidemic nature of the 

 disease coincides with the main ackee season. 



Its localized peculiarity may be due to this fruit not being plenti- 

 fully grown elsewhere, or that it is not in other places used as a food. 



If the dose taken is small and vomiting takes place at once the 

 poison is rejected and recovery may follow. 



The children are chiefly affected because they are given " pot- 

 water " in which the ackee fruit has been boiled, a water solution of 

 the toxin being most dangerous; also it is due to the children, more 

 than adults, picking up the fallen unripe fruit and eating it. 



The fruit is poisonous if it is picked up from a decayed, bruised, 

 or broken branch; if forced open and not opened naturally on the 

 tree and other conditions. 



SYMPTOlViATOLOGY. 



These can be summed up under three heads : — 



(i) Vomiting. — The patient, almost invariably a child, has dis- 

 comfort or pain in the stomach. It vomits once or twice or four times. 

 Recovery may follow if all the toxin is rejected, or, on the contrary,, 

 the child may be fairly well or sleep, if at night, for several hours.- 

 Then there may be another attack of vomiting, probably cerebral in 

 origin, of frothy mucus, followed by watery or bile-stained fluid. A 

 few cases do not vomit at all. 



The former is known as Initial vomiting, and the latter as. 



