Bromatoxismus.

In my recent work on the Treatment of Disease although I could find no precedent in previous use for so doing, I used the above term as a general designation for food poisoning of all kinds. The specific forms of food poisoning are designated by various names. Tyrotoxismus, is the name given by Vaughn, to the form of food poisoning caused by the tyrotoxican which be isolated from cheese and ice cream. The name galactotoxismus refers to poisoning induced by the various germs which may be found in impure milk. Kreotoxismus is a very common form of food poisoning but it is seldom called by this name. It results from the eating of infected meat. The term sitotoxismus refers to poisoning by vegetable substances which have become moldy or otherwise contaminated with bacteria. Ichthyotoxismus and mytilotoxismus are terms which. refer to the poisoning which results from eating unhealthy fish, or oysters, clams and shell fish, in. a state of decomposition.

These foods are taken usually with the supposition that they are healthy. The patient himself being in excellent health. After a period of time, varying from half an hour to three or four hours the patient is taken with a griping pain, either in the stomach or bowels. This is often accompanied at once with nausea and violent vomiting. If severe vomiting occur immediately and early after the food is taken, but little harm results from the poisoning, as the larger portion of the food may be vomited before it is absorbed. If much time has elapsed, more harm results, as no more toxins are absorbed.

If the pain increases and persists, the constitutional influence of the poison is very quickly seen and soon becomes conspicuous. There is a free watery diarrhea, the pulse is small, feeble and irregular; the patient becomes chilly, the skin cold; there are severe cramps in the muscles of the legs and arms, the skin is cold and relaxed; there is a profuse cold perspiration; the extremities, as well as the face and nose, and in the later stages, even the breath, are cold. There is great muscular weakness with depression, vertigo, difficult breathing, dullness of the mind, dimness of vision, dilated pupils and sometimes great restlessness and wakfulness. Frequently the mouth becomes sore and there is extreme soreness over the stomach and bowels, and there may be vomiting of blood or hematuria.

There is some variation in the severity of the symptoms, as induced by the different poisons. Those from meat and fish toxins are apt to be the most severe. However, severity in any case depends upon the quantity of the infected substance ingested, and upon the state of the stomach, in promoting its absorption.

The first important thing to be accomplished in the treatment of these patients is the restoration of heat—the elevation of the temperature. The patient should be packed in hot bottles or in a hot pack or placed in a hot bath under circumstances in which there is to be no chilling of the surface. The bowels should be thoroughly evacuated. If vomiting has not been sufficient to evacuate the stomach this must be thoroughly irrigated. It is well to use a high colonic flush after the bowel movement. This may be used at any time if action of the bowels is delayed. After the intestinal canal is evacuated, a full quantity of hot normal salt solution should be introduced unless it becomes necessary, because of the severity of the symptoms, to introduce this by hypodermoclysis.

Immediately the stomach is evacuated, the ordinary gastric sedatives should be used to control the irritability, in order that remedies may be introduced to antagonize the toxins in the system. Bismuth and ingluvin will quiet the stomach if given in frequent doses. They may be given in half an ounce of hot water to which a drop of the tincture of capsicum is added. Echinacea, hydrastis, and perhaps berberis should be given. In some cases calcium sulphid will be indicated.

At no time should the condition of the strength of the patient be overlooked. The action of the heart must be maintained, whatever else is demanded. It may be necessary early to use strychnin or nitroglycerin hypodermically. In some cases brandy may be used hypodermically with good results.

Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.