Page:Tropical Diseases.djvu/968

910 approaches, being of the Cheyne-Stokes type. The pupils are slightly dilated and, until near the end, react to light, etc. Unless during the convulsive seizures, there is no muscular rigidity. Post-mortem examination reveals hyperæmia of viscera with a tendency to minute interstitial hæmorrhages, together with marked fatty changes, especially in the liver and the kidneys, and sometimes to a less degree in the pancreas and heart-muscle.

Etiology.— Scott has shown, on what must be regarded as convincing evidence— clinical, seasonal, epidemiological, and experimental— that the vomiting sickness is really the result of poisoning by a fruit, much used by negroes in Jamaica, called ackee, the fruit of Blighia sapida, a tree very common in the island. When mature and in good condition this fruit is wholesome enough, but if gathered before it is quite ripe and before it has opened while on the tree, or if gathered from an injured branch, or opened after falling on the ground, it is poisonous. It would appear that the poisonous element in the immature and unsound fruit is soluble in water, for the " pot water " in which the ackees have been cooked is much more toxic than the cooked fruit and, further, that the poison is precipitated by alcohol.

Treatment.— An emetic, and washing out the stomach with an alcoholic fluid during the primary vomiting, seem to be indicated.