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PTOMAINE POISONING
Strictly speaking, a ptomaine is a poison elaborated by the action of bacteria on protein food, usually meat,,and it was at one time thought that all cases of ptomaine poisoning were due to the consumption of food which had become poisonous in this way. It is now known however, that in most. if not all cases of living bacteria of a harmful nature are swallowed with the food, and the poisons are produced after their entry into the body. It is therefore possible to develop ptomaine poisoning from mcat which is to all outward appearances healthy. If it has been contaminated with the bacteria in question, although in more cases than not, the food alrcady shows some signs of decomposition.
 
In order to simplify classification, the term ptomaine poisoning is now used to include all cases of bactcrial poisoning due to the consumption of unhealthy food, except where specific disease. e.g. tuberculosis. is conveyed.
 
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Causal Organisms. The common causal organisms of food poisoning are two bacilli which are in many ways similar to the bacillus of typhoid fever. They are the bacillus aertryche and Gaertner'e bacillus. Other bacilli belonging to the same group known as the salmoncella group; are probably guilty in some cases: and the bacillus botulimis, which belongs to quite another family, accounts for the cases known as botulism (q.v.).
These bacilli are sometimes found in the intestiues of animals used as food or may reach the food before or after cooling. Really efficient cooking will always kill these organisms, but unfortunately the temperature of the central part of the food is often not sufficiently raised for this.
Almost all foods may become contaminated, but as the bacteria grow more freely in meat, fish and milk than in other foods, these are more often responsible. Canned and preserved foods give more opportunity for the growth of bacter a than do fresh foods. Canned foods are very liable to contamination as soon as the lid is opened. Shellfish often convey the disease when taken from water contaminated by sewage.
Symptoms of Poisoning.
The symptorns of ptomaine poisoning begin any time from a few hours to a few days after the ingestion of the food, but usually within 36 hours. The time is shorter if the food has been taken on an empty stomach. The disease commences suddenly, sometimes with a shivering attack, and usually there is a furred tonue, a rise of temperature. acute abdoninal pain of colicy type, vomiting and diarrhoea. The stools are frequent, liquid and offesive, and oocasionally contain blood. If the case ;s a severe one, there may also he collapse, cramps. and heart failure. In most cases the symptoms clear up in the course of a few lays, and the patient is soon completely well. Occasionally, in a severe case, death may occur durinr the acute stages, and in a few cases a chronic form of the infection remains, aaxd the patient suffers from recurrent attaclzs of diarrboea for some vears. The disease is especiall,y danerous in young children.
Another symptom of some cases of ptomaine poisoning, especially those due to fish, is the occurrence of nettle-rash on the hands and arms or all over the body.
The dignosis can generally he confirmed by the examination of the stools by a bacteriologist, and the same organism is usually obtainable from any of the food which has been left uneaten.
Treatment
The treatment of ptomaine poisoning consists first of all in putting the patient to bed and keeping him there until all symptoms have disappeared. During the acute stages the diet should be very restricted and entirely fluid, but as much water may be drunk as the patient wishes, in order to replace the loss of fluid due to diarrhoea. Albumen water, barley water, chicken broth and whey are allowed and also lemon or orange juice suitably diluted. Some arrowroot may also be added very soon, but milk is best avoided as it forms an excellent culture medium for the growth of pathogenic bacteria.
The feeds should be guen in small quantities, 3 to 4 ounces every two or three hours. A little brandy is sometimes a useful stimulant to the patient. Hot femntations to the abdomen may be necessary for the relief of pain.
if the case is seen early and there is not much collapse, the best drug treatment is hourly or half-hourly doses of one drachm of a saturated solution of magncsium sulphate (epsom salts) until the bowels are freely opened.
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