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Pathological effects of two West Indian echinoderms
447 TRANSACTIONS OF THE ROYAL SOCIETY OF
TROPICAL MEDICINE AND HYGIENE. Vol. XXXIII. No. 4. January, 1940.
PATHOLOGICAL
EFFECTS OF TWO ECHINODERMS.
WEST
INDIAN
BY
K. VIGORS EARLE, M.D. (LOND.), B.CH. (CANTAB.),* Medical Officer, United British Oilfields of Trinidad, Ltd., Trinidad, British West Indies.
Two varieties of sea-urchin, found in Barbados and other West Indian islands, are of interest on account of their varied pathological effects on the human body. 1. WHrrE SEA-URCHIN (FIG. 1).
Tripneustes esculentus Bell (1878).
K n o w n in Barbados as the white sea-egg or edible sea-egg, it inhabits the sea-bed, where it often adopts a camouflage of green seaweed. It is captured by diving boys who earn a living by its collection and sale. In size, the adult may attain a diameter of 14 cm. and a height of 9.5 cm. Its spines are short, rather slender and sharp-pointed, not nearly equalling the diameter of the test. In colour the spines are all white or whitish : the test is brownish, purple or sometimes a deep greenish-brown. T h e ova, which are orange-coloured, and lie in sections inside the test, are regarded as a delicacy and may be eaten raw (when they h a v e a sweetish taste), like those of the Mediterranean sea-urchin. Usually, however, they are first boiled and then fried. PATHOLOGICAL EFFECTS.
These are of two classes--punctures from the spines; and pathological effects following ingestion of the ova. ~I have to thank Dr. H. H. BAYL*~Y,Mrs. BAYLEYand Mr. J. F. PaCK~R,of Barbados, for much helpful information. Mr. PACK~:Ris also responsib:e for the photographs,
448
SEA-URCIIINS.
Lesions Due to the Spines. These are usually situated in the hands (when the animal has been dived for and tightly grasped) ; or on the feet (in bathers). A certain degree of force is required to cause penetration : if lifted with care the animal can be handled with impunity. Since the spines are brittle they may break off in the puncture wound. Unlike the spines of the common sea-urchin of the Red Sea, described by CASTELLANI and CHALMER$ (1919), they are non-poisonous, but if allowed to remain in situ, as has been shown by BAYLEY (1938), they do not dissolve and almost invariably lead to suppuration. Treatment, therefore, is removal of the spines by careful dissection and the subsequent application of antiseptic dressings. In the event of suppuration, the administration of sulphanilamide derivatives, especially M. & B. 693, is to be recommended.
Efjects Due to Ingestion of Ova. The sea-egg is in season from September to April. Outside these months the ova are immature and the close season is enforced by law. The ovaries are never poisonous like those of the Mediterranean variety mentioned by JORDON (1931), which have toxic properties during the spawning season. Following ingestion of the ova the following reactions may be produced. 1. Allergic.--As the sea-egg is not an everyday article of food its allergic action belongs to the group of " fortunate allergies " described by VAUGHAN (1933). Three separate types of manifestation have been noted though others probably exist but have not been differentiated. Abdominal symptoms include epigastric discomfort and pain, nausea, vomiting and diarrhoea. These resemble the manifestations of fish allergy quoted by ROWE (1937). I have seen the occurrence of epigastric pain, nausea and migraine-like attacks follow ingestion of sea-egg ova by a patient who also showed similar allergic manifestations to mussels, scallops, oysters and cockles (but not to crab, lobster or crayfish). Urticaria, varying in extent and severity, is also known, and may follow ingestion of fresh or cooked ova. Migraine-like attacks, similar to those quoted by BRAY (1937), have also been attributed to ingestion of sea-egg ova. 2. Sensitivity.--Aside from allergic reactions, sea-eggs may disagree with certain persons, producing abdominal distress in a manner similar to mussels (DoDCSON, 1928) and to those food-substances mentioned by ALVAREZ and HINSHAW (1935). Here, certain substances in the ingested sea-egg may (quoting the above writers) " alter peristalsis by direct irritation of the nerve-endings in the mucosa of the stomach and intestine."
K. VIGORS EARLE.
~9
3. Ingestion of bacterial products.--It is possible that some cases of gastroenteritis may be due to irritative substances produced by bacterial action on the sea-egg ova during storage. Staphylococcus aureus, among other organisms, produces relatively heat-stable toxins (ScoTT, 1937), SO that the cooking of a stale sea-egg would not destroy its toxic properties, whilst the cooked article could also develop toxic products if stored for any length of time before being eaten.
FIG. 1. FIG. 1 . - - W H r r E SEA-URCHIN (Tripneustes
esculentus).
4. Ingestion of living bacilli.--Like oysters, clams, mussels, etc., sea-eggs may come into contact with polluted water and thus be contaminated with bacteria of the salmonella and typhoid-paratyphoid groups (JOI~DON, 1931). Whilst no case of typhoid caused by sewage-contaminated sea-eggs has been recorded from Barbados, it is a well-known fact that the cognoscenti prefe r sea-eggs gathered from the Crane Beach and other beds on the eastern or windward coast of Barbados : those gathered on the lee coast are considered inferior, and on this coast numerous drains and sewers debouch,
450
SEA-URCHINS.
Infection with typhoid bacilli has, however, been suspected in the cooked article improperly stored by salesmen who, faute de mieux, have been known to keep them under their beds. 2.
BLACK SEA-URCHIN (Fie. 2).
Centrechinus antillarum Clark (1918).
Known in Barbados as the cobbler, it inhabits the sea-bed but is also found attached to reefs, rocks, piers, piles, breakwaters, sewer-pipes, etc. in diameter it may reach 10 cm. and in height it may attain 5 or 6 cm., whilst the spines may reach 30 to 40 cm. in length. The adult is almost black in colour but in the young animal the spines may be banded with white or almost white striations. The test is hard and hemispherical and on the underside are numerous tentacles, the tips of which possess suckers. By the aid of these the animal can attach itself to rocks and also move quite actively when disturbed. The spines are long and slender and are tipped with sharp points. Along their entire length are small barbs which are directed towards the point of the spine, a fact which would tend to allow them to be withdrawn from the victim were it not for the ease with which the spines themselves break off and afterwards disintegrate when attempts are made to remove them. From the spines exudes a red fluid, the specific gravity of which is higher than that of sea-water. :This fluid changes colour, possibly by oxidation, to brown, on standing in dilution. Drops of such fluid may be seen at the extremities of some o f the spines in Fig. 2. Local folk-lore has it that the cobbler is able to shoot its spines at its victims, but there is no foundation for this superstition. The ova of this species are not eaten. PATHOLOGICAL EFFECTS.
The lesions produced by penetration of the spines occur principally in the feet ; but, where the animal is attached to piles, ladders of piers, etc., the hands, arms and Chest of those climbing up them may be injured. In professional gatherers of sea-eggs the hands may be injured during diving. Having punctured the skin the spine penetrates to a varying depth and then breaks off. Movements of the body and attempts to withdraw the spine result in its fragmentation. At the same time the red fluid mentioned above is liberated into the tissues. It is likely that this fluid has irritant properties, for the pain produced by the puncture is, according to PACKEr (1939) who speaks from personal experience of the lesion, far greater than could be produced by the purely mechanical injury. In any case, the pain arising from these lesions is exquisite. Around each spine a zone of hyperaemia rapidly appears, and the spine if left in situ is eventually removed by clasmatdcytosis. Its disappearance is usually complete in from 24 to 48 hours. Suppuration is rare.
K. VIGORS EARLE.
451
Treatment.--If the spines have penetrated only a short distance an attempt may be made to remove them, but, owing to their extreme fragility, removal is impossible when they are deeply embedded. The wounds should be dressed with antiseptic dressings and pain relieved by suitable analgesics. In Barbados, especially with punctures of the sole of the foot, I found it a wise precaution to administer a prophylactic dose (500 U.S.A. units) of tetanus antitoxin, on account of the prevalence of tetanus in that island (EARLE, 1938, 1939). The
FIG. 2. Fro. 2.--BLACK SEA-URcHIN(Centrechinus antillarurn). patient can be reassured as to the probable speedy dissolution of the spines. Should suppuration occur it must be dealt with by the usual methods. A first-aid treatment among the negroes of Barbados is to urinate over the site of penetration, but the efficacy of this measure has yet to be proved. Similarly, the application of vinegar, weak acids, etc., to the points of entry of the spines, is of doubtful value.
452
SEA-URCHINS. SUMMARY.
1. A n a c c o u n t of two c o m m o n W e s t I n d i a n e c h i n o d e r m s is given. 2. Pathological effects, resulting f r o m p e n e t r a t i o n of the spines and following ingestion of the ova, are described. REFERENCES.
ALVAREZ,W. C. • HINSHAW,H . C .
(1935). Foods that commonly disagree with people. ft. Amer. med. Ass., 104, 2053. BARLEY, H . H . (1938). Personal Communication. BRAY, G . W . (1937). Recent Advances in Allergy, p. 399. London : Ji & A. Churchill, Ltd. CASTELLANI, A. & CHALMERS, A. J. (1919). Manual of Tropical Medicine. 3rd Ed., p. 205. London : Bailli+re, Tindall and Cox. DODGSON, R . W . (1928). Report on mussel purification. 34inistry of Agriculture and Fisheries. Fishing Investigations. Set. 2, 10, 498. EARLE, K . V . (1938). Evipan sodium in the treatment of tetanus. Lancet, 1,435. • (1939). Six cases of tetanus treated with intrathecal antitoxin, intravenous antitoxin and intravenous evipan-sodium narcosis. Caribbean med.J., 1,229. JORDON, E. O. (1931). Food Poisoning and Food-borne Infection. 2nd Ed. p. 60. Chicago : The University of Chicago Press. PACKEI~, J . F . (1939). Personal communicatiom RowE, A. H. (1937). Allergy to fish. Clinical Allergy, p. 598. London : Bailli+re, Tindall and Cox. SCOTT, W . M . (1937). Food poisoning. The British Encyclopaedia of Medical Practice, 5,401. London : Butterworth and Co., Ltd. VAUGHAN,W. T, (1933). Clinical allergy. Oxford Medicine, 9. (1), 216. New York : Oxtbrd University Press.
TROPICAL MEDICINE AND HYGIENE. Vol. XXXIII. No. 4. January, 1940.
PATHOLOGICAL
EFFECTS OF TWO ECHINODERMS.
WEST
INDIAN
BY
K. VIGORS EARLE, M.D. (LOND.), B.CH. (CANTAB.),* Medical Officer, United British Oilfields of Trinidad, Ltd., Trinidad, British West Indies.
Two varieties of sea-urchin, found in Barbados and other West Indian islands, are of interest on account of their varied pathological effects on the human body. 1. WHrrE SEA-URCHIN (FIG. 1).
Tripneustes esculentus Bell (1878).
K n o w n in Barbados as the white sea-egg or edible sea-egg, it inhabits the sea-bed, where it often adopts a camouflage of green seaweed. It is captured by diving boys who earn a living by its collection and sale. In size, the adult may attain a diameter of 14 cm. and a height of 9.5 cm. Its spines are short, rather slender and sharp-pointed, not nearly equalling the diameter of the test. In colour the spines are all white or whitish : the test is brownish, purple or sometimes a deep greenish-brown. T h e ova, which are orange-coloured, and lie in sections inside the test, are regarded as a delicacy and may be eaten raw (when they h a v e a sweetish taste), like those of the Mediterranean sea-urchin. Usually, however, they are first boiled and then fried. PATHOLOGICAL EFFECTS.
These are of two classes--punctures from the spines; and pathological effects following ingestion of the ova. ~I have to thank Dr. H. H. BAYL*~Y,Mrs. BAYLEYand Mr. J. F. PaCK~R,of Barbados, for much helpful information. Mr. PACK~:Ris also responsib:e for the photographs,
448
SEA-URCIIINS.
Lesions Due to the Spines. These are usually situated in the hands (when the animal has been dived for and tightly grasped) ; or on the feet (in bathers). A certain degree of force is required to cause penetration : if lifted with care the animal can be handled with impunity. Since the spines are brittle they may break off in the puncture wound. Unlike the spines of the common sea-urchin of the Red Sea, described by CASTELLANI and CHALMER$ (1919), they are non-poisonous, but if allowed to remain in situ, as has been shown by BAYLEY (1938), they do not dissolve and almost invariably lead to suppuration. Treatment, therefore, is removal of the spines by careful dissection and the subsequent application of antiseptic dressings. In the event of suppuration, the administration of sulphanilamide derivatives, especially M. & B. 693, is to be recommended.
Efjects Due to Ingestion of Ova. The sea-egg is in season from September to April. Outside these months the ova are immature and the close season is enforced by law. The ovaries are never poisonous like those of the Mediterranean variety mentioned by JORDON (1931), which have toxic properties during the spawning season. Following ingestion of the ova the following reactions may be produced. 1. Allergic.--As the sea-egg is not an everyday article of food its allergic action belongs to the group of " fortunate allergies " described by VAUGHAN (1933). Three separate types of manifestation have been noted though others probably exist but have not been differentiated. Abdominal symptoms include epigastric discomfort and pain, nausea, vomiting and diarrhoea. These resemble the manifestations of fish allergy quoted by ROWE (1937). I have seen the occurrence of epigastric pain, nausea and migraine-like attacks follow ingestion of sea-egg ova by a patient who also showed similar allergic manifestations to mussels, scallops, oysters and cockles (but not to crab, lobster or crayfish). Urticaria, varying in extent and severity, is also known, and may follow ingestion of fresh or cooked ova. Migraine-like attacks, similar to those quoted by BRAY (1937), have also been attributed to ingestion of sea-egg ova. 2. Sensitivity.--Aside from allergic reactions, sea-eggs may disagree with certain persons, producing abdominal distress in a manner similar to mussels (DoDCSON, 1928) and to those food-substances mentioned by ALVAREZ and HINSHAW (1935). Here, certain substances in the ingested sea-egg may (quoting the above writers) " alter peristalsis by direct irritation of the nerve-endings in the mucosa of the stomach and intestine."
K. VIGORS EARLE.
~9
3. Ingestion of bacterial products.--It is possible that some cases of gastroenteritis may be due to irritative substances produced by bacterial action on the sea-egg ova during storage. Staphylococcus aureus, among other organisms, produces relatively heat-stable toxins (ScoTT, 1937), SO that the cooking of a stale sea-egg would not destroy its toxic properties, whilst the cooked article could also develop toxic products if stored for any length of time before being eaten.
FIG. 1. FIG. 1 . - - W H r r E SEA-URCHIN (Tripneustes
esculentus).
4. Ingestion of living bacilli.--Like oysters, clams, mussels, etc., sea-eggs may come into contact with polluted water and thus be contaminated with bacteria of the salmonella and typhoid-paratyphoid groups (JOI~DON, 1931). Whilst no case of typhoid caused by sewage-contaminated sea-eggs has been recorded from Barbados, it is a well-known fact that the cognoscenti prefe r sea-eggs gathered from the Crane Beach and other beds on the eastern or windward coast of Barbados : those gathered on the lee coast are considered inferior, and on this coast numerous drains and sewers debouch,
450
SEA-URCHINS.
Infection with typhoid bacilli has, however, been suspected in the cooked article improperly stored by salesmen who, faute de mieux, have been known to keep them under their beds. 2.
BLACK SEA-URCHIN (Fie. 2).
Centrechinus antillarum Clark (1918).
Known in Barbados as the cobbler, it inhabits the sea-bed but is also found attached to reefs, rocks, piers, piles, breakwaters, sewer-pipes, etc. in diameter it may reach 10 cm. and in height it may attain 5 or 6 cm., whilst the spines may reach 30 to 40 cm. in length. The adult is almost black in colour but in the young animal the spines may be banded with white or almost white striations. The test is hard and hemispherical and on the underside are numerous tentacles, the tips of which possess suckers. By the aid of these the animal can attach itself to rocks and also move quite actively when disturbed. The spines are long and slender and are tipped with sharp points. Along their entire length are small barbs which are directed towards the point of the spine, a fact which would tend to allow them to be withdrawn from the victim were it not for the ease with which the spines themselves break off and afterwards disintegrate when attempts are made to remove them. From the spines exudes a red fluid, the specific gravity of which is higher than that of sea-water. :This fluid changes colour, possibly by oxidation, to brown, on standing in dilution. Drops of such fluid may be seen at the extremities of some o f the spines in Fig. 2. Local folk-lore has it that the cobbler is able to shoot its spines at its victims, but there is no foundation for this superstition. The ova of this species are not eaten. PATHOLOGICAL EFFECTS.
The lesions produced by penetration of the spines occur principally in the feet ; but, where the animal is attached to piles, ladders of piers, etc., the hands, arms and Chest of those climbing up them may be injured. In professional gatherers of sea-eggs the hands may be injured during diving. Having punctured the skin the spine penetrates to a varying depth and then breaks off. Movements of the body and attempts to withdraw the spine result in its fragmentation. At the same time the red fluid mentioned above is liberated into the tissues. It is likely that this fluid has irritant properties, for the pain produced by the puncture is, according to PACKEr (1939) who speaks from personal experience of the lesion, far greater than could be produced by the purely mechanical injury. In any case, the pain arising from these lesions is exquisite. Around each spine a zone of hyperaemia rapidly appears, and the spine if left in situ is eventually removed by clasmatdcytosis. Its disappearance is usually complete in from 24 to 48 hours. Suppuration is rare.
K. VIGORS EARLE.
451
Treatment.--If the spines have penetrated only a short distance an attempt may be made to remove them, but, owing to their extreme fragility, removal is impossible when they are deeply embedded. The wounds should be dressed with antiseptic dressings and pain relieved by suitable analgesics. In Barbados, especially with punctures of the sole of the foot, I found it a wise precaution to administer a prophylactic dose (500 U.S.A. units) of tetanus antitoxin, on account of the prevalence of tetanus in that island (EARLE, 1938, 1939). The
FIG. 2. Fro. 2.--BLACK SEA-URcHIN(Centrechinus antillarurn). patient can be reassured as to the probable speedy dissolution of the spines. Should suppuration occur it must be dealt with by the usual methods. A first-aid treatment among the negroes of Barbados is to urinate over the site of penetration, but the efficacy of this measure has yet to be proved. Similarly, the application of vinegar, weak acids, etc., to the points of entry of the spines, is of doubtful value.
452
SEA-URCHINS. SUMMARY.
1. A n a c c o u n t of two c o m m o n W e s t I n d i a n e c h i n o d e r m s is given. 2. Pathological effects, resulting f r o m p e n e t r a t i o n of the spines and following ingestion of the ova, are described. REFERENCES.
ALVAREZ,W. C. • HINSHAW,H . C .
(1935). Foods that commonly disagree with people. ft. Amer. med. Ass., 104, 2053. BARLEY, H . H . (1938). Personal Communication. BRAY, G . W . (1937). Recent Advances in Allergy, p. 399. London : Ji & A. Churchill, Ltd. CASTELLANI, A. & CHALMERS, A. J. (1919). Manual of Tropical Medicine. 3rd Ed., p. 205. London : Bailli+re, Tindall and Cox. DODGSON, R . W . (1928). Report on mussel purification. 34inistry of Agriculture and Fisheries. Fishing Investigations. Set. 2, 10, 498. EARLE, K . V . (1938). Evipan sodium in the treatment of tetanus. Lancet, 1,435. • (1939). Six cases of tetanus treated with intrathecal antitoxin, intravenous antitoxin and intravenous evipan-sodium narcosis. Caribbean med.J., 1,229. JORDON, E. O. (1931). Food Poisoning and Food-borne Infection. 2nd Ed. p. 60. Chicago : The University of Chicago Press. PACKEI~, J . F . (1939). Personal communicatiom RowE, A. H. (1937). Allergy to fish. Clinical Allergy, p. 598. London : Bailli+re, Tindall and Cox. SCOTT, W . M . (1937). Food poisoning. The British Encyclopaedia of Medical Practice, 5,401. London : Butterworth and Co., Ltd. VAUGHAN,W. T, (1933). Clinical allergy. Oxford Medicine, 9. (1), 216. New York : Oxtbrd University Press.