DIVISION III.—FOOD POISONING.

§ 686. A large number of cases of poisoning by food occur yearly; some are detailed in the daily press; the great majority are neither recorded in any journal, scientific or otherwise; nor, on account of their slight and passing character, is medical aid sought. The greatest portion of these cases are probably due to ptomaines existing in the food before being consumed; others may be due to the action of unhealthy fermentation in the intestinal canal itself; in a third class of cases, it is probable that a true zymotic infection is conveyed and develops in the sufferer; the latter class of cases, as, for instance, the Middlesborough epidemic of pleuro-pneumonia, is outside the scope of this treatise.

Confining the attention to cases of food poisoning in which the symptoms have been closely analysed and described, the reader is referred to thirteen cases of food poisoning, investigated by the medical officers of the Local Government Board between the years 1878 and 1891, as follows:—

1878. A Case of Poisoning at Whitchurch from eating Roast Pork.—Only the leg of pork was poisonous, other parts eaten without injury. Two persons died after about thirty hours’ illness. The pork itself, on a particular Sunday, was innocuous; it became poisonous between the Sunday and the Monday; the toxicity appeared to gradually increase, for those who ate it for dinner on the Monday were not taken ill for periods of from seven to nineteen hours, while two persons who ate of it in the evening were attacked four hours after eating.

1880. The Welbeck Epidemic, due to eating cold boiled ham. Over fifty persons affected. Symptoms commenced in from twelve to forty-eight hours.

1881. A Series of Poisoning from eating Baked Pork, Nottingham.—Probably the gravy was the cause and not the pork itself. Many persons seriously ill. One died.

1881. Tinned American Sausage.—A man in Chester died from eating tinned American sausage. Poison found to be unequally distributed in the sausage.

1882. Poisoning at Oldham by Tinned Pigs’ Tongues.—Two families affected. Symptoms commenced in about four hours. All recovered. After a few days’ keeping it would appear that the poison had been decomposed.

1882. A Family Poisoned by Roast Beef at Bishop Stortford.—Only a particular piece of the ribs seemed to be poisonous, the rest of the carcase being innocuous. Symptoms did not commence until several hours after ingestion.

1882. Ten different Families at Whitchurch Poisoned by eating Brawn.—First symptoms after about four hours.

1884. Tinned Salmon at Wolverhampton.—Five persons, two being children, ate of tinned salmon at Wolverhampton. All suffered more or less. The mother’s symptoms began after twelve hours, and she died in five days; the son died in three days, the symptoms commencing in ten hours. The post-mortem signs were similar to those from phosphorus poisoning, viz., fatty degeneration. Mice fed on the material also suffered, and their organs showed a similar degeneration.

1886. The Carlisle A Case.—At a wedding breakfast in Carlisle twenty-four persons were poisoned by food which had been kept in an ill-ventilated cellar. The articles suspected were an American ham, an open game pie, and certain jellies. The bride died. Symptoms commenced in from six to forty-three hours.

1886. Poisoning by Veal Pie at Iron Bridge.—Twelve out of fifteen ate of the pie; all were taken ill in from six to twelve hours.

1887. Poisoning at Retford of Eighty Persons from eating Pork Pie or Brawn.—Symptoms commenced at various intervals, from eight to thirty-six hours.

1889. The Carlisle B Case.—Poisoning by pork pies or boiled salt pork. Number of persons attacked, about twenty-five.

1891. Poisoning by a Meat Pie at Portsmouth.—Thirteen persons suffered from serious illness. Portions of the pies were poisonous to mice.

The symptoms in all these cases were not precisely alike; but they were so far identical as to show as great a similarity as in cases when a number of persons are poisoned by the same chemical substance. Arsenic, for instance, produces several types of poisoning; so does phosphorus.

Severe gastro-enteric disturbance, with more or less affection of the nervous system, were the main characteristics. These symptoms commenced, as before stated, at various intervals after ingestion of the food; but they came on with extreme suddenness. Rigors, prostration, giddiness, offensive diarrhœa, followed by muscular twitchings, dilatation of the pupil, drowsiness, deepening in bad cases to coma, were commonly observed. The post-mortem appearances were those of enteritis, with inflammatory changes in the kidney and liver. Convalescence was slow; sometimes there was desquamation of the skin.

In many of these cases Dr. Klein found bacteria which, under certain conditions, were capable of becoming pathogenic; but in no case does there seem to have been at the same time an exhaustive chemical inquiry; so that, although there was evidence of a poison passing through the kidney, the nature of the poison still remains obscure.

The deaths in England and Wales from unwholesome food during ten years were as follows:—

DEATHS IN ENGLAND AND WALES FROM UNWHOLESOME FOOD DURING THE TEN YEARS 1883-1892.

1883.1884.1885.1886.1887.1888.1889.1890.1891.1892.Total.
Diseased meat,1...........................1
Poisonous fish,232114329633
Unwholesome brawn,...1........................1
Tinned salmon,...2........................2
Putrid meat,...111......1.........4
Diseased food,...1........................1
Mussels,...1............1.........2
Tinned foods,............2...............2
Whelks,............1...............1
Winkles,.....................1......1
Ptomaines,........................1...1
3932445310649

§ 687. German Sausage Poisoning.—A series of cases may be picked out from the accounts of sausage poisoning in Germany, all of which evidently depend upon a poison producing the same symptoms, and the essentially distinctive mark of which is extreme dryness of the skin and mucous membranes, dilatation of the pupil, and paralysis of the upper eyelids (ptosis). In an uncertain time after eating sausages or some form of meat, from one to twenty-four hours, there is a general feeling of uneasiness, a sense of weight about the stomach, nausea, and soon afterwards vomiting, and very often diarrhœa. The diarrhœa is not severe, never assumes a choleraic form, and is unaccompanied by cramps in the muscles. After a considerable interval there is marked dryness of the mucous membrane (a symptom which never fails), the tongue, pharynx, and the mouth generally seem actually destitute of secretion; there is also an absence of perspiration, the nasal mucous membrane participates in this unnatural want of secretion, the very tears are dried up. In a case related by Kraatzer,[678] the patient, losing a son, was much troubled, but wept no tear. This dryness leads to changes in the mucous membrane, it shrivels, and partly desquamates, aphthous swellings may occur, and a diffuse redness and diphtheritic-like patches have been noticed. There is obstinate constipation, probably from a dryness of the mucous lining of the intestines. The breath has an unpleasant odour, there is often a croupy cough, the urinary secretion alone is not decreased but rather augmented. Swallowing may be so difficult as to rise to the grade of aphagia, and the tongue cannot be manipulated properly, so that the speech may be almost unintelligible. At the same time, marked symptoms of the motor nerves of the face are present, the patient’s sight is disturbed, he sees colours or sparks before his eyes; in a few cases there has been transitory blindness, in others diplopia. The pupil in nearly all the cases has been dilated, also in exceptional instances it has been contracted. The levator palpebrae superioris is paralysed, and the resulting ptosis completes the picture. Consciousness remains intact almost to death, there is excessive weakness of the muscles, perhaps from a general paresis. If the patient lives long enough, he gets wretchedly thin, and dies from marasmus. In more rapidly fatal cases, death follows from respiratory paralysis, with or without convulsions.

[678] Quoted by Husemann, Vergiftung durch Wurstgift (Maschka’s Handbook).

The post-mortem appearances which have been observed are—the mucous membranes of the mouth, gullet, and throat are white, hard, and parchment-like; that of the stomach is more or less injected with numerous hæmorrhages: the kidneys are somewhat congested, with some effusion of blood in the tubuli; the spleen is large and very full of blood, and the lungs are often œdematous, pneumonic, or bronchitic.