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THE UNIVERSITY OF CHICAGO
SCIENCE SERIES
_Editorial Committee_
ELIAKIM HASTINGS MOORE, _Chairman_
JOHN MERLE COULTER
ROBERT ANDREWS MILLIKAN
The University of Chicago Science Series, established by the Trustees of
the University, owes its origin to a feeling that there should be a
medium of publication occupying a position between the technical
journals with their short articles and the elaborate treatises which
attempt to cover several or all aspects of a wide field. The volumes of
the series will differ from the discussions generally appearing in
technical journals in that they will present the complete results of an
experiment or series of investigations which previously have appeared
only in scattered articles, if published at all. On the other hand, they
will differ from detailed treatises by confining themselves to specific
problems of current interest, and in presenting the subject in as
summary a manner and with as little technical detail as is consistent
with sound method.
FOOD POISONING
THE UNIVERSITY OF CHICAGO PRESS
CHICAGO, ILLINOIS
+Agents+
THE BAKER & TAYLOR COMPANY
NEW YORK
THE CUNNINGHAM, CURTISS & WELCH COMPANY
LOS ANGELES
THE CAMBRIDGE UNIVERSITY PRESS
LONDON AND EDINBURGH
THE MARUZEN-KABUSHIKI-KAISHA
TOKYO, OSAKA, KYOTO, FUKUOSA, SENDAI
THE MISSION BOOK COMPANY
SHANGHAI
FOOD POISONING
_By_
EDWIN OAKES JORDAN
_Chairman of the Department of Hygiene and Bacteriology
The University of Chicago_
[Illustration: emblem]
THE UNIVERSITY OF CHICAGO PRESS
CHICAGO, ILLINOIS
COPYRIGHT 1917 BY
THE UNIVERSITY OF CHICAGO
All Rights Reserved
Published May 1917
Composed and Printed By
The University of Chicago Press
Chicago, Illinois, U.S.A.
CONTENTS
CHAPTER PAGE
I. INTRODUCTION 1
The Extent of Food Poisoning
Various Kinds of Food Poisoning
The Articles of Food Most Commonly
Connected with Food Poisoning
II. SENSITIZATION TO PROTEIN FOODS 9
III. POISONOUS PLANTS AND ANIMALS 13
Poisonous Plants
Poisonous Animals
IV. MINERAL OR ORGANIC POISONS ADDED TO FOOD 26
Arsenic
Antimony
Lead
Tin
Copper
Various Coloring Substances
Food Preservatives
Food Substitutes
V. FOOD-BORNE PATHOGENIC BACTERIA 44
Typhoid Food Infection
Asiatic Cholera
Tuberculosis
Various Milk-borne Infections
Possible Infection with _B. proteus_
VI. FOOD-BORNE PATHOGENIC BACTERIA (_Continued_) 58
Paratyphoid Infection
Typical Paratyphoid Outbreaks
General Characters of Paratyphoid Infection
Toxin Production
Sources of Infection
Means of Prevention
VII. ANIMAL PARASITES 79
Trichiniasis
Teniasis
Uncinariasis
Other Parasites
VIII. POISONOUS PRODUCTS FORMED IN FOOD BY BACTERIA
AND OTHER MICRO-ORGANISMS 85
Ergotism
Botulism
Symptoms
Anatomical Lesions
Bacteriology
Epidemiology
Prevention and Treatment
Other Bacterial Poisons
Spoiled and Decomposed Food
IX. POISONING OF OBSCURE OR UNKNOWN NATURE 100
Milksickness or Trembles
Deficiency Diseases
Beriberi
Pellagra
Lathyrism
Favism
Scurvy
Rachitis
The Foods Most Commonly Poisonous
INDEX 109
CHAPTER I
INTRODUCTION
How frequently food poisoning occurs is not definitely known. Everybody
is aware that certain articles of food are now and again held
responsible for more or less severe "attacks of indigestion" or other
physiological disturbances that have followed their consumption, but in
many cases the evidence for assuming a causal connection is of the
slightest. That convenient refuge from etiological uncertainty, "ptomain
poisoning," is a diagnosis that unquestionably has been made to cover a
great variety of diverse conditions, from appendicitis and the pain
caused by gallstones to the simple abdominal distention resulting from
reckless gorging.
No doubt can be entertained, however, that intestinal and other
disorders due to particular articles of food occur much more frequently
than they are recorded. There are few persons who have not experienced
gastro-intestinal attacks of moderate severity which could be reasonably
attributed to something eaten shortly before. It is often possible to
specify with a fair degree of certainty the offending food. The great
majority of such attacks are of a mild character, are quickly recovered
from, and are never heard of beyond the immediate family circle. Only
when the attack is more serious than the average or when a large number
of persons are affected simultaneously does knowledge of the occurrence
become more widely spread. A small proportion of food-poisoning cases
receives notice in the public press and a still smaller proportion is
reported in the medical journals. Very few indeed are ever completely
investigated as to their origin.
Although most attacks of food poisoning are usually of a slight and
apparently temporary nature, it does not follow that they are to be
considered negligible or of trivial importance from the standpoint of
public health. The human organism is always more or less weakened by
such attacks, many of them, as we shall see, genuine infections; and, as
is known to be the case with many infectious diseases, some permanent
injurious impression may be left on the body of the affected individual.
Under certain conditions it is possible that degenerative changes are
initiated or accelerated in the kidneys or blood vessels by the acute
poisoning which is manifested for a short time in even the milder cases.
In yet greater degree these changes may follow those insidious forms of
food poisoning due to the frequent ingestion of small quantities of
mineral or organic poisons, which in each dose may cause little or no
measurable physiological change, but whose cumulative effect may be
vicious. In view of the grave situation evidenced by the increase in the
degenerative diseases affecting early middle life in the United
States,[1] the extent, causes, and means of prevention of food poisoning
seem pressing subjects for investigation.
THE EXTENT OF FOOD POISONING
Since cases of food poisoning, "ptomain poisoning," and the like are not
required by law to be reported, public health authorities in general
possess no information respecting their occurrence. Very indirect and
imperfect indications of the prevalence of certain kinds of food
poisoning are afforded by casual press reports. Such as they are, these
accounts are the only available material. Tables I and II summarize data
I have gathered through a press-clipping bureau and other sources during
the period October, 1913, to October, 1915. They serve to show at least
the universality and complexity of the problem.
The 375 group and family outbreaks together involved 5,238 persons.
While it is not probable that all the instances reported as due to food
poisoning can properly be so considered, there is no doubt that the
number recorded in the tables falls far short of the actual occurrences.
In the past few years the writer has investigated several large
food-poisoning outbreaks which have never been reported in the press nor
received public notice in any way. There is reason to think that the
majority of cases escape notice. Probably several thousand outbreaks of
food poisoning in families and larger groups, affecting at least
15,000-20,000 persons, occur in the United States in the course of a
year.
The assignment of causes indicated in Table I is of limited value. The
tendency to incriminate canned food is here manifest. Proper
investigation of the origin of an outbreak is so rarely carried out that
the articles of food ordinarily accused are selected rather as the
result of popular prejudice and tradition than of any careful inquiry.
TABLE I
FOOD POISONING IN THE UNITED STATES, OCTOBER, 1913, TO OCTOBER, 1915
=================================================================
Assigned cause | Group | |
|and Family|Individual|
| Outbreaks| Cases | Total
-----------------------------------+----------+----------+-------
Meat | 40 | 35 | 75
Canned fish | 29 | 35 | 64
Canned vegetables | 27 | 34 | 61
Ice cream | 31 | 22 | 53
Fish, oysters | 17 | 31 | 48
Cheese | 31 | 9 | 40
Sausage and canned meat | 18 | 18 | 36
Milk | 14 | 13 | 27
Mushrooms | 12 | 7 | 19
Fruit | 8 | 11 | 19
Vegetables | 11 | 7 | 18
Fowl | 12 | 4 | 16
Salad | 9 | 5 | 14
Contact of food or drink with metal| 12 | 1 | 13
Miscellaneous | 29 | 55 | 84
-----------------------------------+----------+----------+-------
| 300 | 287 | 587
No cause assigned | 357 | 88 | 445
-----------------------------------+----------+----------+-------
| 657 | 375 | 1,032
-----------------------------------------------------------------
TABLE II
SEASONAL DISTRIBUTION OF FOOD POISONING CASES, 1914-15 (GROUP, FAMILY,
AND INDIVIDUAL)
==========================================
January | 90 ||May | 63 ||September| 76
February| 66 ||June |108 ||October | 96
March | 75 ||July | 99 ||November | 96
April | 79 ||August| 96 ||December | 88
------------------------------------------
There is no very striking seasonal incidence apparent in the figures
here gathered (Table II). The warmer months seem to have a slight
preponderance of cases, but general conclusions from such data are
hardly warranted.
VARIOUS KINDS OF FOOD POISONING
Cases of poisoning by articles of food may be distinguished as: (1)
those caused by some injurious constituent in the food itself, and (2)
those caused by a peculiar condition of the individual consuming the
food, by virtue of which essentially wholesome food substances are
capable of producing physiological disturbance in certain individuals.
The latter group includes persons, apparently normal in other respects,
who are more or less injuriously affected by some particular article of
diet, such as eggs or milk, which is eaten with impunity by all normal
individuals. This is the so-called food sensitization or food allergy.
Food poisoning, as more commonly understood, is due to the composition,
contents, or contamination of the food itself. It is not within the
scope of this book to consider any of those cases in which definite
poisonous substances are added to food with criminal intent. The term
food poisoning is here taken to include the occasional cases of
poisoning from organic poisons present in normal animal or plant
tissues, the more or less injurious consequences following the
consumption of food into which formed mineral or organic poisons have
been introduced by accident or with intent to improve appearances or
keeping quality, the cases of infection due to the swallowing of
bacteria and other parasites which infest or contaminate certain foods,
and the poisoning due to deleterious substances produced in food by the
growth of bacteria, molds, and similar organisms. As already pointed
out, little is known about the relative frequency of occurrence of these
different causes or the extent to which they are separately and
collectively operative.
THE ARTICLES OF FOOD MOST COMMONLY CONNECTED WITH FOOD POISONING
In addition to the definitely poisonous plants or animals, certain
everyday articles of food have been frequently associated with the more
serious outbreaks of food poisoning. Meat in particular has been
implicated so often that the term meat poisoning is used about as
commonly as the term food poisoning in general discussions of this
subject. Certain it is that the great majority of the best-studied and
most severe outbreaks of food poisoning have been attributed on good
grounds to the use of meat or meat products. Other animal foods, and
especially milk and its derivatives, cheese and ice-cream, have likewise
been held responsible for extensive and notable outbreaks.
Perhaps the most significant feature of food poisoning attacks is the
frequency with which they have been traced to the use of raw or
imperfectly cooked food. The probable interpretation of this fact will
be discussed in the later chapters. Especially have the use of uncooked
milk, either by itself or mixed with other food substances, and the
eating of raw sausage brought in their train symptoms of poisoning in a
disproportionately large number of cases.
Canned goods of various sorts have likewise been repeatedly accused of
causing injurious effects, but the evidence adduced is not always
convincing. The actual degree of danger from this source is far from
being determined. The National Canners Association publishes in the
annual report of the secretary a brief list of "libels on the industry"
or instances in which canned foods of various sorts were regarded as the
cause of illness. The 1916 report contains fifty-one cases of this
character, none of which was considered by the investigator of the
Association to be based on sound evidence. A still more searching
investigation of all such cases would seem to be desirable, not with a
view to incriminating or exculpating any particular product, but simply
for the purpose of ascertaining and placing on record all the facts.
FOOTNOTES:
[1] Tables A and B show that the "expectation of life" for adults of
forty years and over is shorter in New York City now than it was thirty
years ago (Table A), and that this increase in the death-rate in the
higher-age groups is manifested in recent years in a wide area in this
country (Table B). This increased mortality is due chiefly to diseases
of the heart, arteries, and kidneys, and to cancer.
TABLE A[1a]
APPROXIMATE LIFE TABLE, TRIENNA 1879-81 AND 1909-11, BASED ON NEW YORK
CITY STATISTICS
==================================================
|Expectation|Expectation| Gain (+) or
| of Life, | of Life, |Loss (-) in Years
Ages | 1879-81 | 1909-11 | of Expectancy
--------+-----------+-----------+-----------------
Under 5 | 41.3 | 51.9 | +10.6
5 | 46.3 | 51.1 | + 4.8
10 | 43.8 | 46.9 | + 3.1
15 | 39.7 | 42.5 | + 2.8
20 | 35.8 | 38.3 | + 2.5
25 | 32.6 | 34.3 | + 1.7
30 | 29.6 | 30.5 | + 0.9
35 | 26.7 | 26.9 | + 0.2
40 | 23.0 | 23.4 | - 0.5
45 | 21.1 | 20.0 | - 1.1
50 | 18.3 | 16.8 | - 1.5
55 | 15.4 | 13.9 | - 1.5
60 | 13.0 | 11.3 | - 1.7
65 | 10.5 | 9.1 | - 1.4
70 | 8.9 | 7.2 | - 1.7
75 | 7.3 | 5.5 | - 1.8
80 | 6.4 | 4.3 | - 2.1
85 | 5.5 | 2.2 | - 3.3
Balance | | | +26.6
| | | -16.6
| | |-----------------
| | | +10.0
--------------------------------------------------
TABLE B[1b]
COMPARISON OF MORTALITY OF MALES AND FEMALES, BY AGE GROUPS. DEATH-RATES
PER 1,000 POPULATION (REGISTRATION STATES AS CONSTITUTED IN 1900)
============================================================
Ages | Males |Percentage | Females |Percentage
|-----------|Increase or|-----------|Increase or
| 1900| 1911| Decrease | 1900| 1911| Decrease
------------+-----+-----+-----------+-----------------------
Under 5 | 54.2| 39.8| -26.27 | 45.8| 33.3| -27.29
5-9 | 4.7| 3.4| -27.66 | 4.6| 3.1| -32.61
10-14 | 2.9| 2.4| -17.24 | 3.1| 2.1| -32.26
15-19 | 4.9| 3.7| -24.49 | 4.8| 3.3| -31.25
20-24 | 7.0| 5.3| -24.29 | 6.7| 4.7| -29.85
25-34 | 8.3| 6.7| -19.28 | 8.2| 6.0| -26.83
35-44 | 10.8| 10.4| -3.70 | 9.8| 8.3| -15.31
45-54 | 15.8| 16.1| +1.90 | 14.2| 12.9| -9.15
55-64 | 28.9| 30.9| +6.92 | 25.8| 26.8| +0.78
65-74 | 59.6| 61.6| +3.36 | 53.8| 55.1| +2.42
75 and over|146.1|147.4| +0.89 |139.5|139.2| +0.22
All ages | 17.6| 15.8| -10.23 | 16.5| 14.0| -15.15
------------------------------------------------------------
[1a] _Monthly Bull., Dept. of Health, City of New York_, III (1913),
113.
[1b] Dublin, _Amer. Jour. Public Health_, III (1915), 1262.