designated as _Mytilotoxismus paralyticus_. As early as 1827 Combe
reported his observations upon thirty persons who had suffered from
this kind of mussel poisoning. The first symptoms, as a rule, appeared
within two hours after eating the poisonous food. Some suffered from
nausea and vomiting, but these were not constant or lasting symptoms.
All complained of a prickly feeling in the hands, heat and constriction
of the throat, difficulty of swallowing and speaking, numbness about
the mouth, gradually extending over the face and to the arms, with
great debility of the limbs. Most of the sufferers were unable to
stand; the action of the heart was feeble, and the face grew pale and
expressed much anxiety. Two of the thirty cases terminated fatally.
Post-mortem examination showed no abnormality.
Many opinions have been expressed concerning the nature of harmful
mussels. Until quite recently it was a common belief that certain
species are constantly toxic. Virchow has attempted to describe the
dangerous variety of mussels, stating that it has a brighter shell,
sweeter, more penetrating, bouillonlike odor than the edible kind, and
that the flesh of the poisonous mussel is yellow; the water in which
they are boiled becomes bluish.
However, this belief in a poisonous species is now admitted to be
erroneous. At one time it was suggested that mussels became hurtful
by absorbing the copper from the bottoms of vessels, but Christison
made an analysis of the mussels that poisoned the men mentioned by
Combe, with negative results, and also pointed out the fact that the
symptoms were not those of poisoning with copper. Some have held that
the ill effects were due wholly to idiosyncrasies in the consumers,
but cats and dogs are affected in the same way as men are. It has also
been believed that all mussels are poisonous during the period of
reproduction. This theory is the basis of the popular superstition that
shellfish should not be eaten during the months in the name of which
the letter "r" does not occur. At one time this popular idea took the
form of a legal enactment in France forbidding the sale of shellfish
from May 1st to September 1st. This widespread idea has a grain of
truth in it, inasmuch as decomposition is more likely to alter food
injuriously during the summer months. However, poisoning with mussels
may occur at any time of the year.
It has been pretty well demonstrated that the first two forms of mussel
poisoning mentioned above are due to putrefactive processes, while
the paralytic manifestations seen in other cases are due to a poison
isolated a few years ago by Brieger, and named by him mytilotoxin. Any
mussel may acquire this poison when it lives in filthy water. Indeed,
it has been shown experimentally that edible mussels may become harmful
when left for fourteen days or longer in filthy water; while, on the
other hand, poisonous mussels may become harmless if kept four weeks
or longer in clear water. This is true not only of mussels, but of
oysters as well. Some years ago, many cases of poisoning from oysters
were reported at Havre. The oysters had been taken from a bed near the
outlet of a drain from a public water closet. Both oysters and mussels
may harbor the typhoid bacillus, and may act as carriers of this germ
to man.
There should be most stringent police regulations against the sale of
all kinds of mollusks, and all fish as well, taken from filthy waters.
Certainly one should avoid shellfish from impure waters, and it is not
too much to insist that those offered for food should be washed in
clean water. All forms of clam and oyster broth should be avoided when
it has stood even for a few hours at summer heat. These preparations
very quickly become infected with bacteria, which develop most potent
poisons.
FISH POISONING.--Some fish are supplied with poisonous glands, by means
of which they secure their prey and protect themselves from their
enemies. The "dragon weaver," or "sea weaver" (_Trachinus draco_),
is one of the best known of these fish. There are numerous varieties
widely distributed in salt waters. The poisonous spine is attached
partly to the maxilla and partly to the gill cover at its base. This
spine is connected with a poisonous gland; the spine itself is grooved
and covered with a thin membrane, which converts the grooves into
canals. When the point enters another animal its membrane is stripped
back and the poison enters the wound. Men sometimes wound their feet
with the barbs of this fish while bathing. It also occasionally happens
that a fisherman pricks his fingers with one of these barbs. The most
poisonous variety of this fish known is found in the Mediterranean Sea.
Wounds produced by these animals sometimes cause death. In _Synanceia
brachio_ there are in the dorsal fin thirteen barbs, each connected
with two poison reservoirs. The secretion from these glands is clear,
bluish in color, and acid in reaction, and when introduced beneath the
skin causes local gangrene and, if in sufficient quantity, general
paralysis. In _Plotosus lineatus_ there is a powerful barb in front of
the ventral fin, and the poison is not discharged unless the end of
the barb is broken. The most poisonous variety of this fish is found
only in tropical waters. In _Scorpæna scrofa_ and other species of this
family there are poison glands connected with the barbs in the dorsal
and in some varieties in the caudal fin.
A disease known as _kakke_ was a few years ago quite prevalent in
Japan and other countries along the eastern coast of Asia. With
the opening up of Japan to the civilized world the study of this
disease by scientific methods was undertaken by the observant and
intelligent natives who acquired their medical training in Europe and
America. In Tokio the disease generally appears in May, reaches its
greatest prevalence in August, and gradually disappears in September
and October. The researches of Miura and others have fairly well
demonstrated that this disease is due to the eating of fish belonging
to the family of _Scombridæ_. There are other kinds of fish in
Japanese waters that undoubtedly are poisonous. This is true of the
_tetrodon_, of which, according to Remey, there are twelve species
whose ovaries are poisonous. Dogs fed upon these organs soon suffered
from salivation, vomiting, and convulsive muscular contractions. When
some of the fluid obtained by rubbing the ovaries in a mortar was
injected subcutaneously in dogs the symptoms were much more severe, and
death resulted. Tahara states that he has isolated from the roe of the
tetrodon two poisons, one of which is a crystalline base, while the
other is a white, waxy body. From 1885 to 1892 inclusive, 933 cases of
poisoning with this fish were reported in Tokio, with a mortality of
seventy-two per cent.
Fish poisoning is quite frequently observed in the West Indies, where
the complex of symptoms is designated by the Spanish term _siguatera_.
It is believed by the natives that the poisonous properties of the fish
are due to the fact that they feed upon decomposing medusæ and corals.
In certain localities it is stated that all fish caught off certain
coral reefs are unfit for food. However, all statements concerning the
origin and nature of the poison in these fish are mere assumptions,
since no scientific work has been done. Whatever the source of the
poison may be, it is quite powerful, and death not infrequently
results. The symptoms are those of gastro-intestinal irritation
followed by collapse.
In Russia fish poisoning sometimes causes severe and widespread
epidemics. The Government has offered a large reward for any one who
will positively determine the cause of the fish being poisonous and
suggest successful means of preventing these outbreaks. Schmidt, after
studying several of these epidemics, states the following conclusions:
(_a_) The harmful effects are not due to putrefactive processes. (_b_)
Fish poisoning in Russia is always due to the eating of some member of
the sturgeon tribe. (_c_) The ill effects are not due to the method of
catching the fish, the use of salt, or to imperfections in the methods
of preservation. (_d_) The deleterious substance is not uniformly
distributed through the fish, but is confined to certain parts. (_e_)
The poisonous portions are not distinguishable from the nonpoisonous,
either macroscopically or microscopically. (_f_) When the fish is
cooked it may be eaten without harm. (_g_) The poison is an animal
alkaloid produced most probably by bacteria that cause an infectious
disease in the fish during life.
The conclusion reached by Schmidt is confirmed by the researches of
Madame Sieber, who found a poisonous bacillus in fish which had caused
an epidemic.
In the United States fish poisoning is most frequently due to
decomposition in canned fish. The most prominent symptoms are nausea,
vomiting, and purging. Sometimes there is a scarlatinous rash, which
may cover the whole body. The writer has studied two outbreaks of
this kind of fish poisoning. In both instances canned salmon was the
cause of the trouble. Although a discussion of the treatment of food
poisoning is foreign to this paper, the writer must call attention to
the danger in the administration of opiates in cases of poisoning with
canned fish. Vomiting and purging are efforts on the part of Nature to
remove the poison, and should be assisted by the stomach tube and by
irrigation of the colon. In one of the cases seen by the writer large
doses of morphine had been administered in order to check the vomiting
and purging and to relieve the pain; in this case death resulted. The
danger of arresting the elimination of the poison in all cases of food
poisoning can not be too emphatically condemned.
MEAT POISONING.--The diseases most frequently transmitted from the
lower animals to man by the consumption of the flesh or milk of the
former by the latter are tuberculosis, anthrax, symptomatic anthrax,
pleuro-pneumonia, trichinosis, mucous diarrhoea, and actinomycosis.
It hardly comes within the scope of this article to discuss in detail
the transmission of these diseases from the lower animals to man.
However, the writer must be allowed to offer a few opinions concerning
some mooted questions pertaining to the consumption of the flesh
of tuberculous animals. Some hold that it is sufficient to condemn
the diseased part of the tuberculous cow, and that the remainder
may be eaten with perfect safety. Others teach that "total seizure"
and destruction of the entire carcass by the health authorities are
desirable. Experiments consisting of the inoculation of guinea pigs
with the meat and meat juices of tuberculous animals have given
different results to several investigators. To one who has seen
tuberculous animals slaughtered, these differences in opinion and in
experimental results are easily explainable. The tuberculous invasion
may be confined to a single gland, and this may occur in a portion
of the carcass not ordinarily eaten; while, on the other hand, the
invasion may be much more extensive and the muscles may be involved.
The tuberculous portion may consist of hard nodules that do not break
down and contaminate other tissues in the process of removal, but the
writer has seen a tuberculous abscess in the liver holding nearly a
pint of broken-down infected matter ruptured or cut in removing this
organ, and its contents spread over the greater part of the carcass.
This explains why one investigator succeeds in inducing tuberculosis
in guinea pigs by introducing small bits of meat from a tuberculous
cow into the abdominal cavity, while another equally skillful
bacteriologist follows the same details and fails to get positive
results. No one desires to eat any portion of a tuberculous animal, and
the only safety lies in "total seizure" and destruction. That the milk
from tuberculous cows, even when the udder is not involved, may contain
the specific bacillus has been demonstrated experimentally. The writer
has suggested that every one selling milk should be licensed, and the
granting of a license should be dependent upon the application of the
tuberculin test to every cow from which milk is sold. The frequency
with which tuberculosis is transmitted to children through milk should
justify this action.
That a profuse diarrhoea may render the flesh of an animal unfit
food for man was demonstrated by the cases studied by Gärtner. In this
instance the cow was observed to have a profuse diarrhoea for two
days before she was slaughtered. Both the raw and cooked meat from this
animal poisoned the persons who ate it. Medical literature contains the
records of many cases of meat poisoning due to the eating of the flesh
of cows slaughtered while suffering from puerperal fever. It has been
found that the flesh of animals dead of symptomatic anthrax may retain
its infection after having been preserved in a dry state for ten years.
One of the most frequently observed forms of meat poisoning is that
due to the eating of decomposed sausage. Sausage poisoning, known
as _botulismus_, is most common in parts of Germany. Germans who
have brought to the United States their methods of preparing sausage
occasionally suffer from this form of poisoning. The writer had
occasion two years ago to investigate six cases of this kind, two
of which proved fatal. The sausage meat had been placed in uncooked
sections of the intestines and alternately frozen and thawed and
then eaten raw. In this instance the meat was infected with a highly
virulent bacillus, which resembled very closely the _Bacterium coli_.
In England, Ballard has reported numerous epidemics of meat poisoning,
in most of which the meat had become infected with some nonspecific,
poison-producing germ. In 1894 the writer was called upon to
investigate cases of poisoning due to the eating of pressed chicken.
The chickens were killed Tuesday afternoon and left hanging in a market
room at ordinary temperature until Wednesday forenoon, when they were
drawn and carried to a restaurant and here left in a warm room until
Thursday, when they were cooked (not thoroughly), pressed, and served
at a banquet in which nearly two hundred men participated. All ate
of the chicken, and were more or less seriously poisoned. The meat
contained a slender bacillus, which was fatal to white rats, guinea
pigs, dogs, and rabbits.
Ermengem states that since 1867 there have been reported 112 epidemics
of meat poisoning, in which 6,000 persons have been affected. In 103 of
these outbreaks the meat came from diseased animals, while in only five
was there any evidence that putrefactive changes in the meat had taken
place. My experience convinces me that in this country meat poisoning
frequently results from putrefactive changes.
Instances of poisoning from the eating of canned meats have become
quite common. Although it may be possible that in some instances the
ill effects result from metallic poisoning, in a great majority of
cases the poisonous substances are formed by putrefactive changes. In
many cases it is probable that decomposition begins after the can has
been opened by the consumer; in others the canning is imperfectly done,
and putrefaction is far advanced before the food reaches the consumer.
In still other instances the meat may have been taken from diseased
animals, or it may have undergone putrefactive changes before the
canning. It should always be remembered that canned meat is especially
liable to putrefactive changes after the can has been opened, and when
the contents of the open can are not consumed at once the remainder
should be kept in a cold place or should be thrown away. People are
especially careless on this point. While every one knows that fresh
meat should be kept in a cold place during the summer, an open can of
meat is often allowed to stand at summer temperature and its contents
eaten hours after the can has been opened. This is not safe, and has
caused several outbreaks of meat poisoning that have come under the
observation of the writer.
MILK POISONING.--In discussing this form of food poisoning we will
exclude any consideration of the distribution of the specific
infectious diseases through milk as the carrier of the infection,
and will confine ourselves to that form of milk poisoning which is
due to infection with nonspecific, poison-producing germs. Infants
are highly susceptible to the action of the galactotoxicons (milk
poisons). There can no longer be any doubt that these poisons are
largely responsible for much of the infantile mortality which is
alarmingly high in all parts of the world. It has been positively shown
that the summer diarrhoea of infancy is due to milk poisoning. The
diarrhoeas prevalent among infants during the summer months are not
due to a specific germ, but there are many bacteria that grow rapidly
in milk and form poisons which induce vomiting and purging, and may
cause death. These diseases occur almost exclusively among children
artificially fed. It is true that there are differences in chemical
composition between the milk of woman and that of the cow, but these
variations in percentage of proteids, fats, and carbohydrates are of
less importance than the infection of milk with harmful bacteria. The
child that takes its food exclusively from the breast of a healthy
mother obtains a food that is free from poisonous bacteria, while the
bottle-fed child may take into its body with its food a great number
and variety of germs, some of which may be quite deadly in their
effects. The diarrhoeas of infancy are practically confined to the
hot months, because a high temperature is essential to the growth and
wide distribution of the poison-producing bacteria. Furthermore, during
the summer time these bacteria grow abundantly in all kinds of filth.
Within recent years the medical profession has so urgently called
attention to the danger of infected milk that there has been a great
improvement in the care of this article of diet, but that there is yet
room for more scientific and thorough work in this direction must be
granted. The sterilization and Pasteurization of milk have doubtlessly
saved the lives of many children, but every intelligent physician knows
that even the most careful mother or nurse often fails to secure a milk
that is altogether safe.
It is true that milk often contains germs the spores of which
are not destroyed by the ordinary methods of sterilization and
Pasteurization. However, these germs are not the most dangerous ones
found in milk. Moreover, every mother and nurse should remember
that in the preparation of sterilized milk for the child it is not
only necessary to heat the milk, but, after it has been heated to a
temperature sufficiently high and sufficiently prolonged, the milk must
subsequently be kept at a low temperature until the child is ready to
take it, when it may be warmed. It should be borne in mind that the
subsequent cooling of the milk and keeping it at a low temperature is a
necessary feature in the preparation of it as a food for the infant.
CHEESE POISONING.--Under this heading we shall include the ill effects
that may follow the eating of not only cheese but other milk products,
such as ice cream, cream custard, cream puffs, etc. Any poison formed
in milk may exist in the various milk products, and it is impossible
to draw any sharp line of distinction between milk poisoning and
cheese poisoning. However, the distinction is greater than is at first
apparent. Under the head of milk poisoning we have called especial
attention to those substances formed in milk to which children are
particularly susceptible, while in cheese and other milk products
there are formed poisonous substances against which age does not give
immunity. Since milk is practically the sole food during the first year
or eighteen months of life, the effect of its poisons upon infants is
of the greatest importance; on the other hand, milk products are seldom
taken by the infant, but are frequent articles of diet in after life.
In 1884 the writer succeeded in isolating from poisonous cheese a
highly active basic substance, to which he gave the name _tyrotoxicon_.
The symptoms produced by this poison are quite marked, but differ in
degree according to the amount of the poison taken. At first there is
dryness of the mouth, followed by constriction of the fauces, then
nausea, vomiting, and purging. The first vomited matter consists of
food, then it becomes watery and is frequently stained with blood. The
stools are at first semisolid, and then are watery and serous. The
heart is depressed, the pulse becomes weak and irregular, and in severe
cases the face appears cyanotic. There may be dilatation of the pupil,
but this is not seen in all. The most dangerous cases are those in
which the vomiting is slight and soon ceases altogether, and the bowels
are constipated from the beginning. Such cases as these require prompt
and energetic treatment. The stomach and bowels should be thoroughly
irrigated in order to remove the poison, and the action of the heart
must be sustained.
At one time the writer believed that tyrotoxicon was the active agent
in all samples of poisonous cheese, but more extended experimentation
has convinced him that this is not the case. Indeed, this poison is
rarely found, while the number of poisons in harmful cheese is no doubt
considerable. There are numerous poisonous albumins found in cheese
and other milk products. While all of these are gastro-intestinal
irritants, they differ considerably in other respects.
In 1895 the writer and Perkins made a prolonged study of a bacillus
found in cheese which had poisoned fifty people. Chemically the
poison produced by this germ is distinguished from tyrotoxicon by
the fact that it is not removed from alkaline solution with ether.
Physiologically the new poison has a more pronounced effect on the
heart, in which it resembles muscarin or neurin more closely than it
does tyrotoxicon. Pathologically, the two poisons are unlike, inasmuch
as the new poison induces marked congestion of the tissues about the
point of injection when used upon animals hypodermically. Furthermore,
the intestinal constrictions which are so uniformly observed in animals
poisoned by tyrotoxicon was not once seen in our work with this new
poison, although it was carefully looked for in all our experiments.
In 1898 the writer, with McClymonds, examined samples of cheese from
more than sixty manufacturers in this country and in Europe. In all
samples of ordinary American green cheese poisonous germs were found in
greater or less abundance. These germs resemble very closely the colon
bacillus, and most likely their presence in the milk is to be accounted
for by contamination with bits of fecal matter from the cow. It is more
than probable that the manufacture of cheese is yet in its infancy,
and we need some one to do for this industry what Pasteur did for the
manufacture of beer. At present the flavor of a given cheese depends
upon the bacteria and molds which accidentally get into it. The time
will probably come when all milk used for the manufacture of cheese
will be sterilized, and then selected molds and bacteria will be sown
in it. In this way the flavor and value of a cheese will be determined
with scientific accuracy, and will not be left to accident.