Food poisoning

“ Savage and others believe that the hypothesis that food poisoning outbreaks are derived from ordinary fecal infection of food is quite unfounded. It is pointed out that there is good evidence of the frequent occurrence of intestinal bacteria in such food as sausages and chopped meat, and that consequently, if paratyphoid infections could occur through ordinary contamination with intestinal bacteria not connected with any specific animal infection, food poisoning outbreaks should be exceedingly common instead of—as is the case—comparatively rare. ”

“ 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 ”

“ 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 [p.5] of food ordinarily accused are selected rather as the result of popular prejudice and tradition than of any careful inquiry. ”

“ 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. ”

“ Several outbreaks of food poisoning in man have been [p.76] attributed on more or less cogent evidence to food contamination by one of these viruses either directly by accident, as in the case described by Shibayama, [87] in which cakes prepared for rats were eaten by men, or indirectly through food contaminated by mice or rats that had been infected with the virus. ”

“ The even greater culpability of raw milk is due to the fact that milk is not only, like meat, sometimes obtained from an infected animal, but that it is a particularly good culture medium for bacteria, and in the process of collection or distribution may become infected through the agency of a human carrier. Foods such as ice-cream that are prepared with milk are also often connected with food poisoning. It seems probable that illness caused by ice-cream is much more commonly due to bacterial infection than to poisoning with metals or flavoring extracts. ”

“ Many cases of so-called food poisoning are due to the presence of pathogenic bacteria in the food. In some instances, as in the typical meat poisoning epidemics, symptoms develop so soon after eating that the particular food involved is immediately suspected and laid hands on. In other cases the guilty article of food is difficult to trace. Certain cases of tuberculosis are undoubtedly caused by swallowing tubercle bacilli in the food, but the precise source and date of infection can be rarely, if ever, certainly established. ”

“ The conspicuous frequency with which the consumption of raw meat provokes food poisoning has already been set forth and in large part explained by the occasional derivation of meat from animals infected with parasites harmful to man. ”

“ In the first place, it is only within recent years that it has been recognized that foods ordinarily harmless may become most powerful poisons. In the second place, the more extensive use of preserved foods of various kinds has led to an actual increase in the number of outbreaks of food poisoning. ”

“ In recent times the employment of chemical preservatives has acquired a new aspect through the increasing tendency of manufacturers to add to food products antiseptic chemicals in wide variety and of dubious physiological effect.
It is not so easy and simple as it might appear to declare that no substance that is poisonous shall be added to food. The scientific conception of a poison is one involving the amount as well as the kind of substance. Common salt itself is poisonous in large doses, but, as everyone knows, small amounts are not only not injurious, but absolutely necessary to health. ”

“ The interesting case reported by Barber [112] shows that there are other possibilities of food poisoning by formed bacterial poisons. Acute attacks of gastro-enteritis were produced in several individuals by the use of milk containing a poisonous substance elaborated by a white staphylococcus. This staphylococcus occurred in almost pure culture in the udder of the cow from which the milk was derived. The milk when used fresh was harmless and the poison was generated in effective quantities only when the milk stood some hours at room temperature [p.97] before being used. ”

“ An epidemic of food poisoning occurred in July, 1915, at and near Westerly, Rhode Island. [66] The outbreak was characterized by the usual symptoms of acute gastro-enteritis, and followed the eating of pie which was obtained at a restaurant in Westerly. All the circumstances of the outbreak showed that a particular batch of pies was responsible. About sixty persons were made seriously ill and four died. ”

“ It is a familiar fact that certain foods that can be eaten with impunity by most persons prove more or less acutely poisonous for others. Strawberries and some other fruits and some kinds of shellfish are among the articles of food more commonly implicated. Unpleasant reactions to the use of eggs and of cow's milk are also noted. The severity of the attacks may vary from a slight rash to violent gastro-intestinal, circulatory, and nervous disturbances. ”

“ Only the first-named motive can claim any legitimate justification, and its gratification by the use of chemical preservatives is surrounded with hygienic difficulties and uncertainty, as already set forth. From the unbiased view of human physiology the dangers of slow poisoning from chemically treated foods must be regarded as no less real because they are insidious and not easily traced. ”

“ If such food is swallowed by man after the bacteria have produced their poisonous bodies, it will tend to produce an immediate poisoning of his system. The effect may be sudden and severe if considerable quantity of the poisonous material is swallowed, or slight but protracted if small quantities are repeatedly consumed in food. Such instances are not uncommon. Well-known examples are cases of ice-cream poisoning, poisoning from eating cheese or from drinking milk, or in not a few instances from eating fish or meats within which bacteria have had opportunity for growth. ”

“ The majority of meat poisoning outbreaks that have been bacterially studied in recent years have been traceable to one or another member of this group and not to "ptomain poisoning." (2) Bacteria of the paratyphoid enteritidis group that are culturally alike but agglutinatively dissimilar can, when taken in with the food, give rise to identical clinical symptoms in man. (3) Food poisoning bacteria of this group, when derived directly from diseased animals, seem more likely to be of the Gärtner type (B. enteritidis) than of the B. suipestifer type. ”

“ It is worth noting that some of the internal organs, as the liver and kidneys, are more likely to contain bacteria than the masses of muscle commonly eaten as "meat." Sausages, from their composition and mode of preparation, and chopped meat ("hamburger steak") are also to be treated with especial care. Consumption of such foods as raw sausage or diseased goose liver (paté de foie gras) involves a relatively high risk. It is true of paratyphoid infection as of most other forms of food poisoning that thorough cooking of food greatly diminishes the likelihood of trouble. ”

“ But we have no right to assume that the everyday decomposition products of the banal bacteria are in all cases without injurious effects. Even though no sharply defined acute form of poisoning may be laid at their door, it does not follow that an irritating or perhaps slightly toxic action of the ordinary decomposition products is altogether absent. Our present knowledge of the nature and degree of danger to be apprehended from the use of spoiled food is imperfect and unsatisfactory. ”

“ 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 diarrhœa, and actinomycosis. ”

“ The injurious effects of organisms contained in foods has been elucidated by the excellent work of the late Dr. Ballard. From the careful study of a number of epidemics due to food poisoning, this patient observer was able, without the aid of modern bacteriology, to arrive at a simple principle which must not be forgotten. Food poisoning is due either to bacteria themselves or to their products, which are contained in the substance of the food. ”

“ Canned meat and fish have produced the most violent types of ptomaine poisoning. As a rule in these cases the canned article has begun to decompose and while the decomposition may not have advanced sufficiently far to be discernible from the flavor or odor, it is there, and if the resistance of the individual eating this food is not great, serious danger may result. Poisoning develops in some individuals upon the eating of shellfish, strawberries, oranges, pimentos, and various other foods,—another evidence of personal idiosyncrasy against certain articles of diet. ”

“ Of all other methods employed by poisoners, the administration of the lethal dose through the medium of food or drink seems ever to have been the favourite. The poisoned wine or cake recurs with a somewhat monotonous frequency in the history of the poisoner, from the earliest times down to the present day. Women especially seem to have been attracted by this mode of poisoning, a fact probably due to their control and direction of domestic matters, which rendered the introduction of a poisonous substance into food or drink an easy matter. ”

“ The belief that mineral poisons such as arsenic or copper might be taken up by grazing animals and eliminated in the milk finds no justification either in analytical or in clinical data. Many plants, known or suspected to be poisonous, have been accused of furnishing the substance that imparts the poisonous quality to the milk of animals suffering from trembles, but there is no agreement as to the responsible species. Feeding experiments with suspected plants have in no case given unambiguous results. ”

“ It is evident, therefore, that bacterial growth in substances used as food is not necessarily injurious and may in some cases increase the palatability of food without destroying its wholesomeness. Little or nothing is known about the correlation of visible signs of decomposition with the presence of poisonous products, and it is at present impossible to say at what point in the process of decomposition a food becomes unfit to use owing to the accumulation of poisonous substances within it. ”

“ Fig. 6.—Bacillus enteritidis, Gärtner; pure culture; Van Ermengem preparation. (Kolle and Wassermann.)
The discovery of the connection of paratyphoid bacilli with meat poisoning dates from the investigation by Gärtner, [67] in 1888, of a meat poisoning outbreak in Frankenhausen, a small town in Germany. This epidemic was traced to the use of meat from a cow that was slaughtered because she was ill with a severe enteritis. Fifty-eight persons were affected in varying grades of severity; the attack resulted fatally in one young workman who ate about eight hundred grams of raw meat. ”

“ Certain substances, the so-called irritant poisons, such as arsenic, tartar emetic and the like, induce their toxic effects by causing irritation and inflammation of the alimentary canal. All authorities agree that poisoning by these substances cannot be proved, or even rendered, very probable, by symptoms alone—that chemical evidence, the discovery of the poison in the food, dejections, or in case of death the body, is absolutely essential for making out a case. ”

“ Some of these are relatively rare or for other reasons are not likely to be eaten by man or beast; others contain a poison only in some particular part, or are poisonous only at certain seasons of the year; in some the poison is not dangerous when taken by the mouth, but only when brought in contact with the skin or injected beneath the skin or into the circulation. ”

“ It is a most interesting fact, therefore, that this most deadly foe of man becomes dangerous only when the latter is harboring in his body waste or decomposing matters that are slowly poisoning him. It is in the process of digesting this material that the bacterium excretes poisons—toxins—of the most virulent nature, which are absorbed into the blood of the human victim, creating the condition popularly known as blood poisoning.
Bacteria perform a most important function in the economy of nature, viz., the conversion of decaying and dead matter into food for plants. ”