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Food Poisoning.
FOOD POISONING.-PNEUMOCOCOAND THEIR ANTIBODIES.
THE
LANCET.
LONDON: SATURDAY, SEPT. 16, 1922.
THE
Food Poisoning. special judicial inquiry into the
outbreak of
food poisoning at Loch Maree has now been concluded. The jury found that no fault or negligence attached to any person, that no precautions which could be suggested would have avoided the accident, and that there were no defects in the system of manufacture. A judicial inquiry could hardly come to any other conclusion
on
the facts submitted, but
a
scientific
cannot leave the matter there, and it is worth while to consider how such disastrous outbreaks can be prevented, or at least their occurrence reduced to a minimum. In the Loch Maree cases sufficient material was available to establish definitely that the outbreak
profession
of botulism, and that the vehicle of infection was the wild duck paste used to make the sandwiches which were supplied to the infected cases. This paste not only contained extremely virulent botuline toxin of type A, but from the paste the botuline bacillus itself was isolated. The organism was also obtained from one of the sandwiches made from the paste. Unfortunately no satisfactory explanation is available as to how the paste became contaminated. Dr. A. W. J. MACFADDEN, the medical officer of the Ministry of Health in charge of the Food Section, went over the factory and was satisfied as to its cleanliness and The bacillus itself is the methods of production. comparatively unresistant to heat, while the toxin is said to be destroyed by exposure to a temperature of 80° C. for half an hour ; both should therefore have succumbed to the ordinary processes of manufacture. The spores were at one time supposed not to be of high resistance, but later investigations have shown that they behave towards heat very much like the spores of other anaerobes, and may resist even a temperature of 100° C. In the Loch Maree outbreak it was shown that the potted meat had been sterilised sufficiently to destroy bacilli and toxins, and, since there was no evidence of local contamination of the paste, presumably the spores of B. botulinus survived the heating processes, subsequently to multiply and produce their virulent toxin. Two facts stand out as worthy of comment. Experience with infected canned fruits has shown that the peculiar musty odour of foods contaminated with the botuline organism is a valuable danger signal, leading to rejection. Discrimination becomes impossible when highly spiced foods, such as wild duck paste, are used, and the safety factor is lost. The unfortunate hotel party would have been much better served if they had been provided with fresh food, such as eggs and greenstuff, for their outdoor lunch ; if this outbreak brings such foods more into vogue for this purpose it will have done some good. The other point is the need for knowledge as to the distribution of B. botulinus in nature. Some mention has already been made1 of investigations on the distribution of the spores in soil and other I places, but the inquiry is still incomplete. The possible relationship to animal disease has been scarcely studied in tnis’ country, nor do we know ’, the extent to which the bacillus may be present in
the excrement of birds and animals. It was found in the intestine of a pig by KEMPNER and POLLOCK many years ago, and more recently by DICKSON and BURKE, and has been isolated from fruit contaminated by excreta. Whether the spores gained access to the wild duck paste from these or other sources must remain a matter of speculation. The whole problem of the distribution in nature of the bacilli of food poisoning and the tracing of the paths of infection is one which demands intensive study before outbreaks can be prevented. It is a matter of satisfaction that this need has been realised, and that a year agothe Ministry of Health and the Medical Research Council combined to initiate a special inquiry, the work being under the control of Dr. W. G. SAVAGE and Dr. MAcFADDEN. Considerable progress has been made, although no results have as yet been reported. Pending more extended knowledge the decision of the Ministry of Health to make botulinus antitoxins available in certain large cities is of value, as prompt administration of the serum may save lives.
The Pneumococci and Their Antibodies.
was one
1 THE LANCET,
Sept. 2nd, p. 523.
623
MANY years ago OSLER
pointed out that pneumonia steadily rivalling tuberculosis as, in JOHN BUNYAN’S quaint phrase, Captain of the Men of
was
No disease, as Dr. W. H. WYNN remarked1 in recently our columns, is so great a foe to the hardworking business or professional man. Sir GEORGE NEWMAN states in the preface to a report2 on Bacteriological Studies, just issued by the Ministry of Health, that during the year 1921 pneumonia was responsible for the death of 34,708 persons in England and Wales, apart from deaths in which pneumonia was the secondary complication, for example, measles, whooping-cough, and influenza. If the number of these deaths from secondary complications, statistics of which are not given, be added to the 34,000 odd deaths from pneumonia itself, OsLER’s statement must be well within the mark. And when we consider, further, the number of cases in which a terminal pneumonia is the last phase in many of the chronic maladies such as valvular disease of the heart, we may surely regard this disease as one of the chief enemies of mankind. All attempts, therefore, to explore the causes of this excessive mortality are to be welcomed, and the researches of the group of workers at the Ministry of Health are a record of painstaking bacteriological investigation. The report in question consists of four sections : (1) A review of the recent work on pneumococci by Dr. ARTHUR EASTWOOD, (2) types of pneumococci by Dr. F. GRIFFITH, (3) serological differences amongst pneumococci by Dr. EASTWOOD, and (4) the distribution and serological characters of influenza bacilli by Dr. W. M. SCOTT. This last section deals entirely with the influenza bacillus, and therefore does not come within the range of our present discussion, albeit it is a careful inquiry into a difficult subject on which light is much needed. Dr. EASTWOOD makes the work of NEUFELD and his colleagues the starting-point of the review of the present-day pneumococcal immunity problem. Some years ago NEUFELD and HANDEL showed that the majority of the strains of virulent pneumococci isolated from cases of pneumonia were serologically Death.
2 THE LANCET, 1921, ii., 720. THE LANCET, Sept. 2nd, p. 493. 2 Reports on Public Health and Medical Subjects. Published by H.M. Stationery Office. 1922. 2s. 6d. 1
No. 13.
THE
LANCET.
LONDON: SATURDAY, SEPT. 16, 1922.
THE
Food Poisoning. special judicial inquiry into the
outbreak of
food poisoning at Loch Maree has now been concluded. The jury found that no fault or negligence attached to any person, that no precautions which could be suggested would have avoided the accident, and that there were no defects in the system of manufacture. A judicial inquiry could hardly come to any other conclusion
on
the facts submitted, but
a
scientific
cannot leave the matter there, and it is worth while to consider how such disastrous outbreaks can be prevented, or at least their occurrence reduced to a minimum. In the Loch Maree cases sufficient material was available to establish definitely that the outbreak
profession
of botulism, and that the vehicle of infection was the wild duck paste used to make the sandwiches which were supplied to the infected cases. This paste not only contained extremely virulent botuline toxin of type A, but from the paste the botuline bacillus itself was isolated. The organism was also obtained from one of the sandwiches made from the paste. Unfortunately no satisfactory explanation is available as to how the paste became contaminated. Dr. A. W. J. MACFADDEN, the medical officer of the Ministry of Health in charge of the Food Section, went over the factory and was satisfied as to its cleanliness and The bacillus itself is the methods of production. comparatively unresistant to heat, while the toxin is said to be destroyed by exposure to a temperature of 80° C. for half an hour ; both should therefore have succumbed to the ordinary processes of manufacture. The spores were at one time supposed not to be of high resistance, but later investigations have shown that they behave towards heat very much like the spores of other anaerobes, and may resist even a temperature of 100° C. In the Loch Maree outbreak it was shown that the potted meat had been sterilised sufficiently to destroy bacilli and toxins, and, since there was no evidence of local contamination of the paste, presumably the spores of B. botulinus survived the heating processes, subsequently to multiply and produce their virulent toxin. Two facts stand out as worthy of comment. Experience with infected canned fruits has shown that the peculiar musty odour of foods contaminated with the botuline organism is a valuable danger signal, leading to rejection. Discrimination becomes impossible when highly spiced foods, such as wild duck paste, are used, and the safety factor is lost. The unfortunate hotel party would have been much better served if they had been provided with fresh food, such as eggs and greenstuff, for their outdoor lunch ; if this outbreak brings such foods more into vogue for this purpose it will have done some good. The other point is the need for knowledge as to the distribution of B. botulinus in nature. Some mention has already been made1 of investigations on the distribution of the spores in soil and other I places, but the inquiry is still incomplete. The possible relationship to animal disease has been scarcely studied in tnis’ country, nor do we know ’, the extent to which the bacillus may be present in
the excrement of birds and animals. It was found in the intestine of a pig by KEMPNER and POLLOCK many years ago, and more recently by DICKSON and BURKE, and has been isolated from fruit contaminated by excreta. Whether the spores gained access to the wild duck paste from these or other sources must remain a matter of speculation. The whole problem of the distribution in nature of the bacilli of food poisoning and the tracing of the paths of infection is one which demands intensive study before outbreaks can be prevented. It is a matter of satisfaction that this need has been realised, and that a year agothe Ministry of Health and the Medical Research Council combined to initiate a special inquiry, the work being under the control of Dr. W. G. SAVAGE and Dr. MAcFADDEN. Considerable progress has been made, although no results have as yet been reported. Pending more extended knowledge the decision of the Ministry of Health to make botulinus antitoxins available in certain large cities is of value, as prompt administration of the serum may save lives.
The Pneumococci and Their Antibodies.
was one
1 THE LANCET,
Sept. 2nd, p. 523.
623
MANY years ago OSLER
pointed out that pneumonia steadily rivalling tuberculosis as, in JOHN BUNYAN’S quaint phrase, Captain of the Men of
was
No disease, as Dr. W. H. WYNN remarked1 in recently our columns, is so great a foe to the hardworking business or professional man. Sir GEORGE NEWMAN states in the preface to a report2 on Bacteriological Studies, just issued by the Ministry of Health, that during the year 1921 pneumonia was responsible for the death of 34,708 persons in England and Wales, apart from deaths in which pneumonia was the secondary complication, for example, measles, whooping-cough, and influenza. If the number of these deaths from secondary complications, statistics of which are not given, be added to the 34,000 odd deaths from pneumonia itself, OsLER’s statement must be well within the mark. And when we consider, further, the number of cases in which a terminal pneumonia is the last phase in many of the chronic maladies such as valvular disease of the heart, we may surely regard this disease as one of the chief enemies of mankind. All attempts, therefore, to explore the causes of this excessive mortality are to be welcomed, and the researches of the group of workers at the Ministry of Health are a record of painstaking bacteriological investigation. The report in question consists of four sections : (1) A review of the recent work on pneumococci by Dr. ARTHUR EASTWOOD, (2) types of pneumococci by Dr. F. GRIFFITH, (3) serological differences amongst pneumococci by Dr. EASTWOOD, and (4) the distribution and serological characters of influenza bacilli by Dr. W. M. SCOTT. This last section deals entirely with the influenza bacillus, and therefore does not come within the range of our present discussion, albeit it is a careful inquiry into a difficult subject on which light is much needed. Dr. EASTWOOD makes the work of NEUFELD and his colleagues the starting-point of the review of the present-day pneumococcal immunity problem. Some years ago NEUFELD and HANDEL showed that the majority of the strains of virulent pneumococci isolated from cases of pneumonia were serologically Death.
2 THE LANCET, 1921, ii., 720. THE LANCET, Sept. 2nd, p. 493. 2 Reports on Public Health and Medical Subjects. Published by H.M. Stationery Office. 1922. 2s. 6d. 1
No. 13.