SECTION VII.— VARIOUS DISINFECTING AGENTS. (Part 3)

were noticed. Burrow reports similar cases with delirium, convulsions, coma, and death within three days. In a third class of cases, there may be a kind of intoxication resembling somewhat that of alcohol ; then paralysis, coma, and death. In 1827, Combe observed thirty persons poisoned, two of them fatally, with mussels. He describes the symptoms as follows: '* None, so far as I know, complained of anything peculiar in the smell or taste of the animals, and nine suffered immediately after taking them. In general, an hour or two elapsed, sometimes more; and the bad effects consisted xS6 report of committee on disinfectants. rather in uneasy feelings and debility, than in any distress referable to the stomach. Some children suffered from eating only two or three ; and it will be remembered that Robertson, a young and healthy man, only took five or six. In two or three hours they complained of a slight tension at the stomach. One or two had cardalgia, nausea, and vomit- ing ; but these were not general or lasting symptoms. They then com- plained of a prickly feeling in their hands, heat and constriction of the mouth and throat, difficulty of swallowing and speaking freely, numbness about the mouth, gradually extending to the arms, with great debility of the limbs. The degree of muscular debility varied a good deal, but was an invariable symptom. In some it merely prevented them from walk- ing firmly, but in most of them it amounted to perfect inability to stand. While in bed they could move their limbs with tolerable freedom, but on being raised to the perpendicular posture, they felt their limbs sink under them. Some complained of a bad, coppery taste in the mouth, but in general this was in answer to what lawyers call a leading question. There was slight pain of the abdomen, increased on pressure, particu- larly in the region of the bladder, which organ suffered variously in its functions. In some the secretion of urine was suspended ; in others it was free, but passed with pain and great effort. The action of the heart was feeble ; the breathing unaffected ; the face pale, expressive of much anxiety ; the surface rather cold ; the mental faculties unimpaired. Un- luckily, the two fatal cases were not seen by any medical person, and we are therefore unable to state minutely the train of symptoms. We ascer- tained that the woman, in whose house were five sufferers, went away as in a gentle sleep, and that a few moments before death she had spoken and swallowed." The woman died within three hours. The other death was that of a watchman, who was found dead in his box six or seven hours alter he had eaten the mussels. Post-mortem examination in these showed no abnormality. The stomach contained some of the food partially digested. The explorer, Voncouver, reports four cases similar to those observed bv Combe. One of the sailors died in five and a half hours after eating the mussels. In some recent cases reported by Schmidtmann, as quoted by Brieger, the symptoms were as follows : Some dock hands and their families ate of cooked blue mussels, which had been taken near a newly built dock. The symptoms appeared, according to the amount eaten, from soon after eating to several hours later. There was a sensation of constriction in the throat, mouth, and lips ; the teeth were set on edge as though sour apples had been eaten. There was dizziness, no headache, a sensation of flving, and an intoxication similar to that produced by alcohol. The pulse was rapid (from eighty to ninety), no elevation of temperature, the pupils dilated and reactionless. Speech was difficult, broken, and jerky. The limbs felt heavy ; the hands grasped spasmodically at objects, and missed their aim. The legs were no longer able to support the body, and the knees knocked together. There were nausea, vomiting, no ab- REPORT OF COMMITTEE ON DISINFECTANTS. 187 dominal pain, no diarrhoea. The hands became numb, and the feet cold. The sensation of cold soon extended over the entire body, and in some the perspiration flowed freely. There was a sensation of suffocation, then a restful and dreamless sleep. One person died in an hour and three quarters, another in three and a half hours, and a third in five hours, after eating of the mussels. In one of these fatal cases, rigor mortis was marked, and remained for twenty-four hours. The vessels of all the organs were distended ; only the heart was empty. Virchow concluded from the conditions observed that the blood had absorbed oxygen with great avidity. There was marked hypersemia and swelling of the mucous membrane of the stomach and intestines, which Virchow pronounced an enteritis. The spleen was enormously enlarged, and the liver showed numerous haemorrhagic in- farctions. Many theories have been advanced to account for poisonous mussels. It was formerly believed that the effects were due to copper, which the animals obtained from the bottoms of vessels ; but as Christison remarks, copper does not produce these symptoms. Moreover, Christison made analysis of the mussels which produced the symptoms observed by Combe, and was unable to detect any copper. Bouchardat found copper in some poisonous mussels ; but he does not state the amount, nor the source of the animals. Edwards advanced the theory that the symptoms were wholly due to idiosyncrasy in the consumer. This may be true in some instances where only one or two of those partaking of the food are affected, but it certainly is not a tenable hypothesis in such instances as those reported by Combe and Schmidtmann, where all those who partook of the food were affected. Coldstream found the livers of the Leith mussels, as he thought, larger, darker, and more brittle than normal, and to this diseased condition he attributed the ill effects. Lamoroux, Mohring, De Beune, Chenu, and Du Roxleau nave sup- posed that the poisonous effects were due to a particular species of me- dusas, upon which the animals fed. De Beune found in the vomited matter of one person suffering from mussel poisoning some medusas, and he states that these are most abundant during the summer, when mussels are most frequently found to be poisonous. The theory of Burrow, that the animal is always poisonous during the period of reproduction, has been received with considerable credit. However, cases of poisoning have occurred at different seasons of the year. Crumpe, in 1872, suggested that there is a species of mussel which is in and of itself poisonous, and this species is often mixed with the edible variety. Schmidtmann and Virchow formerly supported this idea. They state that the poisonous species has a brighter shell, a sweeter, more pen- etrating, bouillon-like odor, than the edible kind ; also, that the flesh of the former is yellow, and that the water in which they are cooked is bluish. jS8 report of committee on disinfectants. Lohmeyer also champions this opinion. This theory, however, is op- posed by the majority of zoologists. Mobius states that the peculiarities of the supposed poisonous variety, pointed out by Virchow and Schmidt- mann, are really due to the conditions under which the animal lives, the amount of salt in the water, the temperature of the water, whether it is moving or still wrater, the nature of the bottom, etc. Finally, Mobius states that the sexual glands, which form the greater part of the mantle, are white in the male and yellow in the female. However, it has been shown later by Schmidtmann and Virchow that edible mussels may be- come poisonous if left in filthy water for fourteen days or longer ; and, on the other hand, poisonous ones may become fit for food if kept for four weeks in good water. This, of course, overthrows the theory of the existence of a special poisonous species. Cats and dogs which have eaten voluntarily of poisonous mussels have suffered from symptoms similar to those observed in man, and rabbits have been poisoned by the administration of the water in which the food has been cooked. A rabbit, which was treated in this manner by Schmidt- mann, died within one minute. From these mussels Brieger extracted the ptomaine, mytilotoxin. This poison has a curare-like action. Wheth- er or not those mussels which produce other symptoms also contain ptomaines, remains for future investigations to determine. Sausage Poisoning. This is also known as botulismus and allan- tiasis. While considerable diversity has been observed in symptoms of sausage poisoning, we cannot divide the cases into classes from their symptomatology, as was done in mussel poisoning. The first effects may manifest themselves at any time from one hour to twenty-four hours after eating of the sausage, and cases are recorded in which, it is stated, no symptoms appeared until several days had passed. However, we must remember that trichinosis was frequently, in former times, classed as sausage poisoning, and it is highly probable that these cases of long delay in the appearance of the symptoms were really not due to putre- faction, but to the presence of parasites in the meat. A large majority of the 1 24 cases more recently reported by Muller sickened within twenty- four hours, and out of the forty-eight of these which were fatal, six died within the first twenty -four hours. At first, there is dryness of the mouth, constriction of the throat, un- easiness in the stomach, nausea, vomiting, vertigo, indistinctness of vision, dilatation of the pupils, difficulty in swallowing, and usually diarrhoea, though obstinate constipation may exist from the first. There is, as a rule, a sensation of suffocation, and the breathing becomes labored. The pulse is small, thready, and rapid. In some cases the radial pulse maybe imperceptible. Marked nervous prostration and muscular debil- ity follow. These symptoms vary greatly in prominence in individual cases. The retching and vomiting, which may be most distressing and persistent in some instances, in others are trivial at the beginning, and soon cease altogether. The same is true of the diarrhoea. As a rule, the functions of the brain proceed normally, but there may be delirium* REPORT OF COMMITTEE ON DISINFECTANTS. 189 then coma, and death. In some there are marked convulsive movements, especially of the limbs ; in others, paralysis may be an early and marked symptom. The pupils may dilate, then become normal, and again dilate. There is frequently ptosis, and paralysis of the muscles of accommodation is not rare. Complete blindness has followed in a few instances. The fatality varies greatly in different outbreaks. In 1820 Kerner collected reports of seventy-six cases, of which thirty-seven were fatal. In his second publication (1822) he increased the number to 155 cases,, with eighty-four fatal results. This gave a mortality of over fifty per cent. ; while in one outbreak reported by Miiller the mortality was less than two per cent. A large proportion of the cases of sausage poisoning have occurred in Wurtemberg, and the immediately adjacent portions of Baden. This fact has, without doubt, been correctly ascribed to the methods there practised of preparing and curing the sausage. It is said to be common for the people to use the dried blood of the sheep, ox, and goat in the preparation of this article. Moreover, the blood is kept sometimes for days in wooden boxes and at a high temperature before it is used. In these cases it is altogether likely that putrefaction progresses to the poisonous stage before the process of curing is begun. However, cases of poisoning have occurred from beef and pork sausages as well. Moreover, the method of curing employed in Wurtemberg favors putrefaction. A kind of sausage known as "blunzen" is made by filling the stomachs of hogs with the meat. In curing, the interior of this great mass is not acted upon, and putrefaction sets in. The curing is usually done by hanging the sausage in the chimney. At night, the fire often goes out, and the meat freezes. The alternate freezing and thawing renders decomposition more easy. The interior of the sausage is gener- ally the most poisonous Indeed, in many instances those who have eaten of the outer portions have been unharmed, while those who have eaten of the interior of the same sausage have been most seriously af- fected. Many German writers state that when a poisonous sausage is cut, the putrid portion has a dirty, grayish-green color, and a soft, smeary con- sistency. A disagreeable odor, resembling that of putrid cheese, is per- ceptible. The taste is unpleasant, and sometimes there is produced a smarting of the mouth and throat. Post-mortem examination after sausage poisoning shows no characteristic lesion. It is generally stated that putrefaction sets in very tardily ; but Miiller shows that no reliance can be placed upon this point, and states that out of forty-eight recorded alitopsies, it was especially stated in eleven that putrefaction rapidly developed. In some instances there has been noticed hyperemia of the stomach and intestinal canal, but this is by no means constant. The liver and brain have been reported as congested, but this would result from the failure of the heart, and would by no means be characteristic of poisoning with sausage. 19° REPORT OF COMMITTEE ON DISINFECTANTS. Von Faber, in 1821, observed sixteen persons, who were made sick by eating fresh, unsmoked sausage made from the flesh of a pig which had suffered from an abscess on the neck. Five of the patients died. The symptoms were as follows : There was constriction of the throat, difficulty in swallowing, retching, vomiting, colic-like pains, vertigo, hoarseness, dimness of vision, and headache. Later, and in the severe cases, there was complete exhaustion, and finally paralysis. The eye- balls were retracted ; the pupils were sometimes dilated, then contracted ; they did not respond to light ; there was paralysis of the upper lids. The tonsils were swollen, but not as in tonsillitis. Liquids which were not irritating could be carried as far as the oesophagus, when they were ejected from the mouth and nose with coughing. Solid foods could not be swallowed at all. On the back of the tongue and in the pharynx there was observed a puriform exudate. Obstinate constipation existed in all, while the sphincter ani was par- alyzed. The breathing was easy, but all had a croupous cough. The skin was dry. There was incontinence of urine. There was no delir- ium, and the mind remained clear to the last. Post-mortem examinations were held on four. The skin was rough (u goose-flesh"). The abdomen was retracted. The large vessels in the upper part of the stomach were filled with black blood. The con- tents of the stomach consisted of a reddish-brown, semi-fluid substance, which gave off a repugnant, acid odor. In one case the omentum was found greatly congested. The large intestines were very pale, and the right ventricle of the heart was filled with dark, fluid blood. Schiiz cites thirteen cases of poisoning from liver sausage, in which the symptoms differed from the foregoing in the following respects : (1) In only one out of the thirteen was there constipation: all the others had numerous, watery, typhoid-like stools. (2) Symptoms involving the sense of sight were present in only three ; in all the pupils were unchanged. (3) The croupous cough was wholly wanting ; though in many there was complete loss of voice. Difficulty of swallowing was complained of by only one. (4) Delirium was marked in all ; and in one the disturbance of the mental faculties was prominent for several weeks. (5) There were no deaths. (6) The time between eating the sausage and the appearance of the symptoms varied from eighteen to twenty-four hours, and the duration of the sickness from one to four weeks ; though in one case complete recovery did not occur until after two and a half months. The sausages were not smoked, and all observed a garlic odor, though no garlic had been added to the meat. Tripe reports sixty-four cases. The symptoms came on from three and a half to thirty-six hours after eating. The stools were frequent, watery, and of offensive odor. In some there was delirium. One died. In the fatal case, the hands and face were cold and swollen. The pulse REPORT OF COMMITTEE ON DISINFECTANTS. 191 was rapid and weak. The pupils were contracted, but responded to light. The small intestine was found inflamed. Hedinger reports the cases of a man and a woman with the usual symptoms, but during recovery the dilatation of the pupils was followed by contraction. Birds ate of this sausage, and were not affected. Roser reports cases in which there was found after death abscesses of the tonsils, dark, bluish appearance of the mucous membrane of the pharynx, larynx, and bronchial tubes, dark redness of the fundus of the stomach, and circumscribed gray, red, and black spots on the mucous membrane of the intestines. The liver was brittle, and the spleen en- larged. Many theories concerning the nature of the active principle of poison- ous sausage have been advanced. It was once believed to consist of pyroligneous acid, which was supposed to be absorbed by the meat from the smoke used in curing it ; but soon it was found that unsmoked sau- sage might be poisonous also. Emmert believed that the active agent was hydrocyanic acid, and Jager's theory supposed the presence of picric acid. But these acids are not found in poisonous sausage, and, more- over, their toxicological effects are wholly unlike those observed in sau- sage poisoning. As we have elsewhere seen, Kerner believed that he had found the poisonous principle in a fatty acid. This theory was sup- ported by Dann, Buchner, and Schuman. Kerner believed the poison to consist of either caseic or sebacic acid, or both, while Buchner named it acidum