FOOD-INFECTION WITH TOXICOGENIC 
GERMS. 
BY 
VICTOR C. VAUGHAN, M.D., 
PROFESSOR OF HYGIENE AND DEAN OF THE DEPARTMENT OF MEDICINE 
AND SURGERY IN MICHIGAN UNIVERSITY, 
AND 
GEORGE D. PERKINS, M.D., 
OF ANN ARBOR, MICH. 
FROM 
THE MEDICAL NEWS, 
November 16, 1895. [Reprinted from The Medical News, November 16, 1895.] 
FOOD-INFECTION WITH TOXICOGENIC 
GERMS. 
By VICTOR C. VAUGHAN, M.D., 
PROFESSOR OF HYGIENE AND DEAN OF THE DEPARTMENT OF MEDICINE 
AND SURGERY IN MICHIGAN UNIVERSITY, 
AND 
GEORGE D. PERKINS, M.D., 
OF ANN ARBOR, MICH. 
Within recent years there has apparently been a 
great increase in the number of instances of food- 
poisoning. This increase has been partly real and 
partly only apparent. The actual increase has been 
due to the larger consumption of preserved foods 
and the wider distribution of food from a given 
point. When we recognize the facts that the scien- 
tific principles of bacteriology are involved in the 
preparation of every can of preserved food and that 
this work is done wholly by those who are grossly 
ignorant of these principles, we can only wonder 
that harm does not come to the consumer more fre- 
quently than it does. Moreover, diseased and 
damaged articles of food can be worked in pre- 
served preparations and sold as prime goods when 
they could not be so disposed of otherwise. We do 
not claim that this is a fraud frequently practised, 
but that it has been occasionally resorted to both 
in this country and in Europe has been abundantly 
demonstrated. 2 
It is not our purpose in this paper to discuss the 
use of tuberculous meat and milk or of any other 
food invaded by specific infection; but we wish to 
give our attention to those cases of food-poisoning 
in which the infecting agent is a saprophytic poison- 
producing microorganism. 
The apparent increase in the number of instances 
of this kind is due to the fact that the medical pro- 
fession has but recently learned to recognize this 
form of food-infection as a cause of illness, or, at 
least, has been in the possession of the knowledge 
necessary to convert suspicion into demonstration. 
Only a few years ago we were seeking for the cause 
of the summer diarrheas of infancy in mysterious 
telluric and meteorologic conditions, but now we 
know that these diseases are solely due to infected, 
and consequently poisonous, food. Formerly many 
cases of food-poisoning were supposed to be due to 
the accidental or criminal addition of some metallic 
or vegetable poison to the food, and unjust accusa- 
tion, possibly in some instances unjust punishment, 
has resulted. Now we know that not only the 
symptoms of gastrointestinal irritant, inorganic pois- 
ons, but those of typhoid fever and typhus fever, 
scarlet fever, and other acute exanthemata, and 
even those of pneumonia, may be closely simulated 
by the symptoms induced by infected foods. 
The effects of poisonous foods as gastrointestinal 
irritants are too well known to demand illustrative 
examples. The production of a continued fever 
closely simulating typhoid has been repeatedly ob- 
served. The following brief abstract of a case re- 
ported by Gaflfky will serve as an illustration : 3 
D., the chemist of the Hygienic Institute at Gies- 
sen, did not feel well on the morning of October 
ioth, but in company with assistant B. he visited 
Frankfort. During the day he had a severe head- 
ache, no appetite, and frequent chilly sensations. 
On returning to Giessen at night he was scarcely 
able to walk. On the next day he refused all food, 
was slightly delirious, and had one watery stool. On 
the 13th his condition showed serious infection. His 
face was red, his eyes sunken, his temperature 105.20, 
and he lay in a half-unconscious state. The tongue 
was heavily coated ; the abdomen distended and 
painful on pressure. He had five dark-brown, later 
greenish, stools. The urine was concentrated and 
contained 2 per cent, of albumin, as determined by 
Esbach tubes; it gave the diazo-reaction and the 
indican-reaction and contained white blood-corpus- 
cles and numerous granular casts. 
From the 13th to the 17th the patient was stupid, 
but not delirious. The abdomen was greatly dis- 
tended and from 20 to 24 stools were passed each 
day, with great tenesmus. The temperature re- 
mained high notwithstanding repeated one-gram 
doses of antipyrin. Sleep was broken and one gram 
of sulfonal was given at night. The urine remained 
as before, and the pulse varied from 92 to 100. 
From the 18th to the 20th the mental dulness 
was less marked. Appetite was somewhat improved 
and the number of stools decreased to from 8 to 10 
in 24 hours. The amount of albumin in the urine 
was somewhat decreased and microscopic examina- 
tion showed fatty casts and white blood-corpuscles. 
Small doses of opium were given by mouth and in 
suppositories. 
On the morning of the 21st hemorrhage from the 
bowels, about 300 c.c. in amount, occurred. Seve- 
ral doses of opium were given and ice-bags were 
kept on the abdomen. After the hemorrhage there 4 
were three slightly bloody stools. From this time 
the improvement was slow, but fairly constant. The 
fever disappeared October 29th. 
After recovery, marked anesthesia of the anterior 
surface of the thigh developed and remained for 
some weeks, the anesthetic area gradually becoming 
smaller. The hair fell out, mental activity tired, 
and the eyes were easily fatigued for some months. 
Two workers in the same laboratory were affected 
in the same manner, but less severely. The only 
food or drink which these three men had in com- 
mon was some uncooked milk taken on the morn- 
ing of October 9th. D. ordered the milk sent to 
the laboratory, drank the greater part of it himself, 
giving B. a small cupful, and the servant drank a 
little left by the others. The cow that gave this 
milk was suffering from a bloody diarrhea. Gaffky 
found in the stools of the cow and in those of the 
patients a small highly virulent form of the bacillus 
coli, and to this he ascribes the ill effects. He sup- 
poses that some of the liquid discharges from the 
cow fell on the udder and thus found its way into 
the milk. 
Gaffky suggests that the epidemic in Christiana 
in 1888, in which 6000 persons sickened within 
three weeks, was probably due to milk-infection. 
Hausemann states that this epidemic was regarded 
as morbus sui generis. It was evidently neither 
cholera nor typhoid fever. Half of those affected 
were children, and yet nurslings escaped altogether. 
However, milk, as an etiologic factor, seems not 
to have been considered by the attending physi- 
cians. 
A case of food-poisoning resembling scarlet fever 
was seen by one of us two years ago and may be 
briefly reported as follows: 5 
K., a very vigorous man of 34, ate freely of 
canned salmon. Others at the table with him re- 
marked that the taste of the salmon was peculiar 
and refrained from eating it. Twelve hours later 
K. began to suffer from nausea, vomiting, and a 
griping pain in the abdomen. Eighteen hours after 
he had eaten the fish, Dr. Vaughan saw him. He was 
vomiting small quantities of mucus, colored with 
bile, at frequent intervals. The bowels had not 
moved and the griping pain continued. He was 
covered with a scarlatinous rash from head to foot. 
His pulse was 140, temperature 102°, and respira- 
tion shallow and irregular. The stomach and large 
intestines were washed out thoroughly, and ten 
grains of calomel, soon followed by twelve ounces 
of solution of magnesium citrate, were administered, 
for the purpose of cleansing the small intestines. 
After these medicines had acted freely, K. began to 
improve. The next day the rash had disappeared, 
but the temperature remained above the normal for 
four or five days, and it was not until a week later 
that he was able to leave his house. The remainder 
of the salmon was submitted to various tests. The 
absence of inorganic poisons was demonstrated. It 
was found that the subcutaneous injection of twenty 
drops of the fluid expressed from the salmon caused 
evident illness and suffering in a white rat. The 
only germ that could be found either by direct mi- 
croscopic examination or by the preparation of 
plate-cultures was a micrococcus, and this was 
present in the salmon in great numbers. This germ 
grew fairly well in beef-tea, but the injection of five 
c.cm. of beef-tea cultures of different ages failed to 
affect white rats, kittens, or rabbits. However, this 
micrococcus when grown for twenty days in a ster- 
ilized egg, after Hueppe’s method of anaerobic cul- 
ture, produced a most potent poison. The white 6 
of the egg became thin, watery, markedly alkaline, 
and ten drops sufficed to kill white rats. 
The resemblance of the symptoms of food-poison- 
ing in some instances to epidemic pneumonia is well 
illustrated in the Middlesborough pneumonia-epi- 
demic which has been reported by Ballard and is 
too well known to require further mention, except 
to state that 490 deaths resulted. 
That Winckel’s disease, a septic pneumonia, may 
be due to infection of the food with the bacillus en- 
teritidis first discovered by Gartner in poisonous 
meat has been demonstrated. Lubarsch has re- 
ported such a case in an infant. 
The stools were greenish and of bad odor. The 
child became cyanotic and the respiration increased 
to sixty per minute. Auscultation and percussion 
were negative in results. The breathing was wholly 
costal and the abdomen distended. The urine con- 
tained neither albumin nor hemoglobin. Postmor- 
tem examination showed pneumonia of the left 
lower lobe, bilateral purulent bronchitis, atelectasis 
of the right lung, parenchymatous cloudiness of the 
kidneys, fatty infiltration and engorgement of the 
liver, and slightly enlarged spleen. All other patho- 
logic conditions were believed to be consequent 
upon the septic pneumonia. Plates made from the 
diseased organs developed only the bacillus enteri- 
tidis. 
It is quite impossible to draw any sharp line be- 
tween intoxication and infection in the study of the 
symptoms of food-poisoning. Some of the bacterial 
poisons are slow in inducing their effects, and even 
when a germ-free preparation is used in our experi- 
ments upon animals, it [sometimes happens that 7 
many hours elapse before any effects are observed, 
even in cases ultimately terminating fatally. The 
relation of the germ to the production of the un- 
toward symptoms may, according to the case, be 
stated in one or the other of the following ways: 
(i) The chemic poison is generated only and wholly 
in the food before it is taken; (2) The infecting 
organism may begin the elaboration of its poisonous 
products outside, and continue the same within, the 
body ; (3) The infection may not result in the pro- 
duction of poisons until the food is taken into the 
body. The first of these conditions is well illus- 
trated by the “Iron Bridge” cases reported by 
Ballard. The infecting germ would not grow at a 
temperature above 86°. Of course animal inocula- 
tions with this germ were wholly without result, but 
cultures grown at 6o° were markedly poisonous. It 
is probable that this condition holds good in a 
larger number of instances than we suspect. The 
second condition is the one existing in some cases 
of poisoning with milk and its products. However, 
in these the infecting microorganisms do not thrive 
in the body unless they be supplied with the food 
especially suited for them. The complete with- 
drawal of milk as a food leads to their speedy dis- 
appearance. The violent vomiting and purging 
which result are curative means and should not be 
checked unless there be danger of death from ex- 
haustion. The most dangerous cases of cheese- 
poisoning are those in which vomiting and purging 
do not occur. Some months ago one of us saw 
some twenty persons who had been poisoned with 
cream. All but two were vomiting and purging 8 
and complaining most vehemently. These were 
sure that they would die. The two exceptional 
ones were uttering no complaints. In fact, they 
were practically comatose, and thorough washing 
out of the stomach and intestines was resorted to 
before they realized that they were in danger. 
When the third condition mentioned exists, a 
true infection results. Such is the case most prob- 
ably in those instances already cited as resembling 
typhoid fever and pneumonia. 
We have been frequently called upon to examine 
food suspected of having caused untoward effects, 
and the method followed in these examinations may 
be of some interest. Whenever there is the slight- 
est possibility that a metallic poison may be present, 
tests for the same are made. This is always done 
with canned foods. However, when a teaspoonful 
or less of ice-cream causes vomiting and purging, 
the idea that these effects can be due to zinc sulphate 
dissolved in the freezer or to artificially prepared 
vanillin used in flavoring is simply too preposter- 
ous to be entertained by anyone acquainted with the 
quantities of these substances necessary to induce 
such effects. Ten years ago we went through with 
all the tests for metallic poisons in many samples of 
poisonous cheese and ice-cream, but we no longer 
waste our time in this manner. 
The examination of foods for bacterial poisons 
cannot be made except in a properly equipped bac- 
teriologic laboratory. It is our purpose to merely 
point out at this time the methods that may be fol- 
lowed. We take it for granted that the one who 
undertakes work of this kind is already familiar 9 
with the ordinary technic of bacteriologic re- 
search. The line of procedure will vary somewhat 
with the kind of food to be examined, the form in 
which it has been prepared, and the quantity sup- 
plied the analyst. All samples should be examined 
with as little delay as possible after the article has 
become the object of suspicion. When delay is un- 
avoidable, further bacterial growth should be re- 
tarded in the meantime as far as is possible by 
keeping the suspected article at a low temperature. 
Germs not present at the time of the supposed 
poisoning may be accidentally introduced, or non- 
toxicogenic bacteria may multiply to such an extent 
that the detection of the harmful organisms is ren- 
dered impossible. 
As a rule, the quantity of the food supplied the 
analyst is not sufficient to allow of the detection or 
the isolation of the chemic poison directly. To try 
to find the poison in a few ounces of cheese or a 
small bit of meat by direct extraction is a task that 
would be undertaken only by one quite ignorant of 
the nature of these poisons. In all but exceptional 
instances in which many pounds of the food are 
supplied, the portion that reaches the laboratory 
can only be regarded as the bearer of the germ to 
the activity of which the poison is due. This 
germ must be detected, isolated, grown in pure 
culture, and its toxicogenic properties demon- 
strated upon lower animals. It should be clearly 
understood that the most thorough study of the 
morphologic characteristics of the germ and of the 
chemic properties of the poison will not suffice 
without an accompanying determination of the toxicologic action of the cultures. The infec- 
tious nature of the bacterium should also be 
studied. 
It should always be borne in mind that the article 
of food has probably been through several hands 
before reaching the analyst, some of which may not 
have been germ-free. In the examination of pieces 
of meat and cheese, the surface should be sterilized 
with a broad, heated knife or other piece of iron. 
It has been shown that bacteria deposited on such 
surfaces penetrate slowly. Then with other steril- 
ized knives sections should be made and one or 
more small bits taken from the interior should be 
placed in sterilized bouillon. Not less than a dozen 
tubes should be inoculated in this way. Three of 
these should be grown aerobically at ordinary tem- 
perature ; three anaerobically at the same tempera- 
ture ; three aerobically at 37°C.; and three anaero- 
bically at 37°C. It is quite essential that all these 
conditions of growth should be tried. Some of the 
toxicogenic germs grow best at relatively low tem- 
perature, from 20° to 25°C., and fail wholly to de- 
velop at 37°C. Others have their optimum growth 
at the last-mentioned temperature. Some develop 
only when freely supplied with air, and others only 
when the air is excluded. 
In the examination of liquid and semi-liquid 
foods, such as milk, custard, cream, broths, and 
jellies, small bits or a few drops should be placed in 
sterilized bouillon and grown under the conditions 
already mentioned. 
A growth having appeared in one or more of 
these tubes, the bacteria should be examined in hanging drops and in stained mounts. If more 
than one organism be present, plate-cultures should 
be made and each germ should again be grown 
under the conditions mentioned. 
The infectious character of each organism should 
be tested on the lower animals : (i) by feeding, (2) 
by subcutaneous inoculation, (3) by intraperitoneal 
inoculation, and (4) by intravenous inoculation. 
The animals generally employed in these experi- 
ments are white mice, white rats, guinea-pigs, kit- 
tens, and rabbits. A given germ may be toxico- 
genic to one of these animals and not to the others. 
Mice and kittens are specially suitable for feeding- 
experiments. Young kittens are quite susceptible 
to most of the bacterial poisons found in milk and 
its products. The quantity of the bouillon-culture, 
24 hours old or older, first employed should be re- 
latively large, from one to ten c.cm., according to 
the animal and the method of infection. If these 
amounts prove active, smaller quantities should be 
tried until the limit is reached. 
Next, the action of cultures from which the bac- 
teria have been removed by filtration through porce- 
lain should be tested, and, if these prove active, 
the effect of different degrees of heat on the toxicity 
of the cultures should be determined. 
If by the experiments already mentioned a toxico- 
genic germ has been discovered, its morphologic, 
cultural, tinctorial, and pathogenic properties may 
be studied as thoroughly as the investigator may de- 
sire. The study of the bacterial poison may also be 
carried to the same extent. 12 
The following reports are taken as illustrations of 
the results obtained by the method given: 
Dec. 31st, 1894, Dr. Traver, of Somerset, Mich., 
was called to see the family of Mr. Van Allen. He 
found the father, mother, and two children suffering 
from protracted vomiting and marked exhaustion. 
There was no fever and no diarrhea. Tyrotoxicon- 
poisoning was suspected, but inquiry showed that 
their supper had consisted of bread, butter, tea, 
dried beef, and raspberry-sauce. There was noth- 
ing in the appearance or odor of the meat to cause 
any suspicion. In fact, it seemed to be of excep- 
tionally good quality. Anaerobic cultures from the 
interior of the meat were made and developed a 
bacillus, from two to three times as long as broad, 
taking the ordinary stains well, motile, with no 
spore-formation, not liquefying gelatin, but coagu- 
lating milk, growing best at the temperature of the 
body, but developing its poison at ordinary tem- 
perature, producing gas abundantly, and pathogenic 
to white rats, rabbits, and guinea-pigs. Sterilized 
cultures were also poisonous. 
Of a large number of men at a banquet at Sturgis, 
Mich., April 26, 1894, everyone who ate of the 
pressed chicken served was made sick. Some who 
were not at the banquet, but who aided in prepar- 
ing for it, ate small bits of the chicken, and were 
also sick. All were attacked, within from two to 
four hours after eating the chicken, with nausea, 
violent griping, and purging; many fainted while 
attempting to arise from bed. 
The chickens were killed Tuesday afternoon, 
picked and left hanging in the market-room (not in 
a cooling-room) until Wednesday forenoon, when 
they were drawn and carried to a restaurant and 
here left in a warm room until Thursday morning, 13 
when they were cooked (not very thoroughly), 
pressed, and served at the banquet that night. 
Those who ate of the unpressed chicken were also 
made ill. 
The pressed chicken contained two microorgan- 
isms, a slender bacillus, from four to five times as 
long as broad, and a streptococcus. The bacillus 
was fatal to white rats, guinea-pigs, and rabbits when 
administered intraperitoneally, intravenously, and 
subcutaneously. The streptococcus was not fatal 
when given in pure cultures, but mixed cultures of 
the two induced death, and in these instances, when 
administered subcutaneously, in addition to the 
lesions formed after the employment of pure cultures 
of the bacillus, there was extensive sloughing. This 
bacillus is motile, takes the ordinary stains readily, 
and is decolorized by Gram’s method. It grows 
very slowly at ordinary temperature and rapidly at 
98°F. Of two cultures of equal age, one grown at 
ordinary temperature and the other at 98°F., one 
c.cm. of the former was necessary to induce death, 
while one-fourth c.cm. of the other proved fatal. 
The anaerobic cultures were much more powerful 
than the aerobic. On gelatin-plates exposed to the 
air the growth was slow, while on those kept in an 
atmosphere of hydrogen it was much more rapid. 
Spores could not be detected. The bacillus coagulates 
milk and decolorizes litmus-gelatin. On potatoes 
it forms a dirty, thick, slimy growth. It does not 
liquefy gelatin and the production of gas was not 
observed. Streaks on agar-agar are yellowish white, 
slimy, and with but little tendency to spread. One 
half c.cm. of a beef-tea culture heated to i4o°F. for 
30 minutes killed guinea-pigs. One c.cm. heated to 
2120 F. for 15 minutes failed to kill. Animals in- 
oculated by the methods mentioned showed evi- 
dences of abdominal pain within from one to two 14 
hours and several were found dead after twelve 
hours. The abdominal cavity was found filled with 
a clear fluid, the bloodvessels were much congested, 
and the peritoneum inflamed. In some instances a 
bloody fluid was found in the pleural cavity. The Medical News. 
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