Question

• 1887, Barnes, a physician living in Carlilse, Cumberland NW England reports on a case of food poisoning at a wedding breakfast.
• “It has long been known that certain kinds of animal food are liable to undergo some change which deprives them of their wholesome and nutritive properties, and converts them into virulent irritant poisons”

The case

• After the ceremony in Carlisle, England the wedding party were served “breakfast” at the house of the bride’s aunt and uncle at 11.30 am on the 19^th August 1886
• Newly married husband and wife depart for Edinburgh, Scotland after the breakfast and arrive later that day
• Husband becomes ill* at around 9 to 10 pm, but recovers after 5 days
• Around 5 to 7 am on the 20^th, the wife becomes ill* and dies 5 days later
• Both husband and wife blame the game pie

Death certificate states cause of death as “irritant poisoning after partaking of game pie

The investigation

• At request of hotel landlord and husband, no post-mortem was carried out
• The Scottish authorities did nothing because the illness was not caused in Scotland
• The Carlisle coroner did nothing because the death had occurred outside his jurisdiction
• Many other guests had also become ill, but the only death was the bride
• Barnes decides to investigate because no-one else will!

The circumstances

• The house was 20 years old and water supply and sewage system were in good order
• The food was stored in a cellar which was mostly below ground so was cool

But even in November the household staff reported that milk and meat tended to go “off” in a couple of days

• The cellar was damp, but no obvious cause of the poisoning could be found
• The aunt and uncle had not lived in the house long, but there had been no previous problems
• The weather had been particularly hot and humid
• Smells had been reported coming from the sewers, but there had been no unusual deaths reported
• But there had been an increase in the number of reported cases of diarrhoea
• A professional cook with a good reputation had been employed. Cook also became ill
• Perishable food ingredients had been bought no more than 5 days before the wedding and mostly the day before
• In all 19 people ate the wedding breakfast
• 2 adolescent girls were not ill, 1 died, 4 had slight symptoms and 12 were severely ill but recovered in 5 -6 days
• 5 people (including 2 nurses) who visited the house after 20^thalso became ill with the same symptoms

The symptoms

• Green, foul smelling, watery diarrhoea that began before any vomiting
• Vomiting
• Desquamation of hands and limbs
• Pimply rash as illness subsided
• Herpes on the lips
• Slight pyrexia (severe in a few)
• Little, dark urine
• Blurred and dimmed vision
• Some experienced headache
• In some diarrhoea last over 14 days

The Food

• Game pie with no crust – hare, wood-pigeon and beef
• Boiled salmon with freshly made mayonnaise
• Roast chicken: the chicken had been slaughtered on the 14^th and hung in the cellar
• Boiled ham (imported from America)*
• Grouse
• Lemon whip, red and yellow jelly
• Turkish delight
• Fruit and nuts – tinned pineapple and apricots, fresh melon, apples, pears, grapes, walnuts
• Wedding cake and bread rolls

*The ham

• The ham had been imported wet and packed in salt. It arrived at Liverpool docks on the 4^th August
• It was steeped in cold water for 24 hours, washed in warm water and hung to dry over a coal (coke) fire for 3 days
• The ham weighed 12.5 pounds (~5 kg): 1/3 cut from the thick end was used
• It appears some was used for breakfast before the wedding
• The ham flesh looked OK, but the bone “had peculiar yellowish colour and the marrow was soft”
• It was cooked for 3 hours and glazed with gelatine and egg
• The same batch of gelatine was used to make the jellies.

Other information

The cream used in tea and coffee was “scalded” (i.e. brought to the boil and then cooled) as it was thought that, because of the hot weather, it would not otherwise keep.

Most of the food, once prepared, was stored in the cellar for between 17 and 21 hours

Barnes approach

• Surveyed all the guests about what exactly they ate
• If 2 or more of the severely ill reported they did not eat a particular food he excluded these items
• some guests ate more than once in the house
• This left Barnes with 7 suspect foods:
  • Bread
  • Game pie
  • Ham
  • Jelly
  • Wedding cake
  • Salmon and mayonnaise
• But no one item was common to all who became ill and not eaten by the 2 who stayed well

Analysis

• Everyone had bread
• 10 had pie, but 9 did not including the 2 adolescent girls
• Of the 9 who did not have pie, 7 were ill, 4 of them severely
• 17 had ham at some point
• Of the 2 who did not have ham, 1 had no symptoms and the other had slight symptoms
• 15 had jelly of whom 2 had no symptoms (the girls)
• 4 did not have jelly, but the cook who became severely ill had tasted it the day before
• Everyone who became ill had either (pie and jelly) or (ham and jelly)

More analysis

• The gravel of the cellar floor did not show pathogenic microbes
• Further analysis of the food (we are not told which food) found the presence of dead bacilli of the same type that had been found in a recent previous case of food poisoning in Carlisle where 80 people got sick and 4 died.
• Ham contained large colonies of living vegetative micrococci of diameter 2 microns.
• No toxic inorganic substances were found in any of the food

What can you conclude about the possible infective agent?

--Suggest any organisms that could have caused the outbreak and which one you think is the most likely and why

Which food or foods were contaminated?

--Explain why you think the food(s) you suggest are the contaminated food(s)

How did the contamination get into the food(s)?

--Mention all possible routes of contamination, and explain why your chosen contamination route is the most logical

Answer all the questions, i will give u a thumb!

Answer 1

1. From the present case study finding at a wedding party, after eating the breakfast most of them were ill, except 2 and 1 got died after 6 days.Its a food poisoning caused by some organism.

In the present scenario, who had ill were exhibit the symptoms such as:

*Green, foul-smelling, watery diarrhoea that began before any vomiting

*Vomiting

*Desquamation of hands and limbs

*Pimply rash as illness subsided

*Herpes on the lips

*Slight pyrexia (severe in a few)

*Little, dark urine

*Blurred and dimmed vision

*Some experienced headache

Here the symptoms started within a day

From the symptoms, we can conclude that the diagnosis of whom who were infected are Salmonellosis that is caused by Salmonella typhi. Thus the symptoms started within 12 hours or within a day and bride may the case of severe salmonellosis results in death.

Here the possible infective organism for the present case is Salmonella Typhi.

2. The most foods which are prepared and handled by the cook that is mostly Ham contaminated by the Salmonella Typhi. In the present scenario, the cook is acting as a carrier for the disease.

3. The main possible route of contamination is by

*feco-oral route (Here the cook is acting as a carrier of the infection, already he has got infection may be through a feco-oral route)

*Direct contact with the infected person (cook) and

*From the carrier of the disease (cook) shed the organism in faeces and are not maintaining the personal hygiene properly and handled the food items is capable of infecting others through the food, drinks and contacts.