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9
daughter of the shopkeeper was a carrier of the organism and had infected the
pudding with her fingers. No chemical poison was detectable in the pudding, nor
in unused portions of the ingredients of which it was made, nor in the vessels in
which it was prepared or stored.
This report deals chiefly with the patients treated at Highgate hospital, and
these include the only two who died. Accounts of the two fatal cases may be
summarised thus:—
A. S., aged 11 years.
History. On 7th October, 1933, at 8 p.m., patient bought some pease-pudding. He returned
home and at once ate the pudding and went to bed in apparently normal health. At 3 a.m.,
on 8th October, he was awakened by abdominal pain, he vomited green fluid several times and
later diarrhoea set in. Stools were frequent, watery and contained bright blood. Dr. C. O'Brien,
who was summoned, diagnosed acute food poisoning and sent the child to Highgate hospital.
No other member of the family ate pease-pudding or was subsequently affected.
Condition on admission: At 1.20 p.m. (8th October), the boy appeared drowsy and
dehydrated. Lips were pale and cyanosed and the skin warm.
Cardiovascular system: Marked tachycardia (140) but no enlargement or murmurs detected.
Poor quality sounds with tic-tac rhythm at the apex. Pulse tension low.
Digestive system: Tongue slightly furred. Slight abdominal pain and tenderness in the
epigastric region. Stools passed soon after admission contained much blood and mucus. No
abnormal physical signs were found in the other systems of the body.
Subsequent course: At 2.50 p.m. the breath smelled strongly of acetone, lips and extremities
were cyanosed, pulse barely felt and heart sounds extremely feeble. There was mild delirium.
A pint of intravenous saline was given with marked improvement, the colour becoming
almost normal; the pulse tension raised and mental condition clearer. Diarrhoea continued
and many offensive stools containing blood and mucus were passed.
At 7 p.m. there was a sudden relapse—features cyanosed, pulse not palpable, air-hunger
and delirium. Coma developed and death ensued at 7.30 p.m.
A post-mortem examination was performed by Sir Bernard Spilsbury (who has
kindly consented to reference being made to the findings). The outstanding lesion
was intense acute inflammation of the mucosa and sub-mucosa of the colon in almost
its whole length. In the lower part of the small intestine, there was a slight degree
of inflammation. The stomach showed no abnormality, and cloudy swelling was the
only evidence of toxic damage to the kidneys and liver. The spleen was normal.
There was congestion of the vessels of the brain.
In a specimen of feces passed in hospital numerous polymorph, leucocytes
were present in a slightly bile-coloured mucous stool. B. dysenteries (Sonne) was
isolated from this specimen and from the mucous contents of the colon taken after
death. The organism was fully identified by bacteriological and serological methods.
J. W. A., aged 13 years.
History. On 7th October, 1933, at 9 p.m., patient ate pease-pudding and went to bed in
apparently normal health at 10.30 p.m. At 1.30 a.m., 8th October, the patient was wakened
by severe abdominal pain, frequent vomiting of green fluid and diarrhoea. The patient's sister
who also took pease-pudding was similarly affected. They were admitted to Highgate
hospital at 11.30 a.m.
Condition on admission: The patient was drowsy and dehydrated in appearance, hps
cyanosed and temperature 102-8°F. Cardiovascular system:—Heart normal in size but rapid
(130), apical sounds wpre of poor quality and had a tic-tac rhythm. Pulse tension was low.
Digestive system:—Tongue slightly furred and odour of acetone in breath. No features of
note were found in other systems of the body.
Subsequent course. Frequent watery, offensive stools passed, containing mucus and green
pigment. Cyanosis became more marked, the pulse tension fell and air hunger was apparent.
Half-a-pint of intravenous saline was given with difficulty owing to the restless condition
of the patient, but the general condition did not improve and death took place at 8.30 p.m.
The post-mortem findings were almost exactly the same as those of A. S., but
the content of the colon was pink muco-pus.
No stool, passed before death, was examined, but B. dysenteries (Sonne) was
obtained from the colon at the post-mortem examination and was not found in the
bile nor in the contents of the small intestine.
More clinical and pathological observations were made on the patients who
recovered. These were L. A., 15 years (sister of J. W. A.); G. C., 16 years; W. C.,
12 years; and D. E., 10 years.