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To summarise, from the one factory through the same shipper were obtained
Cheeses made about the same date, which being sold in Bethnal Green,
Bermondsey, Croydon, Deptford, Finsbury, and Tunbridge Wells, their
consumption was followed by illness in those who ate them.
It thus appears that there was a definite causal relation between this
particular consignment of Cheese, and the various outbreaks.
It is not at all extraordinary that by one investigator a definite ptomain
should be discovered, while its presence failed detection by two others.
It was not possible to separate or identify the" batches "or" vats" of
Cheese, and the shipping mark in no way assists one in this respect.
Assuming that some amount of poisonous material was present, it might
be in small quantities, and in all probability would be very unequally
distributed throughout the consignment.
The maker of the Cheese failed to detect anything unusual in the appearance
of the Cheese when ripened ready for shipment.
The fact that the Cheese did not produce symptoms in all cases when eaten
would further tend to show that the poison was not present in all portions.
From time to time, doubtless, such cases occur, and the chief interest in the
present outbreak is the fact that it was possible to trace them all to the same
shipper, and to a shipment about the same date, though of different marks.
The symptoms in all the above cases were similar, and are those usually
ascribed to the action of Tyrotoxicon or Tyrotoxin, a ptomain which is sometimes
found in poisonous cheese, This is one of a large class of substances
formed by the action of bacteria upon nitrogenous compounds, which in the
majority of cases produce well-marked symptoms.
It is an exceedingly unstable body, being easily destroyed by the action of
heat and moisture, and even by exposure to the air; and being present in very
small proportions, it has never been isolated in sufficiently large quantities to
allow of its composition being definitely determined. Its chemical and clinical
actions are precisely identical with those of diazo-benzol, which is simply a
transition product of putrefaction. Most of the observations upon this
material so far have been made by Professor Victor C. Vaughan, of Ann
Arbor, Michigan, who has had the opportunity of investigating several outbreaks
caused by it.
It appears probable that it occurs in the milk, and it has been suggested as
one of the causes of the wide-spread outbreaks of summer diarrhoea among
children.