By Reimert Thorolf Ravenholt, MD MPH


A considerable number of food poisoning incidents occur every year in every major community. Such incidents often go unrecognized; and many recognized incidents are not reported to the health authorities. But occasionally the nature of the illness is so distinctive, the latent interval sufficiently short, and the numbers of people involved and the circumstances are such that a number of victims report their illnesses to the health department. These are the visible part of the food poisoning "iceberg", and it is imperative that all such reports be carefully received and recorded on a standard Food Poisoning Report form, by the epidemiologist, a designated public health nurse or sanitarian. Each report should then be promptly examined by the community epidemiologist, and whenever the nature and circumstances of the reported illness warrants it, an appropriate investigation must be quickly performed, initially by telephone. Often an investigation is triggered by a cluster of two or more reports closely associated in nature, time, and place.

Herewith a number of food poisoning investigation reports from my files, which may be useful for neophyte epidemiologists when confronted with similar incidents:

A Mop, a Sink, and Some Lettuce

 Botulism from Pickled Beets

Coffee With Arsenic

First Citizen Banquet Illness

Staphylococcal Food Poisoning by Infra-Red

Shigellosis Outbreak From a Church Potluck Dinner

Ship's Restaurant Food Poisoning

Occasionally we received bogus reports of food-borne illness; some from obvious cranks, or persons seeking to develop a basis for suing a restaurant or manufacturer; which wasted the time of one or more of us. And not infrequently, someone would bring a can or bottle with dubious contents and demand that we analyze the contents "for any poisonous substance". To do such an open-ended examination for every conceivable poison that might be in a specimen would require exorbitant expenditure of laboratory and manpower resources. But if we summarily refused to examine any such specimen, the offended party might soon complain about our disinterest to political officials, with repercussions. Hence, we ordinarily accepted such specimens, to be held in a refrigerator or freezer pending submission of one or more stool specimens, By requiring submission of a designated number of stool specimens before undertaking any extensive laboratory examination requested, we fended off many cranks – few of whom are willing to go to the trouble of submitting multiple stool specimens.

During my seven years with the Seattle-King County Health Department, I investigated many food poisoning outbreaks, some of which were quite memorable; and for some of which I have found reports. One such I remember, but for which I do not yet find a report, was from "The Maison Blanche" restaurant (no longer operative). It came to my notice because a number of prominent business persons who ate lunch there became sufficiently ill with high fever and diarrheal illness that they were hospitalized, and Salmonella Typhimurium isolated from their feces. These cases were reported to the health department. From the known cases and luncheon companions, I obtained sufficient food consumption histories that the crab salad was clearly identified as the offending vehicle. I then visited the restaurant, examined the facilities, obtained additional histories, and obtained rectal swabs from each of the nine food preparation personnel in the kitchen. All of these specimens subsequently yielded the Salmonella organism – thus suggesting that the kitchen help also became infected from the common vehicle. When meeting with the manager of the restaurant, I queried him concerning the source and handling of the crab meat used in making the salads. He then showed me cans of the Alaskan crab ordinarily used; and added that he, personally, had ceased eating crab since he visited an Alaskan crab cannery two years earlier. There, the daily catch was first steamed, then shelled by native women; with the meat then placed in # 10 cans, frozen and transported to markets in Seattle and elsewhere. While visiting the cannery he observed one of the crab workers, whose child was playing nearby, help the child defecate; after which she picked-up the stool and tossed it into the bay, and then simply wiped-off her hands before returning to schucking crab! Because the cooking of the crab meat occurred before the schucking, any bacterial contamination from schucking was preserved by freezing until eaten. That realization, plus the taking of rectal swabs from all the cooks, caused me to lose my appetite for crab salads during some years! The Maison Blanche outbreak demonstrated how restaurants – through no fault of their own -- may produce food poisoning outbreaks due to faulty handling of food stuffs at any prior point in the long food chain.


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