588 MICROBIOLOGY OF FOODS 



The first symptoms of botulism appear, as a rule, in from eight to 

 one hundred and twenty hours after the poisonous food has been taken. 

 In exceptional instances they may appear as early as two hours after 

 the meal or be delayed until the ninth or tenth day. In most instances 

 the first symptoms are referable to paralysis of motor or secretory nerves. 

 Double vision due to paralysis of the external recti or even of all the 

 extra-ocular muscles, dilated and sluggish pupils, difficulty in swallow- 

 ing, dryness of the mouth, nausea and vomiting, accumulation of 

 mucus in the paralyzed pharynx resulting in paroxysms of choking, 

 persistent constipation, rapidly progressive weakness, with undis- 

 turbed sensation and clear mentality, are the most characteristic 

 manifestations of the disease. Disturbance of vision is often the initial 

 symptom. Less frequently the illness begins with vomiting. Usu- 

 ally the temperature remains subnormal but fever is present in some 

 instances, possibly on account of complicating bronchopneumonia or 

 other terminal infection. The following graphic description of the 

 fully developed disease is quoted from Dickson's monograph (page 46) : 

 "The general appearance of the patient is most distressing. The ex- 

 treme muscular weakness, the anxiety and the utter helplessness, the 

 difficulty in swallowing, the attacks of strangling, the struggle for 

 breath, and the unsuccessful attempts to articulate constitute a clinical 

 picture which, when once observed, can never be forgotten. The 

 face is usually pale, but. in the early stages may be congested. There 

 may be normal appetite and excessive thirst, but the patient is afraid 

 to try to swallow. At times the strangling spells are so severe that 

 there is incontinence of urine, and the accumulation of thick, tenacious 

 mucus in the pharynx is a constant source of annoyance. The fact 

 that the patient remains in full possession of his mental powers and 

 can realize the seriousness of his condition only adds to the distressing 

 character of the situation." 



At autopsy, congestion of the central nervous system is constantly 

 found and, in nearly every case, thrombosis of the meningeal vessels 

 as well as the blood vessels in various other organs. The ganglion 

 cells are well preserved in many cases although some of the earlier 

 observers recorded disturbances of the Nissl granules and displacement 

 and distortion of the nucleus of the motor cells. The cerebrospinal 

 fluid contained 80 cells per cu. mm. in one case during life. The 

 differential diagnosis of a single case of the disease in the absence of 



