A housewife fixed lunch for herself and two others. The lunchconsisted of home-canned gefilte fish (served cold with horseradishon toast) soft drinks and milk. She ate two portions of gefiltefish, her employee ate one portion and her daughter-in-law ate halfa portion. Four hours later, she complained of headache, epigastricdistress, hoarseness and slight dyspnea. The epigastric distresscontinued. She vomited repeatedly and experienced dryness of themouth, weakness, constipation, and urinary retention. Examinationby a physician revealed an anxious woman with labored respirations(26 per minute); a blood pressure of 80/58 mm Hg, and a pulse rateof 110 beats per minute. The pupils were equal in size but somewhatdilated; they were reactive to light. Extraocular eye movementswere normal, and no facial weakness was noted. Her throat and mouthwere dry, and her voice was hoarse. The chest was normal toauscultation and to percussion. The abdomen was soft and nontender,with decreased bowel sounds. Deep tendon reflexes were normal.Because of a history of mild hypertension, the findings oftachycardia and hypotension and the history of substernal distresssuggested the possibility of a myocardial infarction. The patientwas hospitalized. Lab findings included normal results for acomplete blood cell count and urinalysis. Values of serumelectrolytes, bilirubin, amylase, and protein determined on serumfrom blood drawn the morning after admission were all within normallimits. Chest and abdominal X-ray films were interpreted as normal.An EKG was unchanged from previous tracings. The patient wastreated symptomatically with antacids, nasogastric suction, andintravenous administration of fluids. Three days later the patienthad a cardiopulmonary arrest and was resuscitated. Spontaneousrespiration did not occur, and breathing was maintained on amechanical respirator. No apparent benefit resulted from 80,000units of bivalent (types A & B) and 10,000 units of type Eantitoxin, which were administered intravenously. The next day thepatient died. Autopsy showed generalized ischemic changes in thecentral nervous system and moderate arteriosclerosis of thecoronary arteries with slight hypertrophy of the left ventricle.The liver and the spleen were enlarged and hyperemic. The lungsshowed pulmonary edema with focal acute bronchopneumonia. The othertwo patients survived the infection.
